1. Supporting Quality Care NURS 274 Nursing Leadership Darlene LoPresto, BSN, RN,C Graduate Student FSU

2. Standards of Care   Structural   Process/Performance   Outcome

3. Nursing Specific Standards

4. MICHIGAN LEGISLATURE 95th Legislature Regular Session Michigan Compiled Laws Complete Through PA 169 and includes 172-184 and 204 of 2010 PUBLIC HEALTH CODE (EXCERPT) Act 368 of 1978 Part 172 NURSING Section 333.17201Section 333.17201SectionDefinitions; principles of construction. Section 333.17208Section 333.17208SectionLicensed practical nurse; health profession subfield. Section 333.17209Section 333.17209SectionRenewal of license to practice as trained attendant; eligibility; “practice as a trained attendant” defined; original license prohibited; licensed psychiatric attendant nurse considered licensed practical nurse. Section 333.17210Section 333.17210SectionRegistered professional nurse; issuance of specialty certification; qualifications. Section 333.17211Section 333.17211SectionPractice of nursing or as licensed practical nurse; license or authorization required; use of words, titles, or letters. Section 333.17212Section 333.17212SectionRegistered professional nurse; ordering, receiving, or dispensing complimentary starter dose drugs. Section 333.17213Section 333.17213SectionLicensure as registered professional nurse; graduate of nurse education program located outside of United States; requirements. Section 333.17221Section 333.17221SectionMichigan board of nursing; creation; number and qualifications of members; terms. Section 333.17224, 333.17225Section 333.17224, 333.17225SectionRepealed. 1989, Act 201, Imd. Eff. Oct. 23, 1989. Section 333.17231Section 333.17231SectionHonorary license; "advanced illness" defined; name of section. Section 333.17241Section 333.17241SectionNursing education program; application to conduct; evidence required; evaluation; inspection; report; approval; continuation of existing programs; accreditation by national board or organization; education program for psychiatric attendant nurses or trained attendants prohibited. Section 333.17242Section 333.17242SectionInspection of approved nursing education program; report; notice of deficiency; removal from list of approved programs; hearing.

6. Accrediting Agency Standards

7.   committed to improving health care safety   continuously improve quality of care   accreditation of health care organizations   accreditation is a risk-reduction activity   reduce the risk of adverse outcomes

8.   HFAP determines a facility’s ability to deliver high quality patient care by using our CARE methodology.   This process includes an in-depth review of both open and closed patient records as well as direct observation of care provided.

9. http:www.ahrq.gov Clinical Information Clinical Practice Guidelines Clinical Practice Guidelines Current and archived Clinical Practice Guidelines — beta blockers practice advisory — treating tobacco use and dependence Tobacco Cessation U.S. Public Health Service Clinical Practice Guideline: Pathfinder page links to materials that help tobacco users quit. Surgeon General Reports: The latest information to help people quit smoking, and to help health care professionals treat tobacco use and dependence. U.S. Public Health Service Clinical Practice Guideline: Surgeon General Reports

10. Public Transparency   Broad scale quality initiative   Consumers compare facilities   Informed choices   Better public information

11. Public Transparency   www.healthgrades.com   www.mihospitalinform.org   www.hospitalcompare.hhs.gov   www.hospitalconnect.com   www.wedmd.com

12. Public Transparency   http://www.healthgrades.com/hospital- directory/michigan-mi/patient-safety- HGSTA7662386230092 http://www.healthgrades.com/hospital- directory/michigan-mi/patient-safety- HGSTA7662386230092

13. The Consumer Assessment of Healthcare Providers and Systems (CAHPS ): Health care organizations use CAHPS results to:   Assess the patient-centeredness of care;   Compare and report on performance   Improve quality of care.   standardized surveys of patients' experiences http://www.hospitalcompare.hhs.gov/hospital- compare.aspx?hid=230037&lat=41.8933451&lng=- 84.6269824&stype=GENERAL&&stateSearched=MI

14. Quality Improvement

15. Benchmarking   A benchmark is a specific quantitative standard for an outcome with which you compare your own institution. (Ellis & Hartley, 2009)

16. Sources of Date   Key Indicators   QA (Incident Reports)   Audits   Surveys

17. QI/PI Process

18. Sentinel Event

19. Risk Management   Policies, procedures, & practices involved in identification, analysis, assessment, control, and avoidance, minimization, or elimination of unacceptable risks. (www.businessdictionary.com)

20. RM Focus   Studies QA findings and trends   Think ahead about defense strategies   Proactive identification and elimination of risk areas institution wide   Patient and family are informed

21. Incident Report Process Root Cause Analysis: Goal = Answer:   What happened?   Why did it happen?   What do you do to prevent if from happening again?

22. Incident Report Process: Five Why’s Technique Example: Problem Statement: You are on your way home from work and your car stops in the middle of the road. 1. 1. Why did your car stop? - Because it ran out of gas. 2. 2. 2. Why did it run out of gas? - Because I didn't buy any gas on my way to work. 3. 3. 3. Why didn't you buy any gas this morning? - Because I didn't have any money. 4. 4. 4. Why didn't you have any money? - Because I lost it all last night in a poker game. 5. 5. 5. Why did you lose your money in last night's poker game? - Because I'm not very good at "bluffing" when I don't have a good hand.

23. Incident Report Process: Systems Focus   Not one person’s fault   Involves people and/ or processes   System failure results in error

24. Never Events: Effective October 1, 2008 No reimbursement Must note if ‘Present on Admission” Requirements of ‘Never Event’ occurs: -Report event -Root cause analysis -Waive costs -Apology

25. Magnet Status   Recognition of nursing excellence   14 Forces of Magnetism   Goals   Benefits

26. Michigan Magnet Status   Beaumont Hospital Troy MI 2009 Beaumont Hospital   Bronson Methodist Hospital Kalamazoo MI 2009 Bronson Methodist Hospital   Children's Hospital of Michigan Detroit MI 2008 Children's Hospital of Michigan   DMC Huron Valley Sinai Hospital Commerce Township MI 2009 DMC Huron Valley Sinai Hospital   Detroit Receiving Hospital and University Health Center Detroit MI 2009 Detroit Receiving Hospital and University Health Center   Holland Community Hospital Holland MI 2007 Holland Community Hospital   Munson Medical Center Traverse City MI 2006 Munson Medical Center   Oaklawn Hospital Marshall MI 2009 Oaklawn Hospital   Sparrow Hospital Lansing MI 2009 Sparrow Hospital   Spectrum Health-Blodgett Hospital Grand Rapids MI 2009 Spectrum Health-Blodgett Hospital   Spectrum Health-Butterworth Hospital Grand Rapids MI 2009 Spectrum Health-Butterworth Hospital   Spectrum Health-Helen DeVos Children's Hospital Grand Rapids MI 2009 Spectrum Health-Helen DeVos Children's Hospital   William Beaumont Hospital Royal Oak MI 2004 William Beaumont Hospital

27. Questions? As the professional nurse You make the difference! You make the difference!