QSEN Case Western Frances Payne Bolton School of Nursing

Quality and Safety Education for Nurses

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SAFETY Bundle Simulation Day

Posted by on Feb 14, 2017 in News |

At conclusion of junior year, students completed course theory in Nursing Foundations and Adult Health and Illness pertaining to but not limited to peri-operative nursing, SBAR communication, patient safety risks, cardiopulmonary resuscitation, and medication delivery. Students had one semester of medical surgical clinical and also completed their foundation skills competencies through-out the year in labs. Safety Bundle Day was constructed to apply a full day simulation experience in lieu of the last clinical day for the entire junior class. The purpose was to apply the culmination of content learned to clinical practice in a safe controlled environment, provide an opportunity to apply new skills in the mock code, collaborate with one another and with interdisciplinary persons. In a cost effective planning approach, faculty organized the simulation utilizing available materials in lab, and resources within the college at large, and personnel, i.e.: simulation operating room facility The activity ran multiple times through-out the day with student groups pre-assigned. 1. Operating room: Surgeon (interdisciplinary teamwork and collaboration) provided group of students’ discussion on various nursing roles in operating room, circulating nurse, scrub nurse, nurse anesthetist and/or anesthesiologist. Students scrubbed and gowned, maintaining sterility (safety and QI) Students opened sterile drapes and equipment, identified safety concerns in operating room, patient positioning, oxygenation, and fluid volume. Surgeon role play of time out procedure (QI and EBP) and discussed sutures, dressings, specimen collection, and blood loss. Students role played SBAR report to one another for recovery room transport (Communication, Safety). Recommend utilization of unique resource opportunities, facilities, and interdisciplinary care providers to enrich simulation experience and student interaction. This exercise can be basic or further developed according to available resources and learning objectives. Additional interdisciplinary roles could include medical techs, surgical techs, medical residents, physician assistants, nurse practitioners, certified nurse anesthetists, anesthesiologist, for further elaborate simulation scenario. 2. Patient Bedside Environment: Similar to “House of Horror, or “Little Room of Errors” students enter lab to find 4 patient rooms with various safety risks for patient, self, and others. One section relates to intravenous tubing, central line dressing, oxygen, and tracheostomy risks on a mannequin. Another section has basic patient safety risks related to side-rails,...

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An Education Strategy Engaging Nursing Students in a Classroom and Hospital Interprofessional Patient Safety Experience

Posted by on Feb 7, 2017 in Teaching Strategies |

The purpose of this assignment is to help nursing students gain an understanding of their role in patient safety and provide an opportunity to apply the knowledge, skill, and attitude essential to provide safe, quality care. The one six-hour assignment is for pre-licensure students in the third year of their nursing program. The students participate in a (a) one hour didactic classroom lecture, (b) 90 minute group exercise, and (c) a three hour collaborative hands-on experience with other healthcare professionals. The lecture consists of information on national organizations involvement and support of patient safety, review of the National Patient Safety Goals, the JCAHO tracer methodology, and the QSEN patient safety KSAs. Students will divide into groups of 4-5 for the group exercise. Students will view the first three parts of the Lewis Blackman Story video. This video is one of several available on the QSEN website and can be accessed via URL http://qsen.org/faculty-resources/videos/the-lewis-blackman-story/. Following the video, each group will receive a case study and asked to participate as a member of the healthcare team. The group will identify safety risks in the case study associated with healthcare team members’ behavior and technology and identify appropriate actions to take to eliminate safety risks. As a final activity, students will engage in an exercise with a systems thinking approach during a hands-on project in the hospital setting. Members of the healthcare team and students will assess the quality and safety of care delivery. The focus of the interprofessional experience will relate directly to a current safety initiative based on the National Patient Safety Goals (NPSGs). The collaborative activity utilizes the tracer methodology used by The Joint Commission during accreditation surveys. The tracer methodology follows the care experience and treatment of patients throughout the health care experience and provides a way to assess compliance with standards and evaluate the care delivery. The course instructor contacted the nurse manager of a hospital division where nursing students were completing their clinical rotation. The meeting provided opportunity to discuss the objectives, identify a date and time convenient for students and division nurses, identify bedside nurses to participate, identify the divisions NPSG initiatives, and review the...

