The document discusses leadership influence on professional nursing practice and quality of care. It begins by outlining an agenda that articulates the importance of standards, measures, transparency and enforcement to ensure quality. It then identifies strategies for an open culture and describes mechanisms to improve support for compassionate nursing. The significance of a strong patient-centered leadership team is affirmed. Finally, methods to accurately collect, implement and utilize information are illustrated.
Objectives:
1.Introduce the Measuring and Monitoring of Safety Framework to a Canadian healthcare audience
2.Describe how the framework would work in Canada
The fourth webinar picks-up directly from the third session, focusing on the next key step to inform implementation initiatives: identifying barriers and enablers to implementation.
READ MORE: http://bit.ly/2kIxtQo
Changing practice through knowledge translation and implementation science.
Have you asked, told, taught and begged, but your hand hygiene results aren’t changing as quickly as you want? Changing practice is hard! Join CPSI on May 4th for an interactive webinar exploring the fundamentals of knowledge translation and the efforts of Public Health Ontario to change practice through this innovative science. We will also look at how you can impact patient and family hand hygiene efforts through the successful use of campaigns.
Objectives:
1.Introduce the Measuring and Monitoring of Safety Framework to a Canadian healthcare audience
2.Describe how the framework would work in Canada
The fourth webinar picks-up directly from the third session, focusing on the next key step to inform implementation initiatives: identifying barriers and enablers to implementation.
READ MORE: http://bit.ly/2kIxtQo
Changing practice through knowledge translation and implementation science.
Have you asked, told, taught and begged, but your hand hygiene results aren’t changing as quickly as you want? Changing practice is hard! Join CPSI on May 4th for an interactive webinar exploring the fundamentals of knowledge translation and the efforts of Public Health Ontario to change practice through this innovative science. We will also look at how you can impact patient and family hand hygiene efforts through the successful use of campaigns.
How the CIHI – CPSI collaborative on hospital harm can support patient safety initiatives in your organization
Most patients in Canadian hospitals experience safe care, but when harm happens there is a significant impact on patients, families, the healthcare team, and the health system in general. Until now, there hasn't been a standard approach to measuring and monitoring harm experienced by patients in hospital.
Evidence demonstrates that communication is one of the leading contributors to adverse events. Transitions of care epitomize this challenge.
WATCH ON DEMAND: https://goo.gl/M1ovsS
A presentation, describes basics of Clinical Governance
What do we have in common
as Medical Doctors/Medical
Practitioners?
1. We are technical experts in our fields
2. We are leaders
3. We are managers
4. We are accountable for the patient care and health services
5. We are change agents
6. We are respected highly in the community
7. We are responsive
8. We are good communicators and negotiators
9. We are kind and empathic
10. We are decent and disciplined
Clinical Governance is a strategic framework for the development of high quality healthcare
"A framework through which organizations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish" – NHS, UK
“clinical governance is a way of making sure that everyone who passes through health system is well cared for”
or
System that enable staff to work in the best possible way
+
Staff performing to the highest possible standards
Seven pillars of Clinical Governance
Patient and public involvement (PPI)
Risk management
Staffing and staff management
Education and training
Clinical effectiveness & Research
Using clinical information & IT
Clinical audit
Patient and public involvement
Ensuring services meet the need of the patients
Patient and public feedback is used to improve services
Patients and the public are involved in the development of services and the monitoring of treatment outcomes
Risk management
Complying with protocols
Learning from mistakes and near-misses
Reporting adverse events
Assessing the risks – probability of occurrence, impact
Promoting blame free culture
Staffing and staff management
Appropriate recruitment and management of staff
Ensuring that underperformance is identified and addressed
Encouraging staff retention by motivating and developing staff
Providing good working conditions
Education and Training
Providing appropriate support available to enable staff to be competent in doing their jobs and to develop their skills so that they are up to date
Professional development needs to continue through lifelong learning
Clinical effectiveness & Research
Clinical effectiveness implies ensuring that everything we do is designed to provide the best outcomes for patients
Clinical audit
Clinical audit is a quality improvement cycle that involves measurement of the effectiveness of healthcare against agreed and proven standards for high quality, and taking action to bring practice in line with these standards so as to improve the quality of care and health outcomes
Clinical audit is a systematic process of looking at your practice and asking:
What should we be doing?
Are we doing it?
If not, how can we improve?
Delegate pack from the Patient Safety Collaborative launch event held in London on 14 October 2014
Includes agenda, speaker biographies and AHSN plans
More information at http://www.nhsiq.nhs.uk/improvement-programmes/patient-safety/patient-safety-collaboratives.aspx
As patients and families impacted by harm, we imagine progressive approaches in responding to patient safety incidents – focused on restoring health and repairing trust.
We can change how we respond to healthcare harm by shifting the focus away from what happened, towards who has been affected and in what way. This is your opportunity to hear about innovative approaches in Canada, New Zealand, and the United States that appreciate these human impacts.
