Quality and Safety Education for Nurses
Clinical Orientation ChecklistPresented by: Academic Clinical Practice Task Force (Silver Dunker K., Manning K., Knowles, S.)Clinical Orientation ChecklistIntroductions Daily routine Student Contact Information Report Attendance policy / Tardiness policyMake-up Policy Patient Care: Vital signs Contact number students should use if late or absent. Head to Toe Then how to link patient assessment with nursing interventions and medical plan of care Process faculty will use if clinical needs to be canceled/Inclement weather cancellation Medication Administration Schedule / Medication supervision schedule Professionalism and expected behavior Assigned Treatments Dress code Break times /Lunch/dinner time HIPAA and Social Media When to communicate to instructor and patient’s assigned nurse Pre-clinical assignment Shift Documentation requirement(s) Patient preparation times / Time to meet for clinical Report Place to meet for clinical / Where to put student belongings Off Unit assignment(s) and Documentation Requirement(s) Where to find student assignment schedule / How to find out the Nurse assigned to Patient Post-conference Intro to Assigned Nurse How to Receive Patient reportReport sheet and Information to collect Patient Report Expectations for clinical objectives Gaining access to the computer system Clinical Paperwork What to look up prior to patient care / Navigating Patient Health Record Explanation of reflective thinking Medication cards/informationCommons medications on Unit Cell phone use Weekly / every other week clinical evaluations/ Formative Evaluation and form Resources Available on unit / cell phone use Summative Evaluation Policies specific to the institutionPatient safety: fall precautions, Transmission-based precaution Methods for clinical evaluation Tour of Unit Where to sit on unit when not in a patient room Clinical Orientation Scavenger HuntMedical RecordAdmissionHistory and PhysicalDoctors’ OrdersNursing Notes (Interdisciplinary Health Team)Daily NotesTrends: Vital Signs, Laboratory Data, Weight, I & ONon-Medication orders: Code status, activity, dietPlan of Care Plan For Patient: Nursing care and collaborative team care including consulting physicians and other healthcare team members Nursing StationWhere can you find the nurse, patient care assistant? (PCA), medical or surgical teamLabs- how are labs ordered, collected, and sentNew Doctors Orders- how do you know a new order is written?ID Bands- what kinds are used, how do they are placed, and how are they replaced?Medication RoomSyringesNew TubingMedicationsMed-Books, IV BooksAlcohol SwabsAll NeedlesTubing DatesIV start suppliesGlucometer Supply ClosetAll suppliesWound careBed bathIV suppliesIV solutionsDressing kitsCentral Line Care Kits (for picc lines)Suture removal/staple removal kitsSterile GlovesMasksRespiratory SuppliesNasal CannulaVital Sign Machine and equipment including pulse oximeterMasksRestraintsBiohazard bagsSpecimen CupsTapeLinensBlanketsLinensAll bath supplies Dirty Utility RoomWhat is found in this roomWhat do I put in this room BathroomsWhere are they located on this unit?QSEN Activities and Post Conference IdeasSafetyQSEN Definition: Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.Clinical Objective: Students will remain in compliance with policies and procedures of the school of nursing and the clinical partner.Students will maintain safety during their clinical practice and will remain in compliance with the School of Nursing School and Clinical Partner. KnowledgeSkillsAttitudes Safe Patient Care SituationsDiscuss National Patient Safety Goals for the organizationTransfer of patients: Student will use correct body mechanics with patients and self.Student will discuss their plan in maintaining safe practice while caring for patients.Student will appreciate their role in maintaining patient safety during their clinical experience.Safety with medications:Discuss possible work-arounds and use of inappropriate abbreviations.Administer medications according to both clinical partner and school of nursing guidelines.Student will communicate with clinical partner their role in medication administration. Discuss root cause analysis and plan for safety in clinical with medications.Practice root cause analysis and how to perform this activity in near miss or medication error. Student will appreciate their role in preventing medication errors.Suggested Activities: OrientationProvide students an example of a near miss and discuss how to manage this situation.Discuss with students how to give medications safely in clinical area. Review the expectations of the nursing school, clinical rotation course, and clinical facility.Discuss with students unsafe patient situations and how to communicate safety. Discuss plan for medication administration in clinical agency. How many students will give medicationsTimes medications will be givenTypes of medications that will be givenTypes of medications that will NOT be givenMonitoring and patient assessment when giving medicationsDocumentation and Electronic Medical Administration RecordAdditional Semester ActivityProvide students with example of an error, then go through process of root cause analysis and next steps according to clinical partner policy and procedures.Teamwork and CollaborationQSEN Definition: Function effectively within nursing and interprofessional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.Objective: Students will work as a team and collaborate with the healthcare delivery partners while practicing in the clinical setting.KnowledgeSkillsAttitudesDescribe the role of the student in the clinical site. Discuss the level of the student and expectations within the