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Building on Strength: Blending TCAB and QSEN

Building on Strength: Blending TCAB and QSEN. Our Team. Deborah Struth, MSN, RN Cheryl Carr, MSN, RN, CNE Wendeline Grbach, MSN, RN, CCRN, CNLC Alex Saladino, PhD Linda Kmetz, PhD, RN. A Wonderful Opportunity…. Doesn’t mean there won’t be Challenges. TCAB Academic Partners – The Faculty

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Building on Strength: Blending TCAB and QSEN

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  1. Building on Strength: Blending TCAB and QSEN

  2. Our Team • Deborah Struth, MSN, RN • Cheryl Carr, MSN, RN, CNE • Wendeline Grbach, MSN, RN, CCRN, CNLC • Alex Saladino, PhD • Linda Kmetz, PhD, RN

  3. A Wonderful Opportunity….. Doesn’t mean there won’t be Challenges

  4. TCAB Academic Partners – The Faculty Team Facilitator: Patricia Chiverton, EdD, RN, FANP Dean, University of Rochester School of Nursing

  5. UPMC Shadyside’s Faculty Transformational Journey • TCAB Team • Faculty Retreat • Test of Change Methodology in Curriculum • Deep Dive • Faculty Vitality Survey UPMC Shadyside School of Nursing

  6. Patient Safety Objectives Addressed through the ACGME Prism • The resident will be able to : • Recognize and understand team behaviors that strengthen/weaken patient safety. • Incorporate effective team behaviors into their practices. • Identify errors in their practices, analyze them and learn from them. • Develop system-based strategies to prevent recurrence of errors. • Recognize and understand communication behaviors that strengthen/weaken patient safety. • Incorporate effective communication behaviors into their practices. • Provide appropriate disclosure to patients when errors occur.

  7. QSEN • Assumptions • Each competency is broad and contains elements of the others Patient-centered care Safety Teamwork/collaboration Informatics Quality improvement Evidence-based practice UPMC Shadyside School of Nursing

  8. Example: Teamwork and CollaborationFunction effectively within nursing and inter-professional teams, fostering open communication, mutual respect and shared decision-making to achieve quality patient care. UPMC Shadyside School of Nursing

  9. Example: SafetyMinimizes risk of harm to patients and providers through both system effectiveness and individual performance. UPMC Shadyside School of Nursing

  10. Transforming Care at the Bedside (TCAB) Patient Centered Care Value Adding Vitality and Teamwork Safety and Reliability Transformational Leadership Quality and Safety Education for Nurses (QSEN) Safety Patient-centered care Teamwork/collaboration Informatics Quality improvement Evidence-based practice Blending:

  11. TCAB: • “While there were a wide range of changes being tested, sustained, and spread in participating hospitals, participants repeatedly emphasized in our interviews that the change in unit culture and engagement of front line staff in improvement activities were central to their TCAB experience…no single innovation made a difference. Rather it was the process of TCAB, that made a difference.” Jack Needleman, PhD, FAAN

  12. Initial Areas of Program Development • Incorporation of Crew Resource Management principles • Investigation of clinical education utilizing WorkSampling Methodology of faculty and students • Curricular additions of Human Patient Simulation • Incorporation of teamwork and safety utilizingTeamSTEPPS curriculum UPMC Shadyside School of Nursing

  13. N101: Introduction to Professional Nursing Teaching Activities • Relationship-Based Care introduced and integrated throughout course • Lab: Hospital of the Future: emphasizes need for effective communication, teamwork, rapid response, a caring and healing environment, and TCAB initiatives Relationship-Based Care: A Model for Transforming Practice Creative Health Care Management. Koloroutis, Mary, (2004). UPMC Shadyside School of Nursing

  14. N102: Introduction to Nursing Practice Strategies Teaching Activities • SBAR-R • 60 Second “Situational Assessment” • High-fidelity Patient Simulation UPMC Shadyside School of Nursing

  15. “60 Second” Situational Assessment Tool UPMC Shadyside School of Nursing

  16. SBAR-R UPMC Shadyside School of Nursing

  17. N300:Nursing Practice StrategiesPediatrics/Obstetrics/Mental Health/Critical Care • Eight-hour day high-fidelity high risk simulation experiences every 8 weeks • Student and faculty members utilize SBAR-R for communication pathways throughout the scenarios • Pre- and post-test evaluations related to problem-based scenario with improvements noted UPMC Shadyside School of Nursing

  18. N400: Professional Role Transitions Teaching Activities • Student driven test of change projects designed to identify practice system vulnerabilities which impact patient safety and develop action plans for best practice solutions • Students utilize SBAR-R when collaborating with healthcare team members • Students perform open chart audits to identify patient risk using Global Triggers tool UPMC Shadyside School of Nursing

  19. N200 Level Courses: PDA Time Study • Goal: Redesign of Clinical Education into Structured Standardized Clinical Education Curricula • PI Methodology • Collect data regarding current process – TCAB • Validate assumptions – TCAB Observation Process • Involve workers in redesign • Prototype: Rapid Cycle Tests of Change • Adopt, Adapt or Abandon

  20. Definitions • TCAB: All care processes are free of waste and promote continuous flow – Muda • Value added nursing care • Necessary but not necessarily value added • Non-value added nursing care

  21. What the study is… • A form of work/self sampling designed to give minutes back to the clinical instructor and the student • Using the latest technology, adapted for the education environment.

  22. What is getting in the way? • Barriers • Work around • Broken processes • Time eaters

  23. Faculty Engagement • Presented study idea at Nursing 200 (Medical Surgical Nursing) Faculty Retreat

  24. Time Study Features • Easy to use interface redesigned for education • Study is conducted with minimal distraction • Detailed category list developed by instructors • Over 80 hospitals currently using for RN studies • Statistical software automatically provides analysis-in the form of pie charts, stack charts, pareto charts and tabular output • Original program designed for IHI TCAB initiatives

  25. Randomly Selected Clinical Instructors and Students

  26. Methodology • Each week, 2 random faculty and 2 random students carry a PDA to their clinical site. • 8 hour day on Wednesday and Thursday • The PDAs are returned to the school for downloading of data and subsequent “turnaround” to the next 4 people carrying them. • System analyst assists in organizing the data into graphs and pareto charts.

  27. Data Points • Approximately 10-14 data points are captured in an 8 hour clinical day • Goal – 300 data points/semester

  28. How Student Nurses Spend their time on Medical-Surgical Units: Work Sampling through 060608

  29. The Redesign: • Improvement Specialists to observe and clarify PDA data. • Situational Assessment adapted to meet clinical judgment expectations of the student nurse in the medical-surgical environment. • Dissemination • Redistributing clinical unit based hours to simulation center • N200 level team to design idealized medical-surgical clinical curricula, incorporating QSEN competencies

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