Published Back to Strategy Search Strategy Submission Basic Pharmacology in Nursing Practice Competency Exam Author: Carol F. Durham Ed.D.(c.), RN Title: Director Clinical Education & Resource Center and Clinical Associate Professor Coauthors: Joan Williams, RN, MSN, Clinical Assistant Professor, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA Darlene Baker, RN, MSN, Assistant Director Clinical Education & Reso Institution: UNC-Chapel Hill School of Nursing Email: noreply@noreply.org Competency Categories: Safety Learner Level(s): Pre-Licensure ADN/Diploma Learner Setting(s): Skills or Simulation Laboratories Strategy Type: General Strategy Learning Objectives: n/a Strategy Overview: The teaching strategy is designed to evaluate the following KSAs: Knowledge: Examine human factors and basic safety design principles as well as commonly used unsafe practices, including work-arounds and dangerous abbreviations. Attitude: Appreciate the cognitive and physical limits of human performance. Skill: Use appropriate strategies to reduce reliance on memory. Knowledge: Delineate general categories of errors and hazards in care. Attitude: Recognize the value of open communication from the patient family and healthcare team. Skill: Communicate observations or concerns related to hazards and errors to patients, families and/or healthcare team. Submitted Materials: Additional Materials: If other examples or information are desired please contact Carol Durham, Director, Clinical Education & Resource Center at Carol_Durham@unc.edu and be CERTAIN to list in the subject line "QSEN teaching" otherwise the request may not be received. Evaluation Description: This synthesis/learning activity requires first semester pre-licensure nursing students to apply their nursing knowledge and skills associated with the planning, administration, and evaluation of medication therapeutics. This pass/fail competency exam goes far beyond demonstrating knowledge or skill. The expectation for this exam is for the student to demonstrate synthesis of the pharmacology knowledge as they integrate it with the performance of the requisite psychomotor skills. The competent demonstration of these skills is very important as they enter clinical in the next semester. So, as part of the pharmacology course, they demonstrate their proficiency through this psychomotor/cognitive exam. They are required to demonstrate the 6 Rights of Medication Administration (Right Medication, Right Patient, Right Dose, Right Time, Right Route, and Right Documentation) and the 3 medication checks. They are also expected to perform patient identification using two identifiers. Strategy Implementation: At the beginning of the semester the students are given logistic and preparatory instructions (see Basic Pharm Comp log and prep). They are asked to sign up for a time for open lab to review skills as they desire and a 30-minute block for the exam. This is a pass/fail assignment associated with their pharmacology course. The Basic Pharmacology Exam was developed in response to a curricular change. The flow of the courses and the pharmacology competency exam changed in Spring 2007. As planning ensued for the pharmacology exam it became evident to the educators that the students would not be able to pass the Advanced Pharmacology in Nursing Practice Competency Exam and that an additional basic exam needed to be designed. This basic exam is intended to allow first semester pre-licensure nursing students to integrate classroom information with the psychomotor skills they have learned in their fundamental skills labs. The content was leveled to allow the students success while challenging them to think critically. The Basic Pharmacology in Nursing Practice Competency Exam takes a total of 30 minutes for a given student. We run two cases (two students) in each room for the 30 minutes. They have to complete 2 patient care scenarios (see Basic Pharm Comp Ampicillin as an example) acting as a medical-surgical nurse. The students have 12 minutes to assess, interview, utilize available resources, and implement interventions with their patient. Between cases, they have 3 minutes to rotate to the RIGHT and prepare to begin the next case. This activity has been designed to mirror the activities as a nurse in the hospital or clinic involved with medication administration. A timekeeper using automatic timers manages the rotation in each room. No feedback is provided between cases. At the end of the third case, in the remaining 5 minutes the evaluators provide feedback. To facilitate efficient use of time, the students are instructed to receive feedback from the current station and then rotate to the LEFT, visiting the previous 2 stations to receive feedback on their performance. Each evaluator has a form where they record their comments to facilitate accurate and informative feedback. The timekeeper in the room holds the master P/F list and lets the students know of their pass/fail status as they exit. Students are expected to pass both of the medication administration simulations and have to return if they fail any one. This exam's counterpart has historically been a very challenging exam for the students because it is timed and they have to respond as in a real medication administration situation. Each of the scenarios requires different cognitive and psychomotor skills, requiring critical thinking and implementation.

