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Partnering Together: QSEN in Practice
Laura H. Clayton, PhD, RN, CNE Barbara Kemerer, MSN, MBA, RN
Shepherd University, Shepherdstown WV
Presented at Nurse Educator’s Conference in the Rockies
Breckenridge, CO July 18, 2014
Shepherd University
Shepherdstown, WV
Shepherd University
German Street
Shepherdstown, WV
90 minutes from Washington DC and Baltimore
Erma Ora Byrd Hall
Objectives Participants will be able to:
Describe why new graduates need to learn about quality improvement in their undergraduate programs.
Develop strategies for implementing quality improvement projects into the curriculum.
Describe the value of partnering with clinical agencies to enhance patient outcomes.
Identify resources to assist in developing QI competencies in undergraduate nursing students.
Literature Review ANA Safety and Quality Initiative (Montaivo, 2007)
National Database of Nursing Quality Indicators
To Err is Human: Building a Safer Health Care System (IOM, 1999)
Crossing the Quality Chasm: A New Health System for the 21st Century (IOM, 2001)
6 aims for care - Safe, effective, patient centered, timely, efficient, equitable
Literature Review Health Professions Education: A Bridge to Quality
(IOM, 2003)
“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.” (Institute of Medicine, 2003, p. 3)
Literature Review Quality and Safety in Education for Nurses (QSEN,
2009)
Patient-centered care
Teamwork and collaboration
Evidence-based practice
Quality improvement
Informatics
Safety
Literature Review Essentials of Baccalaureate Education for
Professional Nursing (AACN, 2009)
Essential II: Basic Organizational and Systems Leadership for Quality Care and Patient Safety
Knowledge and skills in leadership, quality improvement, and patient safety are necessary to provide high quality health care.
Essential VI: Interprofessional Communication and Collaboration for Improving Patient Health Outcomes
Communication and collaboration among healthcare professionals are critical to delivering high quality and safe patient care.
Literature Review Future of Nursing: Leading Change, Advancing
Health (IOM, 2010)
“Nurses should be full partners in redesigning healthcare by taking responsibility for identifying problems; developing and implementing improvement plans; tracking improvements; and making changes to achieve established goals. No other health care provider is in a better position to ensure that safe, quality healthcare is available to all patients than nurses providing bedside care” (Flores,
Hickenlooper & Saxton, 2013)
Quality Improvement “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.” (American Association of Colleges of Nursing: QSEN Education Consortium.
Retrieved from: http://www.qsen.org)
Why Healthcare Agencies Require QI CMS payment reforms (Centers for Medicare and Medicaid Services, 2011)
Benefits of QI
Financial (Unruh, Agrawal & Hassmiller, 2011)
Health quality benefits (Cohen et al., 2008; Weiner et al., 2006)
Increase RNs knowledge, skill and satisfaction (Calomeni, Solberg & Conn, 1999)
Professional mandates for RNs to lead efforts (HRSA,
2010)
Deficiencies in quality healthcare (AHRQ, 2012)
Nursing Education Accreditation Commission of Collegiate Nursing Education (AACN, 2013)
“Demonstrate an understanding of the basic elements of the research process and models of applying evidence to clinical practice” (p. 16)
“Demonstrate leadership and communication skills to effectively implement patient safety and improvement initiatives within the context of the interprofessional team” (p. 14)
Accrediting Commission for Education in Nursing (2013)
“Students participate in clinical experiences that are evidence-based and reflect contemporary practice and nationally established patient health and safety goals” (Standard 4.10)
Effective QI Program Challenges RNs expected to lead QI projects (Murray, Douglas, Girdley, &
Jarzemsky, 2010)
Staff RNs lack of education and experience (Flores,
Hickenlooper & Saxton, 2013)
Nursing faculty lack education and experience (Flores,
Hickenlooper & Saxton, 2013)
38.6% new graduates “poorly” or “very poorly” prepared about or had “never heard of QI” (Kovner, Brewer,
Yingrengreung, & Fairchild, 2010)
Minimal training provided to staff RNs (Djukic, Kovner, Brewer,
Fatehi, & Seltzer, 2013)
Nursing Education Implications Faculty need to develop competence
Self-education
Partner with clinical agencies
Nursing students need to learn QI both theoretically and experientially (Headrick & Khaleel, 2008; Thronlow &
McGuimn, 2010)
Learning about QI without practicing it does not lead to development of QI competency (Armstrong, Headrick,
Madigosky, & Ogrinc, 2012)
QI Tools and Resources Transforming Care at the Bedside
http://www.innovations.ahrq.gov/index.aspx
Institute for Healthcare Improvement
http://www.ihi.org/Pages/default.aspx
Quality and Safety Education for Nurses
http://qsen.org/
Nurses Improving Care for Healthsystem Elders
http://www.nicheprogram.org/
Clinical Microsystems
http://clinicalmicrosystem.org/
National Patient Safety Goals
http://www.jointcommission.org/standards_information/npsgs.aspx
Designing QI Competencies
Jefferson Rock
Harpers Ferry, WV
Stepping Stones to Implementation
Faculty education on QSEN
Faculty “buy-in”
Provided examples
Revised course expected student outcomes
Revised clinical evaluation tools
Student and faculty feedback
Nursing Research and EBP Course Competence Category - EBP and Quality Improvement
Learner Setting
Strategy Overview Select clinical practice problem
Update clinical agency policy
Learner Objective Identify a clinical practice question and develop change
project aimed at improving patient outcomes.