This interactive webinar is hosted by Patients for Patient Safety Canada, the patient-led program of the Canadian Patient Safety Institute and the Canadian arm of the World Health Organization Patients for Patient Safety Global Network.
Have you ever wanted to learn more about human factors in health care and it’s impact on patient safety? Well now is the time. Join us on Oct. 4th at noon ET as Dr. Kathy Momtahan and Dr. Gianni D’Egidio explore the work of the Canadian Human Factors in Healthcare Network and recent human factors evaluations of hospital external defibrillators.
Dr. Edward Wagner, Director (Emeritus) MacColl Center, Senior Investigator, Group Health Research Institute addresses the 2014 Weitzman Symposium on The Future of Primary Care
Presentations from the patient safety conference held at Teesside University on 1 and 2 September 2014 - Students at the forefront of continuing and improving our culture of safe care
Family members are a vital part of the healthcare team and are often best positioned to recognize the sometimes subtle, yet very important changes in their loved one's condition that may indicate deterioration. You may not know WHAT is wrong, but you know something just isn't right. Empower yourself and your loved ones with information and resources to help you recognize the signs of deteriorating patient condition and effectively discuss your concerns with the healthcare provider.
Belinda Phipps: Why choice matters - Improving the experience of maternity careThe King's Fund
Belinda Phipps, Chief Executive of the National Childbirth Trust, looks at what maternity service choices are available and why having choice is important for mothers.
How the CIHI – CPSI collaborative on hospital harm can support patient safety initiatives in your organization
Most patients in Canadian hospitals experience safe care, but when harm happens there is a significant impact on patients, families, the healthcare team, and the health system in general. Until now, there hasn't been a standard approach to measuring and monitoring harm experienced by patients in hospital.
Evidence demonstrates that communication is one of the leading contributors to adverse events. Transitions of care epitomize this challenge.
WATCH ON DEMAND: https://goo.gl/M1ovsS
A presentation, describes basics of Clinical Governance
What do we have in common
as Medical Doctors/Medical
Practitioners?
1. We are technical experts in our fields
2. We are leaders
3. We are managers
4. We are accountable for the patient care and health services
5. We are change agents
6. We are respected highly in the community
7. We are responsive
8. We are good communicators and negotiators
9. We are kind and empathic
10. We are decent and disciplined
Clinical Governance is a strategic framework for the development of high quality healthcare
"A framework through which organizations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish" – NHS, UK
“clinical governance is a way of making sure that everyone who passes through health system is well cared for”
or
System that enable staff to work in the best possible way
+
Staff performing to the highest possible standards
Seven pillars of Clinical Governance
Patient and public involvement (PPI)
Risk management
Staffing and staff management
Education and training
Clinical effectiveness & Research
Using clinical information & IT
Clinical audit
Patient and public involvement
Ensuring services meet the need of the patients
Patient and public feedback is used to improve services
Patients and the public are involved in the development of services and the monitoring of treatment outcomes
Risk management
Complying with protocols
Learning from mistakes and near-misses
Reporting adverse events
Assessing the risks – probability of occurrence, impact
Promoting blame free culture
Staffing and staff management
Appropriate recruitment and management of staff
Ensuring that underperformance is identified and addressed
Encouraging staff retention by motivating and developing staff
Providing good working conditions
Education and Training
Providing appropriate support available to enable staff to be competent in doing their jobs and to develop their skills so that they are up to date
Professional development needs to continue through lifelong learning
Clinical effectiveness & Research
Clinical effectiveness implies ensuring that everything we do is designed to provide the best outcomes for patients
Clinical audit
Clinical audit is a quality improvement cycle that involves measurement of the effectiveness of healthcare against agreed and proven standards for high quality, and taking action to bring practice in line with these standards so as to improve the quality of care and health outcomes
Clinical audit is a systematic process of looking at your practice and asking:
What should we be doing?
Are we doing it?
If not, how can we improve?
Delegate pack from the Patient Safety Collaborative launch event held in London on 14 October 2014
Includes agenda, speaker biographies and AHSN plans
More information at http://www.nhsiq.nhs.uk/improvement-programmes/patient-safety/patient-safety-collaboratives.aspx
As patients and families impacted by harm, we imagine progressive approaches in responding to patient safety incidents – focused on restoring health and repairing trust.
We can change how we respond to healthcare harm by shifting the focus away from what happened, towards who has been affected and in what way. This is your opportunity to hear about innovative approaches in Canada, New Zealand, and the United States that appreciate these human impacts.
This interactive webinar is hosted by Patients for Patient Safety Canada, the patient-led program of the Canadian Patient Safety Institute and the Canadian arm of the World Health Organization Patients for Patient Safety Global Network.
