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IOM/QSEN Competencies
 Health professions education: A bridge to quality(2003)
An Introduction to the Competencies and Knowledge, Skills, and Attitudes
 QSEN
 Funded by Robert Wood Johnson Foundation
 Focused on transforming basic education for nurses
 Reflects a new identity for nurses that demonstrates knowledge, skills and attitudes that emphasize quality and safety in patient care

Gerry Altmiller, EdD, APRN, ACNS‐BC
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Phase I Development
Phase II Implementation
Phase III Dissemination
 Relevance to Nursing Education and Clinical Practice
 Baccalaureate Essentials /Master’s Essentials
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 Transition to Practice Program
Objectives
Patient Centered Care
 Participants will be able to identify knowledge, skills,  Patient is in control and a full partner; care is based and attitudes that emphasize the IOM/QSEN competencies.
on respect for patient’s preferences, values, and needs. (Offer more control, choice, self‐efficacy, and individualization of care)
 Consider patient’s cultural preferences
 Participants will identify at least one strategy that can be incorporated into their classroom or clinical teaching.
 White board initiatives for patient goals
 IHI Home Page Patient Centered Care 101 1.5 contact hrs
 The Picker Institute‐Advancing the Principles of Patient‐
Centered Care http://pickerinstitute.org
 Participants will identify resources for linking strategies that promote quality and safety to their specific theory or clinical teaching.
©Altmiller  Institute for Patient‐ and Family‐Centered Care http://www.ipfcc.org
 https://www4.georgetown.edu/uis/keybridge/keyform/for
m.cfm?formID=277
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Patient Centered Care
Patient Centered Care
 Keeping the focus on the patient
 Value added nursing care (rounding)
 Non‐value added nursing care (waiting for assistance, delays, looking for supplies)
 Necessary but non‐value added nursing care (medication preparation, documentation
 Keep focused on patient goals and solving problems at  Transforming care (TJC)
 http://www.centerfortransforminghealthcare.org/projects
/detail.aspx?Project=6
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the point of care
 Promote relationship building with patients
First Touch – Home
 Involve patient in all we do
 Situational Awareness
 Rapid response teams to avoid codes on Med‐Surg units
 Personal accountability in all we do
 Reducing admission rates
 Helping nurses obtain new skill sets
 http://www.ihi.org/offerings/Initiatives/PastStrategicIn
itiatives/TCAB/Pages/Materials.aspx Improve patient satisfaction
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Teamwork and Collaboration
 Achieve quality patient outcomes by effectively communicating with nurses and inter‐professional teams having mutual respect and shared decision making.
 Synergistic effects of effective interdisciplinary collaboration
System based solutions for Safe hand‐offs
Acknowledging other team members contributions
Ability to raise concerns; Assertion  CUS (concerned, uncomfortable, safety)
 2 challenge rule
 Critical Language “I need some clarity.”
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Teamwork and Collaboration
Effective Communication
 SBAR
 Situation
 Background
 Assessment
 Recommendation
 Rapid Response Teams
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Teamwork and Collaboration
 Leadership during high stress team efforts
P
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 Integrate best current evidence, clinical expertise, and patient preferences and values to deliver optimal health care.
 Reduce Variability through evidence
U
D
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Evidence Based Practice
F
 Integration of Standards
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“It’s less of a thing to do…it’s more of a way to be”
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 Conflict Management Strategies
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 TeamSTEPPS Tools and Videos
 TeamSTEPPS
http://www.ahrq.gov/teamsteppstools/instructor/videos.
htm
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Evidence Based Practice
 Translate new knowledge into practice
 Provide guidance in weighing evidence
 Share the evidence that links studies to optimum clinical outcomes and business results
 http://www.guidelines.gov/ National Guideline Clearinghouse | Home
 The Cochrane Collaboration
 Identify those at risk for infection
 Bundles and protocols
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http://www.jointcommission.org/infection_control.aspx
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Handwashing
Proper hygiene for in and out of room
Pressure ulcer prevention
Ventilator associated pneumonia prevention
Influenza/pneumococcal disease prevention
Quality Improvement (QI)
 Monitor outcomes of care processes and use improvement methods to design and test changes to improve the health care system.
 Culture of Safety
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Report errors/adverse events/near misses
Systematic Investigations of problems
Safe to ask for help
 System wide transformation

