Quality care can be defined using the acronym STEEP. Patients have a right to medical care that is free from harm, delivered in a quick, well organized manner, delivered without judgment, correctly treats the disease/disorder and welcomes the patient and/or family input in the planning process. All of these steps must be taken or we (nurses/healthcare) will “fall” short of our goal of quality care.
Function effectively within nursing and inter-professional team, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.
Safe, effective, satisfying patient care requires teamwork, collaboration with and communication among members of the team, including the patient and family as active partners.
Team work is a joint action by two or more people, in which each person contributes wit different skills and expresses his or her individual interests and opinions to the unity and efficiency of the group in order to achieve common goals.
Joint decision making among independent parties involving joint ownership of decisions and collective responsibility for outcomes. The essence of collaboration involves working across professional boundaries.
Teamwork and collaboration can be difficult when dealing with persons from different racial and cultural backgrounds. There can be communication break down between patient’s primary language, medical terminology, colloquialisms, cultural idioms, and slang. There can be differences of opinion as to what the final goal is. For example: Quantity of Life versus Quality of Life. There are generational differences within each culture which may affect work ethic, learning styles, communication patterns and motivation
When can the patient/family lead? That is the basis for family/pt centered care. A team of experts does not necessarily work together well. There can be a lack of communication. There may be conflict in decision making. An expert team envelopes the QSEN competencies in order to promote that best outcomes for the patient.
When the expert team is working together, there will be shared decision making.
Briefly discuss (have student state how each of the above are utilized at our facilities)
How is the electronic medical record promoting patient health and safety.What advantages are present with real time access to EBPHow are informatics able to reduce/prevent errors (pharmacy, MD office, ED through Discharge)How it fosters data collection for analysis and system design to improve patient outcomes.
Like a drop of water, informaticEach piece of patient data is but one drop
Also referred to as Patient/Family-Centered Care (PFCC). According to 2 researchers that wrote about a Patient-centered practice model, they said that “there is no universal definition of PFCC because the definition changes with each context in which it is being used (Small, 2011).” When looking at a literature search on MEDLINE of the term, patient-centered care, it came up with over 7,000 citations of the term with over 5,000 of these studies published after 2001. All of the other key competencies are also parts of patient-family centered care such as teamwork & collaboration, EBP, Quality Improvement, Safety, and Informatics. All of these components incorporated together make patient-family centered care meet best practice guidelines in nursing care.
Families want to be listened to and respected as a care partner, being told the truth, having care and information sharing coordinated with all members of the team, and partnering with staff who are able to provide both technically and emotionally supportive care.
The IOM put out a report brief called, “The Future of Nursing: Leading Change, Advancing Health” which states that nursing practice is now seen in many settings, including hospitals, schools, homes, retail health clinics, long-term care facilities, battlefields, and community and public health centers and that nurses should practice to the full extent of their education and training (IOM, 2010).
Families rank more highly the following:Goes hand in hand with HCAPS survey regarding patient satisfaction with communication with healthcare team and discharge teaching and information
Different methods can be used to do a root cause analysis: Fishbone diagrams which looks specifically at certain areas (people, environment, equipment, processes) to identify cause of issue or the “ 5 WHYs?” for everything that is said. For example, Why did this pt die? Answer: Monitor alarm was turned off. WHY was alarm turned off? And repeat 5 times Why?PDSA (plan, do, study, act) is a strategy to improve care.
The huddles or meeting could be a part of report, whether verbal or the walking rounds.
Remember that we have to include the ancillary personnell
Remember that hospital acquired skin breakdown is not a reimbursable item
Qsen final presentation
QSENWhat is it?What does it mean?
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
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 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