Have you ever wanted to learn more about human factors in health care and it’s impact on patient safety? Well now is the time. Join us on Oct. 4th at noon ET as Dr. Kathy Momtahan and Dr. Gianni D’Egidio explore the work of the Canadian Human Factors in Healthcare Network and recent human factors evaluations of hospital external defibrillators.
Dr. Edward Wagner, Director (Emeritus) MacColl Center, Senior Investigator, Group Health Research Institute addresses the 2014 Weitzman Symposium on The Future of Primary Care
Presentations from the patient safety conference held at Teesside University on 1 and 2 September 2014 - Students at the forefront of continuing and improving our culture of safe care
Family members are a vital part of the healthcare team and are often best positioned to recognize the sometimes subtle, yet very important changes in their loved one's condition that may indicate deterioration. You may not know WHAT is wrong, but you know something just isn't right. Empower yourself and your loved ones with information and resources to help you recognize the signs of deteriorating patient condition and effectively discuss your concerns with the healthcare provider.
Belinda Phipps: Why choice matters - Improving the experience of maternity careThe King's Fund
Belinda Phipps, Chief Executive of the National Childbirth Trust, looks at what maternity service choices are available and why having choice is important for mothers.
John Wilderspin: Early implementers update: making the best use of combined r...The King's Fund
John Wilderspin, National Director, Health and Wellbeing Board Implementation, Department of Health, discusses health and wellbeing boards and the progress of early adopters.
Commission on the Future of Health and Social Care in England infographicsThe King's Fund
With health and social care services facing unprecedented challenges, are the current arrangements fit for purpose?
Our new set of infographics considers how people's health and social care needs might change in the future, and looks at the facts and figures behind health and social care spending.
Paul Zollinger-Read: Understanding the big pictureThe King's Fund
Paul Zollinger-Read, GP and Medical Adviser and Clinical Lead on Primary Care, The King's Fund speaks on 'Understanding the big picture: how consortia can grasp early opportunities and take ownership of reforms'
Frances Patterson: Creating a new framework for delivering adult social careThe King's Fund
Frances Patterson QC, Public Law Commissioner at the Law Commission, outlines the recommendations set out in the new legal framework for adult social care.
Chris Ham: capitated budgets - a flexible way to enable new models of careThe King's Fund
Chris Ham, Chief Executive at The King’s Fund, looks at how high performing integrated systems are using capitated budgets and shares examples of eight PCTs who are commissioning integrated care in an innovative way.
Patient Safety and Professional Nursing Practice C.docxkarlhennesey
Patient Safety and
Professional
Nursing Practice
Chapter 8
Patient Safety
• Ensures that nursing practice is safe, effective,
efficient, equitable, timely, and patient-centered
(ANA)
• Minimization of risk of harm to patients and
providers through both system effectiveness and
individual performance (QSEN & NOF)
To Err is Human: Building a Safer
Health System (IOM, 2000)
• At least 44,000 and possibly up to 98,000
people die each year as the result of
preventable harm
• Cause of the errors is defective system
processes that either lead people to make
mistakes or fail to stop them from making a
mistake, not the recklessness of individual
providers
Error
• Error is the failure of a planned action to be
completed as intended, or the use of a wrong
plan to achieve an aim with the goal of
preventing, recognizing, and mitigating harm
• Common errors include drug events and
improper transfusions, surgical injuries and
wrong-site surgeries, suicides, restraint-related
injuries or death, falls, burns, pressure ulcers,
and mistaken patient identities (IOM, 2000)
Event Analysis
• Individual approach or system approach
– Culture of blame
– Culture of safety
– Just culture
• Root-cause analysis
• TERCAP
• Reason’s Adverse Event Trajectory
Classification of Error
• Type of error
– Communication
– Patient management
– Clinical performance
• Where the error occurs
– Latent failure and active failure
– Organizational system failures and system process
or technical failure
Human Factor Errors
• Skill-based
– Deviation in the pattern of a routine activity such
as an interruption
• Knowledge-based
• Rule-based
– Conscious decision by the nurse to “workaround”
or take a shortcut, so the system defense
mechanisms are bypassed, thereby increasing risk
of harm to patient
To Err is Human: Building A Safer
Health System (IOM, 2000) (1 of 2)
• User-centered designs with functions that make
it hard or impossible to do the wrong thing
• Avoidance of reliance on memory by
standardizing and simplifying procedures
• Attending to work safety by addressing work
hours, workloads, and staffing ratios
• Avoidance of reliance on vigilance by using
alarms and checklists
To Err is Human: Building A Safer
Health System (IOM, 2000) (2 of 2)
• Training programs for interprofessional teams
• Involving patients in their care; anticipation of
the unexpected during organizational changes
• Design for recovery from errors
• Improvement of access to accurate, timely
information such as the use of decision-making
tools at the point of care
Crossing the Quality Chasm: A New
Health System for the 21st Century
(IOM, 2000)
• STEEEP
– Safe
– Timely
– Effective
– Efficient
– Equitable
– Patient-centered
• 10 rules for redesign
– Rule #6: Safety is a
system property
Keeping Patients Safe: Transforming the
Work Environment of Nurses
(IOM, 2004) ...
