2017 QSEN National Forum Using QI to Leverage Academic Practice Partnerships Chito A. Belchez, MSN, RN-BC David Martin, MN, RN Amanda Gartner, MSN, RN, CPHQ The University of Kansas Hospital University of Kansas School of Nursing Contact: cbelchez@kumc.edu

Session Objectives Identify strategies in a BSN program that promote quality improvement and change management with students. Describe how students apply quality improvement process in the classroom setting. Describe the outcomes of establishing a collaborative partnership between a Magnet hospital and an NLN Center for Excellence school of nursing.

The University of Kansas Hospital The Setting The University of Kansas Hospital University of Kansas School of Nursing Traditional RN pre-licensure and RN-BSN Program New “Partnership Program” with area Community Colleges Total enrolment in 2017 – 300+ NCLEX Pass rate above National Average Magnet Prepared Generalist Nurse Emphasis Concept Based Curriculum in an Active Learning Environment

QI Course QI Project “The Pot” Kumm, S. & Fletcher, K.A. (2012). From Daunting Task to New Beginnings: Bachelor of Science in Nursing Curriculum Revision using the New Essentials. Journal of Professional Nursing, 28 (2): 82-89.

SON Goals of the Project Foster knowledge and skills about chart auditing, quality outcomes, and big data Provide students with “real life” chart audit experience Develop initial PDSA plan Shared audit information and PDSA plan with Hospital Nursing QI Department

TUKH Nursing Goals of the Project Support the hospital’s Magnet culture Quality of Care Quality Improvement Nurses as Teachers Provide baseline or ongoing process measurement for quality improvement Value added contribution by students to the improvement process

Structure/Process Hospital Preparation: Nursing School Preparation: HIS Training and System Requirement EMR Access Developed definitions and audit tools for performance measures Nursing School Preparation: Knowledge of QI process: PDCA/PDSA Skills in data mining and chart audit Active Learning Environment

Process Senior Nursing students Class divided into 14 Teams of 7-8 students Students accessed TUKH EMR electronically during the 2 hour class period Audit tools provided by TUKH Nursing QI Department TUKH mentors available during class

Process Audits performed were related to National Patient Safety Goals and Magnet Empirical Outcomes (nursing sensitive indicators) Critical Results Follow Up Blood Administration Vital Signs CAUTI/CLABSI Process Measures HAPU Screening and Staging Sepsis Screening Pain Management Documentation

Outcomes Over 90 students participated in the course each of the four years (2013 – 2016) Approximately 1,500 audits conducted each year during the course Used audit results to develop PDSA QI Projects 14 PDSA developed, shared, reviewed and presented to TUKH quality improvement teams Potential cost savings: $10/audit = $15,000/year

Outcomes: Shared Experiences The University of Kansas Hospital KU School of Nursing Identifies gaps in the system and opportunities Redirection of resources within the system Shared Experiences and Interprofessional collaboration Project potential evolution – partnership with Lean Promotion Office and Getting to the Gemba Application of QI knowledge and skills (QSEN, 2012) Introduced students to Big Data Science Enhance partnership with KU Nursing Aided career and professional development The key lesson of Stone Soup is that interprofessional cooperation between clinical and academic community amidst scarcity of resources (healthcare cost) can lead to the generation of new perspectives (nourishing soup) on quality improvement compared to one person or department could od on their own.

Student Feedback Discuss what skills your team have gained from this activity and how would you apply it in the practice setting. “From this activity, we gained skills that will be implemented into our practice. The skills we learned specifically were how to perform a chart audit, compiling data, and analyzing data. For the most part, we have only been given data and used it to make changes. This activity showed us how to actually gather our own data to analyze a specific compliance rate. We then had to brainstorm as a group how to create a new way to raise our compliance rate. ……“ The key lesson of Stone Soup is that interprofessional cooperation between clinical and academic community amidst scarcity of resources (healthcare cost) can lead to the generation of new perspectives (nourishing soup) on quality improvement compared to one person or department could od on their own.

Student Feedback “…….Our skills have to be completely nursing based and clinically applicable. We acquired new skills on our ways of thinking. We had to implement an intervention that would actually make a difference and be seen by the necessary people. For our critical result documentation, we had to think like a nurse and take on the perspective of how something would make a difference in our thought process. Altogether, this activity furthered our nursing knowledge and increased our nursing thought process.”

Student Feedback “We found how to navigate through databases in order to find adequate and proper information. We learned how to incorporate other profession als into our PDCA form to make our implementation more holistic - it doesn’t just focus on nursing tasks it focuses on interprofessional contribution. In regards to implementing a project of this magnitude in our future practice setting, we have learned how to effectively get information to a large amount of people and how to analyze and access literature effectively to see if it is relevant.” The key lesson of Stone Soup is that interprofessional cooperation between clinical and academic community amidst scarcity of resources (healthcare cost) can lead to the generation of new perspectives (nourishing soup) on quality improvement compared to one person or department could of on their own.

Conclusion Chart audit project yielded mutual benefits to KU School of Nursing, students, TUKH Nursing QI Department. Students are capable of doing continuous quality improvement with real life parameters. Considerable thought and planning is needed from all parties.

References Berkow, S., Virsktis, K., Stewart, J., & Conway, L. (2008). Assessing new graduate nurse performance. Journal of Nursing Administration. 38(11). 468-474. Kumm, S. & Fletcher, K.A. (2012). From Daunting Task to New Beginnings: Bachelor of Science in Nursing Curriculum Revision using the New Essentials. Journal of Professional Nursing, 28 (2): 82-89. Sherwood, G., & Barnsteiner, J. (2012). Quality and Safety in Nursing: A competency approach to improving outcomes. John Wiley & Sons. West Sussex, UK. Quality and Safety Education for Nurses (QSEN). Competencies: Pre-licensure KSAs. Retrieved from: http://qsen.org/competencies/pre-licensure-ksas/