team.Discuss with students: Skills students will be performing during the clinical rotationSkills which will require direct supervision and Skills student may perform independently Students will complete a journal assignment regarding their role as a team member in caring for their patient in the clinical setting.Discuss the nursing roles on the clinical unit.Assign one student to the role of clinical leader “Charge Nurse” during the clinical day. Students will complete a journal assignment regarding their experience in the charge nurse role specifically noting prioritization of patients on the clinical assignments. Discuss the importance of good communication in the care of patients. Role play and give examples of good and poor communication styles while working as a team member.Practice using SBAR and CUS communication strategies.Discuss scenarios with students of both effective and ineffective communication styles of the nurse or other members of the care team.Suggested Activities: OrientationDuring the orientation have students define the members in the hospital healthcare team.Additional Semester ActivitiesHave students role play inter-collaborative communication. Possible scenarios: a) rounding with provider, b) when to call the team members, and c) advocating for their patient. Have students communicate about a situation to the clinical faculty, nurse or a phone call to the physician using a tool:SBAR: Situation, Background, Assessment, RecommendationCUS: a) “I am Concerned”, b) “I am Uncomfortable”, c) “This is a Safety Issue”InformaticsQSEN Definition: Use information and technology to communicate, manage knowledge, mitigate error, and support decision making.Objective: Students will utilize technology and equipment in the clinical unit while maintaining the Health Insurance Portability and Accountability Act (HIPPA). KnowledgeSkillsAttitudesIdentify steps in using the computerized medical record system, which will help them in gathering necessary patient care information. Log onto the computerized system.Locate pertinent patient care information in the medical record necessary for patient care. Appreciate the skills involved in learning a new computerized system with each clinical rotation.Discuss how the technology and computer system can help the students in monitoring their patient.Have students track and analyze trends in the patient data in order to understand critical changes in the patient from shift to shift. Value how technology can help to build a care plan for the patient based on data that is current and trending.Suggested Activities: OrientationOn the first day during the orientation, have students work in groups of 2 navigating the medical record. Have students log into the computerized medical record system. As a scavenger hunt, assign students to find several items in the computerized medical record that will help them understand the plan for the plan of care for their patient, such as: Nursing Notes, History and Physical, Orders (medicine and non-medicine), labs, microbiology, radiology reports, consults.Have students discuss their role in maintaining HIPPA. Additional Semester ActivitiesHave students use the computerized record to trend data: Compare laboratory results upon admission versus laboratory results on their clinical day. Compare the patient’s vital signs from the previous shift to the vital signs the students has taken. Have students look at microbiology results and discuss how the plan of care is related to these laboratory results. Discuss pertinent negative laboratory results. Discuss why a patient’s normal laboratory level can be just as important as an abnormal finding. Discuss abnormal findings and how the laboratory results and the medical orders are related.Patient Centered CareQSEN Definition: 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.Objective: Students will provide patient centered care to all assigned patients in the healthcare setting.KnowledgeSkillsAttitudesIntegrate understanding of the various patients the student will be caring for on the clinical unit, including cultural awareness.Identify which types of patients come to receive care on the unit that the student is assigned. (Is this related to the medical diagnoses of the patients?)Discuss culturally sensitive care for specific cultures that receive care in the healthcare system.The student will appreciate their role in the care of the patient as it relates to the patient’s experience. .Discuss the 5th vital sign “Pain.” Learn the different types of pain (Acute, Chronic, and Surgical). Discuss pain management. Perform a pain assessment: Obtain both subjective and objective data.Practice documentation of the pain assessment.Identify and review commonly administered pain medications, which are specific to the clinical unit. The student will discuss self-perception of pain management.The student will discuss how patients may perceive and experience pain, noting each patient’s tolerance and that pain management varies between patients.Discuss legal and ethical issues related to patient-centered-care.Discuss who makes the patient decisions in their plan of care.Discuss each patient situation in terms of ethical and legal management and incorporate these elements into the patient’s plan of care.The student will appreciate how each patient’s preferences will affect how they make decisions regarding their care.Suggested Activities: OrientationDuring the orientation discuss the types of medical diagnoses of patients that receive care on the clinical unit. Discuss the differences between medical and surgical patients.Discuss specific cultures of the patients frequently cared for within the healthcare system. During the orientation, review a