Patient Safety and Professional Nursing Practice C.docxssuser562afc1
Patient Safety and
Professional
Nursing Practice
Chapter 8
Patient Safety
• Ensures that nursing practice is safe, effective,
efficient, equitable, timely, and patient-centered
(ANA)
• Minimization of risk of harm to patients and
providers through both system effectiveness and
individual performance (QSEN & NOF)
To Err is Human: Building a Safer
Health System (IOM, 2000)
• At least 44,000 and possibly up to 98,000
people die each year as the result of
preventable harm
• Cause of the errors is defective system
processes that either lead people to make
mistakes or fail to stop them from making a
mistake, not the recklessness of individual
providers
Error
• Error is the failure of a planned action to be
completed as intended, or the use of a wrong
plan to achieve an aim with the goal of
preventing, recognizing, and mitigating harm
• Common errors include drug events and
improper transfusions, surgical injuries and
wrong-site surgeries, suicides, restraint-related
injuries or death, falls, burns, pressure ulcers,
and mistaken patient identities (IOM, 2000)
Event Analysis
• Individual approach or system approach
– Culture of blame
– Culture of safety
– Just culture
• Root-cause analysis
• TERCAP
• Reason’s Adverse Event Trajectory
Classification of Error
• Type of error
– Communication
– Patient management
– Clinical performance
• Where the error occurs
– Latent failure and active failure
– Organizational system failures and system process
or technical failure
Human Factor Errors
• Skill-based
– Deviation in the pattern of a routine activity such
as an interruption
• Knowledge-based
• Rule-based
– Conscious decision by the nurse to “workaround”
or take a shortcut, so the system defense
mechanisms are bypassed, thereby increasing risk
of harm to patient
To Err is Human: Building A Safer
Health System (IOM, 2000) (1 of 2)
• User-centered designs with functions that make
it hard or impossible to do the wrong thing
• Avoidance of reliance on memory by
standardizing and simplifying procedures
• Attending to work safety by addressing work
hours, workloads, and staffing ratios
• Avoidance of reliance on vigilance by using
alarms and checklists
To Err is Human: Building A Safer
Health System (IOM, 2000) (2 of 2)
• Training programs for interprofessional teams
• Involving patients in their care; anticipation of
the unexpected during organizational changes
• Design for recovery from errors
• Improvement of access to accurate, timely
information such as the use of decision-making
tools at the point of care
Crossing the Quality Chasm: A New
Health System for the 21st Century
(IOM, 2000)
• STEEEP
– Safe
– Timely
– Effective
– Efficient
– Equitable
– Patient-centered
• 10 rules for redesign
– Rule #6: Safety is a
system property
Keeping Patients Safe: Transforming the
Work Environment of Nurses
(IOM, 2004).
Patient safety is the cornerstone of high-quality healthcare services. In the presentation, A summary of the frameworks & practical approaches to improve safety of patient care.
NHS Improving Quality was invited to take part in a recently held event that celebrated the work that is being done in partnership between the Pennine Acute Hospitals NHS Trust and AQuA to deliver a Quality Improvement Methodologies Programme (QuIMP).
Gillian Phazey, Learning and Organisational Development Manager at Pennine Acute Hospitals NHS Trust explains:
'The Learning and Organisational Development and Governance teams at the Pennine Acute Hospitals NHS Trust have been working collaboratively with AQuA to deliver a Quality Improvement Methodologies Programme (QuIMP) to support staff in developing knowledge and skills in this topic. The programme has been specifically designed to support colleagues wanting to gain an introduction to the fundamentals and concepts of quality improvement. So far, two cohorts of staff, from clinical and non-clinical areas of the Trust have completed the programme, and have completed quality improvement projects in their own work area to apply their knowledge. On 17th July a celebration event was held for cohort 2 where staff presented their work in poster or presentation form, the aim of which is to share and spread learning across the Trust. Projects were wide ranging, from introducing new processes to reduce complaints and drug errors, to improving patient experience by implementing new tools and techniques. The day was a great success with the Chief Executive and Chief Nurse in attendance. The Trust is highly supportive of this approach in equipping staff with these important techniques, and the programme supports not only our internal quality agenda and objectives, but more widely responds to the recommendations of the Berwick report. The next cohort is starting in September this year.'
Fiona Thow, Patient Safety Collaborative Delivery Lead at NHS Improving Quality delivered a keynote speech, (link to presentation slides) providing a national perspective on the plans for improving patient safety and took the opportunity to introduce the national safety collaboratives. She also highlighted the need for organisations and individuals to think differently about safety for both patients and staff.
