Published Back to Strategy Search Strategy Submission Triage Simulation to enhance communication and clinical reasoning skills Author: Julie Brown Harold MSN, RN, CEN Title: Assistant Professor Coauthors: Institution: Louisiana State University- Alexandria Email: Jharold@lsua.edu Competency Categories: Evidence-Based Practice, Patient-Centered Care, Safety, Teamwork and Collaboration Learner Level(s): New Graduates/Transition to Practice, Pre-Licensure ADN/Diploma, Pre-Licensure BSN, RN to BSN Learner Setting(s): Skills or Simulation Laboratories Strategy Type: General Strategy Learning Objectives: - Apply effective therapeutic communication skills during triage. (patient-centered care, safety) - Demonstrate a focused assessment. (patient-centered care, safety, evidence-based practice) - Implement the nursing process using evidence-based practice. (patient-centered care, safety, evidence-based practice) - Recognize abnormal vital signs and effectively communicate to the healthcare team. (patient-centered care, teamwork, and collaboration, safety, evidence-based practice) - Apply clinical reasoning to determine the patient problem list. (patient-centered care, safety, evidence-based practice) - Perform accurate documentation (Informatics) Strategy Overview: This simulation activity provides an opportunity for nursing students to apply QSEN competencies in recognizing and addressing physiological, psychosocial, developmental, cultural, and socioeconomic barriers this patient scenario includes. This simulation scenario allows the student to be in the role of an Emergency Room triage nurse. The scenario supplies basic information about the patient to prompt the student to utilize therapeutic, effective communication and clinical reasoning to determine the patient's problem list. The student will also have to ignore distractors while employing nonjudgmental, unbiased, and culturally sensitive behaviors. They will have to use evidence-based practice, clinical reasoning, and judgment to recognize the urgency of the situation and determine the course of action. They will have to use teamwork and collaboration to notify a provider. This simulation should be completed within a 20-minute time frame. Submitted Materials: 287.TRIAGE-SIMULATION-QSEN-Final.docx - https://drive.google.com/open?id=1rsa1MFagByC5Sgae31znxTuDvjipCdUq&usp=drive_copy Additional Materials: Evaluation Description: Objectives will be evaluated utilizing the provided rubric. The rubric’s key parts are to ensure that the student displays cultural sensitivity, practices effective and therapeutic communication, and utilizes clinical reasoning and judgment on a time-sensitive issue such as sepsis.

Published Back to Strategy Search Strategy Submission Using Beers Criteriato Prevent Medication Related Problems in Older Adults Author: Viki Saidleman RN MS Title: Nursing Instructor Coauthors: none Institution: East Central University Email: viklvog@ecok.edu Competency Categories: Evidence-Based Practice, Patient-Centered Care, Safety, Teamwork and Collaboration Learner Level(s): Pre-Licensure BSN, RN to BSN Learner Setting(s): Classroom, Clinical Setting Strategy Type: Online or Web-based Modules Learning Objectives: 1. Value the concept of EBP as integral to determining best clinical practice for older adults. (EBP-attitude) 2. Describe how the strength and relevance of evidence in Beers Criteria influences the choice of interventions in provision of patient-centered care. (EBP-knowledge) (Patient-centered care-skill) 3. Demonstrate effective use of strategies to reduce risk of medication related harm to older adults. (Safety-Skill) 5. Assert own position/perspective in discussions about patient care. (Teamwork & Collaboration-skill) 6. Appreciate importance of intra- and inter-professional collaboration. (Teamwork & Collaboration-skill) Strategy Overview: This strategy can be used for either pre-licensure or RN to BSN students utilizing the clinical setting and either group or individual work in class, in post-clinical conference, or via online discussions or blogs. Prior to clinical, students are assigned the American Geriatric Society 2015 updated Beers Criteria for potentially inappropriate medication use for older adults link for review, the Hartford Geriatric Nursing Beers you-tube for viewing, and the ConsultGeri.org Try This Series site for regarding the Beers Criteria for reading. On the clinical day, a brief discussion can be held in pre-conference about Beers Criteria with a review of definitions for quality and strength of evidence and a brief account of methods used to analyze the evidence and to make recommendations. Students will be instructed to select an older adult patient over age 65 with 8 or more medications. In clinical, students are to record basic patient information like the client's medical diagnoses, prescribed, routine, prn and over the counter medications as well as vitamin and mineral supplements. They will record these on the first section of the QSEN Beers Learning Strategy Form. After the clinical experience, students are instructed to complete the second section of the form requiring students to utilize the Beers Criteria to analyze the patient's medications using the 5 tables in the Beers document to review the strength and quality of evidence, rationale, recommendations, safety concerns, risks, etc. The third part of the form includes questions about teamwork and collaboration interventions and appropriate patient centered interventions relevant for the completed evaluation of medications. This third part can be done in writing (individually or as a small group), on-line as part of a blog or discussion board or as part of a clinical post-conference session. The strategy focuses on the application of evidence to practice in the geriatric setting regarding medication safety. Attention is given to quality and safety by focusing on risk reduction and prevention of medication related problems for the older adult vulnerable population. Patient centered care is addressed with individualized interventions