Work as a member of a team using EBP to update clinical agency policies.
Evaluation
Literature Review Table PICO question
Summary of Findings
Application of Findings to Changes in Policy/Procedure
Authors and (year) (Oldest to
most recent)
Level of Evidence
Design Qualitative
Quantitative (Specify type)
Purpose/ Research Question
Sample (Sample size, sampling method)
Setting (Where
completed)
Methods (How was data
collected, tools used, reliability,
validity)
Findings (Specific statistical
results and what still needs to be studied)
Population Health Course Competence Category - Quality Improvement, Teamwork
and Collaboration
Learner Setting
Strategy Overview Community assessment and project implementation
Learner Objective Conduct a community assessment
Identify priority community need
Develop, implement and evaluate project aimed at meeting the need
Evaluation
Leadership and Capstone Courses
Competency Category – Quality Improvement
Learner Settings- Level 4 - (Theory & Clinical)
Strategy Overview – Involved in QI (EBP) project
Learner Objectives – Identify a problem and participate in at least 1 element of the Plan-Do-Check-Act process
Evaluation- Student analyzes their contributions in an online discussion forum
Framework
Plan
Do
Check
Act
Leadership - Theory
Week Two – Unit on Quality Improvement* Objective - Identify a problem and participate in
at least 1 element of the Plan-Do-Check-Act process
Mid to end of semester – online discussion forum
QI Skills Needed by RNs* Seeking information about outcomes of care and
QI projects
Using tools such as flow charts
Participating in root cause analysis
Using single quality measures to measure performance
Using tools for understanding variation in practice
(Kovner, Brewer, Yingrengreung, & Fairchild, 2010)
Use national patient safety resources, initiatives, or regulations
Use QI framework
Data collection Current performance
Assess gaps
Data analysis
Measurement
Project implementation
Use QI data or project monitoring tools
Criteria for Posting Project Online Describe clinical site
Use QI and EBP terminology
Discuss history and significance of the problem
Explain your contributions to the process
Recommend any measures to overcome barriers that have not been addressed
Initial Discussion and Response to Someone Else’s Discussion is 5% of Leadership Grade
Capstone - Clinical 120 patient care hours with a BSN RN preceptor on a
medical/surgical unit, intensive care, or emergency department
Project is a required element
Student must give a presentation to the agency
Graded as: (above expectations, meets expectations, unacceptable performance)
Student Responsibilities Autonomous project with preceptor
Student gives schedule to faculty
Seek faculty guidance as appropriate
Official deadline is “by the end of the clinical”
Faculty Responsibilities Faculty orients preceptor
Faculty meets with student and preceptor
Preceptor completes student clinical evaluation
QI Projects Bedside reporting
Hourly rounding
Fall prevention
Medication safety
Preventing (UTIs, CL infections, Decubiti)
Safe patient handling
Alarm fatigue
MRSA, C diff, and CBE education
Assessing for sepsis
Lateral bullying
Stethoscope hygiene
Student Involvement Literature review
Surveys
Data analysis
Developed tools for measurement and/or education
Presented findings verbally/visually to staff, management
Benefits Stronger agency partnerships
Job offers to students
Students appreciated making a difference for the agency and not just a classroom assignment
Students developed hands-on experience with QI
Challenges and Concerns Students complete the project outside of the
120 hours of direct care
Not all preceptors aware of unit based QI projects or process
Lack of “buy-in” from faculty and clinical educators, preceptors and agencies???
