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

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

3. 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

4. A Short Review of QSEN History
The Quality and Safety Education for Nurses (QSEN) project began in Funded by the Robert Wood Johnson Foundation, the project had three phases between 2005 and 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.

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

6. 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

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

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

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

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

11. 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

12. 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

13. Informatics Documents outcomes of patient care
Recognizes 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

14. 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

15. 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

16. 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?

17. 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

18. 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

19. 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.

20. 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!

21. 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

22. 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

23. 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

24. 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

25. 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

26. 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

27. 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

28. 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

29. Questions?