Application of QSEN as a Curriculum Model for Linking Doctor of Nursing Practice (DNP) Capstones to Quality & Safety Carol M. Patton, Dr. PH, RN, CRNP,

Application of QSEN as a Application of QSEN as a Curriculum Model for Linking Curriculum Model for Linking

Doctor of Nursing Practice Doctor of Nursing Practice (DNP) Capstones to Quality & (DNP) Capstones to Quality &

Safety Safety Carol M. Patton, Dr. PH, RN, CRNP, FNP-BC, Carol M. Patton, Dr. PH, RN, CRNP, FNP-BC,

CNE, Healthcare Informatics Certificate, Parish CNE, Healthcare Informatics Certificate, Parish Nurse, DNP(c)Nurse, DNP(c)

724 825 3145 EDT724 825 3145 [email protected]@windstream.net

PurposePurposeThe purpose of this presentation is to The purpose of this presentation is to enableenable the learner to discuss evidence- the learner to discuss evidence-based findings of the DNP Capstone based findings of the DNP Capstone project, examine the American project, examine the American Association of Colleges of Nursing (AACN) Association of Colleges of Nursing (AACN) DNP essentials regarding guidance for the DNP essentials regarding guidance for the DNP Capstone and examine linkages DNP Capstone and examine linkages between DNP Capstone Projects to Quality between DNP Capstone Projects to Quality and Safety Education for Nurses (QSEN) to and Safety Education for Nurses (QSEN) to improve patient quality and safety in a improve patient quality and safety in a variety of healthcare environments.variety of healthcare environments.

ObjectivesObjectivesAt the end of this session the participant will:At the end of this session the participant will:

Identify two strategies for linking DNP Identify two strategies for linking DNP Capstone Projects to quality and safety Capstone Projects to quality and safety initiatives in diverse healthcare delivery initiatives in diverse healthcare delivery settingssettings

Have increased awareness and sensitivity Have increased awareness and sensitivity to QSEN for DNP Capstone Projects to QSEN for DNP Capstone Projects focusing on patient-centered care, focusing on patient-centered care, teamwork and collaboration, evidence-teamwork and collaboration, evidence-based practice, quality improvement & based practice, quality improvement & safety, and informaticssafety, and informatics

Objectives Objectives (Continued)(Continued)

Examine a model for engaging Examine a model for engaging DNP learners in conversation with DNP learners in conversation with diverse healthcare delivery diverse healthcare delivery settings related to DNP Capstone settings related to DNP Capstone Projects linked to QSEN Projects linked to QSEN initiativesinitiativesExamine strategies to assist Examine strategies to assist learners to link with a variety of learners to link with a variety of healthcare organizations in which healthcare organizations in which to develop strategies and partner to develop strategies and partner with healthcare personnel for the with healthcare personnel for the DNP Capstone ProjectDNP Capstone Project

AACN DNP Essentials Related to the DNP AACN DNP Essentials Related to the DNP Capstone Project – Requirements for DNP Capstone Project – Requirements for DNP

ProgramsProgramsEssential 1Essential 1

1. Scientific underpinnings for 1. Scientific underpinnings for practice: practice: Programs must Programs must provide provide adequate content on life processes adequate content on life processes and functions of the body.and functions of the body.

Essential 2Essential 2

2. Organizational and 2. Organizational and systems leadership for systems leadership for quality improvement and quality improvement and systems thinking: systems thinking: DNP DNP graduates must be graduates must be knowledgeable about patients on knowledgeable about patients on individual, population and individual, population and community levels to help create community levels to help create new health care delivery models.new health care delivery models.


3. Clinical scholarship 3. Clinical scholarship andand analytical analytical methods for evidence-methods for evidence-based practice: based practice: DNP DNP graduates must be able graduates must be able to put research into to put research into practice.practice.

Essential 4Essential 44. Information systems or 4. Information systems or technology and patient care technology and patient care technology for the improvement technology for the improvement and transformation of health and transformation of health care: care: DNP graduates should know DNP graduates should know how to evaluate programs and how to evaluate programs and information systems to best care for information systems to best care for patients as well as to evaluate patients as well as to evaluate ethical and legal issues surrounding ethical and legal issues surrounding health care technology.health care technology.


5. Health care policy for 5. Health care policy for advocacy in health care: advocacy in health care: DNP programs should DNP programs should prepare graduates to take prepare graduates to take on leadership roles in on leadership roles in political action to promote political action to promote patient care as well as the patient care as well as the nursing profession.nursing profession.


6. Interprofessional 6. Interprofessional collaboration for improving collaboration for improving patient and population patient and population health outcomes: health outcomes: DNP DNP programs should contain programs should contain content to prepare students content to prepare students for working in and creating for working in and creating collaborative health care collaborative health care teams.teams.


7. Clinical prevention and 7. Clinical prevention and population health for population health for improving the nation’s improving the nation’s health: health: DNP graduates DNP graduates should be able to provide risk should be able to provide risk reduction and illness reduction and illness prevention for patients and prevention for patients and families as well as entire families as well as entire populations.populations.


