gerry altmiller, edd, aprn, acns-bc, anef, faan
TRANSCRIPT
Gerry Altmiller, EdD, APRN, ACNS-BC, ANEF, FAAN
Presenter has no conflict
of interest
Health professions education: A bridge to quality(2003)
IOM; Now National Academy of Medicine
QSEN
Funded by Robert Wood Johnson Foundation
Focused on transforming basic education for nurses
Reflects a new identity for nurses that demonstrates knowledge, skills and attitudes that emphasize quality and safety in patient care
Relevance to Nursing Education and Clinical Practice
Pre-licensure Education/Accreditation
Baccalaureate Essentials /Master’s Essentials
Transition to Practice Programs/Continuing Education
QSEN Competencies
The QSEN Opportunity
Current Language
that aligns with
practice
QSEN aligns with
The Joint
Commission and
Magnet® Standards
Identify knowledge, skills, and attitudes that emphasize the QSEN competencies.
Demonstrate strategies that can be integrated into classroom or clinical teaching to support behaviors consistent with the QSEN competencies.
Discuss resources to support educational strategies aimed at quality improvement, patient safety, and systems effectiveness to promote student learning in classroom and clinical teaching.
Objectives
©Altmiller
Introduce all competencies early in
curriculum
• Support development of curricular threads
• Emphasis on both individual patients and
systems should occur throughout the
curriculum
Barton, A., Armstrong, G., Preheim, G., Gelmon, S.B., & Andrus, L.C. (2009). A national
delphi to determine developmental progression of quality and safety competencies in
nursing education. Nursing Outlook , 57, 313-322.
Leveling the KSAs
Basic Training for
Students, Nurses, All Providers
http://www.ihi.org
Basic Quality and
Safety Certificate
with completion of
13 modules
At TCNJ
Article in Nurse Educator September 2018
Patient is in control and a full partner; care is
based on respect for patient’s preferences, values,
and needs.
(Offer more control, choice, self-efficacy, individualization of care)
What does patient-centered care really mean?
Don Berwick
Consider patient’s cultural preferences
Picker Institute Resources: http://www.ipfcc.org/
Patient-centered Care
Keeping the focus on the patient
White board initiatives for patient goals
Value added nursing care (rounding)
Non-value added nursing care (waiting for assistance,
delays, looking for supplies)
Necessary but non-value added nursing care
(medication preparation, documentation)
Patient-centered Care
©Altmiller
Seeing through the patient’s eyes
The Immigrant
https://www.youtube.com/watch?v=B_SfRXKgpaI
Promote relationship building with patients
Solving problems at the point of care
Involve patient in all we do
Situational Awareness
Rapid response teams to avoid codes on Med-Surg units
Personal accountability in all we do
Reducing admission rates
Helping nurses obtain new skill sets
Medication Reconciliation
Patient-centered Care
Patient-centered Care
Medication Reconciliation
Medication Reconciliation
Exercise
Bob is a 55-year old business man in the Emergency Room for complaints of shortness of breath, headache, & generalized pitting edema. Bob was recently diagnosed with congestive heart failure. His current vital signs are: HR 62, BP 115/85, RR 30, O2 Sat 90%, Temp 98. He has no known drug allergies. He is awake, oriented and talkative, but only offers information if asked directly.
Medication Reconciliation
Exercise
When asked about his medications, Bob
states he takes a ‘water pill’ irregularly because
of its effects during work. (He believes this
medication begins with an L.) He also takes
Digoxin, a blood pressure medication (Meta-
something) prescribed years ago by another
health care provider. He uses an inhaler
(which he shows to you and you see it is
Albuterol) & takes a multi-vitamin.
Medication Reconciliation
Exercise
• At this point, what are you worried about in planning care for Bob?
• What other information do you need?
• What questions would you ask Bob to obtain this information?
Medication Reconciliation
ExerciseFollowing further discussion with Bob, he reluctantly
admits:
• He has Gout and takes colchicine.
