project team: mary ellen murray, ph.d, rn paula jarzemsky, ms, rn diana girdley, ms, rn steve...

Project Team:Project Team:Mary Ellen Murray, PH.D, RNMary Ellen Murray, PH.D, RNPaula Jarzemsky, MS, RNPaula Jarzemsky, MS, RNDiana Girdley, MS, RNDiana Girdley, MS, RNSteve Douglas, MS, RNSteve Douglas, MS, RN

Greetings From University of Greetings From University of WisconsinWisconsin

UNIVERSITY OF UNIVERSITY OF WISCONSIN-WISCONSIN-MADISONMADISON


Partnership with Partnership with PracticePractice

Identification of Identification of participantsparticipants

3 formal meetings 3 formal meetings

(Jan, Mar, May)(Jan, Mar, May)– Overview of QSEN / Overview of QSEN /

invited proposalsinvited proposals– Opportunity to work on Opportunity to work on

projectsprojects– Project summaries / Project summaries /

AbstractsAbstracts One outcome: One outcome:

Patient Safety ToolPatient Safety Tool

HOW WAS THIS HOW WAS THIS INNOVATION INNOVATION ACCOMPLISHED? ACCOMPLISHED?

Patient Safety Scan Patient Safety Scan

History of the Safety History of the Safety ScanScan

– Eaglewood retreat in October, 2007Eaglewood retreat in October, 2007– Motivated to change approach to clinical Motivated to change approach to clinical

teaching by incorporating an agenda of :teaching by incorporating an agenda of :

Safety & Patient Centered CareSafety & Patient Centered Care

Development of the Development of the ToolTool Checklist for students (who need Checklist for students (who need

structure and focus)structure and focus)

5 minute sit-down with patient as 5 minute sit-down with patient as an initiative for an initiative for – Therapeutic communicationTherapeutic communication– Identification of patient Identification of patient

goals/concernsgoals/concerns

The The Safety Safety

Scan Scan

Page 1Page 1

The The

Safety Safety

Scan Scan

Page 2Page 2

The The Safety Safety ScanScan Page 2 Page 2 (Cont’d)(Cont’d)

Implementation of the Implementation of the Safety Scan Safety Scan

Each student was to complete the Each student was to complete the form within the 1form within the 1stst 30 minutes on unit 30 minutes on unit

Safety issues identified were Safety issues identified were discussed in post-conferencediscussed in post-conference

Process established for reporting Process established for reporting staff/system errorsstaff/system errors

Forms were collected after each Forms were collected after each clinicalclinical

Safety AssessmentSafety Assessment

Majority of issues noted were environmentalMajority of issues noted were environmental

Other safety issues noted by students:Other safety issues noted by students:

– Hand gel not by doorHand gel not by door– Visitor doesn’t wear gown when patient on Visitor doesn’t wear gown when patient on

contact isolationcontact isolation– IV team started IV without using gloves or IV team started IV without using gloves or

communicating what they were doing.communicating what they were doing.– Wound care nurse failed to wash handsWound care nurse failed to wash hands– Med sheets and other notes left out for others to Med sheets and other notes left out for others to

readread

5 minute sit-down5 minute sit-down

What would you like to see happen What would you like to see happen today:today:

Home, bath/shower, pain Home, bath/shower, pain management, family visit, informationmanagement, family visit, information

““Soak feet and get up in a chair”Soak feet and get up in a chair” ““Win the lottery”Win the lottery” ““Watch the “Price is Right”Watch the “Price is Right”

5 minute sit-down5 minute sit-downIIs there anything that could s there anything that could have have made your hospital stay made your hospital stay better?better?

ExcellentExcellent Better pain control and Better pain control and

communicationcommunication ““Let me sleep in more – Let me sleep in more –

put a lock on the door”put a lock on the door” ““You couldn’t have done You couldn’t have done

better if you had rocked better if you had rocked me like a baby”me like a baby”

““A drink”A drink”

5 minute sit-down 5 minute sit-down What should nursing students What should nursing students know about being a patient in the know about being a patient in the hospital?hospital?

