Reducing nursing process errors and minimizing the risk of sentinel events by orienting preceptors and newly hired nurse

1. Reducing nursing process errors and minimizing the risk of sentinel events by orienting preceptors and newly hired nurses to the facility, unit, and patient population: An evidence based approach Dora Nogueda, RN and Kelley Oliver, RN Northeastern State University

2. Topics for Discussion Identification of Clinical Problem Significance of the Problem Impact of the Problem Literature Review Approaches to the Problem Leadership Support Evaluation

4. CLINICAL QUESTION “Does an individualized , structured orientation program for preceptors and newly hired nurses decrease the occurrence of nursing process errors and minimize the risk for sentinel events, compared to a non-structure or non-individualized orientation program?“

5. PICO Question POPULATION Preceptors and Newly Hired Nurses INTERVENTION Develop a structured preceptor and newly hired nursing orientation program

6. PICO Question COMPARISON Nurses participating in a non-structured , non-individualized orientation program OUTCOME Decrease nursing process errors by 50% by October, 2011 and minimize the risk for sentinel events.

7. Nursing process errors, like medication administration errors, failure to execute all the physician orders in a timely manner, and failure to follow facility protocols exactly as written can result in negative patient outcomes, lawsuits against the facility, liability for the nurses, and decrease job satisfaction. Issue for Nursing

8. Significance of the Problem Inconsistencies in teaching Lack of a defined competency process Absence of a medication administration education program No requirement to complete a medication dosage calculation test or intravenous admixture training

9. Significance of the Problem Current orientation program was not facilitated by the facility educator No availability of classrooms, skills labs, computer learning stations, a library containing current educational material, and a designated education department.

10. Significance of the Problem No structured preceptor selection process Preceptors were chosen based on perceived experience and time with the organization The facility did not have a preceptor training program

11. Significance of the Problem The facility did not have an assessment tool in place for newly hired nurses or preceptors. The facility did not required self-assessments or post-orientation evaluations to be completed by the preceptors or orientees.

12. Impact Nurses who have adequate orientation, education, experience, and support are less likely to commit errors. Errors in treatment of a patient may result in a sentinel event to include death or permanent disability. Nursing process errors place the patient, nurse, and facility at risk.

13. Impact Staffing shortages, lack of time, and cost are all potential reasons that preceptors and newly hired nurses do not receive an adequate orientation.

14. LITERATURE REVIEW

15. Decreasing Nursing Process Errors Nurses, researchers, administrators, patients, and families have described error reduction techniques such as standardization of processes, formal teamwork training, minimizing interruptions, identifying high risk medications, and implementing appropriate information technology (Friedman, Provan, Moore, & Hanneman, 2008, p. 426).

16. Literature Review Evidence clearly supports the need to systematically review how a nursing orientation process may be contributing to nursing process errors and be undermining of patient safety  (Gregory, et al., 2007, p. 82).  

17. Evidence Based Practice Development of nurses starts with a well prepared preceptor. Preceptor programs provide newly hired nursing staff with planned, individualized, structured orientation programs to assist with the transition into practice (Singer, 2006, p. 624).

18. Literature Review Preceptorship preparation is an ongoing process that requires support, resources, continuing education, monitoring, and incentives (Heffernan, C., Heffernan, E., Brosnan, & Brown, 2009, p. 548).

19. Evidence Based Practice Newly hired nurses must utilize critical thinking skills to successfully complete orientation and prevent nursing process errors.

20. Literature Review “Critical thinking, advanced problem solving, and expert communication skills are an integral part of nursing practice and should be developed through nursing education programmes” (Fero, et al., 2008, p. 146).

21. Evidence Based Practice Having an accurate assessment of the knowledge a newly hired nurse possesses is essential to developing an individualized training program.

22. Literature Review Patricia Benner’s Novice to Expert Model utilizes five levels of competence: novice, advanced beginner, competent, proficient, and expert to determine a nurse’s level of competence (Fero, et al., 2008, p. 141).

23. Patricia Benner’s Novice to Expert:Levels of Nursing Experience

24. 5 Step Process Leadership Support

25. 5 Step Process

26. Cost to Facility The biggest cost to the facility, if this program is implemented, will be time and teaching resources. The facility may elect to pay preceptors more money when they are precepting a newly hired nurse.

27. Policy and Procedure The facility will need to adapt policy and procedures to outline preceptor training and selection The facility will need to adapt orientation policy and procedures to include individualized training based on self-assessment pre-orientation competencies.

28. Conclusion Evidence supports that implementing a preceptor and newly hired nursing orientation program will prevent nursing process errors. Evidence Based Practice information has been provided to the facility to implement an orientation program. Multiple departments were involved in the process. All staff were supportive and enthusiastic during the design process.

29. EVALUATION Did program meet the needs of the facility? Did program elicit staff “buy-in”? With implementation of the program, could nursing process errors be decreased?

30. Update As a result of the EBP presentation PSH implemented following: Conducted a preceptor training workshop for all selected nursing preceptors. Started a individualized newly hired nursing orientation pilot program with three participants. Quality Assurance Coordinator developed a tracking mechanism for nursing process errors Pharmacist conducted a pharmacy training program

31. Evidence Based Practice Project Questions……..