• He drinks ‘occasionally’ (1 drink at lunch, 2 after work, and 1 before bed.) Last drink was last night around 9 pm
• He ‘occasionally’ uses cocaine – last time 3 days ago.
• Last night he also took cialis he obtained from a friend. He experienced substernal chest pain during intercourse so he took Aspirin and Mylanta. Neither helped so he took a Nitroglycerin. He went to bed and awoke this am with a headache and shortness of breath.
Medication Reconciliation
Exercise
• At this point, what are you worried about in planning care for Bob?
• What actions will you take as Bob’s nurse?
• Is there other information you still need?
• How will you obtain, communicate, and record this information?
Medication Reconciliation
What do we now know?
✓ Bob has 3 medication interactions & needs education
✓ Metoprolol, Nitroglycerin & Cialis together ↓ BP
✓ Magnesium in Mylanta inactivates effects of Digoxin
✓ Aspirin & colchicine bind together preventing uric acid from being excreted by the kidneys
✓ Taking Lasix inconsistently affects recidivism (relapse)
✓ Patient education should include diagnosis & medical management, Medication actions/side effects, the importance of medication reconciliation with primary physician along with his role with patient safety
Medication Reconciliation
Exercise
As you reflect on Bob’s
case, list all the potential
errors providers could make
if they did not know Bob’s
story and have a list of
Bob’s current medications.
Courtesy of:
Judy Young, RN, Elizabeth Burgess, BSN , and
Pam Ironside, PhD, RN, FAAN
Indiana University School of Nursing
Medication List
for Clinical
Experience
Nurse Educator Article2018
Achieve quality patient outcomes by effectively communicating with nurses and inter-professional teams having mutual respect and shared decision
making.
Teams provide a safety net for individuals
An individual, no matter how professional or experienced, can never be as reliable as a team Nance 2008
http://www.youtube.com/watch?v=Ip8vOqZ_o2ILucian Leape-The Mistake
Teamwork and
Collaboration
What does a healthy team
look like?
Synergistic result of effective interdisciplinary
collaboration
System-based solutions for Safe hand-offs
Acknowledging other team members contributions
Ability to raise concerns; Assertion
CUS (concerned, uncomfortable, safety)
2 challenge rule
Critical Language “I need some clarity.”
Teamwork and
Collaboration
Safety Strategy Tools
Two-Challenge Rule
Safety Strategy Tools
Cross Monitoring Works as a safety net for
individual performance
Members monitor each
other and are able to give
immediate feedback
http://www.ahrq.gov/professionals/education/curriculum-
tools/teamstepps/instructor/videos/ts_ldcrossmon/crossMo
nitorIntern.html
Safety Strategy Tools
Check-back Redundant checks
http://www.ahrq.gov/professionals/education/curriculum-
tools/teamstepps/instructor/videos/ts_checkback/checkback.html
Teamwork and
Collaboration
Effective Standardized
Communication
SBAR
Situation
Background
Assessment
Recommendation
Leadership during high stress team efforts
Pre-briefing
Usually conducted by team leader, reviews plan with team before
beginning.
Debriefing
Feedback whether positive (reinforcing) or negative (corrective) should
always be an unbiased reflection of events and open the door to
discussion of evidence-based practice
TeamSTEPPS Tools and Videos
http://www.ahrq.gov/professionals/education/curriculum-
tools/teamstepps/instructor/videos/index.html
Teamwork and
Collaboration
Example from Class:
Safety Strategies Applied for
Hypocalcemia post
thyroidectomy
Outcome without safety
strategies
http://www.ahrq.gov/prof
essionals/education/curric
ulum-
tools/teamstepps/instructo
r/videos/ts_vig003a/vig00
3a.html
Improved outcome with
safety strategies
http://www.ahrq.gov/prof
essionals/education/curric
ulum-
tools/teamstepps/instructo
r/videos/ts_vig003b/vig00
3b.html
©Altmiller
Think about a situation/conversation where there was
conflict that impacted patient safety-tell the story.
