Taking QSEN over the Red Line Moving the QSEN competencies into perioperative practice

Faculty Disclosure Susan Bakewell, MS, RN-BC No Conflict Susan D. Root, MSN, RN, CNOR No Conflict Patricia Brown, BSN, RN No Conflict

Objectives Examine the history of the QSEN movement Describe the unique features of the perioperative environment Illustrate how QSEN can be integrated into perioperative processes

A Short Review of QSEN History The Quality and Safety Education for Nurses (QSEN) project began in 2005. Funded by the Robert Wood Johnson Foundation, the project had three phases between 2005 and 2012. The overall goal through all phases of QSEN has been to address the challenge of preparing future nurses with the knowledge, skills, and attitudes (KSAs) necessary to continuously improve the quality and safety of the healthcare systems in which they work.

The Relationship between AORN & QSEN How the relationship began Where we are now

AORNs Implementation of QSEN Competencies Fundamentals Course for Nursing Students Periop 101 for RN’s Periop 101 for ASC Periop 101 for OB RN Circulators

The Perioperative Environment – What’s beyond the red line? Behind the double doors Don’t go over the red line

The Perioperative Environment – “Sacred Cows” Special “garb” Look but don’t touch “Unfriendly” atmosphere

The Perioperative Environment – What nursing process? Assessment Planning Implementation Evaluation Nursing Process??? Assessment . Planning Implementation Evaluation

QSEN Competencies Undergraduate and graduate versions Patient-Centered Care Teamwork & Collaboration Evidence Based Practice Quality Improvement Safety Informatics

Patient-Centered Care Identifies immediate patient needs based upon assessment data, developmental level, diagnosis specific priorities in collaboration with family Evaluates outcomes of care & modifies plan of care as appropriate 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

QSEN in Practice Patient Centered Care Definition: 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.  Knowledge: Analyze ethical and legal implications of patient-centered care. Describe the limits and boundaries of therapeutic patient-centered care. Informed consent Skills:  Assess patients’ understanding of their health issues and create plans with the patients to manage their health Patient teaching, rehabilitation versus home care/visiting nurse Attitude: Commit to respecting the rights of patients to determine their care plan to the extent that they want Religious/cultural preferences, end of life, DNR

Informatics Documents outcomes of patient care Recognizes email as a vital communication throughout the organization Use information and technology to communicate, manage knowledge, mitigate error, and support decision making. Children's Hospital Colorado

QSEN in Practice Informatics Definition: Use information and technology to communicate, manage knowledge, mitigate error, and support decision making. Knowledge: Know the current regulatory requirements for information systems use PHI/HIPPA Skills: Use federal and other regulations related to information systems in selecting and implementing information systems in practice PHI/HIPPA, screen protection. Who can you access via EHR Attitude: Appreciate the role that federal regulation plays in developing and implementing information systems that will improve patient care and create more effective delivery systems Review of quality measures related to technology

Evidence-Based Practice (EBP) Accesses resources- Policy & Procedures Discusses how to formulate a clinical question using Problem Intervention Comparison Outcome (PICO) Applies evidence to practice Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care. Children's Hospital Colorado

QSEN in Practice Evidence-Based Practice (EBP) Definition: Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care. Knowledge: Identify principles that comprise the critical appraisal of research evidence Is the research valid/peer reviewed Skills: Critically appraise original research and evidence summaries related to area of practice Quality and best practice for your practice Attitude: Value knowing the evidence base for one’s practice specialty area Where doe the evidence for you practice originate?

QSEN in Practice EBP Hospital Acquired Pressure injury HAPI rate increased Rather than blame- Proactive EBQI Project for Surgical Cluster Literature: 45% of all HAPI begin in OR Assessment and preventative measures are lacking in Perioperative Setting Munro Scale Series of scales for risk assessment in preoperative, intraoperative, and post operative areas

Quality Improvement (QI) Identify nurse sensitive indicators Aware of OR specific bench mark data 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 health care systems. Children's Hospital Colorado

QSEN in Practice Quality Improvement (QI) Definition: 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 systems. Knowledge: Understand principles of change management LEAN, Six Sigma Skills: Apply change management principles by using data to improve patient and systems outcomes Exemplify how change helps meet national standards and keeps patients safe Attitude: Appreciate that all improvement is change Demonstrate leadership in affecting the necessary change Understanding how collecting data makes a change to patient care.

QSEN in Practice QI Knowledge-implement and sustain this project using small changes Skills-utilize the PDSA cycle for evaluating small changes Attitude- appreciate the value of what our nursing cluster team can do to improve care- Celebrate!

Safety Identifies the stages of general anesthesia, common patient responses, as well as appropriate nursing interventions Demonstrates ability to dispense medications to sterile field Minimizes risk of harm to patients and providers through both system effectiveness and individual performance. Children's Hospital Colorado

QSEN in Practice Safety Definition: Minimize risk of harm to patients and providers through both system effectiveness and individual performance Knowledge: Analyze factors that create a culture of safety and a “just culture” How do we interact with co-workers, communication, accountability Skills: Use existing resources to design and implement improvements in practice (e.g., National Patient Safety Goals) Use evidence and research based strategies to promote a “just culture” How do the NPSG apply to your practice? Attitude: Commit to being a safety mentor and role model Accept the cognitive and physical limits of human performance Value a systems approach to improving patient care instead of blaming individuals Team STEPPS

QSEN in Practice Safety Minimize the risk of harm to our surgical patients from HAPIs Knowledge- communication on rate of HAPIs in surgical patient population with RN staff, anesthesia and surgery Skills- implement existing resource of the MPURAS Attitude- presented information to staff on how patients are impacted by HAPIs

QSEN in Practice Teamwork and Collaboration Definition: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision- making to achieve quality patient care. Knowledge: Analyze self and other team members strengths, limitations, and values Team member knowledge Skills: Demonstrate awareness of personal strengths and limitations as well as those of team members Self assessment and evaluating Attitude: Value the contributions of self and others to effective team function Team and self evaluation and continued learning

Teamwork and Collaboration Identifies Chain of Command Aware of Professional Practice Model Delegates according to Nurse Practice Act Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care. Children's Hospital Colorado

QSEN in Practice Teamwork and Collaboration Function effectively fostering open communication, mutual respect and shared decision making to achieve decreased incidence of HAPIs in surgical patients Knowledge- strategies for communication Skills- clarify roles and accountability Attitude- value teamwork and relationships

QSEN in Practice Barriers Identified Staff buy-in Lack of initial support from surgeons & anesthesia Holds up flow Not all areas of form completed Viewed as “another thing for nurses to do” No release time to oversee project Overcoming Barriers Enlisted support of chair of surgery and chair of anesthesia Shared data/information with everyone Staff meetings Charts Daily conversations

Lessons Learned Change is hard Cannot be deterred by barriers Relationships are important-Tap into them Find ways to engage direct care people that don’t want to engage Be glad for short gains-staff are thinking about HAPI Joy in this work

Questions?