1. Integrating Patient Safety across the Curriculum to Improve Healthcare Quality: One School’s Journey Susan Grinslade, PhD, RN, PHNCS, BC Sharon Hewner, PhD, RN Donna Fabry, DNP, RN

2. Purpose  Describe curriculum revision process  Describe innovative teaching pedagogy and assignments  Describe program outcomes after revision process

3. Background Guiding Documents:  AACN Baccalaureate Nursing Essentials (2008)  Institute of Health Care Improvement (IHI.org)  IOM Quality Series and related reports on health science education  Quality and Safety Education in Nursing (QSEN) Other:  CMS changes specific to reimbursement  Anticipated changes ACA

4. Courses Three courses were specifically developed:  Highlight importance of quality and safety Promoting Quality and Culture of Safety  Highlight legislative, economic and regulations related to health care Transitioning to Professional Nursing Practice as Leader/Manager  Highlight evidence-based practice Evidence-Based Practice and Nursing Research

5. Promoting Quality and Culture of Safety Baccalaureate & RN-BS The purpose of this course is to examine concepts of quality health outcomes and safety within the context of professional nursing practice. The numerous roles of the nurse within health care organizations are explored. The healthy work environment and its influence on nurses, nursing practice and outcomes are analyzed. Systems and processes to achieve and sustain quality health outcomes, and safe, effective, patient-centered holistic nursing care are examined in depth. Legal and ethical issues related to these topics are addressed. Alice’s Story Transition analysis Medication reconciliation Beer’s criteria QI problem RCA or FMEA Structure, process, outcome

6. Transitioning to Professional Nursing Practice as Leader Manager Baccalaureate & RN-BS The purpose of this course is to prepare the baccalaureate nursing student for transition to professional nursing practice as a leader/ manager. Organizational structures and processes of health care organizations as context for professional nursing practice are discussed. The collaborative roles of the nurse as leader and manager within the framework of legislative, economic, and regulated health care environments are analyzed. The legal and ethical parameters which influence the role of the nurse as leader/manager are explored. Incorporating strategies and processes for successful transition and practice, a personal career plan is developed. Quality and Patient Safety Meeting Attendance Reflective Analysis Interprofessional Team Meeting/Report QI and Financial Evidence-Based Project  Propose change, resources required, projected cost, limitations, engage healthcare team  Financial implications: cost to implement, cost savings or revenue, VBP initiative  Constraints, barriers and problem solving (evidence-based) Quality and Safety Poster Presentation to Unit

7. Evidence – Based Practice and Nursing Research Baccalaureate & RN-BS This course provides a foundation for evidence- based practice in nursing. Specific elements of evidence-based practice include formulating the clinical question, conducting a search strategy, clinically appraising the evidence, and implementation of evidence in the clinical environment. Basic concepts of the research process will form the foundation for assessing the quality of evidence. The relationship between evidence-based findings and nursing practice to achieve favorable and cost- containing client outcomes will be explored. PICOT Project Unit based Synthesis of evidence Practice Recommendation Barriers and strategies Poster presentation Formal paper

8. Integration of IHI Open School Modules  IHI provides modular, on-line courses to promote skills, change agents in health care.  Basic Certificate comprised of 16 courses – can be taken for CEU  Integrated across the curriculum Link: http://www.ihi.org/education/IHIOpenSchool/resources/Pages/MoreMedicalAndNursingSchoolsRequireBasicCertificate.aspx http://www.ihi.org/education/IHIOpenSchool/resources/Pages/MoreMedicalAndNursingSchoolsRequireBasicCertificate.aspx

9. What do Students say about IHI? Stevie W. “These modules have been a great way to synthesize online learning with real-world experience, through informative, comprehensive modules, which include multimedia modes of learning.” Rebecca M. “The IHI modules prepare us Nurses with insightful information and has given us the knowledge to make improvements in our own practices. It has guided me and prepared me to become a leader in nursing and given me the abilities to create a safe environment for my patients as well as helped me to continue to provide quality care.”

10. Transitions Course Financial and Quality Improvement Evidence Based Team Project: Start with PICOT from clinical unit -  Proposed change (evidence-based), resources required, projected cost, limitations, engage healthcare team  Financial implications: cost to implement, cost savings or revenue, VBP initiative  Constraints, barriers and problem solving (evidence-based)

11. Other Innovations QSEN KSAs:  integrated into scoring rubric  integrated into patient high fidelity simulations Interprofessional Activities:  clinical presentations  remote health experiences - Appalachia

12. Outcomes  Improved NCLEX-RN 1 st time pass rate  EBI Achievement of Program Outcomes - 78.2% (‘14) 93% (’13) responded “extremely well” prepared to provide safe care 79.8% responded “extremely well” prepared to provide evidence-based care 69% responded “extremely well” prepared to collaborate with interprofessional team to provide quality care 72% responded “extremely well” prepared to use leadership to provide safe, patient- centered effective care

13. Outcomes, cont’d. Post-graduate study to compare UB (focused curriculum) with Stony Brook (standard) curriculum (2013)  Safety Scores were higher for Safety, Inevitability, Incompetence, Patient, Situation and Total Safety Score for UB graduates  Scores were higher for Training, Curriculum and Team for SB graduates  Due to the small sample size (n=39), the t-test for differences in group means were not statistically significant

14. Outcomes, cont’d. Study to determine if a “safety focused course” would change attitudes in RN-BS students n=16 (2013)  All attitudes changed on Attitudes to Patient Safety Questionnaire  Significant changes in: Patient Safety, General* Team Functioning** Patient’s Role in Error* Situational awareness**  62.5% identified IHI modules as an excellent source of knowledge

15. Outcomes, cont’d. Community Partners  Expressed preference for UB graduates “I can always tell a UB graduate – well prepared – your team is doing great job educating on quality”  Senior Quality Improvement Project STOP Call Don’t Fall adopted by health care system for integration across 5 hospitals

16. Conclusions / Recommendations  Initiatives have improved quality of graduates  Graduates firmly grounded in concepts of safety and quality in relationship to fiscal management  Incorporation of IHI modules highly recommended  Innovative evidence-based projects prepare graduates for active engagement in quality improvement  Initiatives and projects have engaged hospital/unit staff