Exercise
Stops the automatic emotional response
Responding-not reacting
Rehearsed direct responses
I see from your expression there is something…….
I learn most from people who communicate directly..
When things are different from what I learned…..
It is my understanding that there was more information…….
I don’t feel right talking about this….
I don’t feel right talking about him/her….
Griffin, 2004
Strategy:
Cognitive Rehearsal
©Altmiller
Strategy: Using Safety
Language
CUS-Concerned, Uncomfortable, Safety
To advocate for patient
To advocate for self
Two Challenge Rule
Use of Critical Language “I need some clarity.”
SBAR Framework
Reflection
What went well?
What could have gone better?
What could I have done differently?
Strategy: De-escalation
Building Practice Setting Skills
Continue to Develop communication skills
Civility techniques
De-escalation-maintain civility in the face of incivility
Active Listening, discretion
Focus on patient needs-not power struggle
Deliver constructive feedback effectively
Emphasize as opportunity to learn; improve
See from patient’s viewpoint
Retell your story Reframe situation/conversation using:
Cognitive Rehearsal
Safety Strategies
De-escalation
Exercise
©altmiller
The surgery was a planned caesarian section. Delivery of the baby via C-section was uncomplicated; until it was time to close the patient. The attending had left the OR and let the fellow and resident take over the case. The circulating nurse informed the doctors that a pad was missing. The fellow and resident were very sure of themselves and insisted that the nurse had counted wrong and went on and closed the patient up. Two days later the patient became hypotensive, febrile and complained of sharp abdominal pain. A flat plate of the abdomen revealed a foreign object left inside of her. The circulating nurse should have spoken up using CUS with the doctors by stating, "I'm concerned, I'm uncomfortable and closing her up without accounting for the missing pad is unsafe." The two-challenge rule should have also been invoked when the initial concern was ignored. The nurse should have voiced her concern twice to ensure that she was being heard. The doctors should have acknowledged her challenge and asked the nurse to perform another pad count with another nurse or with one of them. Once the pad count was off the second time, the doctors should not have closed the patient and began searching the body cavity for the missing pad. Although it might be intimidating for new nurses, we must learn to speak up and ensure the safety for everyone we provide care for! Our ultimate goal as a nurse is to advocate for our patients and improve the quality of care for our patients.
Example
Managing Challenging Communications
http://qsen.org/teamwork-and-collaboration-teaching-
strategies-to-manage-challenging-communications/
Teaching strategy for reframing our
stories
Teamwork and
Collaboration
Teamwork: When to Lead; When to Follow
http://www.youtube.com/watch?v=fW8amMCVAJQ
Teamwork and
Collaboration
A nurse is worried about the safety of a patient’s
medication dose. In approaching the physician to address
it, which communication strategy would be most
appropriate in this situation to advocate for the safety of
the patient?
a. Two-challenge rule
b. CUS
c. Critical language
d. SBAR
Evaluating
Comprehension
Integrate best current evidence, clinical expertise, and patient preferences and values to deliver optimal health
care.