based upon the medication evaluation using Beers Criteria. Students are asked to formulate teamwork and collaboration strategies to address medication concerns. Submitted Materials: 2016-QSEN-Beers-Learning-Strategy-Form-1.rtf - https://drive.google.com/open?id=1EnuS4KywbSsSoi0-igh5UJZf0HEQ1P2Z&usp=drive_copy Discussion-Questions-for-Using-Beers-Criteria-to-Prevent-Medication-Related-Problems-in-Older-Adults.docx - https://drive.google.com/open?id=1Gvj3CfHAJ2oD8zwNh8bGnUhJwS3cxPzh&usp=drive_copy Best-Grading-Rubric-Using-Beers-Criteria-to-Prevent-Medication-Related-Problems.docx - https://drive.google.com/open?id=1G5BSckVs4-gVtZAuAT5ebpNivSo4nwat&usp=drive_copy Evaluation-Tool-for-Using-the-Beers-Criteria-to-Prevent-Medication-Related-Problems-in-Older-Adults-Evaluation-Tool.docx - https://drive.google.com/open?id=1HZz8OuIPz6WjAkK5Vtlw-uEk6vQ6jUcF&usp=drive_copy Additional Materials: https://www.guideline.gov/summaries/summary/49933? https://www.youtube.com/watch?v=USCwt-ISCTY https://consultgeri.org/try-this/general-assessment/issue-16 Evaluation Description: Evaluation will be based upon the following: 1) successful individual or group completion of the QSEN Beer's Learning Strategy paper after clinical 2) successful after clinical written discussion, post-conference discussion or on-line blog or discussion 3) use of the Best Grading Rubric applied to the paperwork and discussion 4) student evaluation tool using a Likert scale

Published Back to Strategy Search Strategy Submission Nurse as the leader of the team huddle. An unfolding oncology case study. Author: Kimberly Silver Dunker DNP, RN Title: Assoicate Professor of Nursing Coauthors: Institution: Worcester State University Email: kdunker@worcester.edu Competency Categories: Evidence-Based Practice, Patient-Centered Care, Quality Improvement, Safety, Teamwork and Collaboration Learner Level(s): New Graduates/Transition to Practice, Pre-Licensure ADN/Diploma, Pre-Licensure BSN Learner Setting(s): Classroom, Clinical Setting Strategy Type: Case Studies Learning Objectives: Learning Objectives This unfolding case study was designed to 
provide an opportunity for nursing students to learn about caring for a patient who has pancreatic cancer. It will focus on the following KSAs Patient Centered Care Students will identify how a nurse can advocate during the team huddle (Knowledge, Skills) Teamwork and Collaboration Discuss the role of the nurse in advocating for a patient during a team huddle (Knowledge) Students will discuss how a team huddle can promote patient centered care. (Knowledge) Learn to collaborate with the medical team to maintain quality in delivering care to oncology patients. (Knowledge, Skill) Safety Students will identify potential medication errors and value the importance of the medication reconciliation process during admission. (Knowledge, Attitudes) Students will value own role in identifying potential medication side effects of clients they care for. (Attitude) Define HIPPA and opportunities to protect patient’s private information (Knowledge, Skills) Evidence Based Practice Students will identify current evidence based practice when identifying treatment options for their patients. (Knowledge) Students will learn how the nurse can incorporate evidence based practice into the clients clinical decision making. Quality Improvement Students will learn then discuss the role of the hospital unit council or ethics committee in maintaining patient centered care. (Knowledge) Strategy Overview: Strategy Overview The strategy is an unfolding case study
 involving a man diagnosed with pancreatic cancer The case will teach the student to discover attitudes, beliefs, and values of the professional nurse when caring for cancer patients and managing diagnosis, treatment options including chemotherapy, radiation, and surgery. It begins with his initial diagnosis at 48 years old. He was brought to the emergency room because of severe itching and jaundice. His laboratory and diagnostics are discussed in the case. He had high bilirubin levels and a mas on the head of his pancreas. He also has positive CA-19-9 level, which is discussed in detail. He underwent an ERCP and then was scheduled to have chemo and radiation as well as preparation for a pancreatico-duodenectomy (whipple) procedure. This case discusses pre and post op care and complications this patient experienced. Submitted Materials: Gall-Pancreas_TeamWork_QSEN-a-1-revised.ppt - https://drive.google.com/open?id=1Xm9Xks18zQbHov6L8sspThZnDqvR3jD6&usp=drive_copy Additional Materials: This unfolding case includes actual video’s, which are embedded in the power point presentation included. The videos are taken 4 months before the patient died from pancreatic cancer and after he had received chemotherapy, radiation, and surgery for his cancer. Pancreatic Cancer Diagnosis https://youtu.be/oXVJsjyGjdk ERCP & Surgical Plan for Pancreatic CA https://youtu.be/qj8zay2ECjg CA-19-9 Pancreatic Cancer https://youtu.be/N8l3IgSXqkA Chemo and Radiation Pancreatic Cancer https://youtu.be/omu3S2glqJY Preparation for a Whipple Procedure https://youtu.be/VhuqEkOlVeg Post Whipple Complications https://youtu.be/qqL32IdxRuI Post Op Whipple Paralytic Ileus Complications https://youtu.be/zAZHaaBsqNw Evaluation Description: This unfolding case study is presented in the classroom to pre-licensure level nursing students enrolled in a medical-surgical nursing. 
The students are encouraged to participate by answering questions and collaborating regarding their answers. This lecture is powerful because it not only discusses the topic of pancreatic cancer but also enables the students to explore the role of the nurse involved in care of a patient who has undergone a surgical oncology procedure. This case clearly ties in EBP, Patient Centered Care, Safety, and Teamwork & Collaboration. Following this presentation, the students will complete a writing reflection to relate how this unfolding case study enhanced their knowledge, skills and and attitudes as related to patient-centered care and team huddles.