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Using Beers Criteriato Prevent Medication Related Problems in Older Adults

Posted by on Feb 6, 2017 in News |

This strategy can be used for either pre-licensure or RN to BSN students utilizing the clinical setting and either group or individual work in class, in post-clinical conference, or via online discussions or blogs. Prior to clinical, students are assigned the American Geriatric Society 2015 updated Beers Criteria for potentially inappropriate medication use for older adults link for review, the Hartford Geriatric Nursing Beers you-tube for viewing, and the ConsultGeri.org Try This Series site for regarding the Beers Criteria for reading. On the clinical day, a brief discussion can be held in pre-conference about Beers Criteria with a review of definitions for quality and strength of evidence and a brief account of methods used to analyze the evidence and to make recommendations. Students will be instructed to select an older adult patient over age 65 with 8 or more medications. In clinical, students are to record basic patient information like the client’s medical diagnoses, prescribed, routine, prn and over the counter medications as well as vitamin and mineral supplements. They will record these on the first section of the QSEN Beers Learning Strategy Form. After the clinical experience, students are instructed to complete the second section of the form requiring students to utilize the Beers Criteria to analyze the patient’s medications using the 5 tables in the Beers document to review the strength and quality of evidence, rationale, recommendations, safety concerns, risks, etc. The third part of the form includes questions about teamwork and collaboration interventions and appropriate patient centered interventions relevant for the completed evaluation of medications. This third part can be done in writing (individually or as a small group), on-line as part of a blog or discussion board or as part of a clinical post-conference session. The strategy focuses on the application of evidence to practice in the geriatric setting regarding medication safety. Attention is given to quality and safety by focusing on risk reduction and prevention of medication related problems for the older adult vulnerable population. Patient centered care is addressed with individualized interventions based upon the medication evaluation using Beers Criteria. Students are asked to formulate teamwork and collaboration strategies to address medication...

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QSEN TEACHING STRATEGY: USING AN AQUARIUM AND PUMP TO DEMONSTRATE CARDIAC FUNCTION

Posted by on Feb 6, 2017 in News |

Students were asked to troubleshoot cardiac function problems demonstrated with an aquarium and pump. The following principles were demonstrated: First, the aquarium pump is electrical. Therefore, the pump must be plugged in to receive an electrical charge. Positive cations (such as magnesium, potassium, calcium, and sodium) provide the electrical charge to the heart, which is represented by the plugging the pump into the electrical outlet. To help students retain normal laboratory values, students were taught the 2X4 Rule: representing ideal serum magnesium and potassium levels for cardiac electrical function being a serum magnesium 2 mg/dL and serum potassium 4 mEq/L. The extension cord was labeled with “K” and “MG” for demonstration. Second, the pump requires sufficient volume (preload) to produce cardiac output. This is demonstrated by adding water from a container marked preload. The pump cannot function effectively or efficiently with a volume deficit or fluid overload. This is demonstrated by either submerging the pump or lifting the pump out of the water. Third, the pump must be able to accommodate resistance (afterload) that is demonstrated by using an obstacle to obstruct outflow. Follow-up discussion addressed the effects of vasodilator and vasoconstrictor medications. Finally, the (plastic) fish do not die from lack of water, but lack of oxygen (due to low perfusion). Follow-up discussion addressed cardiac perfusion, including differences in ventilation and perfusion, which were identified as difficult concepts for the...

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Time Out! QSENizing the Curriculum Requires Educating the Educator

Posted by on Dec 19, 2016 in Teaching Strategies |

This strategy can be used to educate faculty and/or students. (1) Hand each faculty member and/or student Attachment #1: Worksheet and QSEN KSAs for Informatics. (2) Run video (Attachment #2). During each “pause and discuss” session, stop the video and allow faculty and/or students to review the competencies and discuss how the competencies were met or not met during the video in relation to informatics and patient safety. Faculty and/or students should gain valuable insight into how informatics effects patient safety. (3) After the video simulation, faculty and/or students should be given time to openly discuss the worksheet and any barriers experienced in practice. This will help faculty and administrators gain valuable knowledge as to gaps in clinical partnerships faculty and students may...

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