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Purpose:The School of Nursing is committed to integrating QSEN core competencies throughout the undergraduate curriculum. The Quality-Safety Project is an activity designed to expose students to the processes of identifying a quality-safety problem in the clinical arena, using quality tools to analyze issues, and determining an action plan to address the issues/problems. Students collaborate with team members throughout the process and present projects to the entire School of Nursing faculty and student body at the end of the semester.Learning Outcomes and Related QSEN Competencies:Examine how the safety, quality, and cost-effectiveness of health care can be improved through the active involvement of patients and families.?Patient-Centered CareAnalyze the clinical environment and collaborate with team members to identify quality and safety problems/issues.?Teamwork and Collaboration, Quality?Improvement, and SafetyUse quality improvement tools to analyze processes of care, sentinel events, and improve care.?Quality ImprovementParticipate appropriately in analyzing errors and designing system improvements.?Quality Improvement, Safety, and InformaticsValue the need for continuous improvement in clinical practice based on new knowledge.?Evidence-based PracticeDemonstrate commitment to team goals.?Teamwork and CollaborationDemonstrate awareness of own strengths and limitations as a team member.?Teamwork and CollaborationGuidelines:1.??????Select Team Members? ? ? ? ?Students will select team members and work together as a QI Team on this project. It is recommended that team members are together in the same clinical group or simulation group.2.??????Identify a Clinical Problem/Issue for Team QI Project? ? ? ? QI Teams will select from?one?of the following:A clinical problem/issue identified during clinical practice. Examples include problems or issues related to staffing, patient safety, nurse safety, failure to meet practice standards, communication, etc….A clinical problem/issue identified during simulation labA medical error identified during clinical practice. Examples include errors related to medication administration, standards of practice, procedures, etc….A medical error identified during simulation lab3.??????Complete a Fishbone Cause and Effect Diagram for the Problem/Issue? ? ? ???Use the following resources:? ? ? ? ?Using-fishbone-analysis--to-investigate-problems-160413.pdf? ? ? ? ?Fishbone Template.pptx4.??????Consider your Problem/Issue in Terms of the Human Factors (Swiss Cheese Model) and Identify the following – this is optional:Latent FactorsFactors at the blunt end – organizational policies/procedures, management, allocation of resources, etc….Active FactorsFactors at the sharp end – direct contact with the patientYou may want to include the swiss cheese model as part of your poster -?Swiss_Cheese_Model.jpg5.??????Explore the Problem/Issue in Terms of National Quality and Safety Initiatives? ? ? ? ?Link your problem/issue to national quality or safety indicators from?at least one?of the following Organizations (it is appropriate to link to more than one - be sure to talk to Dr. Murray to ensure you are using appropriate initiative or if you need assistance):The Joint Commission (TJC)National Patient Safety Goals (NPSG)National Quality Forum (NQF)Agency for Healthcare Research and Quality (AHRQ)Institute for Healthcare Improvement (IHI)Institute for Safe Medication Practices (ISMP)Healthy People 2020Others6.??????Explore the Problem/Issue in Terms of:ANA Scope and Standards of Practice (2015) ANA Code of Ethics with Interpretive Statements (2015)Nursing Sensitive Indicators7.??????Explore the Problem/Issue in Terms of the QSEN Core Competencies?(Cronenwett et al, 2007).Patient/Family Centered CareRecognize 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 (p. 123).Teamwork and CollaborationFunction effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care (p. 125).SafetyMinimizes risk of harm to patients and providers through both system effectiveness and individual performance (p. 128).Evidence-based PracticeIntegrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care p.126).Quality ImprovementUse 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 (p. 127).InformaticsUse information and technology to communicate, manage knowledge, mitigate error, and support decision making (p.129).8.???????Develop a Plan for Improvement Using the following QI Tools - check with Dr. Murray for additional resourcesPlan-Do-Study-Act (PDSA)Root Cause Analysis (RCA)Others9.??????Plan for Improvement Must Address the Following:A realistic solution based on evidence from the nursing literature including benchmarksExpected outcomes related to:Quality and SafetyQSEN core competenciesNursing Sensitive Indicators10.??Present your project as a poster for the School of Nursing faculty and students at the end of the semester.?Use tri-fold poster boards – must be 36 inches X 48 inchesPoster must be able to stand freely on a tableInclude a title, team members’ names, and references on your posterThere will be time at the beginning of each class the rest of the semester to meet as a team, work on the poster, and discuss with Dr. Murray ................
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