Incorporating QSEN into Hospital Practices We will welcome the participants to this presentation and provide a brief introduction of ourselves to the audience. Deb Tauber, MSN, BSN, CEN Stephanie Teets, MSN, BSN CNL Katherine Weibel, BSN, MBA, RN-BC Chamberlain College of Nursing Adventist Midwest Health

Disclosure Statement Deb Tauber, Stephanie Teets and Katherine Weibel have no financial or commercial interest in this content. We have not financial or commercial interest in the content

Objectives Learner will be able to describe the process of using this methodology to integrate QSEN into the hospital setting, by incorporating QSEN into the hospital orientation process. Demonstrate how teams of healthcare professionals can integrate the competencies of the QSEN process into “Rapid Response Mock Training.” Participant will be able to compare this opportunity to current needs in their organization or nursing school and construct a similar opportunity to meet their specific challenges.   Here are the specific objectives we would like to present and cover today in this brief 30 opportunity

Call From Above Adventist Hospital Leaders recognized QSEN as a potential opportunity for improving patient safety. The first principle for designing safe systems in health care organizations is – according to the IOM report To Err is Human — to provide leadership from the top-most level of the organization. The need to create a safe and effective nursing environment clearly parallels, and indeed overlaps, this IOM dictum. (The Joint Commission, 2012) Integration of QSEN into the hospital holds great promise for improving healthcare Limited literature exists regarding specific methods for integration of QSEN into the hospital. It is well established that many nursing education programs have successfully implemented the QSEN competencies into the curriculum. The focus of this work is the integration of all six QSEN competencies into practice. Senior leadership encouraged the nurses to begin to integrate the QSEN competencies into the framework of nursing orientation and then carry the QSEN culture throughout the organization. A key concept in this project will be to consider if integrating the QSEN competencies within a hospital can help improve hospital HCAHPS scores and or Core Measures.

What Exactly is a Competency? The IOM defined competency as “the habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values and reflection in daily practice” (Brady, 2011). Partnering with leadership we met and presented the QSEN competencies to the hospital leaders and educators between the four centralized locations of the Adventist hospital system. I presented an overview of QSEN and the value of simulation as the two can be easily combined to improve patient safety.

Quality and Safety Education for Nurse (QSEN) QSEN Competency Categories Patient Centered Care Teamwork and Collaboration Evidence-Based Practice  Quality Improvement Safety Informatics The purpose of the QSEN competencies is to meet the challenge of preparing nurses to improve the knowledge, skills and attitudes (KSA’s) necessary to continuously improve the quality and safety of healthcare systems within which they work (Adapted from QSEN, 2009). This poster is displayed and the value of the visual for competencies and let the audience see an example of a quick and easy hand out to communicate the competencies.

Evidence Based Practice (EBP) Implement each competency with evidence Gather best practices Review current healthcare education, nursing and patient safety literature We will discuss the gap analysis identified at the discussion and the socialization of the new concept for the hospital. Very limited literature exists between the specific integration of QSEN to the hospital setting- QSEN has been well documented to be effective in the pedagogy of nursing education and significant literature exists to support its use and it continues to gain popularity in academia. Theoretically this may help transaction to practice for new graduate nurses.

Addressing Disruptive Behaviors Incivility in Healthcare A summary of relevant sources of literature support the findings that the problems of incivility in healthcare are both harmful and costly. Replacement of one nurse can cost an organization between $46,932 - $145,000 (Kennedy, Michols, Halamek, & Arafeh, 2012). “Workplace incivility may be subtle but it creates a heavy financial burden estimated at $24 billion dollars annually” (Spence, Laschinger, Cummings, Wong, & Grau,2014). The specific competency of teamwork and collaboration will next be discussed and the opportunity to improve civility in healthcare.

Summary Graph Data (Tauber, 2014) The specific QSEN/Simulation opportunity was presented for an orientation group and here are the findings.

Safety It is well documented in many initiatives leading healthcare organizations driving improved outcomes (AACN), World Health Organization (WHO), QSEN, The Joint Commission, that the benefit of Interprofessionality will improve patient outcomes and decrease sentinel events. Our example of interprofessionalism provides a model for effective team utilization. Chamberlain College of Nursing and Adventist Hospital System.

