Supporting Quality Care NURS 274 Nursing Leadership Darlene LoPresto, BSN, RN,C Graduate Student FSU

Standards of Care   Structural   Process/Performance   Outcome

Nursing Specific Standards

MICHIGAN LEGISLATURE 95th Legislature Regular Session Michigan Compiled Laws Complete Through PA 169 and includes and 204 of 2010 PUBLIC HEALTH CODE (EXCERPT) Act 368 of 1978 Part 172 NURSING Section Section SectionDefinitions; principles of construction. Section Section SectionLicensed practical nurse; health profession subfield. Section Section SectionRenewal of license to practice as trained attendant; eligibility; “practice as a trained attendant” defined; original license prohibited; licensed psychiatric attendant nurse considered licensed practical nurse. Section Section SectionRegistered professional nurse; issuance of specialty certification; qualifications. Section Section SectionPractice of nursing or as licensed practical nurse; license or authorization required; use of words, titles, or letters. Section Section SectionRegistered professional nurse; ordering, receiving, or dispensing complimentary starter dose drugs. Section Section SectionLicensure as registered professional nurse; graduate of nurse education program located outside of United States; requirements. Section Section SectionMichigan board of nursing; creation; number and qualifications of members; terms. Section , Section , SectionRepealed. 1989, Act 201, Imd. Eff. Oct. 23, Section Section SectionHonorary license; "advanced illness" defined; name of section. Section Section SectionNursing education program; application to conduct; evidence required; evaluation; inspection; report; approval; continuation of existing programs; accreditation by national board or organization; education program for psychiatric attendant nurses or trained attendants prohibited. Section Section SectionInspection of approved nursing education program; report; notice of deficiency; removal from list of approved programs; hearing.

Accrediting Agency Standards

  committed to improving health care safety   continuously improve quality of care   accreditation of health care organizations   accreditation is a risk-reduction activity   reduce the risk of adverse outcomes

  HFAP determines a facility’s ability to deliver high quality patient care by using our CARE methodology.   This process includes an in-depth review of both open and closed patient records as well as direct observation of care provided.

Clinical Information Clinical Practice Guidelines Clinical Practice Guidelines Current and archived Clinical Practice Guidelines — beta blockers practice advisory — treating tobacco use and dependence Tobacco Cessation U.S. Public Health Service Clinical Practice Guideline: Pathfinder page links to materials that help tobacco users quit. Surgeon General Reports: The latest information to help people quit smoking, and to help health care professionals treat tobacco use and dependence. U.S. Public Health Service Clinical Practice Guideline: Surgeon General Reports

Public Transparency   Broad scale quality initiative   Consumers compare facilities   Informed choices   Better public information

Public Transparency          

Public Transparency   directory/michigan-mi/patient-safety- HGSTA directory/michigan-mi/patient-safety- HGSTA

The Consumer Assessment of Healthcare Providers and Systems (CAHPS ): Health care organizations use CAHPS results to:   Assess the patient-centeredness of care;   Compare and report on performance   Improve quality of care.   standardized surveys of patients' experiences compare.aspx?hid=230037&lat= &lng= &stype=GENERAL&&stateSearched=MI

Quality Improvement

Benchmarking   A benchmark is a specific quantitative standard for an outcome with which you compare your own institution. (Ellis & Hartley, 2009)

Sources of Date   Key Indicators   QA (Incident Reports)   Audits   Surveys

QI/PI Process

Sentinel Event

Risk Management   Policies, procedures, & practices involved in identification, analysis, assessment, control, and avoidance, minimization, or elimination of unacceptable risks. (

RM Focus   Studies QA findings and trends   Think ahead about defense strategies   Proactive identification and elimination of risk areas institution wide   Patient and family are informed

Incident Report Process Root Cause Analysis: Goal = Answer:   What happened?   Why did it happen?   What do you do to prevent if from happening again?

Incident Report Process: Five Why’s Technique Example: Problem Statement: You are on your way home from work and your car stops in the middle of the road Why did your car stop? - Because it ran out of gas Why did it run out of gas? - Because I didn't buy any gas on my way to work Why didn't you buy any gas this morning? - Because I didn't have any money Why didn't you have any money? - Because I lost it all last night in a poker game Why did you lose your money in last night's poker game? - Because I'm not very good at "bluffing" when I don't have a good hand.

Incident Report Process: Systems Focus   Not one person’s fault   Involves people and/ or processes   System failure results in error

Never Events: Effective October 1, 2008 No reimbursement Must note if ‘Present on Admission” Requirements of ‘Never Event’ occurs: -Report event -Root cause analysis -Waive costs -Apology

Magnet Status   Recognition of nursing excellence   14 Forces of Magnetism   Goals   Benefits

Michigan Magnet Status   Beaumont Hospital Troy MI 2009 Beaumont Hospital   Bronson Methodist Hospital Kalamazoo MI 2009 Bronson Methodist Hospital   Children's Hospital of Michigan Detroit MI 2008 Children's Hospital of Michigan   DMC Huron Valley Sinai Hospital Commerce Township MI 2009 DMC Huron Valley Sinai Hospital   Detroit Receiving Hospital and University Health Center Detroit MI 2009 Detroit Receiving Hospital and University Health Center   Holland Community Hospital Holland MI 2007 Holland Community Hospital   Munson Medical Center Traverse City MI 2006 Munson Medical Center   Oaklawn Hospital Marshall MI 2009 Oaklawn Hospital   Sparrow Hospital Lansing MI 2009 Sparrow Hospital   Spectrum Health-Blodgett Hospital Grand Rapids MI 2009 Spectrum Health-Blodgett Hospital   Spectrum Health-Butterworth Hospital Grand Rapids MI 2009 Spectrum Health-Butterworth Hospital   Spectrum Health-Helen DeVos Children's Hospital Grand Rapids MI 2009 Spectrum Health-Helen DeVos Children's Hospital   William Beaumont Hospital Royal Oak MI 2004 William Beaumont Hospital

Questions? As the professional nurse You make the difference! You make the difference!