QSEN

What is it?

What does it mean?

Health Care Is Not As Safe As It

Could Be

• 4% of hospitalized patients are harmed

by care supposed to help

– Deaths per year

• Medical Errors: 98,000

– Post op infections and other preventable

complications: 32,000/year

• Motor Vehicle Accidents: 43,459

• Breast Cancer: 42,297

• AIDS: 16,000

Errors

• Medications: nurse is last line of defense

• Surgery: wrong site

• Diagnostic accuracy: wrong treatment

• Equipment failure: IV pump

• Transfusion error: blood type, wrong patient

• Laboratory: incorrect labeling

• System failure: no independent double check

• Environment: clean up spills

• Security: child abduction

What is Quality Care?

• S

• T

• E

• E

• E

• P

Patient/Family Centered

Care

Effective

Equitable

Efficient

Timely

Safe

Quality and Safety in Educating

Nurses

• Purpose is to prepare nurses with the competencies necessary to continuously improve the quality and safety of the health care systems in which they work

• Competencies: – patient/family centered care,

– collaboration and teamwork,

– evidence based practice,

– quality improvement,

– safety

– informatics

Team Work and

Collaboration

Definition

• Function effectively

within the team to

achieve quality

patient care

– Open

communication

– Mutual respect

– Shared decision

making

Key Message

• Safe, effective,

satisfying patient

care requires:

– teamwork,

– collaboration

– communication

• among all team

members

Patient and Family are Members of the Team!

Teamwork is:

• A joint action by two

or more people:

– each person

contributes

• different skills

• opinions

– working with unity

and efficiency

• to achieve common

goals.

Collaboration is….• Joint decision making among

independent parties

– involving joint ownership of decisions

– collective responsibility for outcomes

Working Across Professional Boundaries.

Cultural Barriers to Teamwork

and Collaboration

• Specialized languages

• Face different societal expectations

• Hold differing viewpoints and goals

• Define success very differently

• Represent different generations with

differences about motivation, work

ethic, learning styles, authority

relationships, and communication

patterns.

Who leads the Team?

• Less about one leader for all situations

and more about who has the

necessary skills

– Productive pairs: relational co-leadership

– When can the patient and family lead?

– What is the difference between a team of

experts and an expert team?

Qualities of Expert Teams

• Understanding of scope and individual

strengths

• Skills at communication/conflict

resolution

• Philosophy of “got your back”

• Clear leadership competencies

• Joint responsibility to help each other

• Shared goals and accountability

If Shared Decision-Making

• Strengths of all members are known

and respected

• Mutual appreciation for all

contributions

• Leader is member with greatest

relevant knowledge

• Patient/family is full member…care is

patient/family driven

We are guests in their lives!

Safety

How is safety reflected in

the hospital environment ?

Safety Definition:

Minimizes risk of harm to patients and

providers through both system effectiveness and

individual performance

• How can you

accomplish this?– Wrist bands

– Clutter free

environment

– Patient equipment

– “Time out”

– Medication

reconciliation

– Bed alarms

– Hourly rounding

– SBARR

– Hand washing

You Tube Safety Video

• http://www.youtube.com/watch?v=u49

BME17ED0&feature=related

Points to remember:

• What is patient safety?– Decreased risk of harm

by individual actions or system design

• Who is responsible or patient safety?– All of us

• When do we address a “safety issue”– As soon as we

recognize it

Informatics

• We’ve come a

long way baby

Informatics Definitions

• Use information

and technology to

communicate, man

age

knowledge, mitigate

error, and support

decision making

How can we accomplish this?

• Electronic medical records

• Computerized “evidence based practice” – Literature review for

best practice guidelines

• Error prevention

• Incorporation of “5 rights”

• Data collection and analysis to improve patient outcomes

Points to remember:

• What is my

responsibility?

– Timely, accurate

data collection

– Timely, complete

documentation

– No falsification of

information

What kind of record do you

want?