Published Back to Strategy Search Strategy Submission “QOO” Quality Observation Opportunity: Safely Floating a Student in Clinical Author: Kimberly Silver Dunker DNP, RN Title: Assistant Professor of Nursing Coauthors: Institution: UMASS Graduate School of Nursing Worcester Email: kimberly.silver@umassmed.edu Competency Categories: Evidence-Based Practice, Quality Improvement, Safety Learner Level(s): Pre-Licensure ADN/Diploma, Pre-Licensure BSN Learner Setting(s): Clinical Setting, Skills or Simulation Laboratories Strategy Type: General Strategy Learning Objectives: After viewing this video vignette the students will be able to: Observe how a student will safely float to a “ QOO” (Quality Observation Opportunity) while in a clinical setting. Identify their own roles in communicating essential information about the observation role when floating off the clinical unit to a “ QOO” (Quality Observation Opportunity). Discuss the importance of the learning outcomes of the clinical course and how the observational experience meets required course learning objectives. Communicate their role as an observer and collaborate as a team member while away from the clinical unit and during a Quality Observational Opportunity. Strategy Overview: Online Video Vignette: http://onlinetraining.umassmed.edu/floatingastudent/ This vignette was designed for students to discover opportunities for QOO (Quality Observation Opportunities) while in clinical and how they can leave the clinical unit for a patient observational opportunity. The vignette demonstrates to students how to clearly identify learning objectives for their clinical rotation and to link them to QOO. This vignette also provides an example of how faculty may prepare a student prior for an observational experience and the importance of linking the observation to the role of the registered nurse. Strategy Activity: Prior to beginning clinical the students with their clinical faculty will view the vignette in the nursing lab. Then the student will discuss the clinical objectives and what the appropriate QOOs they might encounter while they are in clinical. This discussion will help the students to identify the importance of the learning outcomes for the clinical and how the QOO might meet those objectives. The discussion will include the role of the student while in “observation,” mode and away from the clinical unit. This discussion will allow the faculty to clearly articulate the importance of this role and emphasizes the role of the student is observation only. Furthermore, this activity will help faculty to coach the students to gather information while on QOO, and to bring essential information from the experience back to the post clinical/conference discussion. Safety Students understand and are able to prepare their patients for a test/diagnostics procedure/ or off the unit examination. The students will care for their patients while off the unit. (Knowledge/Skill) The students will be in observation mode while the patient are having their procedure/exam/test. (Knowledge, Attitudes) Teamwork/Collaboration Students will gather subjective and objective patient data, and will communicate to their faculty member the procedures that their patients are going off the unit for, what the role of the nurse is during the procedure, and nursing care during the procedure. (Knowledge, Skills, Attitudes) Students will clearly understand their role as an observer and be able to articulate this to the nurse/physician/technician with whom they will be engaged during the observation experience. (Knowledge, Attitudes). Students will demonstrate teamwork/collaboration as a member of the patients healthcare team during the observation experience by listening and observing their patient while off the clinical unit. Submitted Materials 1) Observation for Nursing Students 2) CVC Observation 3) Echo Obs 4) Cardiac & Pulm Rehab Obs. 5) EP Obs. Submitted Materials: Additional Materials: http://onlinetraining.umassmed.edu/floatingastudent/ Evaluation Description: This activity was used as a strategy to teach nursing students the importance of the QOO, and to help both students and faculty understand how the clinical objectives are related to the QOO. The faculty can help the students make all QOO meaningful, while teaching the student their role to increase safety of their patient while away from the unit, and communicate their role as an observer. The students will have clear role expectations while away from the faculty and understand the importance of articulating their role when they are on observation. Ultimately by viewing the video vignette both the faculty and student were on the same page as to the expectations are during a QOO. Anecdotal information: This assignment was utilized with pre-licensure nursing students. This video taught both faculty and students how to link the course syllabus objectives with observational experiences. It helped faculty to communicate clearly with students about the expectations while on an observational experience. It helped the student know their expectations as a student observer while away from the clinical unit. These clear expectations maintained good teamwork/collaboration between the academic clinical group and the clinical partner. It also maintained a safe practice environment for the student. Secondarily, new clinical faculty also viewed this video vignette as part of their orientation to clinical. The faculty, were able to see what the expectations were for their students who are in clinical, and how to float a student for a QOO. Feedback from both the clinical faculty and the students was positive. This activity helped increase confidence in both students and faculty in taking advantage of opportunities in clinical, ultimately encouraging students to demonstrate greater critical thinking skills through QOO. This exercise has bridged the clinical practice environment with theory. As a result, clinical nursing faculty have reported feeling they are competent in understanding the syllabus and the clinical objectives and outcomes. This increased knowledge empowered both the faculty and students to incorporate QOOs while in clinical. There was greater safety while in clinical and excellent communication when students left their units for QOO.

Published Back to Strategy Search Strategy Submission Evidence Based Practice (EBP) Project Guidelines and Grading Criteria Author: Dori Taylor Sullivan PhD, RN, BC, CNA, CPHQ Title: Chair, Department of Nursing, Director of Interdisciplinary Studies Coauthors: Anne M. Barker, EdD, RN, Associate Professor of Nursing, Sacred Heart University Institution: College of Education & Health Professions, Sacred Heart University Email: sullivand@sacredheart.edu Competency Categories: Evidence-Based Practice Learner Level(s): Graduate Students, New Graduates/Transition to Practice, Pre-Licensure ADN/Diploma, Pre-Licensure BSN, RN to BSN Learner Setting(s): Classroom, Clinical Setting Strategy Type: General Strategy Learning Objectives: Identify an EBP questions for the project focus Search the literature to identify best current evidence Organize and synthesize the best current evidence identifying gaps, commonalities, and variations. Recommend continuation of current practice or a change in practice based on the evidence. Design a plan changing or reinforcing the recommended practice, including an evaluation component. Work effectively as a contributing team member to the project group Strategy Overview: The EBP project is designed to simulate the practice environment by assigning work teams who compose an EBP question then plan the team’s work to access and evaluate the evidence with the goal of recommending reinforcement of current practice or a change in practice. This exercise has been used in both undergraduate and graduate groups with success, although the level of expectations related to project criteria are higher for graduate students. For pre-licensure students, additional oversight of the topic selection and EBP question formation are strongly advised. Submitted Materials: Additional Materials: Evaluation Description: The evaluation methods for grading are included in the second document attached. Students at both the undergraduate and graduate levels have been able to complete this project within a semester course, although it is critical that the teams get organized early on and finalize an EBP question to focus the project. Students (especially RN to BSN and graduate-level) sometimes have difficulty making the change to considering the evidence for practice versus a traditional research question and proposed study. However, that is a critical part of the learning outcomes for this exercise. Within a values context of service-learning, when possible student teams have identified real-world EBP situations and make contributions to a given healthcare agency through their work. Online students have expressed some concerns about team coordination, however, the overall response to this project assignment has been very positive and generated much enthusiasm from faculty and students.