AHRQ pbrn webinar electronic health record functionality needed to better sup...Vince Pereira, MHA
Feb 28, 2014 presentation by AHRQ - "Electronic health record functionality needed to better support primary care: Joint Statement AAFP, AAP, ABFM, and NAPCRG"
As new payment models emerge that emphasize value over volume, providers are being compelled to look more closely at how to motivate patients—especially those with multiple chronic conditions—to actively manage their care, make better decisions and change behaviors. This editorial webinar will explore the relationships between engagement and improved health outcomes, greater patient satisfaction and better resource utilization. Our panel of experts will share proven strategies for building patients' confidence, disseminating self-management tools and making the best use of your care team.
iWantGreatCare's 7th National Symposium - Building fantastic staff morale, improving quality and reducing costs - took place on Tuesday 21st June at The King's Fund, London.
NHS leaders share their experiences of how they are building excellence in their Trust, reducing costs and growing staff morale by listening to the voice of the patient.
View the slides from these well-regarded delegates:
Alwen Williams, Chief Exective, Barts Health NHS Trust
David Behan, Chief Executive, Care Quality Commission
Dr Nadeem Moghal, Medical Director, Barking, Havering and Redbridge University Hospitals NHS Trust
Liz Mouland, Chief Nurse, First Community Health and Care
Jeremy Howick, clinical epidemiologist and philosopher
A joint presentation on Real People, Real Data at the 2016 International Forum on Quality and Safety in Healthcare in Gothenburg, Sweden. Presented by Leanne Wells of the Consumers Health Forum of Australia; Sam Vaillancourt of St. Michael’s Hospital, Toronto, Canada, and; Dr Paresh Dawda of the Australian National University.
Similar to Jeanette Ives Erickson: Influencing professional nursing practice (20)
Understanding NHS financial pressures: visual resourcesThe King's Fund
This slideset contains key visual elements from our report, Understanding NHS financial pressures: how are they affecting patient care? Please feel free to share and re-use these graphics with credit to The King's Fund.
Nine characteristics of good-quality care in district nursing taken from interviews with patients, carers and staff.
We hope this framework and these slides will be a useful resource for you – please feel free to use them in your work, in documents and presentations.
As part of a joint learning network on integrated housing, care and health, The King's Fund and the National Housing Federation have produced a set of slides illustrating the connections between housing, social care, health and wellbeing.
We hope they will be a useful resource for you – please feel free to use them in your office, in documents or presentations.
District councils’ contribution to public healthThe King's Fund
Our health is primarily determined by factors beyond just
health care. These slides illustrate the ways in which district
councils influence the health of local people through their key
functions and in their wider role supporting communities and
influencing other bodies.
The King’s Fund Events organise more than 20 health and social care events each year. Our highly-regarded conferences attract leading speakers from the government, the NHS, local authorities and the independent and voluntary sectors.
Jos de Blok set up Buurtzorg – which means ‘neighbourhood care’ in Dutch – with a team of four nurses. Today there are nearly 8,000 Buurtzorg nurses in 630 independent teams, caring for 60,000 patients a year. Nurses in Sweden, Norway, Japan and the United States are adopting the Buurtzorg model.
Our infographics highlight some key facts and figures around leadership vacancies in the NHS and some of the difficulties NHS organisations face in recruiting and retaining people for executive positions.
Sharing leadership with patients and users: a roundtable discussionThe King's Fund
‘What more is possible when patients, service users and those delivering services share the leadership task in health and social care?’
We held a roundtable discussion with patient leaders and organisational leads to discuss this question. Our slidepack summaries the conversations, including the opportunities and challenges for patient leaders, and where and how to start shared leadership working.
Making the case for public health interventionsThe King's Fund
In partnership with the Local Government Association, we have produced a set of infographics that describe key facts about the public health system and the return on investment for some public health interventions.
We hope they will be a useful resource for you – please feel free to use them in your office, in documents or presentations.
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Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Jeanette Ives Erickson: Influencing professional nursing practice
1. Leadership Influence on Professional
Nursing Practice and Quality of Care
Jeanette Ives Erickson, RN, DNP, FAAN
Chief Nurse and Senior Vice President for Patient Care
Massachusetts General Hospital
2. 2
Agenda
1. Articulate importance of a structure for clearly
understanding fundamental standards and measures of
compliance, accepted and embraced by the public and
healthcare professionals with rigorous and clear means
of enforcement.
2. Identify strategies for creating a culture for openness,
transparency and candor throughout the system.
3. Describe mechanisms to improve support for
compassionate, caring, and committed nursing.
4. Affirm significance of developing a strong patient-
centered healthcare leadership team.
5. Illustrate methods to collect, implement and utilize
accurate, useful, and relevant information.
5. MGH Death Spurs Review of Patient Monitors
Heart alarm was off, device issues spotlight a growing national problem
February 14, 2011|Liz Kowalczyk, Globe Staff
A Massachusetts General Hospital patient died last month after the alarm on
a heart monitor was inadvertently left off, delaying the response of nurses and
doctors to the patient’s medical crisis.
