1. 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

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

3. 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.”

4. Our Journey Back from QSEN 2016

5. 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

6. 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

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

8. 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)

9. 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

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

11. 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)

12. 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

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

14. 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)

15. 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)

16. 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)

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

18. 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)

19. 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)

20. Summary AY 16-17 Funda mentals OB MS 1 Peds MS 2 MS 3 Total Fall 1 22 12 18
Fall 2 3 1 7 15
Winter 1 4 6 14
Winter 2 13 11 59

21. 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

22. 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.”

23. 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 ing you about being upset in regards to attending simulation lab. Hands down it was great!!!”
-Courtney S.

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

25. Where will you take QSEN 2017?