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Quality & Safety Education for Nurses
(QSEN)
?
Leah Blaney, RN, BSN, CEN, MSN
Community Health Clinical Instructor
Duke University School of Nursing
References
Where do these ideas come from?!
References
References
https://revcycleintelligence.com/news/how-the-nursing-wo...
Dowling-Castronovo, A. & Bradway, C. (2012). Nursing standard of practice protocol: Urinary incontinence (UI) in older adults admitted to acute care. The Hartford Institute for Geriatric Nursing. Retrieved from https://consultgeri.org/geriatric-topics/urinary-incontinence
Hunt, D. (2012). QSEN competencies: A bridge to practice. Nursing made Incredibly Easy,10 (5). doi: 10.1097/01.NME.0000418040.92006.70
Institute of Medicine. 2004. Keeping Patients Safe: Transforming the Work Environment of Nurses. Washington, DC: The National Academies Press. doi: 10.17226/10851
Nursing special report: The influence of nurse work environment on patient, payment and nurse outcomes in acute care settings. (2010). Press Ganey Holdings, Inc.
Quality and safety education for nurses. (2018). The QSEN Institute. Retrieved from qsen.org.
Sherwood, G & Horton-Deutsch, S. (2015). Reflective Organizations: On the Front Lines of QSEN and Reflective Practice Implementation. Indianapolis, IN, USA: Sigma Theta Tau International.
How will the actual practice of an RN change with QSEN?
Practice
Change
Nurses will see quality and safety as a core component
of their work
Nurses will take on work with the patient as the focus
Encouraged to inquire further
Applies evidence based standards and interventions
Will see the value in a system perspective for outcomes
and critical incidents
Will find ways to improve care
(Sherwood & Horton-Deutch, 2015).
True Case Study:
Development of the ED Passport at Duke Regional Hospital Emergency Department
Case
Study
- DRH ED sees > 60,000 patients/year with wait times ranging from 0 minutes to 5+ hours
- Many metrics performed by the department, the hospital, and national agencies
- One metric taken by Press Ganey, Inc. in emergency departments across the U.S. is "Informed About Delays", which is correlated with an improved patient care experience
- A team of nurses at DRH ED worked for 1.5 years on a way
to improve the patient experience and their metrics ...
Objectives:
- Introduce QSEN
- Examine the importance of nursing & its role in quality control
Quick
Overview
- Present the six QSEN competencies
- Reflect on the application of the QSEN competencies
QSEN
What is this, where did it come from, why does it matter?
A
Global
Issue
What is QSEN?
What is QSEN?
-Six QSEN competencies for pre-licensure and graduate nursing programs:
patient-centered care, teamwork and collaboration, evidence-based practice (EBP), quality improvement (QI), safety, and informatics.
-Certain knowledge (understanding), skills (implementation), and attitudes (values) for each competency should be attained by graduation and nurses should continue to address and utilize them in their professional role.
-New graduates depend on experienced RNs and nurse managers for guidance during their transition to practice, so all nurses should understand and practice these competencies
(Sherwood & Horton-Deutsch, 2015; qsen.org, 2018)
Education for improvement
Education for improvement
Robert Wood Johnson Foundation in 2005: Education for Improvement
- funded a national study to educate nurses about patient safety and quality to address the gap between education and practice
- Aim to improve patient outcomes by providing nursing students with a solid foundation so they have the knowledge, skills, and attitudes needed to provide safe and effective quality care
- Phase I: team of experts examined factors related to quality and safety
- Phase II: the six Quality and Safety Education for Nurses (QSEN) competencies developed
- Phase III: faculty development and integration of the competencies into curricula, research, accreditation, and licensing
Why nursing?
Why nursing?
2004 IOM report Keeping Patients Safe: Transforming the Work Environment of Nurses:
-Nurses make up greatest portion of the workforce and carry out the majority of direct patient care
-Nursing actions shown to be directly related to better patient outcomes
-When there are not enough nurses??? - hospitals close beds, restrict admissions, and divert patients in need of emergency services, and patients are placed at risk
-Call for standards in healthcare organizations to improve nursing to < errors and > patient outcomes
2015 Press Ganey Nursing special report: The influence of nurse work environment on patient, payment and nurse outcomes in acute care settings.
-Higher quality of a nursing work environment = higher perceptions of care quality from nurses & patients
-“High-quality nursing care depends on multiple underlying structure and process factors, such as nurses’ skills and education, the availability of sufficient supplies and equipment, staff training, facilities, reliable use of demonstrated nursing best practices, inter-professional relationships, nurse engagement and job satisfaction — all of which influence outcomes."
Is this important?
Is this important?
Institute of Medicine in 1999 - To Err Is Human: Building a Safer Health System
- Each year medical errors cost hospitals in the U.S. $17 billion and $29 billion, with death rates between 44,000 and 98,000.
2015 Press Ganey Nursing special report: The influence of nurse work environment on patient, payment and nurse outcomes in acute care settings.
- 15/100 nurses are "disengaged" (lack commitment, satisfaction with their work).
- A disengaged nurse = $22,200/year in lost revenue as a result of lack of productivity.
100 disengaged nurses = $333, 000/year
15, 000 disengaged nurses = $50 million/year
The six QSEN competencies
The Six
Competencies
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.
Patient-
Centered
Care
Safety
Safety
Preventing harm to patients and health care staff with system effectiveness & individual performance
1) System Effectiveness:
- Safety alerts and safe guards
- Just Culture: report adverse events/near misses and learn from Root-cause analyses to improve the system
2) Individual Responsibility:
- Understanding how safety is compromised when short cuts are taken
- Knowing how to use resources when you are unsure
of what to do in a given situation
Teamwork & Collaboration
Teamwork
&
Collaboration
Working effectively in nursing and interdisciplinary teams to promote open communication, mutual respect, and shared decision-making to ensure quality care
Ex) - Interdisciplinary rounding
- Stroke Team
- Ethics committee
Evidence-Based Practice
Evidence-
Based
Practice
Using current, well-founded evidence for best nursing practice.
Actual practice will be influenced by clinical expertise, availability of resources, patient comorbidities, and patient/family preferences to acheive the best outcome.
How do I know if the care I am giving is evidence-based or considered best practice? How can I help change protocols to match best practice advisories?
Quality Improvement
Quality
Improvement
Use data to track the outcomes of specific interventions, evaluate the results, then design and test changes to continuously improve the quality and safety of health care systems --
Improve the patient care experience, produce better outcomes, eliminate waste, reduce costs.
Ex) Tracking outcomes of incontinence interventions: use of adult diapers vs. use of urinary catheters vs. manual cleaning with
each accident??
(Dowling-Castronovo & Bradway, 2012)
Informatics
Using technology to promote safety and quality in healthcare -- for direct patient care, to communicate, for professional development training, to collect data, in electronic medical records, automated safety checks, and support decision making.
Important to remember technology, like best practice, is always being developed, tested, and
implemented.