Building on strength blending tcab and qsen
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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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Building on strength blending tcab and qsen

Building on Strength:

Blending TCAB and QSEN


Our team

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

A Wonderful Opportunity…..

Doesn’t mean there won’t be Challenges


Building on strength blending tcab and qsen

TCAB Academic Partners – The Faculty

Team Facilitator: Patricia Chiverton, EdD, RN, FANP Dean, University of Rochester School of Nursing


Upmc shadyside s faculty transformational journey

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


Patient safety objectives addressed through the acgme prism

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.


Building on strength blending tcab and qsen

QSEN

  • Assumptions

    • Each competency is broad and contains elements of the others

      Patient-centered careSafety

      Teamwork/collaborationInformatics

      Quality improvementEvidence-based

      practice

UPMC Shadyside

School of Nursing


Building on strength blending tcab and qsen

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


Building on strength blending tcab and qsen

Example: SafetyMinimizes risk of harm to patients and providers through both system effectiveness and individual performance.

UPMC Shadyside

School of Nursing


Blending

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:


Building on strength blending tcab and qsen

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


Initial areas of program development

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


N101 introduction to professional nursing

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


N102 introduction to nursing practice strategies

N102: Introduction to Nursing Practice Strategies

Teaching Activities

  • SBAR-R

  • 60 Second “Situational Assessment”

  • High-fidelity Patient Simulation

UPMC Shadyside

School of Nursing


Building on strength blending tcab and qsen

“60 Second”

Situational Assessment Tool

UPMC Shadyside

School of Nursing


Sbar r

SBAR-R

UPMC Shadyside

School of Nursing


N300 nursing practice strategies pediatrics obstetrics mental health critical care

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


N400 professional role transitions

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


N200 level courses pda time study

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


Definitions

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


What the study is

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.


What is getting in the way

What is getting in the way?

  • Barriers

  • Work around

  • Broken processes

  • Time eaters


Faculty engagement

Faculty Engagement

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


Time study features

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


Randomly selected clinical instructors and students

Randomly Selected Clinical Instructors and Students


Methodology

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.


Data points

Data Points

  • Approximately 10-14 data points are captured in an 8 hour clinical day

  • Goal – 300 data points/semester


How student nurses spend their time on medical surgical units work sampling through 060608

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


The redesign

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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