Be kind, allow control, it’s boring, have Be kind, allow control, it’s boring, have sense of humor, smile, respect privacysense of humor, smile, respect privacy

““It’s hard when staff are crabby”It’s hard when staff are crabby” ““I love this question. I wish more people I love this question. I wish more people

would ask it.”would ask it.” ““What a stupid question. I wish the sun What a stupid question. I wish the sun

would come out.”would come out.”

WHAT WERE THE WHAT WERE THE BIGGEST BIGGEST CHALLENGES?CHALLENGES?

Patient Safety Scan Patient Safety Scan

Student ChallengesStudent Challenges

Communication with Communication with patientspatients

Lack of role-modeling Lack of role-modeling from stafffrom staff

Time – (my Time – (my expectation)expectation)

Staff challengesStaff challenges Experienced staff were Experienced staff were

resistant to either utilize or resistant to either utilize or review the tool with studentsreview the tool with students

Surveys: Surveys: N=8 N=8

Anecdotal:Anecdotal:““We do this already “ – environmental We do this already “ – environmental

scanscan““I’m not prepared to deal with what I I’m not prepared to deal with what I

may hear” – 5 minute sit-downmay hear” – 5 minute sit-downNurse residents: “Can we get this in our Nurse residents: “Can we get this in our

orientation packet?”orientation packet?”

WHAT EVIDENCE OF WHAT EVIDENCE OF IMPACT IMPACT CAN BE SHARED? CAN BE SHARED?

Patient Safety ScanPatient Safety Scan

ImpactImpact

Student empowerment/raised Student empowerment/raised consciousnessconsciousness

Post-conference contentPost-conference content Student feedback – surveysStudent feedback – surveys Adoption for use by other practice pairsAdoption for use by other practice pairs

SUMMARY/CONCLUSIONSSUMMARY/CONCLUSIONS

WHAT WERE SOME IMPORTANT WHAT WERE SOME IMPORTANT THINGS LEARNED THIS YEAR? THINGS LEARNED THIS YEAR?

How is change implemented? How is change implemented?

Preparing for Preparing for Change: Change: The Pencil Metaphor The Pencil Metaphor

Used with permission and adapted Used with permission and adapted fromfrom

Jane H. Barnsteiner, PhD, RN, FAANJane H. Barnsteiner, PhD, RN, FAAN

October 13, 2007October 13, 2007

The pencil provided a The pencil provided a metaphor for the various metaphor for the various positions people assume positions people assume when asked to adapt to when asked to adapt to something new.something new.

Extending the Pencil Extending the Pencil MetaphorMetaphor

Sharp onesSharp ones

The wood The wood (“would”)(“would”)

Hangers-onHangers-on

Avoid the Blank PageAvoid the Blank Page

Allow for creativityAllow for creativity

Make use of existing Make use of existing resources resources

WHAT’S NEXT FOR WHAT’S NEXT FOR YOUR SCHOOL WITH YOUR SCHOOL WITH RESPECT RESPECT TO QSEN? TO QSEN?

University of WI - University of WI - MadisonMadison

Bringing ideas full Bringing ideas full circle circle

Pencil MetaphorPencil Metaphor

Dead woodDead wood

ErasersErasers

Reduce fear of Reduce fear of consequencesconsequences

DisseminationDissemination

The EndThe End

Or is it the Beginning?Or is it the Beginning?

The lead-ersThe lead-ers (Say led). (Say led).

These are the first to take on the These are the first to take on the technology, the early adopters who technology, the early adopters who usually document and usually document and enthusiastically enthusiastically share what they have tried--warts share what they have tried--warts and all. and all.

Students “Led” the Way Students “Led” the Way to Establish the Most to Establish the Most Effective Effective Clinical Partnership! Clinical Partnership!

project team: mary ellen murray, ph.d, rn paula jarzemsky, ms, rn diana girdley, ms, rn steve...

Documents

patient safety toolhow

patient safety scan

safety scaneach student

safety scaneaglewood

mary ellen murray

rnsteve douglas

rn project team

rndiana girdley