Future Curriculum QI Integration Ongoing discussion between both course
coordinators regarding project evaluation
Capstone preceptor “contracts” will now be written and signed
Explore “giving students time” in Leadership course to complete project
Revise project objectives to provide more guidance for students
Explore opening discussion forum earlier so that student comments/suggestions can be acted on
Course Faculty Questions Can preceptors be ASN prepared?
Should there be more than 2 years experience required for preceptors?
How do you convince preceptors to complete student evaluations in a “realistic” manner?
Should specialty units such as “mother/baby” and “mental health” be used?
Designing a QI Project for Your Course or Program
Black Water Falls State Park
Davis, WV
QSEN Mapping Flow Sheet
Class Content/
Activity
Description
Patient
Centered Care
Teamwork and
Collaboration
Evidence-based
Practice
Quality
Improvement
Safety Informatics
Share Your QI Design Plan
Spruce Knob
Seneca Rocks, WV
Questions?
References Accrediting Commission for Education in Nursing. (2013). Accreditation Manual.
Retrieved from http://www.acenursing.net/manuals/SC2013.pdf
Agency for Healthcare Research and Quality. (2012). National Healthcare Quality Report (AHRQ Publication No. 12-0005). Retrieved from www.ahr.gov/qual/nhqr11/nhqr11.pdf
American Association of Colleges of Nursing. (2013). Standards for Accreditation of Baccalaureate and Graduate Nursing Programs (amended 2013). Retrieved from http://www.aacn.nche.edu/ccne-accreditation/standards-procedures-resources/baccalaureate-graduate/standards
Armstrong, G., Headrick, L., Madigosky, W., & Ogrinc, G. (2012). Designing education to improve care. Joint Commission Journal on Quality and Patient Safety, 38(1), 5-14.
Calomeni, C.A., Solberg, L.I., & Conn, S.A. (1999). Nurses on quality improvement teams: How do they benefit. Journal of Nursing Care Quality, 13(5), 75-90.
Centers for Medicare and Medicaid Services. (2014). Medicare’s delivery system reform initiatives achieve significant savings and quality improvements - off to a strong start. Retrieve d from: http://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-Releases/2014-Press-releases-items/2014-01-30.html
Centers for Medicare and Medicaid Services. (2014). Hospital acquired conditions. Retrieved from: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalAcqCond/index.html?redirect=/HospitalAcqCond/02_Statute_Regulations_Program_Instructions.asp#TopOfPage
Cohen, A.B., Restuccia, J.D., Shwartz, M., Drake, J.E., Kang, R., Kralovec, P., … Bohr, D. (2008). A survey of hospital quality improvement activities. Medical Care Research and Review, 65(5), 571-595.
Djukic, M., Kovner, C.T., Brewer, C.S. Fatehi, F.K., & Seltzer, J.R. (2013). A multistate assessment of employer-sponsored quality improvement education for early-career registered nurses. The Journal of Continuing Education in Nursing, 44(X), 1-8. doi 10.3928/00220124-20121115-68.
Flores, D., Hickenlooper, G., & Saxton, R. (2013). An academic practice partnership: Helping new registered nurses to advance quality and patient safety. Online Journal of Issues in Nursing, 18(3).
Headrick, L.A., & Khaleel, N.J. (2008). Getting it right: Educating Professionals to work together in improving health care. Journal of Interprofessional Care, 22, 364-374.
References
References Health Resources and Service Administration. (2010). HRSA study finds nursing
workforce is growing. Retrieved from http://www.hrsa.gov/about/news/pressreleases/2010/100317_hrsa_study_100317_finds_nursing_workforce_is_growing_and_more_diverse.html
Institute of Medicine. (1999). To err is human: Building a safer health system. Retrieved from http://www.iom.edu/Reports/1999/To-Err-is-Human-Building-A-Safer-Health-System.aspx
Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Retrieved from http://www.iom.edu/Reports/2001/Crossing-the-Quality-Chasm-A-New-Health-System-for-the-21st-Century.aspx
Institute of Medicine .(2003). Health professions education: A bridge to quality. Retrieved from http://www.iom.edu/Reports/2003/Health-Professions-Education-A-Bridge-to-Quality.aspx
Institute of Medicine. (2010). The future of nursing: Leading change, advancing health. Retrieved from http://www.iom.edu/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health.aspx
References
Kovner, C.T., Brewer, C.S., Yingrengreung, S., & Fairchild, S. (2010). New nurses’ views on quality improvement education. The Joint Commission Journal on Quality and Patient Safety, 36(1), 29-35.