What is Simulation? “A technique, not a technology, to replace or amplify real experiences with guided experiences, often immersive in nature, that evoke or replicate substantial aspects of the real world in a fully interactive fashion” (Gaba, 2004,p 2). Gaba, D. (2004) The future vision of simulation in health care. Quality and Safety in Health Care, 13 (Suppl 1), 2-10. Simulation will briefly be discussed and its partnership with QSEN and the value of utilization of the two together.

The Value of Simulation Safe environment Learn from mistakes Repetition Enhance teamwork and collaboration Improve Critical Thinking Judgment Organization Prioritization Communication Controlled environment Additional benefits will be discussed.

Mock Codes Mock rapid response Mock stroke alerts Mock cardiac alerts Mock code blues Debriefing afterward Stephanie will discuss the mock code events being done at the organization and how the QSEN competencies complement each other.

Three Phases of Debriefing (Harvard Model - CMS) Reactions - Clear the air and set the stage for discussion Feelings (normalize) Facts Understanding Exploring - explore trainees perspectives on scenario events Discussion and teaching Summary - distill lessons learned for future use What worked well What should be changed next time Major take always The phases of Reflective debriefing will be described and discussed and a very brief example will be provided on how this process is utilized in simulation and how this can easily be adapted at the bedside.

Evaluation Tools QSEN tool for evaluation – We have began to implement this specific tool in evaluating bedside shift reporting and for after rapid responses and code events. We are considering an IRB study to formally utilize the tool.

Integrating QSEN into Clinical Practice Socializing QSEN Introduction to the CNOs with commitment Presentation to nursing leadership, education team, Advanced Practice Nurses Discussions at Patient Care Division Meetings Introduction at orientation The socialization began within the organization and it has been well received from nurses and the leaders within the organization.

Integrating QSEN Revised curriculum for the New Grad Residency Program integrating QSEN competencies into each cohort meeting. The curriculum for the new grad residency program was revamped to include the QSEN competencies. The hope is this will aid in the ease of transition to practice for the new graduate nurses.

Example Curriculum This is a sample of the curriculum for the new graduates and the associated activities and dates.

This is a sample of the specific checklist that lines up with the polices and procedures from the organization and also frames them around the associated QSEN competencies.

As a Beta testing group – we piloted the use of this onboarding checklist with 16 New Graduate Nurses and their preceptors.

Feedback from Beta Testing Group Overall the feedback from the group has been very positive. We are using process improvement for evaluating and improving for the next groups. One of the gaps identified has been getting the behavior portion documented for fear of possible consequences. We hope to improve this. The hope is as the "culture" within the organization changes and people become more comfortable with behavioral expectations it will be easier to hold people accountable for their behavior.

Next Steps We will evaluate the orientation model and modify as needed from our BETA testing group We intend to submit this information for publication Compare HCAPHS, Press Ganey, Core Measures in one specific unit for one year and see if any measurable differences are noted Our next steps will be evaluating the information and using process improvement to make the process better. We have started to write something and intend on submitting it for publication when it is complete. If and when we get IRB approval we will have some data markers to evaluate.

References Gaba, D. (2004) The future vision of simulation in health care. Quality and Safety in Health Care, 13 (Suppl 1), 2-10. INACSL,(2011). Standards of Best Practice: Simulation. Clinical Simulation in Nursing, 7(4), S3-S7. Fero, L., Wesmiller, S., Witsberger, C., Zullo, T., Hoffman, L., Critical Thinking Ability of New Graduate and Experienced Nurses, Journal of Advanced Nursing, 65(1). 139-148. Brady, D. S. (2011). Using Quality and Safety Education for Nurses (QSEN) as a Pedagogical Structure for Course Redesign and Content. International Journal Of Nursing Education Scholarship, 8(1), 1-18. doi:10.2202/1548-923X.2147

References Continued Spence Laschinger, H. K., Cummings, G. G., Wong, C. A., & Grau, A. L. (2014). Resonant Leadership and Workplace Empowerment: The Value of Positive Organizational Cultures in Reducing Workplace Incivility. Nursing Economics, 32 5-11. Tauber, D. A. (2014). [Simulation respectful caring assertive communication evaluation tool]. Unpublished raw data