8. Advanced nursing 8. Advanced nursing practice: practice: DNP DNP programs should programs should provide education for provide education for mastery in one mastery in one specialty area of specialty area of nursing practice.nursing practice.

Overview of Quality & Safety Overview of Quality & Safety Education for Nurses (QSEN)Education for Nurses (QSEN)

The overall goal for the Quality and The overall goal for the Quality and Safety Education for Nurses (QSEN) Safety Education for Nurses (QSEN) project is to meet the challenge of project is to meet the challenge of preparing future nurses who have the preparing future nurses who have the knowledge, skills, and attitudes (KSAs) knowledge, skills, and attitudes (KSAs) necessary to continuously improve the necessary to continuously improve the quality and safety of the healthcare quality and safety of the healthcare systems in which they work.systems in which they work.

Quality and Safety Education for Nurses (QSEN) Quality and Safety Education for Nurses (QSEN) CompetenciesCompetencies (continued) (continued)

Patient-Centered Care – “ Recognize the patient or Patient-Centered Care – “ Recognize the patient or designee as the source of control and full partner in designee as the source of control and full partner in providing compassionate and coordinated care providing compassionate and coordinated care based on respect for patient’s preferences, values, based on respect for patient’s preferences, values, and needs” ( Cronenwett et al.,2007, p. 123).and needs” ( Cronenwett et al.,2007, p. 123).

Teamwork and Collaboration – “Function effectively Teamwork and Collaboration – “Function effectively within nursing and interprofessional teams, within nursing and interprofessional teams, fostering open communication, mutual respect, and fostering open communication, mutual respect, and shared decision-making to achieve quality patient shared decision-making to achieve quality patient care” ( Cronenwett et al., 2007, p.125).care” ( Cronenwett et al., 2007, p.125).


Quality Improvement – “Use data to monitor the Quality Improvement – “Use data to monitor the outcomes outcomes of care processes and use improvement of care processes and use improvement methods to design and test changes to continuously methods to design and test changes to continuously improve the quality and safety of health care systems” improve the quality and safety of health care systems” ( Cronenwett et al., 2007, p. 127).( Cronenwett et al., 2007, p. 127).

Safety – “ Minimize risk of harm to patients and Safety – “ Minimize risk of harm to patients and providers through both system effectiveness and providers through both system effectiveness and individual performance” ( Cronenwett et al., 2007, p. individual performance” ( Cronenwett et al., 2007, p. 128).128).

Informatics – “Use information and technology to Informatics – “Use information and technology to communicate, manage knowledge, mitigate error, and communicate, manage knowledge, mitigate error, and support decision making” ( Cronenwett et al., 2007, p. support decision making” ( Cronenwett et al., 2007, p. 128).128).


Evidence-Based Practice – “ Integrate best Evidence-Based Practice – “ Integrate best current evidence with clinical expertise and current evidence with clinical expertise and patient/family preferences and values for patient/family preferences and values for delivery of optimal health care” ( Cronenwett delivery of optimal health care” ( Cronenwett et al., 2007, p. 126).et al., 2007, p. 126).

Definition of “High Definition of “High Reliability Theory”Reliability Theory”

There is no There is no one definition!one definition!

Reliability is Reliability is defined as defined as “failure-free “failure-free operation over operation over time” time” (Garvin).(Garvin).

Origins of High Origins of High Reliability Theory Reliability Theory

(HRO)(HRO)Came to healthcare Came to healthcare organizations from organizations from naval aviation industry naval aviation industry and the nuclear power and the nuclear power industryindustry

We know the way High We know the way High Reliability Theory is Reliability Theory is used in other used in other industries cannot be industries cannot be directly replicated in directly replicated in healthcare healthcare

These industries found These industries found it necessary to identify it necessary to identify weak danger signals weak danger signals and respond to these and respond to these danger signalsdanger signals

Normal Accident Normal Accident Theory (NAT) Theory (NAT)

Term was coined by Charles PerrowTerm was coined by Charles Perrow

Focuses on investigation of normal accidents Focuses on investigation of normal accidents in “high-risk systems”in “high-risk systems”

A “normal accident” occurs in a complex A “normal accident” occurs in a complex system that has so many parts that it is likely system that has so many parts that it is likely that something is wrong with more than one that something is wrong with more than one part of the system at any given timepart of the system at any given time

A “well-designed system” includes A “well-designed system” includes redundancy, so that each fault by itself does redundancy, so that each fault by itself does not prevent proper operationnot prevent proper operation

Swiss Cheese Swiss Cheese ModelModel

What Drives & Underpins What Drives & Underpins High Reliability TheoryHigh Reliability Theory

Desire to create a culture of safety Desire to create a culture of safety with the with the patient at the center of carepatient at the center of care

Practicing “mindfulness” and Practicing “mindfulness” and striving for perfection with each and striving for perfection with each and every patient encounterevery patient encounter

Being “mindful” means even one Being “mindful” means even one small failure in a safety process or small failure in a safety process or procedure has potential to result in procedure has potential to result in a sentinel event or adverse outcomea sentinel event or adverse outcome

Concept of Concept of “Mindfulness”“Mindfulness”

