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Education and Competency Collaborative Program: Partnering

to Improve Patient Outcomes

Supported by a grant from the Tennessee Hospital Association as part of the CMS Partnership for Patients Hospital

Engagement Network (HEN)

Objectives: 1) Describe collaborative processes utilized to assess, plan, implement and evaluate a shared, problem based learning program to decrease HA-CAUTI; and 2) Locate resources available to implement problem based learning program to decrease HA-CAUTI 2

Opportunity

∗ Since 2007 the Tennessee Hospital Association, working through The Tennessee Center for Patient Safety, has provided leadership and direction to improve patient outcomes and safety.

∗ The collaborative actions between healthcare organizations and quality/safety organizations have improved patient safety and outcomes.

http://tnpatientsafety.com/ 3

Opportunity

∗ Missing from the collaborative are nursing schools and other programs that teach basic patient care skills.

∗ Precedent has been established, the Middle Tennessee Clinical Placement Center workgroups have established shared orientation programs for nursing and other students on such topics as confidentiality, diversity, emergency preparedness, infection prevention and safety.

http://tcps-tn.org/ 4

Proposal

∗ The Tennessee Center for Patient Safety support a collaborative to include nursing schools and healthcare organizations to establish and share evidenced-based, standardized educational and competency programs.

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Proposal

∗ The following opportunity was identified: ∗ Prevention of hospital

acquired catheter associated urinary tract infections (HA-CAUTI)

http://www.wordle.net/ 6

Proposal

∗ Partnership ∗ Aquinas College ∗ Belmont University School of Nursing ∗ Maury Regional Medical Center ∗ Tennessee Center for Patient Safety ∗ Tennessee Clinical Placement System ∗ TriStar Centennial Medical Center

http://www.wordle.net/ 7

Resources available at: http://tnpatientsafety.com/simulation/cauti/

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Opportunity

∗ Program Development (EBP) ∗ Didactic ∗ Simulation ∗ Competency

Demonstration ∗ Flexibility to meet

needs of learners and organization

∗ Grant funding for 2014

Objectives: • Describe the impact of hospital acquired catheter

associated urinary tract infection • Apply recommended evidence-based practices

(bundles) for preventing hospital acquired catheter associated urinary tract infections

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Partner : Aquinas – Delivery Methods

Didactic: Class Room

Simulation: Class Room

Competency Demonstration: Live Simulation

Incidence and risk Pathogenesis Prevention • Necessity / use • Insertion • Maintenance • Handoff / handover • Surveillance

Insertion • Female • Male

Insertion • Female • Male Maintenance

Pre-testing Video Scripted Debrief

Video Scripted Debrief

Competency checklist Recorded Simulation Reviewed Simulation Scripted Debrief Post-testing 12

Partner : Belmont – Delivery Methods

Didactic: Class Room

Simulation: Class Room

Competency Demonstration: Live Simulation

Incidence and risk Pathogenesis Prevention • Necessity / use • Insertion • Maintenance • Handoff / handover • Surveillance

Insertion • Female • Male

Insertion • Female • Male Maintenance

Pre-testing Video Scripted Debrief

Video Scripted Debrief

Competency checklist Recorded Simulation Reviewed Simulation Scripted Debrief Post-testing 13

Partner : TCMC – Educational Approach

∗ Live Sessions ∗ Leadership and staff

member preference ∗ Impart importance ∗ Evoke affective ∗ Set expectations

∗ Simulation ∗ Demonstration

∗ Practice high risk, low volume skill without consequence

∗ Power of debrief ∗ Audit

∗ Enhance/promote critical thinking

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Partner : TCMC – Delivery Methods

Didactic Class Room

Simulation Class Room

Competency Demonstration Live Simulation

Incidence and risk Pathogenesis Prevention • Necessity / use • Insertion • Maintenance • Handoff / handover • Surveillance • Documentation

Insertion • Female • Male Maintenance Surveillance

Insertion • Female • Male

Pre-testing Video Scripted Debrief

Video Scripted Debrief Surveillance audit

Competency checklist Post-testing

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Education and Competency Materials

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Education and Competency Materials

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Education and Competency Materials

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Education and Competency Materials

http://www.laerdal.com/us/doc/94/Interchangeable-Catheterization-and-Enema-Task-Trainer 19

Partner : MRMC – Delivery Methods

Didactic: Computer Based Training

Simulation: Computer Based Training

Competency Demonstration: Live Simulation

Pathogenesis Prevention • Necessity / use • Insertion • Maintenance • Handoff / handover • Surveillance

Insertion • Female • Male

Insertion • Female • Male Maintenance

CBT Video Post test Completed prior to competency

CBT Video Completed prior to competency

Competency checklist Surveillance audit

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Partner : MRMC – Educational Approach

∗ Blended Learning – ∗ Adult learners prior

knowledge ∗ Cost effective ∗ Increase number of staff ∗ Set expectations prior to

demonstration

∗ Demonstration – ∗ Engage muscle memory ∗ Simulate “real life” ∗ Peer Review - culture ∗ Set expectations ∗ Audit – “real cases”

∗ Non-nursing staff

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LMS Assignment Example

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Audit

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Partner: Belmont – Metrics (2014 - 4th QRT)

∗ Pre-test : 41.05 ∗ Post-test: 68.94 2 tailed Paired Sampled Test Sig: .00

“The demo video that was viewed previously was very helpful… Students watching themselves perform procedures and finding their own mistakes...why hasn't this been done before?”

