Implementation of a Clinical Make-up Day using QSEN Competencies as a Framework for Simulation Activities Nina P. Barkell MSN RN, ACNS-Bc Michelle M. Compton MSN RN Oakland Community College

The Challenge: Clinical Absences Large program 400 students Over 30 clinical agencies Agency Requirements Informatics Varying EHRs Access Faculty Student Ratios

The Roots – QSEN 2016 Elaine Mohn-Brown EdD, RN, CMSRN “Using QSEN Competencies to structure clinical seminars.” Gwen Sherwood PhD RN, ANEF, FAAN and Carol Durham EdD RN, ANEF, FAAN “Using story to develop reflective practitioners: QSEN Competencies in Action.” Jill Sanko PhD, MS ARNP, CHSE-A and Mary Mckay DNP ARNP, CNE “Bridging the gap: Making medication administration safer through simulation enhanced pharmacology education for pre-licensure nursing students.”

Our Journey Back from QSEN 2016

The Solution: Clinical Make Up Simulation Day Framework: QSEN Competencies Goal: To provide a mechanism for students who need to make up clinical days that achieves the SLOs and the QSEN Competencies   Global Objectives: Students will: Develop an awareness of the QSEN Competencies Demonstrate accomplishment of specific clinical SLOs Practice collaboratively with students from other courses and other levels in the program

Process Any Level student can attend Experience meets 9 Student Learning Outcomes of the Program Accountability Professionalism Communication and Collaboration Cultural Competence Nursing Process Q & S Critical Thinking Leadership Mentoring encouraged Prep Packet Post-Simulation Reflection and Debriefing

Pre-Briefing Didactic Review of QSEN Competencies ?photo didactic Basic Principles of Quality and Safety Linkages QSEN Competencies Student Learning Outcomes ?photo didactic

SBAR Exercise: Objectives Maintain confidentiality (SLO 2) Demonstrate effective SBAR Reporting (SLO 3, QSEN – Teamwork & Collaboration) Prioritize patient assignments (SLO 9, QSEN – Evidence Based Practice) Describe teaching/discharge planning (SLO 8, QSEN- Patient Centered Care) Discuss provision of culturally competent care (SLO 4, QSEN – Patient Centered Care) Relate care to QSEN Competencies (SLO 6) Apply the Nursing Process (SLO 5) (adapted from Mohn-Brown, 2016)

SBAR Exercise: Implementation 2 minute SBAR focused hand-off report Each student also: Justifies highest priority Nursing Diagnosis or nursing care need Summarizes how nursing care made a difference Explains modifications they would make to the plan of care Explains how teaching and/or discharge needs were met Describes how cultural needs were met Explains how QSEN competencies were met

Student Feedback “This experience improved my confidence to present in front of others and receive feedback.” “The repetition solidified the SBAR Process.” video

Medication Stations: Objectives Apply the nursing process to medication administration (SLO 5) Administers intravenous solutions and medications safely in a simulated clinical environment (SLO 6, QSEN - Safety) Demonstrates critical thinking related to medication administration (SLO 7, QSEN - Safety) Provides relevant teaching related to medications to a simulated patient (SLO 8, QSEN - Patient Centered Care)

Medication Stations: Implementation 6 scenarios set up for hands-on activities High alert medications Maternal child scenarios Sound-alike, Look alike medications IV Push Practice Each student (or student pair) completes 1 scenario Students rotate through each station and student teaches peers (adapted from Mohn-Brown, 2016 and Sanko & Mckay, 2016) video

Student Feedback “Built my confidence with medication administration practice.” “Appreciated the med administration because we don’t get enough in clinical.”

Medical Error Video Station: Objectives Discuss administration of medications that have high potential for serious patient harm. (SLO 6, QSEN - Safety) Identify rationales for holding certain medications (SLO 6, SLO 7, QSEN - Safety, EBP) Identify monitoring parameters for certain medications (SLO 6, SLO 7, QSEN - Safety, EBP)

Medical Error Video Station: Objectives (cont.) Demonstrate therapeutic communication related to an adverse event (SLO 3, QSEN - Safety, Patient Centered Care) Complete the QSRT following an adverse event (SLO 6, QSEN - Safety) Identify individual and systems factors that led to an adverse event (SLO 6, QSEN -Safety)

Medical Error Video Station: Implementation Students watch video. What stands out in this story? What concerns you? Why do you say that? What else could it be? Why? What do you already know that helps in this situation? Examine each QSEN competency. Students complete the QSRT and discuss individual and systems factors that impacted the adverse event in the video (adapted from Sherwood & Durham, 2016)

Student Feedback “Watching and discussing the video was meaningful because it allowed me to pinpoint incidents that can happen.”

Debriefing: Objectives Identify personal learning needs related to the SLOs and the QSEN Competencies (SLO 1) Relate clinical simulation experiences with values of the profession (SLO 2)

Debriefing: Activities Fifteen minutes to write personal reflection, followed by 30 minute group discussion What new application of content/concepts did you learn? How will this affect your future practice? What is the most valuable thing you learned during this simulation experience? Explain. What threats to patient safety did you observe? What personal learning needs did you identify? What is your plan to meet them? (Adapted from Mohn-Brown, 2016)

Summary AY 16-17 Funda mentals OB MS 1 Peds MS 2 MS 3 Total Fall 1 2   2 12 18 Fall 2 3 1 7 15 Winter 1 4 6 14 Winter 2 13 11 59

Student Perspectives Most valuable activity Using SBAR in daily practice Safe practice to avoid med errors “Ask for help when needed.” “Avoid interruptions.” “Check lab values.” “Slow down.” Med administration, IV Push Importance of a Culture of Safety Importance of incorporating QSEN Competencies into care

Feedback about Make Up Sim Day It was a great alternative to making up a clinical day.” “Truly enjoyed this experience.” The day taught me to better incorporate quality and safety into my everyday practice.” “Good chance to interact with students from different levels in the program.”

One of our students didn’t want to come… “I just want to tell you that it was actually AWESOME at simulation lab today. It was such a wonderful and educational experience. So I wholeheartedly apologize for emailing you about being upset in regards to attending simulation lab. Hands down it was great!!!” -Courtney S.

Future Directions Incorporation of Pediatric scenarios Application of scenarios to new curricular model Formal outcome analysis

Where will you take QSEN 2017?