pain assessment including subjective and objective data gathering. Discuss types of pain typically experienced by patients on the clinical unit and pain management.Identify typical pain medications used on the clinical unit. Have students review these medications, create medication cards, and discuss monitoring of pain medication for their patients receiving pain medication.Additional Semester ActivitiesDiscuss how different cultures of people perceive and manage pain.Identify alternative complementary therapies and non-pharmacological pain management methods, which can be incorporated into the patient's plan of care.Discuss who has the authority to makes the decisions for the patient. For example: the patient, a family member, a friend, tribal leader, or religious authority.Include a concept map or care plan to incorporate patient centered care into each clinical day.Quality ImprovementQSEN Definition: Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of health care systems.Objective: Students will act as professional partners within the clinical environment. Students will maintain professional clinical comportment during their clinical experience. KnowledgeSkillsAttitudesDiscuss the role students play in the healthcare system to impact quality and safety while on the clinical unit caring for patients. Have students learn and then practice the following:Root Cause AnalysisPlan Do Study Act (develop task statement)SWOT Analysis (Strength, Weakness, Opportunity, Threat)Utilize the SWOT analysis as a method for journal reflection. Have the students reflect on their own clinical practice each week and how they can improve and enhance quality in their own nursing practice.Discuss Lewin’s Change theory and how the student can lead change to improve quality on the clinical unity.Have students identify something that needs to be changed on the clinical unit or in clinical practice.There are three stages in Lewin’s Change theory: Freezing, Change, and RefreezingHave students reflect upon ways they can impact quality improvement in clinical practice through reflective journal entries each week.Suggested Activity: OrientationDuring the orientation discuss with the students the possible differences between the school's clinical lab and the clinical environment. Review how the lab environment is a controlled environment with standardized procedures in contrast with the clinical environment which, is dynamic, live, and contains a variety of variables that can affect skills, procedures and tasks. Additional Semester ActivitiesStudents will complete a journal reflection using the SWOT analysis. This activity will help students critically analyze their role in improving quality patient care. Discuss with students how they can adapt their own nursing practice to comply with hospital procedures and policies, while learning a variety of methods in nursing care (such as: Medication administration, routes, dosages, and clinical indication, reporting practices, and identifying the provider to call if there is a medication issue.Have students describe a problem that initiated a selected change within the organization. Then using the steps of Lewin’s Change Theory, the students will develop a plan and implement change on the clinical unit. This activity will give students the opportunity to implement the change process and to understand how nurses can be leaders on their clinical unit for continuous quality improvement.Evidence Based PracticeQSEN Definition: Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.Objective: Using Evidence Based Practice, students will identify interventions to care for the complex needs of their assigned patients during the clinical rotation.KnowledgeSkillsAttitudesDiscuss with students the importance of utilizing evidence based practice.Have students identify research to support their plan of care each week when they submit their clinical paperwork. Examples of support can be a journal article, a policy from the facility, or even a trial performed in the facility. Students will complete a reflective journal assignment about how evidence based practice has affected clinical practice. Identify policies and procedures that have been written based on evidence based practice.Students will locate the policies and procedures on the clinical unit. Students will identify common policies which are used in this clinical unit (electrolytes, monitoring, etc.).Students will appreciate the importance of policy and procedures to guide their clinical practice. Suggested Activities: OrientationDuring orientation review clinical guidelines, protocols, and policies and procedures.Have students look up specific policies that are common on the clinical unit.Additional Semester ActivitiesDiscuss with students how to find recent journal articles and why it is important to verify that the information is current. Have students review a journal article for practice information then discuss if this practice is the same or different? Discuss if the management on the unit is aligned with clinical practice guidelines or not.Discuss how the nurse can be a change agent if the practice needs to be updated.Clinical Faculty Evaluative QuestionsDid the checklist help organize your orientation day?Did you add additional items to the checklist?If so, what items did you add?Were you able to integrate QSEN KAS(s) into the clinical orientation?Discuss your experience.Which KAS activities did you utilize? What was your rationale for using the particular strategy?Student feedback: What was their take away learning from completing the activities?Agency feedback: What feedback did you receive from the clinical unit? ................
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