Published Back to Strategy Search Strategy Submission The Jigsaw Teaching Strategy: Maximizing Opportunities for Students to Explore QSEN Competencies Across Clinical Sites Author: David Foley PhD, MSN, RN-BC, MPA Title: Assistant Professor and Director of Faculty Development Coauthors: Institution: Case Western Reserve University Frances Payne Bolton School of Nursing Email: dmf106@case.edu Competency Categories: Evidence-Based Practice, Patient-Centered Care, Quality Improvement, Teamwork and Collaboration Learner Level(s): Pre-Licensure ADN/Diploma, Pre-Licensure BSN Learner Setting(s): Clinical Setting Strategy Type: General Strategy Learning Objectives: Through participation in this Jigsaw Clinical Exercise the student will individually and collectively: •Identify QSEN competencies observed within their assigned clinical settings and provide example(s) of each •During post-conference discussions, use systems thinking to identify themes and patterns in QSEN competencies across clinical sites, especially in terms of patient-centered care, evidence-based practice, safety, and quality improvement •Affirm the importance of teamwork and collaboration in these robust post-conference discussions Strategy Overview: Strategy Overview: A typical early-intermediate didactic nursing course is divided into clinical groups of approximately 6-8 students, with each clinical group typically assigned to a specific clinical location or unit within each location. Although students are often assigned to only one clinical unit during their clinical experience, opportunities to rotate students to other units for direct patient care or observational experiences are often available. As the opportunity arises, each clinical group, or individual member(s) of a clinical group, are assigned 1-2 QSEN competencies and asked to note examples of that competency during their clinical experience. Alternatively, students may also be asked to gather examples of unit policies or related performance improvement initiatives that highlight any QSEN competency. Each clinical group or individual student(s) must gather information related to their QSEN competencies and related policies and be prepared to discuss it with their classmates during post-conference discussion. This pedagogical tool, known as a Jigsaw Learning Strategy, places great emphasis on cooperation and shared responsibility within groups and thus illustrates a valuable opportunity for teamwork and collaboration. As the success of each group depends on the participation of each individual in completing their task, nursing faculty must provide very clear instructions and swift feedback throughout the clinical day in order for the Jigsaw Learning Strategy to be executed effectively. The Jigsaw Learning Strategy for students assigned within the same unit at the clinical location: Clinical faculty assign each student 1 or more QSEN competencies as an area of focus for the day’s activities. Students note evidence of the competency through passive observation, discussion with other nurses, participation in interdisciplinary meetings, and by researching the unit’s policies, if available. Students reconvene for post conference and present their findings to the group. At the conclusion of the post conference, a number of QSEN competencies have been reviewed from the perspective of several students as well as the culture of their clinical units, thus leveraging opportunities for learning. Over the course of several weeks, the QSEN competencies can be rotated between students and after several weeks a complex mosaic of student observations and perspectives has been reviewed. Students dispersed to various clinical units at the same clinical location: (note: appropriate permission should be sought per established guidelines for clinical placement as agreed upon by the clinical site and the school of nursing). Clinical faculty assign each student 1-2 QSEN competencies as an area of focus for the semester’s. Students note evidence of the competency(ies) through passive observation, discussion with other nurses, participation in interdisciplinary meetings, and by researching the unit’s policies, if available. Over the course of several weeks, each student will rotate through the various units and become the clinical group’s ‘expert’ on that QSEN competency. Over the course of the semester an in-depth review of the clinical site’s mastery—or opportunities for improvement—on a QSEN competency will be achieved. • As with any assigned clinical activity, the Jigsaw learning strategy is planned in accordance with the clinical day’s goals, reviewed carefully at the clinical day’s preconference, and monitored by clinical faculty throughout the day. o Students are required to document on the Jigsaw Learning Form, review their findings with their peers, and submit to faculty for focused review at the end of the clinical day. o Faculty reviews the form for effective documentation of QSEN competencies and then returns to students, who will retain them for additional analysis at future clinical pre-/post-conferences or for discussion in the didactic classroom. o If possible, and with permission of students, faculty may post the collection of student observations in an approved location within the clinical site to spur interest in the QSEN competencies among staff. A Jigsaw Meta-Analysis of QSEN Competencies Toward the end of the semester, the didactic instructor can leverage the opportunity of having students from all clinical groups in the same classroom by having representatives from each clinical site present their observations on individual QSEN competencies. Starting with Safety, a representative from each clinical group can be asked to present a brief overview of the clinical site and findings related to that QSEN competency to the class. Students can write their findings in bulleted format on flip-charts then affix them to a classroom wall, if possible. The result is an impressive, although literal, representation of the Jigsaw teaching strategy. Students have been known to photograph the collage with their cell phones for future reference. For larger classes, a discussion board within the course’s learning management system can be created with a section for each QSEN competency. Jigsaw Learning is an example of a teaching strategy that promotes dynamic, meaningful clinical pre- and post-conference discussions. Reactions from students, clinical instructors, and clinical site staff has been quite favorable. Given today’s healthcare climate where safety, quality improvement, teamwork and collaboration, and other QSEN competencies lend themselves to the Magnet