QUALITY AND SAFETY EDUCATION FOR NURSES Megan Childers Ferris State University NURS 320
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- Slide 1
- QUALITY AND SAFETY EDUCATION FOR NURSES Megan Childers Ferris
State University NURS 320
- Slide 2
- 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!!
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- QSEN COMPETENCY: PATIENT CENTERED CARE Patient centered care is
denoted as the delivery of excellence in nursing care to the
patient. The patients 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 patients
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 patients preferences regardless of
whether or not they differ from ones own beliefs.
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- 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.
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- 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.
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- 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.
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- 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.)
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- 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.
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- 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.)
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- 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).
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- 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 IOMs demand to educate nurses and health care
professionals to provide quality and safe patient care.
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- QSEN AND PATIENT SAFETY From the moment of admission until
discharge, the patients 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.
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- IMPROVING PATIENT SAFETY In 2000 the Institute on Medicine
(IOM) released its 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).
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- 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)
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- SWISS CHEESE MODEL FOR ERRORS Reference:
http://www.salemmarafi.com/management/th e-swiss-cheese-model/
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- 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)
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- FACTORS THAT COULD CAUSE PATIENT HARM Different factors that
affect patient safety Patient needs and acuity Working conditions
Healthcare facilitys 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)
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- 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)
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- 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 patients wallet advocate too! Vigilance as a safety
defense
- Slide 20
- 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
patients health status
- Slide 21
- 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
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- 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 nurses
adherence to the standards and competencies of QSEN will help
achieve the best outcomes for the patient.
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- 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. QSENs
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
- Slide 24
- 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 patients direct
environment because it is an integral part of healing. I promote
patient safety by ensuring the patients room is free from clutter,
a clear path to bedside toilet, patients bed is in the lowest
position, and positioning the call light within reach. * Megan
Childers
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- 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 accessevery 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
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- REFERENCES American Association of Colleges of Nursing [AACN].
(n.d.). About QSEN. Retrieved from
http://www.aacn.nche.edu/faculty/qsen/about-qsenhttp://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
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? Whats QSEN? Nursing Outlook, 60, 58-59.
Retrieved from
http://0-dx.doi.org.libcat.ferris.edu/10.1016/j.outlook.2012.01.001http://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 Leaders
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/www.qsen.org/competencies/pre-licensure-ksas/