Transcript File - Megan Childers, RN

QUALITY AND SAFETY
EDUCATION FOR NURSES
Megan Childers
Ferris State University
NURS 320
WHAT IS QUALITY AND SAFETY
EDUCATION FOR NURSES?
 Patient safety and quality of care are the backbone of nursing practice.
 Quality and Safety Education for Nurses (QSEN) is dedicated and invested
for the partnership in education and nursing practice related to safe patient
care (Hunt, 2012).
 The six QSEN competencies developed for nursing programs:
 Patient-centered care
 Teamwork and collaboration
 Evidence-based practice
 Quality improvement
 Safety
 Informatics (Hunt, 2012)
 Nurses can positively impact patient outcomes by utilizing the QSEN
competencies!!
QSEN COMPETENCY: PATIENT CENTERED
CARE
 Patient centered care is denoted as the delivery of excellence in nursing care to
the patient.
 The patient’s care should incorporate the concepts of customer service, quality
improvement, and safety.
 In order to deliver patient centered care, the nurse should view the patient as
an individual and tailor the care and interventions needed to promote a better
prognosis for the patient.
 “Recognize the patient or designee as the source of control and full partner in
providing compassionate and coordinated care based on respect for patient’s
preferences, values, and needs.” (AACN, 2012)
 Examples in practice:
 Advocating for a patient by expressing their concerns or wishes to the medical team, Respecting
a patient’s preferences regardless of whether or not they differ from one’s own beliefs.
QSEN COMPETENCY: TEAMWORK AND
COLLABORATION
 Patient care is dependent upon effective communication and teamwork
between healthcare professionals.
 Interprofessional teamwork should promote and optimize the use of
information, people, and resources to achieve the best clinical outcome for
the patient.
 Teamwork can be denoted as working collaboratively with other healthcare professionals
to achieve a common goal, such as providing efficient and safe patient care.
 “Function effectively within nursing and inter-professional teams, fostering
open communication, mutual respect, and shared decision-making to
achieve quality patient care.” (AACN, 2012)
 Examples in practice:
 When an RN appropriately delegates to his/her assistive personnel, valuing the
contribution they provide to patient care.
QSEN COMPETENCY: EVIDENCE-BASED
PRACTICE
 Advancements in technology and increased access to reputable resources
should compel healthcare professionals to discover the most current
treatment options.
 Evidence based practice is the process of analyzing, collecting, and
interpreting valid information that has been proven effective from research
derived evidence.
 “Integrate best current evidence with clinical expertise and patient/family
preferences and values for delivery of optimal health care.” (AACN, 2012)
 Examples in practice:
 A nurse who regularly reads medical journals to keep up-to-date with current knowledge
and practice, performing a procedure with a sterile field because evidence shows it reduces
chance for infection.
QSEN COMPETENCY: QUALITY
IMPROVEMENT
 Because nurses are the key caregivers in hospitals, they can significantly
influence the quality of care provided and, ultimately, treatment and
patient outcomes.
 Nurses also are pivotal in hospital efforts to improve quality!
 “Use data to monitor the outcomes of care processes and use
improvement methods to design and test changes to continuously
improve the quality and safety of health care systems.” (AACN, 2012)
 Examples in practice:
 Looking at data to see what measures proved most effective in preventing patient
falls and implementing them on a unit to lessen the occurrence of patient falls.
QSEN COMPETENCY: SAFETY
 Nurses implement safety precautions to avoid the occurrence of errors
related to patient care.
 Nurses that adhere to executing the national patient safety goals will
participate in yielding positive outcomes for the treatment and
prognosis of the patient receiving the healthcare.
 “Minimizes the risk of harm to patients and providers through both
system effectiveness and individual performance.” (AACN, 2012)
 Examples in practice:
 Using a bed alarm for a patient identified as a fall risk, not relying on memory when
entering orders, verifying meds with another RN. (QSEN, n.d.)
QSEN COMPETENCY: INFORMATICS
 The nurse upholds the responsibility to assess and anticipate the healthcare
needs and services of a patient and to coordinate which resources are
available and appropriate for interventions.
 Computer technology has been integrated into hospitals through means of
hand held computers and computerized physician order entry. The range of
computer technology in hospitals ranges from the utilization of personal
digital assistants (PDA), which have numerous advantages including the
benefit of a developing a universal computer-based patient record.
 “Use information and technology to communicate, manage knowledge,
mitigate error, and support decision making.” (AACN, 2012)
 Examples in practice:
 Computerized charting, bar-code scanning of meds, graphing of lab value trends to
determine course of treatment.
THE FOCUS OF QSEN
“Addressing the challenge of preparing future nurses with the
knowledge, skills, and attitudes necessary to continuously improve the
quality and safety of the healthcare systems in which they work.”
(“About QSEN”, n.d.)
THE CREATION OF QSEN
 Spearheaded by Linda Cronenwett, PhD, RN, FAAN,
and a group of experts in quality and safety
 QSEN is a national initiative to identify the
competencies and knowledge, skills, and attitudes
needed by all nurses (and health professionals in
general) to continuously improve the quality safety of
health care (Disch, 2012).
QSEN HISTORY
 In 2003 IOM released “Health Professions Education”
imploring health professionals to educate nursing school
graduates on:
 Skills needed to deliver patient-centered care as members of an interdisciplinary
team
 Utilizing and seeking evidence-based practice
 Quality improvement approaches
 Informatics (Disch, 2012)
 In 2005, the Robert Wood Johnson Foundation funded the
QSEN program in response to the IOM’s demand to
educate nurses and health care professionals to provide
quality and safe patient care.
QSEN AND PATIENT SAFETY
 From the moment of admission until discharge, the patient’s
safety should remain the foremost priority for the nurse
providing his/her care.
 Patient safety is denoted as the avoidance of emotional or
physical harm and injury to a patient while he/she is
receiving healthcare.
 Nurses that emphasize patient safety and continue to
uphold it as a priority will prove to be a vital component of
the healthcare team.
IMPROVING PATIENT SAFETY
 In 2000 the Institute on Medicine (IOM) released it’s report
“To Err is Human: Building a Safer Health System”.
 A four-tiered approach for improving patient safety:
 (a) establish a national focus to create leadership, research, tools, and
protocols around patient safety
 (b) identify and learn from errors
 (c) raise performance standards for improvements through the action of
oversight organizations, purchasers of healthcare, and professional groups
 (d) create safety systems at the delivery level (Sammer & James, 2011).
WHY DO WE NEED QSEN?
 Health care is not as safe as it could be…
 Medical errors- a reasonable estimate is that medical
mistakes now kill around 200,000 Americans every year, at a
cost of $29 billion (Levinson, 2010).
 Other leading causes of death in US:
 Heart disease- 650,00
 Cancer-560,000
 Stroke- 140,000 (Levinson, 2010)
SWISS CHEESE MODEL FOR ERRORS
Reference:
http://www.salemmarafi.com/managemen
e-swiss-cheese-model/
WHERE DO THE ERRORS OCCUR?
• Medications – prescribing, dispensing, administering
• Surgery – wrong site
• Poor assessment and inaccurate diagnosis – wrong treatment
•
•
•
•
•
•
and interventions
Equipment failure – IV pump
Transfusion error and reactions- blood type, wrong patient
Laboratory – incorrect labeling
System failure – no double checks or use of QSEN policies
Environment – free of clutter and incidence of patient falls
Security-patient protection and confidentiality (Levinson,
2010)
FACTORS THAT COULD CAUSE PATIENT
HARM
Different factors that affect patient safety
 Patient needs and acuity
 Working conditions
 Healthcare facility’s culture and focus on quality
improvement, education, and competencies offered
 Nurse perceptions on patient health status and his/her
ability to think critically
 Lack of communication between the healthcare team
members (Hunt, 2012)
WHAT IS QUALITY CARE?
STEEEP
 Safe-avoid injury to patients
 Timely-reduce waits and delays in treatment
 Efficient-based on evidence-based practice
 Equitable-provide consistent quality patient care
 Effective-avoid waste and provide cost effective care
 Patient-centered-respect patient autonomy (Baylor Health
Care, 2013)
HOW CAN NURSES DECREASE ERRORS
AND PROVIDE QUALITY CARE?
 Improve communication skills
•
Skills to accurately describe situation, clearly articulate positions and
recommendations
•
•
•
•
SBAR = Situation, Background, Assessment, Recommendation (Richardson & Storr,
2010)
Skills in conflict resolution
Increased emphasis on ensuring that correct message was heard
Respect and valuing of each member of the team drives communication
 Open and honest inter-disciplinary communication
•
•
Respect for each team member
Consistent information given to patient and family-increased patient satisfaction
(Richardson & Storr, 2010)
 Cost effective care-being the patient’s wallet advocate too!
 Vigilance as a safety defense
MORE WAYS TO PROVIDE SAFE PATIENT
CARE
 Use safety precautions for medication administration
 Six rights of medication administration by confirming:
 Right patient
 Right drug
 Right dose
 Right route
 Right time
 Proper documentation (Richardson & Storr, 2010)
 Implement reliable care processes to provide a better diagnosis
 Acknowledge safety precautions that could compromise the patient’s
health status
ABOVE AND BEYOND SAFETY
Include the patient in his/her care
Steps to empower patients to promote safe and
quality care
 Educate
 Communicate
 Respect
 Involve
PRACTICE SAFELY!
 All health professionals should be educated to deliver patient-centered
care as members of an interdisciplinary team, emphasizing evidence-based
practice, quality improvement approaches, and informatics (Hunt, 2012).
 Further research and analysis for patient safety suggestions will yield
potential improvements through nursing empowerment and the
development of safety goals to strengthen and support nurses’ role in
the quality and safety of care (Richardson & Storr, 2010).
 The nurse’s adherence to the standards and competencies of QSEN will
help achieve the best outcomes for the patient.
QSEN RELATED TO MY PRACTICE
 Patient safety comes first! This is the focus of my practice. Quality care
and patient safety go hand-in-hand. These are my core nursing practice
values. In order to deliver quality and safe patient care I recognize the
need to continually strive toward nursing excellence by expanding and
developing my skill sets, and staying current with research and evidence
based practice.
 QSEN was developed to teach health professionals how to deliver
quality and safe patient care. QSEN’s practice standards: “identify the
competencies and knowledge, skills, and attitudes needed by all nurses
to continuously improve the quality safety of health care” (Disch, 2012),
are very much the same as mine.
* Katie Morell
QSEN RELATED TO MY PRACTICE
 Patient safety should be the foremost priority for the nurse providing patient care. In my
current practice in the intensive care unit (ICU), QSEN practice standards influence my
nursing practice in every aspect.