Published Back to Strategy Search Strategy Submission Utilizing the QSEN Framework to Redesign Nursing Orientation Competencies Author: Diana Alemar DNP, AMB-BC, NPD-BC, NEA-BC, CNL Title: Program Director Coauthors: Diana Alemar, Monique Zayas, Lori Perlstein, Warly Remegio, Alycia Jarvis Institution: NewYork-Presbyterian Hospital Email: dia9006@nyp.org Competency Categories: Evidence-Based Practice, Informatics, Patient-Centered Care, Quality Improvement, Safety, Teamwork and Collaboration Learner Level(s): New Graduates/Transition to Practice, Staff Development Learner Setting(s): Clinical Setting Strategy Type: General Strategy Learning Objectives: 1-The Nurse Educator/Nursing Professional Development Practitioner will analyze the organization’s existing clinical orientation competency process for essential nursing content, inclusion of hospital policies, a structure and framework. (Evidenced Based Practice (EBP); Patient-Centered Care; Quality Improvement (QI); Safety) 2- The Nurse Educator/Nursing Professional Development Practitioner will describe an approach for restructuring the orientation competency to align with the QSEN competencies framework. (EBP; QI; Safety; Teamwork and Collaboration; Patient-Centered Care) 3- The Nurse Educator/Nursing Professional Development Practitioner will be able to change from an orientation checklist to a QSEN based competency assessment tool. (EBP; QI; Safety; Teamwork and Collaboration; Patient-Centered Care) 4-The professional nurse will describe the impact of quality and safety competencies on nursing care delivery. (EBP; Patient-Centered Care; QI; Safety) Strategy Overview: The Department of Nursing Professional Development (NPD) embarked on the journey to revamp orientation competencies to ensure nurses are providing evidence-based care, rooted in promoting quality and safety. NPD needed to move away from a checklist-based approach to assess our nurses’ comprehension and implement a competency-based approach, which would give us insight into their knowledge and skills, as well as pinpoint any gaps. Our goal was to develop a single standard competency for all of our campuses. We wanted to ensure a consistent approach, as well as a systematic process for all of our orientation documentation that aligned with our departmental mission and vision. We utilized both the SWOT (Strengths, Weakness, Opportunities, Threats) and SOAR (Strengths, Opportunities, Aspirations, Results) analysis to identify the strengths and opportunities for the organization’s orientation competencies. Based on the results of the analysis, NPD created a vision for QSEN-based orientation competencies for nurses. Next, we formed general and specialty workgroups in order to develop the respective competencies. The workgroups formatted the new competencies to include measurable competency statements focusing on knowledge and skills. All competency statements were developed using Bloom’s taxonomy and supported by hospital policies and procedures. The intent for the inclusion of the policies and procedures within the competencies was to facilitate preceptor and orientee use. The competency statements were then categorized according to the QSEN framework. Within the competency tool, we incorporated a self-assessment of the orientee’s existing competency utilizing Benner’s Novice to Expert Model. The orientee self-identifies as a Novice, Advanced Beginner, or Competent. The self-assessment enables the preceptor and NPD Practioner to establish a baseline understanding of the orientee’s existing competency in order to plan for an individualized orientation. Please note: the categories of “Proficient” and “Expert” were intentionally not included. An orientee may be proficient or an expert in their nursing specialty area; however, as a new hire they are learning how to be a nurse at our organization. The orientee’s competencies were validated using measurable categories: Direct Observation -Actual, Direct Observation-Simulated, and Verbal Discussion. We also included a section where the orientee and/or NPD practitioner could select the patient population being cared for in their practice areas, such as Neonates/Newborns, Pediatrics, Adolescents, Adults, and Geriatrics. Lastly, we included a comment/feedback section for the preceptor to expand upon competency development and progression. Any competency not met while on orientation was documented under the “Action plan” for follow-up by the nurse manager post orientation. Once the competencies were developed, we presented the new competency process to all NPD practitioners across the enterprise to elicit preliminary feedback, and then minor revisions were made accordingly. The general and specialty competencies were piloted on select units for one orientation cycle. We solicited feedback from key stakeholders which included nursing leadership, preceptors, and orientees. Additional revisions were made based on the feedback. Once the documents were updated, nursing leadership and preceptors were educated on the new competency document and process. Submitted Materials: 295-3-Orientation-Competency-Evaluation-QSEN-Model.pdf - https://drive.google.com/open?id=1YcPoyKTxrxzEApLgVJWVrmdv0_nD1V34&usp=drive_copy 295-2-original-FINAL-General-Orientation-Competency-Document-2.9.21.pdf - https://drive.google.com/open?id=1YhgQQr0Wyxobs-IdRec6lXcY2V3J3EQ0&usp=drive_copy Additional Materials: Submitted a sample of a general orientation competency document and an orientation competency evaluation tool - attached. Evaluation Description: NPD Practitioners, nursing leadership, preceptors, and orientees provided positive feedback and presented opportunities for improvement. Most of the feedback provided was anecdotal. Below are the overarching themes: Positive: -The self-assessment is now based on the foundation of Benner’s Novice to Expert Model -The competencies are now measurable statements (not a checklist), making it easier for preceptors to assess and evaluate the orientee’s current state of practice Negative: -Concern about the length of the document now that each competency is a measurable statement. As an opportunity for improvement, NPD developed a satisfaction survey for the orientee, preceptor, NPD Practioner, and nurse leader to evaluate the new competency (see attached). NPD also plans to evaluate the impact of the orientation competency on nurse-sensitive indicators and patient outcomes.

