The ECLIPSE Program Endowed Clinical Professor for Service and Education

at Saginaw Valley State University

Sally Decker, Jane Barnsteiner, Janalou Blecke

Dissemination of QSEN Competencies to faculty and community partners

• Use of concept maps

• Use of conferences

• Use of the overall competency framework in classes

• Use of TEAMSTEPS to focus on communication

Mapping

• Used first for overall QSEN outcome and later for KSA level

• QSEN used as a mapping column in the course concept map

Patient Centered Care: 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; knowledge QSEN Patient Centered Care (knowledge) 250 252 270 272 274 300 360 362 363 364 370 372 374 460 462 463 464 466 480 482 483 484 486

Analyze multiple dimensions of pt centered care: Pt/family/community preferences, values Coordination and integration of care information Information, communication and education Physical comfort and emotional support Involvement of family and friends Transition and continuity

Analyze how diverse cultural, ethnic, spiritual and social backgrounds function as sources of patient, family and community values

Analyze social, political, economic, and historical dimensions of patient care processes and the implications for pt centered care

Integrate knowledge of psychological, spiritual, social, developmental and physiological models of pain and suffering

Analyze ethical and legal implications of pt centered care – describe the limits and boundaries of therapeutic pt centered care

Analyze strategies that empower patient or families in all aspects of the health care process Analyze features of physical facilities that support or pose barriers for pt centered care Analyze reasons for common barriers to active involvement of patients and families in their own health care process

Integrate principles of effective communication with knowledge of quality and safety competencies Analyze principles of consensus building and conflict resolution Analyze advanced practice nursing roles in assuring coordination, integration and continuity of care Describe process of reflective practice

Map coordinates for courses • Phenomenon

• Metaparadigm

• Reference/Framework

• Content

• Topic and Assignment Focus

• NANDA Diagnostic Categories(Assessment & Diagnosis)

• NIC Intervention Categories (Planning Implementation)

• NOC Outcomes (Outcome Identification & Evaluation)

• Standards: AACN Essentials, QSEN, and ANA

Conferences

2009, 2010

And faculty invited to

present at other

conferences

Communication: TeamSTEPPS

• (Team Strategies and Tools to Enhance Performance and Patient Safety)

• TeamSTEPPS is a teamwork system designed for health care professionals that is:

A powerful solution to improve patient safety within your organization.

An evidence-based teamwork system to improve communication and teamwork skills among health care professionals.

Subscores

Team Stepps We Used

Role of the Endowed Clinical Professor to support QSEN dissemination

July 1, 2008 Dr Jane Barnsteiner was appointed as the Andersen/Lange Endowed Clinical Professor in Nursing. The broad goals were to:

• Provide leadership in dissemination of QSEN into the curriculum

• Develop and implement a series of learning collaboratives with faculty and clinical partners to improve quality and safety

Quality Improvement Projects

• Example: Glycemic Control

• Example: Alcohol Withdrawal

• Example: Communication (Silence Kills)

• Example: Teamwork/communication

• Example: Heart Failure

• Example: Remote Monitoring

Process

• Agencies wrote a one page proposal of a project

• For the selected agencies, teams were created to address the project and included a member of the SVSU faculty

• A model for improvement was identified (PDSA or Six Sigma)

• The aims of the project were identified (specific, measureable, actionable, relevant, timeframe)

Interest form for Eclipse project: (return to Sally Decker at SVSU)

Overall goal related to Quality and Safety that would be the focus of an Eclipse Team:

Overall Goal: To reduce readmission rates and length of stay for patients with heart

failure and Bay Medical Center

Intermediate Goal: To use Six Sigma methodology

Outcome:

Decrease readmission and length of stay

Timing of interest in working with a team on this project:

Current___x ___, in about one year_____, not able to forecast_______

Overall idea for what this project might look like at your agency:

Revise standing heart failure orders, integrated plan of care, improved education to

physicians, nurses and patients

Idea of who the participants might be:

Current team is lead by four Sigma Champions, nursing staff, mgt, Home Care,

physicians, pharmacist and case management

Name of agency __Bay Medical Center____________________________

Contact person __Sandy Garzell___________________________

(phone and email)____989-894-9510, sandy.garzell@bhsnet.org

Questions used: • What work has currently been done in your organization on

this topic?

• What hospital and nursing policies currently exist?

• Do you collect data related to this topic?

• What QI models are you using?

• Why is this a priority for the organization?

• What outcome is envisioned?

• Who are the stakeholders, team members and agency chairperson?

Project Goals (Established 7/29/08)

• Ultimate goal / Project Aim / Mission: To improve glycemic control of the MidMichigan

Health adult patient population

• Four Teams:

1. In-Patient

2. Peri-Operative

3. Home Care

4. Long Term Care • Each Team Established Specific Goals

ECLIPSE Project: Improved Glycemic Control

In-Patient: ●Clare ●Gladwin ●Gratiot ●Midland

Peri-Operative: ●Clare ●Gladwin ●Gratiot ●Midland

Home Care: ●Alma ●Bay City ●Clare

●Gladwin ●Gratiot ●Midland

Long Term Care: ●Gladwin Pines ●Stratford Village

Original Goals

• Implement RALS system at each affiliate

• System wide policy on hypoglycemia

• System wide use of same blood glucose record

• Implement system wide order sets

• Achieve 60% physician compliance

• Less than 5% incidence of hypoglycemia

• System wide nursing education

In-Patient Team Members

Chair – J. Foor MSN, RN

Gladwin – K. Kulick RD, CDE

Clare – D. Peckinpaugh BSN, RN, CDE

Midland – J. Ellison BSN, RN; C. Ahearn BSN, RN

Gratiot – S. Anderson BSN, RN

Coordinator – A. Frederick MSN, RN

SVSU – M. Graiver, MSN, RN, Associate Professor

4

5

6

7

8

9

10

Oct-08 Dec-08 Jan-09 Mar-09 Apr-09 Jun-09 Jul-09

Average = 8.3%

Average = 6.5%

Average = 6.8%

A1C

Target Range = 6.5 – 7%

Sliding Scale

in Use

No Sliding Scale

Norovirus

80% in Target

“Value added”

• Visibility as part of ECLIPSE

• Continual movement toward next visit by Dr Barnsteiner

• Involvement of SVSU faculty in the “real world” of agency

• Dr Barnsteiner – resource as to what “others” had done, cheerleader, help with clarification of aims and identification of measurements

Future Plans

Questions