Hospital administrators said they immediately began an investigation, which led
them to inspect and disable the off switch on alarms on all 1,100 of Mass.
General’s heart monitors within a day of the death. The hospital also has
temporarily assigned a nurse in each unit to specifically listen for alarms, out of
concern that sometimes even functioning alarms can’t be heard over the din of a
busy ward.
Patient safety officials said the tragedy at Mass. General shines a spotlight on a
national problem with heart sensors and other ubiquitous patient monitoring
devices. Numerous deaths have been reported because alarms malfunctioned or
were turned off, ignored, or unheard.
5
6. MGH Sentinel Event
Event
• 90 year-old male surgical
patient with complete heart
block sent to CICU
• Plan for pacemaker in a few
days
• Transferred back to surgical
unit on a cardiac monitor
• Found in cardiac arrest
• Code Blue activated
• Patient expired
Post-Event
• RNs discovered monitor alarms were off
Filed safety report
Alerted leadership
• Monitors, pumps, etc… investigated
• Root cause analysis initiated
• Reported to Department of Public Health
• MGH launches Interdisciplinary
Physiologic Monitoring Tiger Team
Physiologic Monitoring Criteria
Physiologic Monitoring Assessment
Physiologic Monitoring Practice
Standards
6
7. 7
Professional Practice Model
• Provides a comprehensive view of the components of
professional practice and the contributions of all
disciplines engaged in patient care. The model reflects an
organizational commitment to teamwork in an effort to
facilitate optimal patient care.
MGH Patient Care Services
• Creates a practice setting that best supports professional
nursing practice and allows nurses to practice to their full
potential.
American Association of Colleges of Nursing, 2010
9. 9
Internal Evaluation: Staff Perceptions of the
Professional Practice Environment Survey
• Provides a report card for reflection and future direction
• Evaluates the effectiveness of the Professional Practice Model based
on eight professional practice environment (PPE) characteristics:
- autonomy
- control over practice
- clinician-physician relationships
- communication
- teamwork
- conflict management
- internal work motivation
- cultural sensitivity
• Identifies opportunities for improvement
• Trends data over time
10. 10
• Publications:
– Ives Erickson, J., Duffy, M.E., Gibbons, M.P., Fitzmaurice, J., Ditomassi, M.,
& Jones, D. (2004). Development and psychometric evaluation of the
professional practice environment (PPE) scale, Journal of Nursing
Scholarship, 3, 279-285
– Ives Erickson, J., Duffy, M.E., Ditomassi, M., & Jones, D. (2009).
Psychometric evaluation of the revised professional practice
environment (RPPE) scale. The Journal of Nursing Administration, 39(5),
236-243
• Translated into five languages; used in 18 countries
• Tool requested by over 105 institutions for evaluation or research
• Five-hospital study conducted
Since we Developed our Survey
11. 11
External Evaluation: Magnet Recognition
Empirical
Outcomes
Structural
Empowerment
Transformational
Leadership
Exemplary
Professional
Practice
New Knowledge
Innovations &
Improvement
12. 12
Just Culture
“The single greatest impediment to error prevention in
the medical industry is “that we punish people for
making mistakes.”
Dr. Lucian Leape
Professor, Harvard School of Public Health
Testimony before Congress on
Health Care Quality Improvement
“Did you commit this error on purpose? Then it’s my
fault – errors stem from systems flaws…I am
responsible for creating safe systems.”
Jeanette Ives Erickson, RN
Chief Nurse
Senior Vice President for Patient Care
Massachusetts General Hospital
13. 13
Just Culture
“People make errors, which lead to accidents. Accidents
lead to deaths. The problem is seldom the fault of the
individual; it is the fault of the system. Change the people
without changing the system and the problem will
continue.”
Don Norman
Author, the Design of Everyday Things
14. 14
Just Culture
1. Emphasizes quality and safety over blame and punishment.
2. Promotes a process where mistakes/errors do not result in
automatic punishment but a process to uncover the root cause of
the error.
3. Human errors that are not deliberate or malicious result in coaching,
counseling, and education to decrease the likelihood of a repeated
error.
4. Promotes increase error reporting that leads to system
improvements to create safer environments for patients and staff.
15. 15
Accountability for Behavior
HUMAN ERROR AT-RISK BEHAVIOR RECKLESS BEHAVIOR
Inadvertent action:
- slip, lapse, mistake
Manage through changes
in:
- Processes
- Procedures
- Training
- Design
- Environment
- Choices
A choice:
- risk not recognized or
believed justified
Manage through:
- Removing incentives
for at-risk behavior
- Creating incentives
for healthy behaviors
- Increasing situational
awareness
Conscious disregard of
unreasonable risk
Manage through:
- Punitive action
CONSOLE COACH RECKLESS BEHAVIOR
16. 16
Proactive Learning Culture
• Not seeing events as
things that are broken
and need to be fixed.