Reduce Variability through evidence
Integration of Standards
“It’s less of a thing to do…and more of a way to be”
Handwashing
Proper hygiene for in and out of room
Pressure injury prevention
Ventilator associated pneumonia prevention
Influenza/pneumococcal disease prevention
Evidence Based Practice
Translate new knowledge into practice
Provide guidance in weighing evidence
On-line tutorial of how to search from NIH
https://www.nlm.nih.gov/bsd/disted/pubmedtutorial/cover.html
Share the evidence that links studies to optimum clinical
outcomes and business results
Help students understand that data drives practice
Evidence Based Practice
Evidence Based Practice
Identify those at risk for infection
Bundles and protocols http://www.ihi.org/resources/Pages/Changes/ChangestoPreventHAIs.aspx
Activity
Group work to make posters that highlight an assigned bundle:
CAUTI
CLABSI
VAP
SSI
MRSA
Nurse Educator 2019 Article
Which describes care bundles? Select all that apply
1. A structured way of improving the process of care
2. A structured way of improving patient outcomes
3. A set of evidence-based practices that must be performed
individually based on patient preferences
4. A set of evidence-based practices that must be performed
collectively
5. A set of evidence-based practices that must be followed
for every patient, every single time
Evaluating
Comprehension
IHI Open School
TA 101 The Triple Aim for Populations (Improving experience, improving health of populations, reducing costs)
PS X1 Partnering to Heal: Teaming up Against HAI
PS X2 Preventing Pressure Ulcers
Need to Move from Treating
Disease to Creating Health
Monitor outcomes of care processes and use
improvement methods to design and test
changes to improve the health care system.
Culture of Safety-Just Culture
Report errors/adverse events/near misses
Systematic investigations of problems
Safe to ask for help
Staff ideas to improve safety welcomed
Quality Improvement (QI)
Continuous
Improvement
Health care professionals have two
interdependent roles: doing the work and
improving the work. Scoville, et al, 2016
In health care professions:
I not only have to do my job, but always be focused on how I can do my job better.
https://www.youtube.com/watch?v=jq52ZjMzqyI
How does Research and
EBP connect to Quality
Improvement and Safety?
System wide transformation
IHI Open School Quality Improvement 101-106
9 contact hrs
Look at waste and variation and eliminate it
Identify where to make changes in the system
Tools and Strategies for Quality Improvement and
Patient Safety -
http://www.ncbi.nlm.nih.gov/books/NBK2682
Quality Improvement (QI)
Engage Nurses and Students
Familiarity with Nurse Sensitive Indicators
Indicators
NDNQI Pressure Ulcer Training
https://members.nursingquality.org/NDNQIPressureUlcerTrai
ning/
Patient Safety-TJC Targeted Solutions
http://www.centerfortransforminghealthcare.org/projects/detai
l.aspx?Project=6
Quality Improvement (QI)
Quality Improvement
PDSA (Plan, Do, Study, Act) What are we trying to accomplish?
How will we know that a change is an improvement?
What changes can we make that will result in improvement?
Student Assignment using Model for Improvement
Improve something about themselves, their school…..
Presentation of data:
Describe Aim
PDSA (Plan, make the change, test it, study it, adjust actions)
Use of Tools (flow charts, check sheets, run charts, bar graphs)
IHI Toolkit for Reporting Data
Grading Rubric
Intro to Nursing
Student’s Results
QSEN Competency Based
Clinical Evaluations
Fundamentals to
Acute Care
Evaluation Instrument
Statistics
Link: https://qsen.tcnj.edu/resources/
Nicholls State
http://qsen.org/clinical-performance-evaluation-
tools-utilizing-the-qsen-competencies/
Western University of Health Sciences
http://qsen.org/clinical-evaluation-tools-integrating-
qsen-core-competencies-and-aacn-bsn-essentials/
University of Massachusetts
http://qsen.org/integrating-qsen-into-clinical-
evaluation-tools/
Other QSEN-Based
Evaluations
Quality
Improvement
Create a
Newsletter
A nurse is leading a quality improvement initiative on the unit
using the PDSA model to improve communication between
the nurses and respiratory therapists. The nurse implemented
the use of a communication log to be used by both disciplines.
Now, one month later the nurse analyses the data, compares
results to predictions and summarizes what was learned.
Which part of the PDSA cycle does this represent?
a. Plan
b. Do
c. Study
d. Act
Evaluating
Comprehension
Minimize risk of harm to patients and providers through
both system effectiveness and individual performance.
