Jessica M Phillips MSN RN BCNPD Professional Development Specialist Lee Galuska PhD RN NEBC Director Nursing Practice Education and Research 2 Who We Are Nationally Ranked Hospital in ID: 714433
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A High-Reliability Approach Using the QSEN Framework Transforms Health System Initial Nursing Competency Validation
Jessica
M. Phillips, MSN, RN, BCNPD,
Professional Development Specialist
Lee Galuska, PhD, RN, NE-BC
, Director; Nursing Practice, Education, and ResearchSlide2
2
Who We Are
Nationally Ranked Hospital in
15
Adult Specialties
10
Children's Specialties
Regionally Ranked Hospital #1 in
California
#1
in Los Angeles metro
area
Rated High Performing in
9
Adult Procedures/ConditionsSlide3
UCLA Health3
Hospitals:
Ronald Reagan UCLA Medical Center – 540 inpatient rooms
Mattel Children’
s Hospital UCLA – 146 inpatient rooms
Stewart and Lynda Resnick Neuropsychiatric Hospital at UCLA – 74 inpatient rooms
Santa Monica UCLA Medical Center and
Orthopaedic Hospital –
266 inpatient rooms Slide4
Background The overall goal for the QSEN project was to meet the challenge of preparing future nurses who will have the knowledge, skills and attitudes (KSAs) necessary to continuously improve the quality and safety of the healthcare systems within which they work
High reliability healthcare organizations provide exceptionally safe, high-quality careCompetent staff, standardization of practice
, and outcome monitoring are a few elements of highly reliable organizationsNursing professional development scope and standards
support the adoption of QSEN competencies in nursing practice
4Slide5
Nursing Professional Dev. Scope and StandardsQSEN competencies accepted in academiaQSEN comp. based on IOM comp. Academic and practice setting alignment
ANPD position acknowledges interprofessional collaboration and continuing education to achieve quality patient care
5
Harper & Maloney
,
2016.;
National Research
Council, 2003 Slide6
Introduction Purpose
Why the Change: Variability in the structures and processes for unit-based nursing orientation and initial competency validation across UCLA Health Current state: decreased reliability in practice, gaps in regulatory compliance, potential gaps in staff preparation for practice and overall retention implications
Desired state: standardization of competency assessment to establish clear expectations for new hires to succeed and provide safe quality careSlide7
MethodsA modified Delphi technique was used with a group of Nursing Professional Development (NPD) Specialists, Clinical Nurse Specialists (CNS), and clinical nurses to design a consistent process and structure for validating initial
competenciesStrategies adopted to get to the desired state:
(1) QSEN Competencies Framework
(2) Knowledge
, Skills, Attitude (KSA) Validation
(3) High-Reliability
Approach
– structures, forms, standards
7Slide8
Strategy #1 QSEN Framework8Slide9
System Adoption of QSEN Nursing orientation – patient experience Newly licensed nurse – initial unit orientation*Preceptor development training (continuing education)
Unit leadership, CNS, and educator training9Slide10
QSEN Competency Based Orientation The six QSEN competencies are:
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
Teamwork and Collaboration:
Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient
care
Evidence-Based Practice:
Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health
careQuality Improvement: Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of healthcare
systemsSafety: Minimizes risk of harm to patients and providers through both system effectiveness and individual performance
Informatics: Use information and technology to communicate, manage knowledge, mitigate error and support decision makingSlide11
QSEN Competency FrameworkClinical and professional competencies organized by QSEN domains including knowledge,
skills, and attitudes required for competent performance
11
Nursing Process
Assessment-Adult
Patient Education
Patient Experience
Pain Management and Pain Service Equipment: Curlin PainSmart Pump (PCA/PCEA) Patient/Family Communication
Interpreter Services Advance Directives End of Life Care Palliative Care Communication
Handoff/Handover Process Delegation Chain of Command Care Coordination Patient Admission Patient Discharge Patient Transfer Patient Transfer Within the Facility Patient Transfer Outside the Facility
Evidence Based Practice
Quality Improvement
Core Measures Immunization Screening in Adults
