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QUALITY AND SAFETY EDUCATION FOR NURSES Megan Childers Ferris State University NURS 320

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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

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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

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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

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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/