IHI Open School Patient Safety 100-106 8.25 contact hrs
Two patient identifiers
Patient armbands where standardized
Correct surgery/Correct site
Medication reconciliation
Standardization of medications
Identify Work-arounds
Time outs
Huddles
Rapid Response Teams
Safety
One Minute Safety
Checklist
Used for clinical
setting
Helps students
prioritize safety
concerns
Safety
•Provide learning opportunities to identify errors in a
safe environment
•Speak the language of quality and safety
AHRQ Glossary https://psnet.ahrq.gov/glossary
•Resources for patient safety informationhttps://www.jointcommission.org/topics/patient_safety.aspx
•Patient Safety Primers
https://psnet.ahrq.gov/primers
Error Prevention
“The single greatest impediment to error
prevention is that we punish people for making
mistakes.” -Lucian Leape
Need to implement non-
punitive responses
to errors
Human Error
• Slips; lapses; forgetfulness
• Distracted
Negligent Behavior
• Doesn’t recognize risk
• Reasonable expectations not met; lacks knowledge, skill, or caring attitude
Reckless Behavior
• Conscious disregard for rules and expectations
• Participates in dangerous situation
Intentional Violations
• Risky behavior
• Causes intentional harm
Error: Someone does
something other than
what should have been doneMarx, 2001
Dr. Jones is a cardiovascular surgeon. He wants to use a new renal artery device that is not yet supplied in the OR. He asks the sales rep to bring some tomorrow for his scheduled case.
The next day, Jane, just off orientation, is the circulating nurse. She is asked where the stent is. Not knowing the plan, she is unable to answer and Dr. Jones insinuates she doesn’t know how to do her job.
Just as the case is beginning, the sales rep brings the stent to the OR. Feeling rushed and stressed, Jane opens the packaging and drops the stent into the sterile field and it is inserted. Following the surgery, the circulating nurse realizes the packaging indicates an expired date on the stent.
The stent delivery by the sales rep was not vetted through central supply. The patient is told about the error. Who is to blame?
Promoting a Just Culture
Who’s to Blame?
Purpose:
Differentiate blameworthy from blameless acts
Focus on situations where action (or inaction) of individuals pose a clear risk
Hand Hygiene-System is improved; now it is up to individual accountability
Pre-op “Time-out”
Marking surgical sites to prevent wrong-site surgery
(104 reported to TJC in 2017; 94 reported for 2018)
Using checklist to reduce bloodstream infections (CLABSI)
Moving from
“No Blame” Culture to
Just Culture
1. Did the individuals intend to cause harm?
2. Did they come to work drunk or impaired?
3. Did they do something they knew was unsafe?
4. Could two or three peers have made the same
mistake in similar circumstances?
5. Do these individuals have a history of involvement
in similar events?
Applying the Fairness Algorithm
◦ http://www.youtube.com/watch?v=8le7vYPUwaM
Culture of Safety VS Culture of
Blame: Fairness Algorithm
Just Culture Principles
in Academia
Patient Centered
Transparency
Teamwork
Constructive feedback
Individual contribution to events
Share story so others can learn
Quality Improvement
Tracks breakdowns in learning; identifies where improvement is possible
Evidence Based Practice
Care based on best practice; guides decisions
Safety
Expect reporting of errors and near misses
Balance of personal and system accountability
Individual strategies
Informatics
Systems to report/track data
Template for
Debriefing After
Student Error
Which of the following best describes a Just Culture?
a. measures individual blame with intentions under which
error occurs
b. contends that there is no blame when errors occur
c. balances individual accountability with system
accountability
d. views negligent actions and reckless conduct as the same
Evaluating
Comprehension
The Lewis Blackman Story
Here are the 5 videos they are between 4 and 6 minutes long
each
Free
download at:
https://www.
youtube.com
/watch?v=Rp
3fGp2fv88
Help Patients Advocate
for Self
1. What is my main problem?
2. What do I need to do?
3. Why is it important for me
to do this?
http://www.npsf.org/?page=askme3
Use information and technology to communicate, manage knowledge, mitigate error and support decision
making.