Published Back to Strategy Search Strategy Submission S-A-F-E-T-Y Card: Safe Assessment and Infection Control “Must Know” Information Author: Angela D. Jones DNP, RN Title: Assistant Professor Coauthors: Institution: Stephen F. Austin State University Email: jonesas7@sfasu.edu Competency Categories: Safety Learner Level(s): Pre-Licensure ADN/Diploma, Pre-Licensure BSN Learner Setting(s): Clinical Setting, Skills or Simulation Laboratories Strategy Type: General Strategy Learning Objectives: Safety: (K) The student will correctly identify elements associated with standard and transmission-based precautions to promote infection control in the clinical setting. (S) The student will demonstrate reduced reliance on memory by using the S-A-F-E-T-Y! card to assist with safety assessment and infection control. (A) The student will discuss their role in promoting patient safety during clinical experiences. Strategy Overview: The S-A-F-E-T-Y! card is a clinical tool to promote quality, safe care specifically designed for the beginning prelicensure nursing student. As students begin to establish a knowledge base of information necessary to promote safe and effective care, the card serves as a reminder of the essential safety and infection control components. The S-A-F-E-T-Y card is intended for student use with each clinical experience (laboratory, simulation, and clinical settings). The safety information contained on the card is common to nursing practice providing a reminder of the key elements to assess and implement during the first encounter. The infection control card is based on the current Center for Disease Control and Prevention transmission-based precautions for promoting basic infection control (2016). The concept of infection control is new to the beginning student and often an area overlooked in healthcare. The goal of adding the infection control information to the S-A-F-E-T-Y! the card is to provide a quick reference for beginning nursing students as they establish a sound knowledge base necessary for promoting quality, safe patient care. Directions for use: The S-A-F-E-T-Y card and the Infection Control card are printed on the front and back of card stock and are laminated for student use in all clinical settings (laboratory, simulation, and with actual patients). The S-A-F-E-T-Y card is given to students at the beginning of the first clinical course and can be used throughout the nursing curriculum as a reminder of basic care principles. Please note: When printing, you will need to print the S-A-F-E-T-Y card and then turn the paper over and print the Infection Control card on the back. This will yield four cards per standard sheet of paper. Student Instructions: The S-A-F-E-T-Y card is to be kept in your pocket for all clinical experiences serving as a reminder of essential elements to promote safe patient care. The intent is to improve patient safety by reducing reliance on your memory. The S-A-F-E-T-Y card is primarily intended for use upon initial entry in the patient room. This will help remind you of the necessary safety assessments and patient education. The infection control side of the S-A-F-E-T-Y card functions to remind you of basic infection control principles that you may need throughout your clinical rotation. This information is common to nursing practice and addresses standard, contact, droplet, and airborne precautions. It provides you with a brief overview of each precaution, the population it is appropriate for, and the personal protective equipment included for each type of precaution. Submitted Materials: Infection-Control-Card-TS-272-2020.docx - https://drive.google.com/open?id=1yd8KzrHBzgkSpwjpDYOU9vF0tX0kM3_6&usp=drive_copy Safety-Card-2020-1.doc - https://drive.google.com/open?id=1q0EnfeLo5ZnZFuUWZROeHGmOOzaFFk_f&usp=drive_copy Additional Materials: Reference: Center for Disease Control and Prevention. (2016, January 6). Infection control basics: Transmission-based precautions. https://www.cdc.gov/infectioncontrol/basics/transmission-based-precautions.html Evaluation Description: The concepts contained on the S-A-F-E-T-Y card are associated with basic standards of care and are not new ideas; however, to the beginning nursing student, the information is new and can be overwhelming and easily overlooked. The S-A-F-E-T-Y card reduces reliance on memory while also encouraging students to value their role in high quality, safe patient care. Because students are encouraged to use the S-A-F-E-T-Y card with each clinical experience, instructors have the opportunity to use this as a point of conversation and to provide immediate student feedback relating to safe and effective care. Evaluation strategies related to student learning are associated with the formative evaluation and take place in the clinical setting. Verbal dialogue between the clinical faculty and the student with specific questions targeting the learning objectives allows the clinical faculty to evaluate student performance. This also provides an opportunity for immediate feedback as needed with the goal of promoting patient safety.

Published Back to Strategy Search Strategy Submission Applying Quality Improvement Skills in the Acute Care Setting Author: Lynne Bryant PhD, RN Title: Assistant Professor Coauthors: Institution: Radford University Email: rbryant3@radford.edu Competency Categories: Quality Improvement Learner Level(s): Pre-Licensure BSN Learner Setting(s): Classroom, Clinical Setting Strategy Type: General Strategy Learning Objectives: The student will: Seek information about outcomes of care for populations served in care setting Use tools (such as flow charts, cause-effect diagrams) to make processes of care explicit Use quality measures to understand performance Use tools (such as control charts and run charts) that are helpful for understanding variation Design a small test of change in daily work (using an experiential learning method such as Plan-Do-Study-Act) Practice aligning the aims, measures and changes involved in improving care Use measures to evaluate the effect of change Appreciate how unwanted variation affects care Value measurement and its role in good patient care Seek information about outcomes of care for populations served in care setting Use tools (such as flow charts, cause-effect diagrams) to make processes of care explicit Use quality measures to understand performance Strategy Overview: Students enrolled in a junior level class in Leadership and Management are concurrently enrolled in Adult I or Adult II (acute care medical surgical content and clinical). The content (knowledge, attitude, and skills practice) for the quality improvement projects is covered in the Leadership class, and the data collection part of the project is conducted during the students' clinical experiences, in collaboration with the clinical faculty. The teacher of the Leadership and Management class facilitates the project and students present the results in that class. Topics that reflect current issues in health care quality are assigned to each clinical group. Examples of topics include: risk for infection from indwelling urinary catheters, risk for infection from intravenous therapy, risk for inadequate pain management, risk for skin breakdown, risk for patient falls, and risk for failure to adequately monitor a patient. Students are responsible for working in their clinical groups to identify issues related to the topic during their clinical experiences. Students examine the issues surrounding their assigned topic while in the clinical setting. They work together in their groups to narrow their projects to a particular process within the assigned topic that can be examined during the time frame of the clinical rotation. Students then flowchart a process related to the assigned topic (for example the process used to identify patients at risk for falls), identify an area of breakdown in that process (for example the distribution of items, such as non-skid slippers, to prevent falls), plan how to measure the breakdown, develop a tool for measurement, and implement the data collection process. After collecting data, they propose a quality improvement strategy based on the analysis of the data. In previous semesters, students were allowed to use a fishbone diagram as an alternative to a flowchart. Examples of both types of presentations are included in the attached documents. Week of Class Assignment Weeks 1 and 2 Introduction to Class and FOCUS-PDCA Process Week 3 Quality Improvement Topics Assigned Week 4 Students are instructed to make observations related to assigned topic in clinical setting Week 5 Students begin to identify and narrow problemStudent flowchart the process within which problem is embedded Areas of process breakdown are identified Possible measurement strategies are discussed Week 6 Students bring draft of data collection instrument to class for review/revision Week 7 through Week 12 Students collect data in clinical setting; no patient identifying information is connected to any of the data Week 13 Students conduct data analysis with assistance of instructor as needed Week 14 Data are reviewed in class and students discuss proposed solution that will be presented in PDCA format Week 15 FOCUS-PDCA presentation Submitted Materials: Additional Materials: Evaluation Description: The project is evaluated through an oral classroom presentation (see attached project guideline). One of the key issues evaluated is that students demonstrate understanding of data-based decision-making and the relationship between the measurement results and the choice of improvement intervention. Students enjoy the project and have an opportunity to use quality improvement skills actively. Their presentations have been excellent and have even been requested by the managers of clinical units for presentation in the hospital.