Sepsis Venous Thromboembolism (VTE) Prophylaxis: VTE Prophylaxis and Anticoagulation Equipment: VTE Devices
Equipment: Foot Pump Nurse Sensitive Indicators: Adult Fall Prevention: Post Fall and Post Fall Head Injury Care
Infection Prevention: Catheter Associated Urinary Tract Infection (CAUTI) Prevention Equipment: Bladder Scanner
Infections Prevention: Central Line-associated Bloodstream Infection (CLASBI) Prevention Skin Care and Wound Management
Blood/Blood Product Administration Central Venous Catheters Cardiopulmonary Monitoring: EKG, pulse oximetry, vital signs device resp. EKG: Lead Placement, 12 Lead Recording/Analysis/Storage, Central and Mirrored Monitor Station Disruptive Behavior (all types pt family): Constant Observation Aide (COA), Suicide Assessment and Precautions, De-escalation Process, and Code Gray, Medical Incapacity Changing Patient Condition: Rapid Response
Equipment: Zoll -AED, Defibrillator, Cardiovert, Pacer, ETCO2 Equipment: Emergency Cart: Code Cart Contents and Location Glycemic Management Equipment: Accu-Chek Inform II Equipment: Insulin Pen Infection Prevention Infusion Therapy: Intravenous Insertion and Venipuncture Equipment: Vein Finder AV400 Equipment: Infusion Pump (Sigma) Lab and Specimen Handling Medication Management and Administration
Procedural Sedation
Respiratory Management and Oxygen Administration
Equipment: Oxygen delivery devices
Restraints
Safe Patient Mobilization: Safe Patient Handling, UMOVE BMAT
Temperature Management:
Cooling Devices
Warming Devices Universal Protocol Documentation Standards and AuditsSlide12
Competency Toolkit Standard Online FormsSlide13
Competency Validation Form13
Web-based competency validation checklist with KSA hyperlinks were developed to support navigation and standardization during unit orientation Slide14
Entire Competency Validation Form14Slide15
Strategy #2 KSA Validation15Slide16
Knowledge, Skills, Attitude Validation16
On the Initial Competency Validation Checklist, hyperlinked KSAsSlide17
Patient Education KSACompetency Domain – hyperlinks of resources, links, live policiesMethod of Verification – methods preceptor, trainer, educator can verify
17Slide18
Strategy #3 High Reliability Approach (Standardization) 18Slide19
High-Reliability Approach 19Slide20
Results Preceptors (n=13)
76% able to access forms86% are using the forms94% validate competency (validation checklist/KSAs
)
CNS
, Educator, Manager (n=43)
56% able to validate use of forms by preceptors
58% meet weekly with preceptor/preceptee
71% able to explain use of forms with preceptors
20Slide21
Results Initial Competency Validation
21Slide22
22
Results Daily Feedback Tool Slide23
Results Weekly Feedback Tool
23Slide24
Competency Program FY17 Implications 24
Overall System Competency Program FY17 (n=965)
FY17 – 86% Clarity of Expectations/Requirements
FY17 – 84% Program “Meets My Needs” Slide25
Future Direction/Next StepsContinue to measure outcome/impact of QSEN competency framework adoption for newly licensed RNs in both system orientation and unit orientation Develop QSEN competency framework for initial new hires (all), population specific and mandatory education
Adoption of QSEN in continuing education, educator competencies, clinical advancement programs, job descriptions, system learning needs assessment
25Slide26
References Altmiller, G. (2013). Application of the quality and safety education for nursing competencies in orthopaedic nursing. Orthopaedic Nursing, 32
(2), 98-103. Cronenwett, L., Sherwood, G., Barnsteiner, J., Disch, J., Johnson, J., Mitchell, P., Sullivan, D. T., & Warren, J. (2007). Quality and safety education for nurses. Nursing Outlook, 55(3), 122-131.
Harper, M. G., & Maloney, P. (2016). Nursing professional development scope and standards of practice
(3
rd
ed.). Chicago, IL: ANPD
Kirkpatrick, D. L. (1994).
Evaluating training programs. San Francisco, CA: Berrett-Koehler Publishers, Inc.Levine, J. & Johnson, J. (2014). An organizational competency validation strategy for registered nurses. Journal for Nurses in Professional Development, 30(2), 58-65. Melnyk, B. M. (2012). Achieving a high-reliability organization through implementation of the ARCC model for systemwide sustainability of evidence-based practice. Nursing Administration Quarterly, 36(2), 127-135.
National Research Council. (2003). Health professions education: A bridge to quality. Washington, DC: The National Academics Press. Wright, D. (2005). The ultimate guide to competency assessment in health care (3rd
ed.). Minneapolis, MN: Creative Health Care Management, Inc.Slide27
Questions and Comments 27