Navigate resources
EHR
Utilize data bases effectively-send students searching
Use technology to seek and report information Creating Run Charts-You Tube
IHI Toolkit for Reporting Data
Use technology to report concerns Institute For Safe Medication Practices http://www.ismp.org/
Model life long learning
Informatics
ISMP-Reporting
Medication Errors
Beginning Data Mining Activities
1. Groups assigned specific illness. Data mine for
5 meaningful websites (10 mins). Present to
classroom.
2. Groups assigned specific zip codes. Charge
them with identifying 2 most significant
illnesses for population residing there.
3. Groups assigned indicator from NDNQI.
Describe national benchmark.
Informatics
Using Technology to
Improve Care
Present a short
case study of
15 year old
diabetic young
man presenting
to ED with
hypoglycemia.
Group Activities
Find innovative ways to teach
self-injecting insulin
Show ways to use technology to
help a newly diagnosed diabetic
with self-management
Find physical and online
resources in your city that could
be recommended to a newly
diagnosed diabetic and family
Mindfulness
Staying focused and tuned in
Ability to see the significance of early and weak signals
and to take strong decisive action to prevent harm
Trouble starts small and is signaled by weak symptoms
that are easy to miss
Situational Awareness
Sense-making
Using multiple cues; critical thinking
And in the midst of this…..
mindfulness and sensemaking
(Weick & Sutcliffe, 2001)
How will we know that
a change is an
improvement?
Video Resources
AHRQ sponsored QSEN Workshop VideosAvailable at:
Virginia Henderson Global e-Repository
https://sigma.nursingrepository.org/handle/10755/621354
The College of New Jersey
https://qsen.tcnj.edu/video-library/
QSEN
http://qsen.org/faculty-resources/academia/tcnj-ahrq-
workshop/
Reading Resources
Nurse Educator
QSEN Supplement
Free Access
Link:
http://journals.lww.com/nurseeducatoronline/toc/2017/09001
Value:
Captures dynamic nature of situational mental models
Enhances critical thinking and problem solving
Focuses on learning concepts rather than nursing tasks
Actively engages students as they problem solve and
make adjustments in patient care based on changing
situations
Teaching with
Unfolding
Case Studies
Concept Focus for
Unfolding Cases
Allows educator to determine the
experience
Creates opportunities to emphasize quality
and safety content
Aligns with application testing
Identify the knowledge, skills, and attitudes you want learners to develop
What details to include What problems will make students think about what you
want them to think about?
What information will they need in advance?
Outline how it will unfold
Consider the amount of time you have for the activity-Classroom or Simulation Lab?
Are there props you want to use?
Begin with an idea
Create a scenario Setting
Situation
Symptoms/manifestations
Problems to encounter
Provide lab data
Provide physician’s orders Medications
IV fluids
Diet
Treatments
Develop the Case
©Altmiller
Short snip-its throughout the case study to
teach major concepts
Provides information that student needs to
know
Provide a journal article for preparation
reading for students
Theory Bursts
High fidelity
Use of monitors, live patients, recorded sessions
Low Fidelity
Create a patient story-follow patient through process
Content Specific
Room of horrors
Tubing connections jig-saw
Create a scenario of system vulnerability needing solutions
Consider multi-disciplinary teaching
Educator as facilitator
As Simulation
Patient admitted to ED
Patient at Pre-natal visit
Patient admitted to ICU
Patient at outpatient visit
Begin with Patient Presentation
What questions do you have?
What are you worried about for the patient?
What action will you take?