Montavio, I. (2007). The national database of nursing quality indicators. Online Journal of Issues in Nursing, 12(3). Doi:10.3912/OJIN.Vol12No03Mar02
Murray, M.E., Douglas, S., Girdley, D., & Jarzemisky, P. (2010). Teaching quality improvement. Journal of Nursing Education, 49, 466-469.
Quality and Safety Education for Nursing Institute. (2009). Pre-licensure KSAS. Retrieved from http://qsen.org/
Thornlow, D.K., & McGuinn, K. (2010). A necessary sea change for nurse faculty development: Spotlight on quality and safety. Journal of Professional Nursing, 26, 71-81.
Unruh, L., Agrawal, M., & Hassimiller, S. (2011). The business case for transforming care at the beside among the “TCAB 10” and lessons learned. Nursing Administration Quarterly, 32(2), 97-109.
QI Projects and Nursing Education Dotson, B.J. & Lewis, L. (2013). Teaching the quality improvement
process to nursing students. Journal of Nursing Education, 52(7), 398-400. doi:10.3928/01484838-20130613-01
Levett-Jones, T., Fahy, K., Parsons, K., & Mitchell, A. (2006). Enhancing nursing students’ clinical placement experiences: A quality improvement project. Contemporary Nurse: A Journal for the Nursing Profession, 23, 58-71.
Sherrod, R. A. & Morrison, R.S. (2008). Improving quality in a nurse-managed rural health clinic. Nursing Education Perspectives, 29(4), 212-216.
Teeley, K.H., Lowe, J.M., Beal, J., & Knapp, M.L. (2006). Incorporating quality improvement concepts and practice into a community health nursing course. Journal of Nursing Education. 45(2), 86-90.
Contact Us:
Barb Kemerer
Laura Clayton
Partnering Together: QSEN in Practice Workshop
Laura H. Clayton, PhD, RN, CNE Barbara Kemerer, MSN, MBA, RN
Shepherd University, Shepherdstown WV Presented at
Nurse Educator’s Conference in the Rockies Breckenridge, CO
July 18, 2014
QSEN Definitions (http://qsen.org/competencies/pre-licensure-ksas/)
Patient-centered Care: 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.
Teamwork and Collaboration: Function effectively within nursing and inter-professional
teams, fostering open communication, mutual respect, and shared decision-making to achieve
quality patient care.
Evidence-based Practice: Integrate best current evidence with clinical expertise and
patient/family preferences and values for delivery of optimal health care.
Quality Improvement: 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.
Safety: Minimizes risk of harm to patients and providers through both system effectiveness and
individual performance.
Informatics: Use information and technology to communicate, manage knowledge, mitigate
error, and support decision making.
Example: Nursing Research and Evidence-based Practice Course
QSEN Content Mapping for Quality Improvement Projects
Class Content/ Activity Description
Patient-centered Care
Teamwork and Collaboration
Evidence-based Practice
Quality Improvement
Safety Informatics
Update Clinical Agency Policy
Value the role of the RN in providing safe and effective patient care.
Identify strategies to improve compliance with policy/procedure in clinical setting.
Work in groups on project.
Provide feedback to clinical agencies on recommended policy changes.
Develop poster presentation.
Complete peer review.
Conduct a literature search.
Develop literature review table.
Compare and contrast EBP with actual practice.
Synthesize findings and make recommendations for practice change as appropriate.
Discuss how change in the policy may impact patient care.
Identify how to monitor effectiveness of changes on patient care.
Discuss application of evidence for decision making to promote patient health and improve quality of care.
Question rationale for routine approaches to care that are not based on evidence and may result in less-than-desired outcomes or adverse events
Locate evidence reports related to clinical practice policy/procedure.
QSEN Content Mapping for Quality Improvement Projects
Class Content/ Activity Description
Patient-centered Care
Teamwork and Collaboration
Evidence-based Practice
Quality Improvement
Safety Informatics