Published Back to Strategy Search Strategy Submission Staff RN Perspective on Evidence Supporting Practice Author: Dori Taylor Sullivan PhD, RN, BC, CNA, CPHQ Title: Chair, Department of Nursing, Director of Interdisciplinary Studies Coauthors: Institution: College of Education & Health Professions, Sacred Heart University Email: sullivand@sacredheart.edu Competency Categories: Evidence-Based Practice Learner Level(s): New Graduates/Transition to Practice, Pre-Licensure ADN/Diploma, Pre-Licensure BSN, RN to BSN Learner Setting(s): Skills or Simulation Laboratories Strategy Type: Case Studies Learning Objectives: Determine an staff RN’s perspective on the evidence basis for a common nursing intervention Categorize the RN’s response as to the “way of knowing” typology Investigate whether and how the evidence basis for common nursing actions are communicated in a designated organizational setting Make recommendations for improving the evidence basis for the common nursing intervention selected Strategy Overview: The basic strategy for this exercise is to provide individual nursing students with the opportunity to observe an RN’s practice then informally interview that nurse as to what evidence supports his/her practice. It is critical that faculty sensitive the student to potential defensive staff reactions – and this exercise is best employed where a relationship already exists between a student and a specific nurse. Role playing a typical interchange of this type as a classroom or clinical laboratory exercise before asking students to complete the assignment is strongly recommended. The attached document details the student assignment and recommended debriefing strategies. This is not a graded assignment. Submitted Materials: Additional Materials: Evaluation Description: This exercise is designed to provide a reality basis to classroom discussions and readings regarding EBP. While some health care organizations have made great strides in integrating EBP, others will be at the very beginning of this initiative. It is important for students to gain an understanding of this reality in nursing practice. Several options are available for debriefing this exercise included: Instructing individual students to report in a reflective log with faculty providing feedback after reviewing the students’ postings Small discussion groups within the classroom or clinical laboratory settings (or a post conference session) can be assigned to compare responses to the questions posed within the assignment with themes reported to the larger group The recommendations for improvement provide a useful focus for relating to the leadership role of RNs within various health care settings

Published Back to Strategy Search Strategy Submission IV Push Evidence-Based Practice Checklist Author: Loretta K Dorn MSN RN CRNI Title: Director of Clinical Nurse Liaisons Coauthors: • Elizabeth (Liz) Campbell, MSN RN, CRNI® Vascular access team Newton-Wellesley Hospital • Denise Dion, MSN, RN, CNE, PCCN Professor Nursing Program at Central Arizona College • Candy Cross MSN-Ed, RN Adjunct Faculty Chandler Gilbert Community College • Marlene M. Steinheiser, PhD, RN, CRNI® Director of Clinical Education Infusion Nurses Society • Susan Paparella, MSN, RN Vice President at the Institute for Safe Medication Practices (ISMP) • Michelle Mandrack, MSN, RN Director of Consulting Services at the Institute for Safe Medication Practices (ISMP) • Visnja Maria Masina, DNP, RN, AGCNS-BC, Adult Clinical Nurse Specialist Cleveland Clinic main campus • Christina Colvin, MSN, APRN, AOCNS, CRNI® Clinical Nurse Specialist Cleveland Clinic main campus • Heather Witek BSN RN Sr Medical Affairs Specialist ICU Medical Institution: Fresenius Kabi Email: loretta.dorn@fresenius-kabi.com Competency Categories: Evidence-Based Practice, Quality Improvement, Safety Learner Level(s): New Graduates/Transition to Practice, Pre-Licensure ADN/Diploma, Pre-Licensure BSN, Staff Development Learner Setting(s): Clinical Setting, Skills or Simulation Laboratories Strategy Type: General Strategy Learning Objectives: This checklist is designed as a tool to: • Support the adoption of safe, standardized practices associated with IV push medication use. • Assist nurse educators in performing a standard competency assessment for nursing students and practicing nurses related to IV Push medication administration. Strategy Overview: There is a lack of standardized IV Push medication preparation and administration teaching strategies in nursing programs throughout the United States. This lack of standardization creates an alarming variation in clinical practice that places patients at a higher risk of harm. The goal of this practice strategy is to provide college nursing programs, hospital nursing residency programs, and any area of practice where IV Push medication is given, an Evidence-Based Practice guide and checklist of best practice standards to utilize in educating student nurses, novice nurses, and experienced nurses, to assess competency in skill acquisition related to IV push medication administration. The checklist when used in nursing will create best practices and reduce patient harm. Nurses that understand evidence-based practice create an environment of patient safety and a knowledgeable professional that can teach and mentor other nurses to ensure continued standardization. Implementation Strategy: The Checklist was created to provide easy access to the practice standards and competency checklist for all nursing programs through QSEN’s website, and the Patient Safety Task Force website, and to publish articles in educational journals of nursing and current nursing practice journals Submitted Materials: 303-2-I.V.-Push-Evidence-Based-Practice-Checklist-AUTHOR-REVISIONS.docx - https://drive.google.com/open?id=1sdsTDG5jkDXGelzu24oChJep1e4hPWxe&usp=drive_copy Additional Materials: Gorski, L., Hadaway, L., Hagle, M., Broadhurst, D., Clare, S., Kleidon, T., . . . Alexander, M. (2021). Infusion Therapy Standards of Practice. Journal of Infusion Nursing, 8th edition. Institute for Safe Medication Practices. (2015). Safe Practice Guidelines for Adult IV Push Medications. Retrieved from Institute for Safe Medication Practices: https://www.ismp.org/sites/default/files/attachments/2017-11/ISMP97-Guidelines-071415-3.%20FINAL.pdf Evaluation Description: In the pre-implementation phase, using the CCNE and ACEN distribution lists, the team conducted a national survey via survey monkey to assess the current educational curriculum related to the teaching of IV Push medication preparation and administration in nursing programs across the country. After researching the topic, the team noted a lack of a standardized blueprint for nursing programs that assess competency related to IV Push medication preparation and administration. The survey demonstrated there is a significant variation in what student nurses are being taught in nursing schools across the United States which creates an unsafe environment for patients. Of great concern, the survey results demonstrated that many nursing programs are teaching student nurses to unsafely, and unnecessarily dilute medications that are manufactured in ready-to-administer syringes which are meant to be used directly from a labeled manufacturer-provided syringe or system. Dilution and/or moving to another syringe can cause concentration errors, medication labeling errors, and potential contamination. Following the publication of this competency assessment tool, we will also send it to the CCNE and ACEN distribution list. A year from publication and dissemination, we will re-survey nursing programs using the same CCNE and ACEN distribution lists to evaluate the utilization of this practice strategy one year after implementation to give nursing schools time to incorporate the strategy into practice.