• Seeing events as
opportunities to improve
our understanding of risk
– System risk
– Behavior risk
17. 17
Weak
• Double checks
• Warnings
• Training
• New procedures
Intermediate
• Redundancy
• Increase staffing
• Checklists
• Standardize
communication tools
• Education
Strong
• Simplify processes
• Standardize equipment
and processes
• Force functions
• New devices with
usability testing
• Physical plant changes
• Tangible involvement
of leadership
18. 18
Professional Accountability
• There is a social contract between society and a
profession.
• Professions are the property of society and are responsible
to society.
• Professions acquire recognition and relevance from society.
• It is society that determines what professional skills and
knowledge are most needed and desired of a profession.
• Society grants professions authority over functions vital to
itself and allows for autonomy in the conduct of their own
affairs.
18
19. 19
Nursing Accountability
• Nursing is responsible to society.
• Nursing must be perceived as serving the interests of
society.
• Professions are therefore expected to act responsibly
and mindful of the public’s trust.
• Self-regulation assures high quality performance and is
the hallmark of a mature profession.
20. Nursing is:
The use of clinical judgment in the provision of care to enable
people to improve, maintain, or recover health to cope with
health problems, and to achieve the best possible quality of
life, whatever their distress or disability until death.
Royal College of Nursing
The protection, promotion, and optimization of health and
abilities, prevention of illness and injury, alleviation of
suffering through the diagnosis and treatment of human
response, and advocacy in the care of individuals, families,
communities, and populations.
American Nurses Association
20
21. 21
MGH Culture of Safety
• Edward P. Lawrence Center for Quality and Safety
• Just Culture embraced
• Robust safety reporting – over 19,000 reports filed in
2012
• Root cause analysis
• Safety Culture Perception Survey
• Model to address professional conduct issues
22. 22
Excellence Every Day
• Nursing Office of Quality and Safety
• Safety reporting structure, process, and outcomes for improvements
and follow up
• Quality
– Data driven
– Nurse-sensitive indicators
– Hospital-acquired conditions
– Audits, surveillance, and prevalence
– Quarterly Performance improvement plans
• Regulatory Compliance
• Magnet Recognition Program
• Service Excellence: Patient satisfaction
24. 24
• Care delivery should always be: patient and family-focused, evidence-
based, accountable and autonomous, coordinated and continuous.
• It’s important to know the patient.
• Inpatient and family care is provided by a designated nurse and
physician who are accountable and responsible for continuity of care.
• Continuity of the team is a basic precept.
• Every novice team member deserves mentoring from an experienced
clinician.
• Every patient deserves the opportunity to participate in the planning of
his/her care.
• Advancements in technology create opportunity for improved provider
communication and efficiency.
Guiding Principles
25. 25
Before During Post
Where Are There Opportunities to Reduce Costs Across These Processes of Care?
Admission
Process: ED,
Direct Admits,
Transfers
Patient Stay;
Direct Patient Care, Tests,
Treatments, Procedures,
Clinical Support,
Operational Support
Discharge
Process
Post
Discharge
Care
Preadmission
Care
Support Functions: Finance, Information Systems, HR
Goal: High-performing interdisciplinary teams that deliver safe, effective, timely,
efficient and equitable care that is patient and family centered.
“Patient Journey” Framework
26. Before During After
Admission
process: ED,
direct admits,
transfers
Patient stay; direct patient care;
tests; treatments; procedures;
clinical support;
operational support
Discharge
process
Post-
discharge
care
Pre-
admission
care
Intervention
Intervention
Intervention
Intervention
Innovations in Care Delivery
Patient Journey Framework
The Interventions
Relationship-based care
Increased accountability through the attending nurse role
Utilization of Evidence Based staffing and care delivery;
Utilization of the Hand-Over Rounding Checklist
•Enhance clinical data-
collection before admission
•Create Innovation Unit
Welcome Packet
•Engage Patients and
families in redesign
•Revise Domains of Practice
•Implement inter-disciplinary team rounds
•Install unit census and in room whiteboards
•Utilize communication devices
•Utilize wireless laptop computers
•Business cards
•Hourly rounding
•Quiet hours
•Implement Discharge
Follow-up Call Program
Goal: High-performing, inter-disciplinary teams that deliver safe, effective,
timely, efficient, and equitable care that is patient- and family-centered
26
27. 27
Relationship Based Care
• A model for transforming practice
• Three crucial relationships
– Care provider’s relationship with patients and families
– Care provider’s relationship with self
– Care provider’s relationship with colleagues
• Incorporates a formula for leading change with:
– Inspiration
– Infrastructure
– Education
– Evidence
– Bolstered by 5 Cs – clarity, competence, confidence,
collaboration, commitment
M. Koloroutis, 2004
28. 28
Relationship-Based Care
M. Koloroutis, 2004
Patient Safety is most effectively safe guarded when an
advocate (most often the nurse) in the health care system
knows the patient, family, and what matters most to them.
