Health Care Is Not As Safe As It Could Be • 4% of hospitalized patients are harmed by care supposed to help – Deaths per year • Medical Errors: 98,000 – Post op infections and other preventable complications: 32,000/year • Motor Vehicle Accidents: 43,459 • Breast Cancer: 42,297 • AIDS: 16,000
Errors• Medications: nurse is last line of defense• Surgery: wrong site• Diagnostic accuracy: wrong treatment• Equipment failure: IV pump• Transfusion error: blood type, wrong patient• Laboratory: incorrect labeling• System failure: no independent double check• Environment: clean up spills• Security: child abduction
What is Quality Care? Safe• S• T Timely• E Efficient• E• E Equitable• P Effective Patient/Family Centered Care
Quality and Safety in Educating Nurses• Purpose is to prepare nurses with the competencies necessary to continuously improve the quality and safety of the health care systems in which they work• Competencies: – patient/family centered care, – collaboration and teamwork, – evidence based practice, – quality improvement, – safety – informatics
Team Work and Collaboration
Definition• Function effectively within the team to achieve quality patient care – Open communication – Mutual respect – Shared decision making
Key Message• Safe, effective, satisfying patient care requires: – teamwork, – collaboration – communication• among all team members Patient and Family are Members of the Team!
Teamwork is:• A joint action by two or more people: – each person contributes • different skills • opinions – working with unity and efficiency • to achieve common goals.
Collaboration is….• Joint decision making among independent parties – involving joint ownership of decisions – collective responsibility for outcomes Working Across Professional Boundaries.
Cultural Barriers to Teamwork and Collaboration• Specialized languages• Face different societal expectations• Hold differing viewpoints and goals• Define success very differently• Represent different generations with differences about motivation, work ethic, learning styles, authority relationships, and communication patterns.
Who leads the Team?• Less about one leader for all situations and more about who has the necessary skills – Productive pairs: relational co-leadership – When can the patient and family lead? – What is the difference between a team of experts and an expert team?
Qualities of Expert Teams• Understanding of scope and individual strengths• Skills at communication/conflict resolution• Philosophy of “got your back”• Clear leadership competencies• Joint responsibility to help each other• Shared goals and accountability
If Shared Decision-Making• Strengths of all members are known and respected• Mutual appreciation for all contributions• Leader is member with greatest relevant knowledge• Patient/family is full member…care is patient/family driven
SafetyHow is safety reflected inthe hospital environment ?
Safety Definition: Minimizes risk of harm to patients andproviders through both system effectiveness and individual performance • How can you accomplish this? – Wrist bands – Medication – Clutter free reconciliation environment – Bed alarms – Patient equipment – Hourly rounding – “Time out” – SBARR – Hand washing
You Tube Safety Video• http://www.youtube.com/watch?v=u49 BME17ED0&feature=related
Points to remember:• What is patient safety? – Decreased risk of harm by individual actions or system design• Who is responsible or patient safety? – All of us• When do we address a “safety issue” – As soon as we recognize it
Informatics• We’ve come a long way baby
Informatics Definitions• Use information and technology to communicate, man age knowledge, mitigate error, and support decision making
How can we accomplish this?• Electronic medical records• Computerized “evidence based practice” – Literature review for best practice guidelines• Error prevention• Incorporation of “5 rights”• Data collection and analysis to improve patient outcomes
Points to remember:• What is my responsibility? – Timely, accurate data collection – Timely, complete documentation – No falsification of information
What kind of record do you want?• It is up to you to keep patient data “clear and concise” so you don’t muddy the water
What is Patient-Centered Care?• 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
Key message•The patient andfamily are in apartnered relationshipwith their health careproviders and areequipped withrelevant information,resources, accessand support to fullyengage in and/ordirect the health careexperience as theychoose.
Institute of Medicine (IOM)States patient-centered care “isproviding care that is respectful of andresponsive to individual patientpreferences, needs, and values andensuring that patient values guide allclinical decisions”
It is not……•Patient focused care:The patient/familymay be involved, butthe health careprovider retainscontrol over decision-making, patient needsand preferences mayor may not besought, and rarelydrive care decisions
What families want……• To know the prognosis,• To talk with the nurse each day,• To know how the patient was being treated,• To know why things were done for the patient,• To be called at home about changes in the patient’s condition,• To receive information about the patient daily,• To know exactly what was being done for the patient,• To be told about transfer plans, and• To know specific facts about the patient’s condition.
How do you provide patient- centered care?• Value seeing health care situations “through patients’ eyes”• Value the patient’s expertise with own health and symptoms• Seek learning opportunities with patients who represent all aspects of human diversity• Recognize personally held attitudes about working with patients from different ethnic, cultural and social backgrounds• Provide patient-centered care with sensitivity and respect for the diversity of human experience
How do you provide patient- centered care?• Communicate patient values, preferences and expressed needs to other members of the health care team• Respect patient preferences for degree of active engagement in the care process• Respect the patient’s right to access to personal health records• Appreciate shared decision-making with empowered patients and families, even when conflicts occur• Participate in building consensus or resolving conflict in the context of patient care
Patient-centered care/pain management• Assess presence and extent of pain and suffering• Elicit expectations of patient & family for relief of pain, discomfort, or suffering• Initiate effective treatments to relieve pain and suffering in-light of patient values, preferences, and expressed needs
CompetencyTo recognize the patient or designee as the source ofcontrol and full partner in providing compassionateand coordinated care based on respect for patient’spreferences, values and needs
Remember…..“We are guests in their lives”… (D Berwick)
Quality ImprovementDefinition: Use ofdata to monitor theoutcomes of careprocesses and use ofimprovementmethods to designand test changes tocontinuously improvethe quality and safetyof healthcare systems(Cronenwett et al, 2007)
Key Message• Improving patient care requires a systematic process of defining problems in order to identify potential causes and develop strategies to improve care. This process requires the ability to measure care. We can only improve if we measure how well we are doing and compare our performance against others.
Overview of Quality Improvement• Nurses and students are parts of the system of care and processes that affect outcomes• For instance, the huddles (meetings) that are held to discuss patients with skin care issues.
Problem: Patient with a fractured hip who developed a sacral decubitiA root cause analysis was done:• Who is involved• What factors contribute• What can we do to prevent this problem• What can be done to treat the issue
Who and What is Involved• Departments: ER, OR, PACU and the nursing unit the patient is on till they are discharged• Equipment/supplies: specialty beds, dressings, skin prep• Nursing care: turning and positioning schedules• Factors to overcome: lack of knowledge about hip replacements and movement
Knowledge necessary• Change the knowledge base about being able to move a post-op hip surgery patient – The hip is fixed and the cement is dry
Skills necessary• Teach turning and positioning for the post-op hip patient• Reinforce the skills necessary when using the specialty beds
Attitudes• Appreciate the cost of treating a hospital acquired skin breakdown.• Recognize the value of preventative steps.
Hospital Based QI• Chart reviews for documentation of pain medication effectiveness• Timing for antibiotics versus cultures• Following the printed protocols for CHF, community acquired pneumonia