Published Back to Strategy Search Strategy Submission Using Simulation to Teach Hospital Quality Improvement Measures Author: Kathy Spade Title: Nursing Simulation/Lab Coordinator Coauthors: Institution: Waket Technical Community College Email: fkspade@waketech.edu Competency Categories: Quality Improvement, Safety, Teamwork and Collaboration Learner Level(s): Pre-Licensure ADN/Diploma Learner Setting(s): Skills or Simulation Laboratories Strategy Type: General Strategy Learning Objectives: This teaching strategy is designed to evaluate the following KSA's: 1. Knowledge: Recognize that nursing and other health professions students are parts of systems of care and care processes that affect outcomes for patients and families. 2. Skills: Use tools to make processes of care explicit. 3. Attitudes: Appreciate that continuous quality improvement is an essential part of the daily work of all health professionals. Strategy Overview: Student nurses should be taught hospital quality improvement efforts while in nursing school. This will help them to better understand the focus of quality care as they enter the hospital setting. The Institute for Healthcare Improvement has developed an Improvement Map for hospitals. This map also serves as a great resource for the development of simulation scenarios that include evidence-based interventions. Many of our patients are elderly. The Improvement Map gives interventions for "Essential Care of Frail Older Patients". These interventions were incorporated into a simulation for an elderly patient with a fractured hip who develops delirium. The following elements from this IHI map were used: 1. Implement standard processes to assess frail older patients on admission to the hospital (Falls Risk, Polypharmacy, Beers Criteria, Mental Status Assessment). 2. Consider following and putting into place appropriate screening and interventions when necessary for a comprehensive approach to minimizing risk in older patients (CAM assessment for delirium, PAINAD scale for delirium). 3. Consider asking, "What is the greatest hazard that this patient faces?" and establish a prevention and treatment program to address the hazard upon each admission. (In this simulation, the patient develops delirium and the physician orders restraints. Discussion takes place as the student has to use TeamStepps- Advocacy and Assertion to question the order. This leads to discussion of prevention of delirium in this high risk population). Submitted Materials: Additional Materials: Evaluation Description: This workshop was funded by a 2012 Perkins Grant. Faculty participated in the simulation and had the opportunity to evaluate this teaching strategy. All acknowledged that teaching quality improvement measures during simulation is important and will ease the transition of our students to the workplace. Students also participated in this simulation and completed a formative evaluation. All students had a better understanding of the standard processes used to assess the frail elderly on admission to the hospital. All used appropriate screening and interventions during simulation to provide a comprehensive approach to minimizing risk to this population of hospitalized patients. Students gained a better understanding of prevention and treatment of delirium in hospitalized frail elderly patients. Many students lacked the opportunity to work with elderly patients experiencing post-operative delirium and stated that this simulation was valuable. Faculty choosing to use this teaching strategy can use their own formative evaluation tool. It is best to administer this immediately after the debriefing session. Many include questions related to effectiveness of the debriefing session if this is a new teaching strategy for them.

Published Back to Strategy Search Strategy Submission Suicide Sentinel Event Analysis: A Website Evaluation Activity Author: Anna Reber-Frantz MS, RN, AHN-BC, CNE Title: DNP Student Coauthors: Institution: Western University of Health Sciences Email: areber-frantz@wuhs.edu Competency Categories: Informatics, Safety Learner Level(s): Pre-Licensure ADN/Diploma Learner Setting(s): Clinical Setting Strategy Type: Online or Web-based Modules Learning Objectives: Explain why information and technology area essential for safe patient care (QSEN Informatics: knowledge). Use high quality electronic sources of healthcare information such as the Joint Commission online website regarding in-patient suicides and national safety initiatives for suicide prevention in health care settings (QSEN: Informatics: skills). Value technologies that support clinical decision-making, error prevention, and care coordination (QSEN Informatics: attitudes). Compare and contrast similarities and differences between two quality assessment guides (QSEN Informatics: skills i.e. apply technology and information management tools to support safe processes of care). Evaluate at least four online website sources of information about suicide and suicide prevention (QSEN Informatics: skill i.e. use high quality electronic sources of healthcare information). Strategy Overview: Part One: 1) The student will access the Joint Commission web-site and find sentinel event information and national initiatives regarding suicide and suicide prevention amongst patients in healthcare organizations. View the following sites: a. Suicide Risk Reduction b. Suicide Event Alert: Issue 7 Inpatient Suicide, Recommendations for Prevention 2) After reviewing the Joint Commission web-sites, the student will then read one of two articles listed below that relates to the subject of online internet searches and summarize the findings of one of the two articles in several paragraphs containing 300 words or less. a. Dutta-Bergman, M. (2003). Trusted online sources of health information: Differences in demographics, health beliefs, and health-information orientation. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1550562/ b. Bernstam, E., Shelton, D., Walji, M., & Meric-Bernstam, F. (2004, October). Instruments to assess the quality of health information on the World Wide Web: What can our patients actually use? International Journal of Medical Informatics, 1-7. doi: 10.1016/j.ijmedinf.2004.10.001 Student will access this article by logging in with their personal log-in to school library database. Assessment/Evaluation : Student written work will be evaluated based on the criteria presented on the Research Article & Quality Assessment Site Summary Rubric provided on page six of this application packet. The rubric will allow the faculty member to assign either 1, 3, or 5 points for each written activity depending on the quality of work submitted. 