IHI Open School Quality Improvement 101‐106 9 contact hrs
 Look at waste and variation and eliminate it
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Identify where to make changes in the system
Tools and Strategies for Quality Improvement and Patient Safety ‐ http://www.ncbi.nlm.nih.gov/books/NBK2682
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Quality Improvement (QI)
Quality Improvement (QI)
 Familiarity with Nursing Sensitive Indicators
https://www.nursingquality.org/data.aspx
 Presentation of data;
 Describe Aim
 PDSA (Plan, the change, how tested, how studied)
 Use of Tools (flow charts, check sheets, run charts, bar graphs)
 PDSA (Plan, Do, Study, Act)
 What are we trying to accomplish?
 How will we know that a change is an
improvement?
 What changes can we make that will result in improvement?
 Personal Improvement Project using Model for Improvement:
 What are we trying to accomplish?
 How will we know that a change is an improvement?
 What changes can we make that will result in improvement?
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Quality Improvement (QI)
Safety
 Minimize risk of harm to patients and providers  Mistake proofing
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Mistake‐proofing the Design of Health Care Processes: Chapter 2 http://www.ahrq.gov/qual/mistakeproof/mistake2.htm
through both system effectiveness and individual performance.
 IHI Open School Patient Safety 100‐106 8.25 contact hrs
 Two patient identifiers
 NDNQI Pressure Ulcer Training

National Database of Nursing Quality Indicators https://www.nursingquality.org/Default.aspx
 Patient armbands where standardized
 Correct surgery/Correct site
 Medication reconciliation
 Standardization of medications
 Patient Safety Solutions
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 Identify Work‐arounds
Patient Safety Solutions ‐ Joint Commission Resources –
Intranet http://www.ccforpatientsafety.org/Patient‐Safety‐
Solutions/
 Time outs
 Huddles
 Non‐verbal communication requires confirmation
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Safety
One Minute Safety Check
 Provide learning opportunities to identify errors in a safe environment
 Speak the language of quality and Safety
 AHRQ Glossary http://www.psnet.ahrq.gov/glossary.aspx
 Resources for patient safety information
 National Patient Safety | Joint Commission http://www.jointcommission.org/PatientSafety/Nationa
lPatientSafetyGoals  AHRQ Patient Safety Network http://www.psnet.ahrq.gov/
 National Patient Safety Foundation http://www.npsf.org
 Used for clinical setting
 Helps students prioritize safety concerns
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C
S
F
VS C
B
A
 Use information and technology to communicate, manage knowledge, mitigate error and support decision making.
 Navigate resources
1 D
2 D
3 D
 Medical Record
4 C
5 D
 A
◦
Informatics
F
A
8
7 YPU M
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And in the midst of this…..”mindfulness and sensemaking (Weick & Sutcliff, 2001)
 Mindfulness
 Staying focused and tuned in
 Ability to see the significance of early and weak signals and to take strong decisive action to prevent harm
 Trouble starts small and is signaled by weak symptoms that are easy to miss
 Situational Awareness
 Utilize data bases effectively
 Use technology to seek information
 Creating Run Charts‐You Tube
 Use technology to report concerns
 Institute For Safe Medication Practices http://www.ismp.org/
 Model life long learning ©Altmiller
Resources
QSEN Teaching Strategies
http://www.qsen.org/
 Sensemaking
 Using multiple cues; critical thinking
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Questions?
Thank you!
Altmiller@Lasalle.edu
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