1. QSEN
What is it?
What does it mean?

2. 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

3. 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

4. What is Quality Care?
Safe
• S
• T Timely
• E
Efficient
• E
• E Equitable
• P
Effective
Patient/Family Centered
Care

5. 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

6. Team Work and
Collaboration

7. Definition
• Function effectively
within the team to
achieve quality
patient care
– Open
communication
– Mutual respect
– Shared decision
making

8. Key Message
• Safe, effective,
satisfying patient
care requires:
– teamwork,
– collaboration
– communication
• among all team
members
Patient and Family are Members of the Team!

9. 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.

10. Collaboration is….
• Joint decision making among
independent parties
– involving joint ownership of decisions
– collective responsibility for outcomes
Working Across Professional Boundaries.

11. 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.

12. 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?

13. 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

14. 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

15. Safety
How is safety reflected in
the hospital environment ?

16. Safety Definition:
Minimizes risk of harm to patients and
providers through both system effectiveness and
individual performance
• How can you
accomplish this?
– Wrist bands – Medication
– Clutter free reconciliation
environment – Bed alarms
– Patient equipment – Hourly rounding
– “Time out” – SBARR
– Hand washing

17. You Tube Safety Video
• http://www.youtube.com/watch?v=u49
BME17ED0&feature=related

18. 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

19. Informatics
• We’ve come a
long way baby

20. Informatics Definitions
• Use information
and technology to
communicate, man
age
knowledge, mitigate
error, and support
decision making

21. 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

22. Points to remember:
• What is my
responsibility?
– Timely, accurate
data collection
– Timely, complete
documentation
– No falsification of
information

23. 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

25. 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

26. Key message
•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.

27. 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”

28. It is not……
•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

29. 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.

30. 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

31. 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

32. Patient-centered care/pain
management
• 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

33. Competency
To 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

34. Remember…..
“We are guests in their
lives”…
(D Berwick)

35. Quality
Improvement
QSEN

36. 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)

37. 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.

38. 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.

39. Problem: Patient with a
fractured hip who developed a
sacral decubiti
A 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

40. 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

41. 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

42. Skills necessary
• Teach turning and positioning for the
post-op hip patient
• Reinforce the skills necessary when
using the specialty beds

43. Attitudes
• Appreciate the cost of treating a
hospital acquired skin breakdown.
• Recognize the value of preventative
steps.

44. 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

45. Quality and Safety Begin
with YOU!