3) Upon completion of the summary of one of the two research articles listed above, the student will then peruse the Dartmouth Biomedical Libraries web-site for Finding and Evaluating High-Quality Information found at http://www.dartmouth.edu/~library/biomed/guides/find-info.html?mswitch- redir=classic 4) Finally, the student will compare and contrast the following two Quality Assessment site guides and comment on similarities and differences in several paragraphs containing 300 words or less. a. A Report on the Evaluation of Criteria Sets for Assessing Health Web Sites found at http://www.hii.org/eca.pdf and Suicide Sentinel Event Analysis: A Website Evaluation Activity b. Assessing the Quality of Internet Health Information at the AHRQ web-site found at http://www.ahrq.gov/data/infoqual.htm Assessment/Evaluation : Student written work will be evaluated based on the criteria presented on the Research Article & Quality Assessment Site Summary Rubric provided on page six of this application packet. The rubric will allow the faculty member to assign either 1, 3, or 5 points for each written activity depending on the quality of the work submitted. Part Two: 1) The student will evaluate at least four online website sources for information about suicide and suicide prevention in healthcare organizations and record findings for each of the four sites on the Suicide Information & Prevention Website Evaluation Criteria Form(s) provided on page seven of this application packet. Submitted Materials: Additional Materials: Evaluation Description: Assessment/Evaluation : Student written work will be evaluated based on the criteria presented on the Suicide Information & Prevention Website Evaluation Rubric provided on page eight of this application packet. The rubric will allow the faculty member to assign either 1,3, or 5 points to each criteria form submitted and then, all four point values will be added together and divided by four to equal a point value for this particular portion of the activity. Total potential points for the entire learning activity will be equal to 15 points overall. Suicide Sentinel Event Analysis: A Website Evaluation Activity Research Article & Quality Assessment Site Summary Rubric Instructions: The research article summary will be assigned a point value of either 1, 3 or 5 points based on the top two criteria while the quality assessment site summary will be assigned a point value of either 1, 3 or 5 points based on the bottom two criteria. Performance → Accomplished Developing Beginning ↓ Criteria for Article (5 points) (3 points) (1 points) Completeness of summary: Use of language. Summary written in proper paragraph format with complete sentences, correct spelling, punctuation, & grammar. APA format integrated appropriately and article referenced according to APA 6th edition guidelines at the end of the summary. Summary generally included complete sentences, correct spelling, punctuation, & grammar and some attempt was made to utilize correct APA 6th edition and formatting in the write-up. Summary included errors in sentence structure, use of spelling, punctuation, & grammar and showed little understanding of how to utilize APA 6th edition formatting in the write-up. Completeness of summary: Use of ideas. Summary addressed key ideas presented in the article. Examples and facts from the article are presented to support key ideas. Summary addressed ideas presented in the article, but not clearly or succinctly. Some examples and facts from the article are presented to support key ideas. Summary attempted to address ideas presented in the article, but lacked pertinent examples and facts to support main ideas. ↓ Criteria for Quality Assessment (5 points) (3 points) (1 points) Completeness of summary: Use of language. Summary included no errors in grammar or spelling that distract the reader from the content. Summary included 2-4 errors in grammar or spelling that distract the reader from the content. Summary included 4 or more errors in grammar or spelling that distract the reader from the content. Completeness of summary: Use of ideas. Summary compares and contrasts items clearly. Points to specific examples to illustrate the comparison and includes only information relevant to the comparison. Summary compares and contrasts items, but the supporting information is general and includes only information relevant to the comparison. Summary compares and contrasts items but the supporting information is incomplete and includes information that is not as relevant to the comparison. Rubric developed by ARF with modifications made from the following rubric sources: Summary Grading Rubric . A document retrieved from Article Review Grading Rubric and Comparison and Contrast Rubric . Retrieved from http://www.readwritethink.org/files/resources/lesson_images/ lesson275/compcon_rubric.pdf Suicide Sentinel Event Analysis: A Website Evaluation Activity Suicide Information & Prevention Website Criteria Form Instructions: Make four copies of this form and evaluate each web-site using this criteria. Credibility: Includes the source, currency, relevance/utility, and editorial review process for the information. Contents/Caveats: Must be accurate and complete and an appropriate disclaimer provided. Clarification of whether site function is to market products and services or is a primary information content provider. Discloser: Includes informing the user of the purpose of the site, as well as any profiling or collection of information associated with using the site. Links: Evaluated according to selection, architecture, content, and back linkages. Design: Encompasses accessibility, logical organization (navigability), and internal search capability. Interactivity: Includes feedback mechanisms and means for exchange of information among users. Information source: AHRQ. (June, 1999). Assessing the Quality of Internet Health Information . Retrieved from http://www.ahrq.gov/data/infoqual.htm Suicide Sentinel Event Analysis: A Website Evaluation Activity Suicide Information & Prevention Website Evaluation Rubric Instructions: Each criteria form will be given a point value, then, all four point values will be added together and divided by four to equal a point value for this portion of the activity. Performance → Accomplished Developing Beginning ↓ Web-site Evaluation Criteria (5 points) (3 points) (1 points) Credibility Write-ups accurately and completely considers source, relevance/utility and editorial review process. Write-ups demonstrate some ability to consider source, relevance/utility and editorial review process. Write-ups miss pertinent data regarding source, relevance/ utility and editorial review process. Content/Caveats Write-ups demonstrate accuracy and completeness, and includes pertinent information about disclaimer and caveats. Write-ups reveal some accuracy and completeness and attempt to address information about disclaimer and caveats. Write-ups reveal limitations in accuracy and completeness and fails to address information about disclaimer or caveats. Disclosure Write-ups clearly articulate the purpose of the site as well as any profiling or collection of information associated with use of the site. Write-ups capture some essences of the purpose of the site and may or may not address whether or not information was collected by users. Write-ups reveal limitations with capturing the main purpose of the site and do not address whether information about users was collected. Links Write-ups clearly address the web-sites ability to connect with other