29. 29
Attending Nurse Role
Responsible Nurse/Attending Nurse
Expand staff nurse role
• Accountable for patient/family continuity and progression along the
developed overall plan of care from admission to discharge
• Ensures, along with the Attending MD, that patient care meets the unit’s
clinical standards and vision of patient- and family-centered care
• Develops and revises the patient care goals with the clinical care team
daily
• Coordinates meetings with clinicians for timely decision making and
connects nurses to optimize handoffs across the continuum
• Is the primary bedside communicator with the patient and family,
discussing plan of the day, care progress, potential discharge, and
answers questions/teaches/coaches
30. Throughput and Efficiency
LOS
TSI bud/flex
Wait time for bed to be ready
Admits
Medication turnaround time
Patient & Staff Satisfaction
MD & RN Communication
Responsiveness
Cleanliness
Noise reduction
Staff perception of support
Equitable care
Quality and Safety
Unplanned Return to OR
Readmission Rate
Restraint Free Rate
Falls/Pressure Ulcer Reduction
Foley Catheter Days
Hard-stop Time Out Performance
Innovation Unit Dashboard (Excerpts)
Ellison17 Ellison18
QUALITY AND SAFETY
Patient-Centered Outcome Measures
Falls per 1,000 Patient Days
Total Fall Rate 4.50 1.46 4.95 0.77 1.92 1.32 2.16 1.79 TBD 0.65 4.85 0.45
Observed (N) 11 3 13 1 2 2 5 2 2 10 1
Falls with Injuryper 1,000 Patient Days
Falls with InjuryRate 0.41 0.49 1.52 0.00 0.96 0.00 0.00 0.89 TBD 0.00 1.45 0.45
Observed (N) 1 1 4 0 1 0 0 1 0 3 1
Hospital Acquired (HA) Pressure Ulcers
Total HAPressure Ulcer Prevalence Rate 0.0% 0.0% 6.9% 0.0% 0.0% 0.0% 0.0% 7.7% TBD NA 4.8% 4.2%
Observed (N) 0 0 2 0 0 0 0 1 1 1
Hospital Acquired (HA) Pressure Ulcers Type II or G
Total HAPressure Ulcer Type II or Greater Prevale 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 7.7% TBD NA 4.8% 4.2%
Observed (N) 0 0 0 0 0 0 0 1 1 1
Restraints
Total Restraint Prevalence Rate 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 7.7% TBD NA 0.0% 0.0%
Observed (N) 0 0 0 0 0 0 0 1 0 0
Peripheral Intravenous (PIV) Infiltrations - Pediatric/
Total PIV Infiltration Prevalence NA NA NA 0.0% 0.0% 0.0% NA NA NA NA NA NA
Observed (N) 0 0 0
Central Line-associated Bloodstream Infections per 1,000 Line Days (CLABSI)
Total CLABSI Rate 6.54 NA 1.36 2.90 4.76 0.00 1.10 1.70 TBD NA 0.00 0.00
Observed (N) 1 1 1 1 0 1 2 0 0
Note:metricstobereportedbeginningFY2012 ColorShadingrelativetoBenchmark:
Catheter-associatedUrinaryTractInfectionsper1,000DeviceDays
Ventilator-associatedPneumoniaper1,000VentDays
MassachusettsGeneralHospital-PCSInnovationUnitsDashboard
Rateisbetter(lower)thanbenchmark.
Rateisworse(higher)thanbenchmark.
Vascular
Bigelow14
Obstetrics
Blake13
ICU
Blake12
NICU
Blake10
CICU
Ellison9
Measures
Ortho
White6
Oncology
Lunder9
Medicine
Ellison16
Pediatrics Surgery
White7
Psych
Blake11
Innovation Unit Dashboard
July – September 2011
30
31. 31
A Strong Safety Culture
1. Creates a learning culture
• Foundation of patient safety
2. Creates an open, fair and just culture
• Encourage reporting
• Reinforce accountability for safety at all levels
3. Designs safe systems
• Systems have the greatest influence on patient safety
4. Manages behavioral choices
• Critical thinking and decision making emphasizes the
continuous evaluation of risk
• Choices lead to desired safety outcomes
33. References
• Agency for Healthcare Quality and Research (2013). Retrieved on
April 27,2013 at http://psnet.ahrq.gov/primer.aspx?primerID=5
• Gosbee, J. (2012). Assessing the strength of healthcare facility
improvement actions. Massachusetts Board of Registration in
Medicine Quality and Patient Safety. Retrieved from:
www.patientsafety.gov
• Just Culture (2013). Retrieved on April 27, 2013 at
https://www.justculture.org/
• Koloroutis, M. (Ed.) (2004). Relationship-based Care: A model for
transformational practice. Minneapolis, MN: Creative Healthcare
Management Inc.