Originally described and coined in 2007 by Originally described and coined in 2007 by University of Michigan professors, Karl Weick and University of Michigan professors, Karl Weick and Kathleen SutcliffeKathleen Sutcliffe

““Mindfulness involves the constant searching by Mindfulness involves the constant searching by staff for the smallest indication of a flaw or hazard staff for the smallest indication of a flaw or hazard that has potential to lead to failure if some action that has potential to lead to failure if some action is not taken to solve or prevent the potential is not taken to solve or prevent the potential problem” (Blouin, nd)problem” (Blouin, nd)

Mindfulness leads organizations to find flaws or Mindfulness leads organizations to find flaws or holes in the Swiss cheese at early stages to holes in the Swiss cheese at early stages to intervene early and prevent near or sentinel intervene early and prevent near or sentinel eventsevents

The Goal of the High The Goal of the High Reliability Organization Reliability Organization

(HRO)(HRO)PerfectionPerfection

Considerations:Considerations:

99% is never good enough99% is never good enough

1 % error is unacceptable1 % error is unacceptable

Safety must be a culture of the Safety must be a culture of the healthcare organizationhealthcare organization

Link organizational mission and Link organizational mission and philosophy translated into the philosophy translated into the strategic plan strategic plan

High Reliability High Reliability Organizing ConceptsOrganizing Concepts

There are five There are five concepts that concepts that create the create the state of state of “mindfulness“mindfulness” needed to ” needed to reliabilityreliability

Mindfulness is Mindfulness is a prerequisite a prerequisite for safetyfor safety

Five Characteristics to Guide Five Characteristics to Guide Thinking in a High Reliability Thinking in a High Reliability

OrganizationOrganization

Sensitivity to OperationsSensitivity to Operations

Preoccupation with FailurePreoccupation with Failure

Deference to ExpertiseDeference to Expertise

ResilienceResilience

Reluctance to SimplifyReluctance to Simplify

Sensitivity to Sensitivity to OperationsOperations

Reduces the Reduces the number of number of errorserrors

Allows errors Allows errors to be quickly to be quickly identified identified and remedied and remedied

Preoccupation with Preoccupation with FailureFailure

““Near Misses” or Near Misses” or “Good Catches” are “Good Catches” are viewed as viewed as invitations for invitations for improvementimprovement

Events caught early Events caught early to prevent failure as to prevent failure as a result of constant, a result of constant, continuous vigilance continuous vigilance prevents prevents catastrophecatastrophe

Deference to Deference to ExpertiseExpertise

Do not rely only on the healthcare Do not rely only on the healthcare professional but listen to patients professional but listen to patients and families and families

There is other essential There is other essential information to provide ideal careinformation to provide ideal care

Defer to whoever has expertise or Defer to whoever has expertise or knowledge that is most relevant knowledge that is most relevant to the choices being madeto the choices being made

ResilienceResilience

Quickly contain errors and Quickly contain errors and improvise when errors or improvise when errors or challenges occurchallenges occur

Systems that can function even Systems that can function even when there are unintended when there are unintended outcomesoutcomes

Nimble to respond to unexpected Nimble to respond to unexpected consequences when there are consequences when there are system failuressystem failures

Reluctance to Reluctance to SimplifySimplify

Refuse to simplify or Refuse to simplify or ignore explanations for ignore explanations for difficulties and problems difficulties and problems they facethey face

Recognize that systems Recognize that systems can fail and in ways that can fail and in ways that have never happened have never happened before before

Recognize there is no Recognize there is no way to avoid every way to avoid every potential error that will potential error that will occur in the future due to occur in the future due to complexity of the health complexity of the health care systemcare system

Characteristics in Healthcare Characteristics in Healthcare Systems Requiring High Systems Requiring High

Reliability Performance by Reliability Performance by Nurses Nurses

HypercomplexityHypercomplexity

Tight couplingTight coupling

Extreme hierarchical differentiationExtreme hierarchical differentiation

Multiple decision makers in a complex Multiple decision makers in a complex communication networkcommunication network

High degree of accountabilityHigh degree of accountability

Two DNP Capstone Exemplars Based Two DNP Capstone Exemplars Based on QSEN & National Quality & Safety on QSEN & National Quality & Safety

Initiatives through Centers for Initiatives through Centers for Medicare & Medicaid (CMS)Medicare & Medicaid (CMS)

Communication Strategies to Link Communication Strategies to Link DNP Students with Healthcare DNP Students with Healthcare

OrganizationsOrganizations

ConclusionsConclusionsEvolution of the DNP in Nursing PracticeEvolution of the DNP in Nursing Practice

Development of the DNP roleDevelopment of the DNP role

Variations & Challenges in DNP-Variations & Challenges in DNP-prepared practitionersprepared practitioners

Achieving clinical valueAchieving clinical value

Practice focus of the DNPPractice focus of the DNP

Evolution to revolutionEvolution to revolution

The Journey to Exemplary The Journey to Exemplary Capstone ProjectsCapstone Projects

QuestionsQuestions

Documents

Application of QSEN as a Curriculum Model for Linking Doctor of Nursing Practice (DNP) Capstones to Quality & Safety Carol M. Patton, Dr. PH, RN, CRNP,