1. Using Quality & Safety Education for Nurses (QSEN) as a framework for RN Orientation David H. James DNP, RN-BC, CCNS Patricia A. Patrician RN, PhD, FAAN Rebecca S. Miltner RN, PhD, CNL, NEA-BC

2. Page 2 Objectives 1. Describe how one large academic medical center uses the QSEN competencies and associated selected Knowledge, Skills, and Attitudes (KSAs) as a framework for general nursing orientation 2. Discuss opportunities for leveraging QSEN competencies beyond a RN orientation program.

3. Page 3 Conflict of Interest???

4. Page 4 Special Thanks…  Ashlea Herrero – Data Analyst UAB Hospital Center for Nursing Excellence  I-Clicker Guru  Pariya Fazeli, PhD –UAB Hospital Center for Nursing Excellence  Stats Consultant  UAB Center for Nursing Excellence Staff  Revision of lectures to reflect QSEN competencies

5. Page 5 A Call To Action… Institute of Medicine (IOM): Core Competencies for Health Professionals- 1.Provide Patient Centered Care 2.Work in interdisciplinary Teams 3.Employ Evidenced Based Practice (EBP) 4.Apply Quality Improvement 5.Utilize informatics 6.(*QSEN added “Safety” list) www.iom.edu

6. Page 6 Nursing Response – QSEN Project  Quality & Safety Education for Nurses (QSEN) – funded by RWJF  Goal: future nurses  Address the challenge of preparing future nurses with the knowledge, skills, and attitudes (KSA) necessary to continuously improve the quality and safety of the healthcare systems in which they work.

7. Page 7 Minding the Gap…  How do we ensure that we are building on content taught in nursing programs?  Does the practice setting look anything like academia?  What about RN hired before patient safety movement (before QSEN)?  What about RN from A.D.N. programs?

8. Page 8 UAB Hospital  1157 beds (937 + 220)  Medical Staff: 1141  RN Staff: 3000  Admissions: >50,000/year  10 city blocks & 4.2 million square feet  ADC: 932

9. Page 9 A snap shot of our newly hired RNs

10. Page 10 Revising RN Orientation

11. Page 11 PDCA  2010 – Major Revision  2 weeks (one week blended orientation)  Did include QSEN framework – Content not “really” clearly mapped objectives  2015 – Major Revision  Reduced to one week + follow up day  Comprehensive cross walk w/ QSEN competencies  Pre/post test  2015 – June Test Revisions  21 items same for pre and post  2016 – Moderate Revisions  Revisited cross walk  Lecture updates, splitting of computer training day

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13. Page 13 Generic RN Orientation Model 24 Cohorts per year 750+ RNs

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16. Page 16 Cross Walk Table QSEN Competency # of Obj. Covered PFCC12 Teamwork6 EBP5 QI7 Safety6 Informatics7  Developed “Cross Walk table” for each day’s agenda  Mapped the topic with specific Pre-Licensure QSEN competencies  Gap analysis for speakers

17. Page 17 Meeting the Objectives Content / Key PointsObjectives Patient & Family Centered Care – Dee Dee Story 1.Value seeing health care situations “through patients’ eyes” (PFCC) 2.Examine common barriers to active involvement of patients in their own health care processes. (PFCC) 3.Examine how the safety, quality and cost effectiveness of health care can be improved through the active involvement of patients and families. (PFCC) Scripted Debriefing: “Debriefing with Good Judgement” Reactions “I Saw”; “I think”; “I wonder” Generalizations to practice

18. Page 18 Meeting the Objectives…. Content / Key PointsObjectives Medication Safety & Pain Mang. (Blended Afternoon) 1.Recognize personal held values and beliefs about the management of pain and suffering (journal club activity)(PFCC). 2.Appreciate the role of the nurse in relief of all types of sources of pain and suffering (PFCC). 3.Read original research and evidence reports related to area of practice.(EBP) 4.Describe approaches for changing processes of care(QI) Bell, L., & Duffy, A. (2009). Pain assessment and management in surgical nursing: a literature review. British Journal Of Nursing, 18(3), 153-156 4p.

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20. Page 20 Test??? AGHHHHHH!!  IRB for June – Aug 2015 Pre & Post Test: Revised based on analysis from prior test 21 questions focusing on QI, Safety, EBP 18 used for analysis due to missing data (i- clicker) Test Questions – Reviewed by experts at UABH/UABSON and pulled from Dycus (2009)

21. Page 21 Test Your Knowledge….  “PICO(T)” is used for which of the following? a.Statistical analysis of difference between two samples b.To organize your evidence base practice question for a literature search c.To determine root cause(s) for patient safety incident. d.To organize a quality improvement project

22. Page 22 Test your Knowledge…  Which of the following tools might be useful to understanding if the patient fall rate on your nursing unit is getting better, worse or staying the same? a.Control chart b.Flow chart c.Pareto chart d.Pie chart

23. Page 23 Test your Knoweldge…  According to the IOM Report To Err is Human: a.44,000 to 98,000 patients die as a result of medical errors annually. harmed b.44,000 to 98,000 patients are harmed by medical errors annually c.Neither of the above d.The report was inherently flawed and meaningless to improving patient safety

24. Page 24 Total Percentage Correct on Domains at Pre & Post Pre (N=171) Post (N=105) Peri OP RN do not participate in RN follow up day *p<0.05

25. Page 25 Reflections & Next Steps…  Themes & Observations:  Comment from experienced ADN RN –”some of those questions require doctorate” – content is new for them  Need more education related to the differences and overlaps associated with QI  EBP  Research.  Next Steps:  Move QSEN beyond generic RN orientation to division/Unit orientation  Move QSEN to clinical ladder  Pair pre/post test for 2016

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27. Page 27 Questions & Contact…  David H. James DNP, RN-BC, CCNS  djames@uabmc.edu

28. Page 28 References:  Cronenwett L, Sherwood G, Warren J, et al. Quality and safety education for nurses. Nurs Outlook. 2007;55(3):122-131.  Dycus, P., & McKeon, L. (2009). Using QSEN to measure quality and safety knowledge, skills, and attitudes of experienced pediatric oncology nurses: an international study. Quality Management In Health Care, 18(3), 202-208  QSEN Institute. QSEN. http://qsen.org. 2014. Accessed August 20, 2014