1) Quality and safety in healthcare aims to minimize risks of harm to patients through effective systems and individual performance. Common medical errors include medication errors, wrong-site surgeries, and misdiagnoses.
2) QSEN seeks to prepare nurses with competencies in patient-centered care, teamwork, evidence-based practice, quality improvement, safety, and informatics to continuously improve healthcare quality and safety.
3) Providing high-quality, patient-centered care requires effective communication, collaboration, and shared decision-making among healthcare team members and with patients and their families.
Definition: Patient-Centered Care
Definition Patient-centered care (patient centred care): “Is a model in which providers partner with families to identify and satisfy the full range of patient needs and preferences.”
To expand this definition, patient-centered care is dependent on the involvement of the staff and care team as well.
“To succeed, a patient-centered approach must also address the staff experience as staff’s ability and inclination to effectively care for patients is unquestionably compromised if they do not feel care for themselves" (Picker Institute).
Researchers from Harvard Medical School, on behalf of Picker Institute and The Commonwealth Fund, defined seven primary dimensions of patient-centered care model.
These factors are identified as:
Respect for patients’ values, preferences and expressed needs
Coordination and integration of care
Information, communication and education
Physical comfort
Emotional support and alleviation of fear and anxiety
Involvement of family and friends
Transition and continuity
This presentation highlights challenges facing the future of education in general and nursing education in particular. Listed are strategies to prepare for future health care. Of note are details of events occuring internationally which impact on higher education.
Definition: Patient-Centered Care
Definition Patient-centered care (patient centred care): “Is a model in which providers partner with families to identify and satisfy the full range of patient needs and preferences.”
To expand this definition, patient-centered care is dependent on the involvement of the staff and care team as well.
“To succeed, a patient-centered approach must also address the staff experience as staff’s ability and inclination to effectively care for patients is unquestionably compromised if they do not feel care for themselves" (Picker Institute).
Researchers from Harvard Medical School, on behalf of Picker Institute and The Commonwealth Fund, defined seven primary dimensions of patient-centered care model.
These factors are identified as:
Respect for patients’ values, preferences and expressed needs
Coordination and integration of care
Information, communication and education
Physical comfort
Emotional support and alleviation of fear and anxiety
Involvement of family and friends
Transition and continuity
This presentation highlights challenges facing the future of education in general and nursing education in particular. Listed are strategies to prepare for future health care. Of note are details of events occuring internationally which impact on higher education.
Holistic healthcare is complete or total patient care that considers the physical, emotional, social, economic, and spiritual needs of the person, his or her response to illness and the effect of the illness on the ability to meet self-care needs.
Holistic healthcare is complete or total patient care that considers the physical, emotional, social, economic, and spiritual needs of the person, his or her response to illness and the effect of the illness on the ability to meet self-care needs.
Enhancing Quality of Care: The Role of Case Management in a Value-Based Healt...Conference Panel
Case management is a critical component of healthcare that has not always been fully recognized for its potential to enhance patient and provider satisfaction, quality of care, and cost containment. However, in today's healthcare landscape, with Value-Based Purchasing holding providers, health systems, and other professionals accountable for the quality and efficiency of their work, case managers have a unique opportunity to demonstrate the value they bring to patients, healthcare teams, and payers.
In this upcoming webinar, Anne Llewellyn will discuss practical strategies for case managers to leverage data and outcomes to illustrate the significant impact they can make in the complex and ever-changing healthcare system. By showcasing the results of their work, case managers can prove their worth and demonstrate how they can contribute to achieving the goals of Value-Based Purchasing, including improved patient outcomes, higher satisfaction rates, and reduced costs. Don't miss this opportunity to learn how case management can help drive success in a value-based healthcare system!
Register Now,
https://conferencepanel.com/conference/demonstrating-the-role-of-case-management-in-a-value-based-healthcare-system
The challenges faced by nursing administrators are many and varies. An overview of such challenges will be helpful in working towards the managerial solutions.
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.
Quality is
degree to which health services for individuals and populations increase the likelihood of desired health outcomes (quality principles),are consistent with current professional knowledge (professional competency),and meet the expectations of healthcare users (the marketplace)
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 Activation for Quality: Identifying Champions and Developing ExpertsAdam Thompson
A presentation aimed at supporting organizations in identifying patients for involvement in quality management activities and identification of needed capacities for meaningful involvement.
This presentation was used for the Ryan White Part B Quality Management Committee to support more effective recruitment of patients for quality management activities
Patient engagement is a critical element of successful transitions of care. Without it, patients are improperly educated about their condition and inadequately prepared to self-manage.
Healthcare organizations need effective and scalable ways of engaging patients post-discharge.
Patient, carer & public involvement in clinical guidelines: the NICE experienceGuíaSalud
Presentación de Victoria Thomas, Associate Director, Patient & Public Involvement Programme de NICE, sobre la participación de pacientes, ciudadanos y público en general en el desarrollo de guías de práctica clínica del NICE. Ponencia realizada en la Jornada Científica GuíaSalud 2010 "La participación de los pacientes en las Guías de Práctica Clínica".
2. 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
3. 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
4. What is Quality Care?
Safe
• S
• T Timely
• E
Efficient
• E
• E Equitable
• P
Effective
Patient/Family Centered
Care
5. 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
7. Definition
• Function effectively
within the team to
achieve quality
patient care
– Open
communication
– Mutual respect
– Shared decision
making
8. Key Message
• Safe, effective,
satisfying patient
care requires:
– teamwork,
– collaboration
– communication
• among all team
members
Patient and Family are Members of the Team!
9. 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.
10. Collaboration is….
• Joint decision making among
independent parties
– involving joint ownership of decisions
– collective responsibility for outcomes
Working Across Professional Boundaries.
11. 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.
12. 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?
13. 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
14. 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
16. Safety Definition:
Minimizes risk of harm to patients and
providers 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
17. You Tube Safety Video
• http://www.youtube.com/watch?v=u49
BME17ED0&feature=related
18. 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
20. Informatics Definitions
• Use information
and technology to
communicate, man
age
knowledge, mitigate
error, and support
decision making
21. 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
22. Points to remember:
• What is my
responsibility?
– Timely, accurate
data collection
– Timely, complete
documentation
– No falsification of
information
23. 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
24.
25. 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
26. Key message
•The patient and
family are in a
partnered relationship
with their health care
providers and are
equipped with
relevant information,
resources, access
and support to fully
engage in and/or
direct the health care
experience as they
choose.
27. Institute of Medicine (IOM)
States patient-centered care “is
providing care that is respectful of and
responsive to individual patient
preferences, needs, and values and
ensuring that patient values guide all
clinical decisions”
28. It is not……
•Patient focused care:
The patient/family
may be involved, but
the health care
provider retains
control over decision-
making, patient needs
and preferences may
or may not be
sought, and rarely
drive care decisions
29. 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.
30. 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
31. 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
32. 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
33. Competency
To 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
36. Quality Improvement
Definition: Use of
data to monitor the
outcomes of care
processes and use of
improvement
methods to design
and test changes to
continuously improve
the quality and safety
of healthcare systems
(Cronenwett et al, 2007)
37. 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.
38. 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.
39. Problem: Patient with a
fractured hip who developed a
sacral decubiti
A 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
40. 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
41. 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
42. Skills necessary
• Teach turning and positioning for the
post-op hip patient
• Reinforce the skills necessary when
using the specialty beds
43. Attitudes
• Appreciate the cost of treating a
hospital acquired skin breakdown.
• Recognize the value of preventative
steps.
44. 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
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