Instructor

19 Graduating BSN Students 2014-Summer

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∗ Academic Year 2014-15 ∗ Pilot with Introduction to Nursing students ∗ Fall 87 students ∗ Spring 88 students ∗ Began implementing Fall some parts of training ∗ Spring added pre/post test ∗ Data incomplete ∗ Difficult to video 80+ students and individually debrief ∗ Work in progress ∗ Faculty see value ∗ Has changed our faculty instruction significantly based on

evidence

Partner: Belmont – Metrics (2015 – 1st QRT)

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Partner: Aquinas – Metrics (2014 - 4th QRT)

∗ More than 30 point improvement from pre-test to post-training test scores

∗ Prime opportunity to discuss difference between “real” nursing and correct nursing

∗ Benefits from contrasting incorrect catheter placement to correct methods.

10 Graduating ADN Students 2014-Fall

“I feel like, if anything, the course allows for us all to be more confident and effective advocates for excellence in infection prevention; which we should all be passionate about.”

Student

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Partner: MRMC – Metrics (2015 )

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Partner: MRMC – Processes & Outcomes

∗ Develop: Evidence Based Practice/Policies ∗ Educate: Unlicensed & allied health care staff (Urinary catheter care

– NTs, Transporters, Respiratory Therapy, Imaging).

∗ Culture: High Risk procedure ∗ Incorporate: Competency into RN orientation. ∗ Implement: Nurse Driven Removal Protocol – Nursing ownership! ∗ MD involvement: order sets ∗ Document: Urinary status every shift

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Partner: MRMC – Processes & Outcomes

∗ Discuss: Status in Interdisciplinary Care Team Conference. ∗ Monitor: Status Board of urinary catheters every unit. ∗ Audit: Processes – address in real time.

∗ Evaluate: Alternatives & processes by frontline staff ∗ Expect: MRMC goal =Zero CAUTI ∗ Next steps: Urinary catheters in community/population

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Partner: TCMC – Metrics (2014 - 4th QRT)

Target Units: ∗ Tower ED ∗ Tower ICUs (adult) ∗ Tower OR ∗ WH/CH OR ∗ WH L&D Other Units: 14

N = RN 322 / Other 40 Pretest ∗ Mean: 49.50 ∗ SD: 22.36 Posttest ∗ Mean: 79.3 ∗ SD: 19.08

Two-tailed P value < 0.0001 (paired)

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Partner: TCMC – Metrics (2015 – 2nd QRT)

2015 Nursing Orientation ∗ 273 2015 AFZ: HA-CAUTI ∗ 101 01-01 to 08-31-2015

Assessment & Documentation Tools Real Time Prompts & Reminders

Assessment & Documentation Tools Real Time Prompts & Reminders

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Lessons Learned

∗ Leadership is an integral part of cultural and patient outcome and safety change. ∗ Relationships and trust impact rate and success of change. ∗ Conflicting priorities are a part of our state (current/future).

∗ Collaboration is an investment that requires resources. ∗ Differences between stakeholders may impact resources

(funding/human resources) and outcomes (number of programs attempted/offered).

∗ Educational interventions alone will not improve patient outcome and safety. ∗ Evidenced based practices must be efficiently and effectively

implemented to improve patient outcomes and safety change. ∗ Assessment and Documentation Tools (Continued Need) ∗ Nurse Driven Protocol to Remove Urinary Catheter ∗ Real Time Prompts and Reminders (Audits, Status Boards, etc.)

∗ Healthcare provider must adapt to cultural and practice changes. ∗ Healthcare providers must own patient outcomes and safety.

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Human Resources Organization Name E-Mail Address

Aquinas College • Catherine Cantrell, MSN, RN

cantrellc@aquinascollege.edu

Belmont University

• Beth Hallmark, PhD, MSN, RN

• Tracy Johnson, DNP, FNP-BC

beth.hallmark@belmont.edu tracy.johnson@belmont.edu

MRMC • Susan K. MacArthur Ed.D, MSN, FNP, RN-BC

SmacArthur@mauryregional.com

TCPS • Chris Clarke, BSN, RN

cclarke@tha.com

TCMC • Gayle Jones, MS, RN

• Lee Ann Hanna, PhD, MSN, RN-BC

Gayle.Jones@hcahealthcare.com LeeAnn.Hanna@HCAHealthcare.com 33

Live Demo: http://tnpatientsafety.com/simulation/cauti/

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When using or adapting resources from the project, please note in writing, “Adapted from the TCPS CAUTI Prevention Simulation Project: www.tnpatientsafety.com/simulation/cauti”

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