Leave something out for them to find
Always bring it back to the patient
Questions for
Students
Activities for Learners
Make a list of priorities
Identify potential complications
Provide safe hand-off using standardized
communication between transitions (SBAR)
Medication calculations
Identify safety threats
Use quality and safety terminology
Delegate work
Use SBAR communication
Shared decision making
Practice going up chain of command
Incorporate interruptions
Pause in the face of uncertainty (time-out)
Cultural aspects
Inclusions
Examinations
Classroom-clinical experience connection
Successful resolution during simulation
Small group work
Identify priorities
List nursing diagnoses
Problem solving
Evaluating Student
Clinical Reasoning
http://qsen.org/peri-operative-nursing-an-unfolding-case-study/
Impact Research:Peri-operative Unfolding Case Study
Developing the Case:
Inclusions: Co-morbidities-DM1, smoker
Potential med errors
Potential wrong-site surgery
Informed consent process
Latex Allergy safety
OR Checklist
Time-out
SBAR hand-off
Preventing postop complications
Incidence Reports
HIPAA
Outline for nursing action: Admits patient for Surgery
Insulin ordered for OR day
Pt scared the night before
Witnesses informed consent
Transports to holding room-site marked
Reports off-uses SBAR
Time out-show process (youtube video)
Receives patient back-uses SBAR
Postop safety-prevent complications
Has near miss med error-reports it
Unknown caller-HIPAA threat
Quantitative:
Exam scores remained stable
Qualitative
Valued seeing peri-op experience through
patient’s eyes
Aha moment-that’s the process!
Enjoyed challenge of problem solving
Mixed Methods
Study Design
Integrating QSEN
Patient Centered Care
Concern for patient
Concern for family
How do we know their wishes?
Patient preferences and values
Family preferences
HIPAA considerations
Cultural values
Identify barriers to care
Teamwork and
Collaboration
Require inter-disciplinary
communication; Student makes
call to physician; uses SBAR
Identifies work to delegate
Uses SBAR for hand-off
Require assertion (CUS)
Situational monitoring
Safety huddles
©Altmiller
Integrating QSEN
Evidence-based Practice Standardized practices
Use of Bundles
Confirming appropriate care
Discuss choice of interventions
Strength of evidence that guides care
Differential diagnosis
Continuous Quality Improvement How do we know the systems
works? Did the patient get the correct medications? Treatments?
What did we do well?
How could it have gone better for the patient?
How could team have worked better together?
What could we have done differently?
Discuss nurse sensitive quality indicators
Integrating QSEN
Safety What risks are present for the patient?
How do we protect the patient?
Mindfulness: What is the worst thing that can happen?
Medication Reconciliation
Safe hand-off
Two patient identifiers
Critical lab values requiring read-back
Work-arounds
Abbreviations
Insert errors for students to find
High Alert medications
Independent double checks
Informatics Reporting of labs
Diagnostic tests
Use infusion pumps
Use monitors
Medication calculations
Use of PDA to retrieve information
Electronic Health Records
Find resources for the patient
Create Unfolding Case Studies that emphasize safety
http://qsen.org/unfolding-case-study-applying-the-qsen-competencies-to-the-care-of-patients-with-parkinsons-disease/
http://qsen.org/perinatal-unfolding-case-study/
http://qsen.org/eating-disorder-unfolding-case-study/
http://qsen.org/peri-operative-nursing-an-unfolding-case-study/
http://qsen.org/schizophrenia-unfolding-case-study/
Teaching with
Unfolding Cases on QSEN.org
References:1. Agency for Healthcare Research and Quality. TeamSTEPPS Instructor Guide.
Retrieved from: https://www.ahrq.gov/teamstepps/index.html
2. Altmiller, G. (2018). QSEN and nursing education: Establishing frameworks for QSEN integration. Nurse Educator 43(5),
230-1.
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7. Institute for Healthcare Improvement. (nd). Open School. Retrieved from www.ihi.org.
8. Lyle-Eldrosolo, G. L. & Waxman, K. T. (2016). Aligning healthcare safety and quality competencies: Quality and Safety
Education for Nurses (QSEN), The Joint Commission, and American Nurses Credentialing Center (ANCC) Magnet®
Standards Crosswalk. Nurse Leader, 14(1), 70-75.
9. Marx D. (2001). Patient safety and the just culture: A primer for health care executives. New York, NY: Trustees of
Columbia University; 2001
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