I maintain environmental standards that will promote the health, safety, and well being for patients and colleagues.

It is important to promote and provide an environment that is free of health risks, harm, disruptive noises or
sounds, and light that might interfere with healing (ANA, 2010). The ICU has environmental standards in place to
ensure patient safety and satisfaction.
 A recent patient survey revealed that patients were unsatisfied with noise originating at
the nursing stations.

The ICU implemented a stoplight that serves as a reminder to nurses and monitors sound levels at the stations.
The stoplight will alert nurses if the noise level is too loud. A quiet hospital-wide initiative stemmed from the
patient satisfaction survey to promote patient comfort and quality rest in a calm environment.

In addition, hazardous materials are labeled and disposed off properly.

Medications are stored in a locked drawer in patient rooms.

I remain cognizant of the patient’s direct environment because it is an integral part of healing. I promote patient safety by
ensuring the patient’s room is free from clutter, a clear path to bedside toilet, patient’s bed is in the lowest position, and
positioning the call light within reach.
*
Megan Childers
QSEN RELATED TO MY PRACTICE
 Safety is my absolute priority when providing care to my patients and not because it
has to be, because I want it to be.
 The standards that the QSEN has set out to ensure nursing school graduates are competent are
all part of my daily practice. My workplace also has programs and committees dedicated to these
standards such as the Safety Committee, Annual Competencies, and classes to present new
information as evidence-based practice provides.
 When I learned about the different competencies of QSEN they all sounded very
familiar and comfortable to me because they are a regular part of my practice. They
are the reason that I delegate appropriately to the techs I work with, I “scrub the
hub” of each PICC line I access…every time, I activate an alarm on the bed of a
confused patient, amongst many other habits that are a part of my safety culture and
awareness.
 I truly do believe that to err is human and therefore I know that there have to be
principles and benchmarks that I hold myself to. We may not be able to be error
free, but we can learn from our practice and continually improve it.
 Emily Curran
REFERENCES
American Association of Colleges of Nursing [AACN]. (n.d.). About QSEN. Retrieved from http://www.aacn.nche.edu/faculty/qsen/about-qsen
American Association of Colleges of Nursing [AACN]. (September 24, 2012). Graduate Level QSEN Competencies Knowledge, Skills and Attitudes. Retrieved from
www.aacn.nche.edu/faculty/qsen/competencies.pdf
American Nurses Association[ANA]. (2010). Nursing: Scope and standards of practice. (2nd ed.). Silver Spring, MD: nursesbooks.org.
Baylor Health Care. (2013). Achieving best care. Retrieved from: http://www.baylorhealth.edu/Quality/AchievingBestCare/Pages/STEEEP.aspx
Disch, J. (2012). QSEN? What’s QSEN? Nursing Outlook, 60, 58-59. Retrieved from http://0-dx.doi.org.libcat.ferris.edu/10.1016/j.outlook.2012.01.001
Hunt, D. (2012). QSEN competencies: a bridge to practice. Nursing Made Incredibly Easy, 10(5), 1-3.
Levinson, D. (2010). Adverse Events in Hospitals: national incidence among medicare beneficiaries. Department of Health and Human Services Office of the Inspector General 8(5), 22-24.
Sammer, C., James, B. (September, 2011). Patient Safety Culture: The Nursing Unit Leader’s Role. OJIN: The Online Journal of Issues in Nursing ,16. doi:10.3912/OJIN.Vol16No03Man03
Richardson, A., & Storr, J. (2010). Patient safety: a literature review on the impact of nursing empowerment, leadership, and collaboration. International Nursing Review, 57, 12-21.
QSEN Institute. (n.d.) Pre-licensure competencies. Retrieved from www.qsen.org/competencies/pre-licensure-ksas/