• It is up to you to

keep patient

data “clear and

concise” so

you don’t

muddy the

water

What is 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

•The patient and

family are in a

partnered relationship

with their health care

providers and are

equipped with

relevant information,

resources, access

and support to fully

engage in and/or

direct the health care

experience as they

choose.

Key message

Institute of Medicine (IOM)

States patient-centered care “is

providing care that is respectful of and

responsive to individual patient

preferences, needs, and values and

ensuring that patient values guide all

clinical decisions”

•Patient focused care:

The patient/family

may be involved, but

the health care

provider retains

control over decision-

making, patient needs

and preferences may

or may not be

sought, and rarely

drive care decisions

It is not……

What families want……

• To know the prognosis,

• To talk with the nurse each day,

• To know how the patient was being treated,

• To know why things were done for the patient,

• To be called at home about changes in the patient’s condition,

• To receive information about the patient daily,

• To know exactly what was being done for the patient,

• To be told about transfer plans, and

• To know specific facts about the patient’s condition.

How do you provide patient-

centered care?• Value seeing health care situations “through

patients’ eyes”

• Value the patient’s expertise with own health

and symptoms

• Seek learning opportunities with patients

who represent all aspects of human diversity

• Recognize personally held attitudes about

working with patients from different ethnic,

cultural and social backgrounds

• Provide patient-centered care with sensitivity

and respect for the diversity of human

experience

How do you provide patient-

centered care?

• Communicate patient values, preferences and expressed needs to other members of the health care team

• Respect patient preferences for degree of active engagement in the care process

• Respect the patient’s right to access to personal health records

• Appreciate shared decision-making with empowered patients and families, even when conflicts occur

• Participate in building consensus or resolving conflict in the context of patient care

• Assess presence and

extent of pain and suffering

• Elicit expectations of

patient & family for relief of

pain, discomfort, or

suffering

• Initiate effective treatments

to relieve pain and

suffering in-light of patient

values, preferences, and

expressed needs

Patient-centered care/pain

management

CompetencyTo 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

Remember…..

“We are guests in their

lives”…

(D Berwick)

Quality

Improvement

QSEN

Quality Improvement

Definition: Use of

data to monitor the

outcomes of care

processes and use of

improvement

methods to design

and test changes to

continuously improve

the quality and safety

of healthcare systems (Cronenwett et al, 2007)

Key Message

• Improving patient care requires a

systematic process of defining

problems in order to identify potential

causes and develop strategies to

improve care. This process requires

the ability to measure care. We can

only improve if we measure how well

we are doing and compare our

performance against others.

Overview of Quality

Improvement

• Nurses and students are parts of the

system of care and processes that

affect outcomes

• For instance, the huddles (meetings)

that are held to discuss patients with

skin care issues.

Problem: Patient with a

fractured hip who developed a

sacral decubitiA root cause analysis was done:

• Who is involved

• What factors contribute

• What can we do to prevent this

problem

• What can be done to treat the issue

Who and What is Involved

• Departments: ER, OR, PACU and the

nursing unit the patient is on till they

are discharged

• Equipment/supplies: specialty

beds, dressings, skin prep

• Nursing care: turning and positioning

schedules

• Factors to overcome: lack of

knowledge about hip replacements

and movement

Knowledge necessary

• Change the knowledge base about

being able to move a post-op hip

surgery patient

– The hip is fixed and the cement is dry

Skills necessary

• Teach turning and positioning for the

post-op hip patient

• Reinforce the skills necessary when

using the specialty beds

Attitudes

• Appreciate the cost of treating a

hospital acquired skin breakdown.

• Recognize the value of preventative

steps.

Hospital Based QI

• Chart reviews for documentation of

pain medication effectiveness

• Timing for antibiotics versus cultures

• Following the printed protocols for

CHF, community acquired pneumonia

Quality and Safety Begin

with YOU!