Status healthcare workplace. Feedback from floor nursing staff has especially been overwhelmingly positive. In fact, a number of the floor staff, especially from clinical sites espousing a shared governance model, have asked to attend post-conferences to learn more about the QSEN Competencies. Students have been overwhelmingly favorable in their response, especially given their strong preference for immediate application of didactic classroom knowledge. Following the clinical day, students are asked to reflect and submit their written reflection to faculty using the Critical Reflection Journal Template. This document asks students to relate their experience identifying QSEN strategies as related to one of the course objectives, classroom content, their daily goal, and future nursing practice. These reflective journals provide students with a suitable outlet to communicate their concerns to faculty, who can in turn provide constructive feedback and guidance. Summary With careful planning and supervision, the Jigsaw Teaching Method can be applied to nursing clinicals as a means to maximize students’ opportunities to individually and collectively identify and analyze QSEN competencies across settings. Post conference discussions allow students the opportunity to collectively share what they learned individually and thus magnify the learning potential of each clinical day. Submitted Materials: QSEN-Competencies-Critical-Reflection-Journal-Format-Revised-1.docx - https://drive.google.com/open?id=14NR4txuwpovXsT2MKBYl4hqmofp0DUmG&usp=drive_copy QSEN-Competency-Jigsaw-Exercise-Documentation-Form.pptx - https://drive.google.com/open?id=1o3fCbxWGSGrkanraTy6aZeGHBAeswSDi&usp=drive_copy Additional Materials: Evaluation Description: 1). Critical Reflection Journal 2). Informal feedback from students and floor staff 3). Review of artifacts (i.e. policies) retrieved by students

Published Back to Strategy Search Strategy Submission Utilizing SBARR: Using Peer Reviewers in a Low-Fidelity Lab Exercise Author: Libba Reed McMillan RN PhD Title: Assistant Professor, Auburn University School of Nursing Coauthors: Institution: Auburn University School of Nursing Email: reedreb@auburn.edu Competency Categories: Safety, Teamwork and Collaboration Learner Level(s): Pre-Licensure ADN/Diploma, Pre-Licensure BSN Learner Setting(s): Skills or Simulation Laboratories Strategy Type: General Strategy Learning Objectives: Demonstrate appropriate use of SBARR technique to communicate effectively with a physician/ health care provider. Evaluate performance of peer(s) in communicating utilizing the SBARR technique. Appreciate the importance of self- assessment of communication skills to ensuring quality and safety in nursing practice. Strategy Overview: This strategy relates to quality and safety as it reduces the reliance upon memory, thus reducing the risk of harm to patients. It utilizes the standardized communication format of SBARR to communicate effectively with health care providers. SBARR is a modified and expanded version of SBAR, which adds Read-back as a means for improving communication in the healthcare setting. This strategy introduces the novice nursing student to the value of standardization as related to safety, as well as serving as a teaching tool via peer evaluation of the communication process. Note: This exercise is NOT geared to measure critical thinking by the student of how to manage a complex health situation. Rather, the primary objective is to practice and apply theory of SBARR communication as a skill. This activity is adaptable by faculty to increasing complexity of exercise, or using a pre and post-test model at beginning of semester and end of semester or completion of nursing school. Roles: SBARR Exercise Leader Faculty/staff in lab to serve as the Physician/Health Care Provider (HCP) Student mentors/ staff to serve as playing the role of the patient Instructions/ Pre-brief (15 minutes) : Students will be given the theory content the previous day on “Communicating with Members of the Health Care Team ”. This lecture includes SBARR technique and the importance of communication by health care providers to safety of the patient and in delivering quality nursing care. This theory content is part of Team STEPPS program by AHRQ. Click here for slideshow. Instructions by the exercise leader will be to give out pocket-sized SBARR cards for reference. The students will also be instructed that they will be given a simple “problem” with their patient, in which they will need to call the attending physician and/ or the health care provider. The students will be given peer- review evaluation forms. These will be used to evaluate their peers as to effective use of the SBARR technique in communicating with the physician/ HCP. The students are told that they have been called into the different patient rooms with the patient requesting to see them as soon as possible due to a complaint or concern. Each concern will necessitate contacting the HCP. It is NOT the role of the student to “diagnose” the problem. The primary objective is to communicate effectively with the HCP. Scenario (1 hour) : Students will arrive to lab/ simulation setting in 4 groups consisting of 4 students in each group. Students will randomly decide the order they will be in the primary role and communicate using SBARR. The other three students are to use the peer evaluation tool to evaluate the primary student’s performance. The “patient” will be in bed. The student will talk with the patient and the patient will communicate their concern regarding a particular problem (see scenario attachment) to the HCP (role played by faulty/staff member). After approximately 6 minutes, the groups will rotate to the next bed; where there will be a different student in the group serving in the primary role, and the other three students will peer evaluate their performance. This process continues through the 4 groups. Debrief : (45 minutes). The SBARR exercise leader will conduct a debrief session consisting of the students completing the SELF ASSESSMENT EVALUATION OF SBARR COMMUNICATION tool. Submitted Materials: 111.SBARR_rubric_peer-review_QSEN-1.docx - https://drive.google.com/open?id=1n2JkfiPECmbp6oAtiFaSwpbE23mfGPmG&usp=drive_copy 111.SBARR_rubric_SELF-ASSESSMENT_QSEN_30-august-2010.docx - https://drive.google.com/open?id=1n2JkfiPECmbp6oAtiFaSwpbE23mfGPmG&usp=drive_copy Additional Materials: SCENARIOS Note: The student mentors will be briefed prior to the students entering the simulation setting. Playing the role of the patient, the student mentor will communicate his/her complaints/ concerns. SCENARIO A Ms Kim McIntyre, 40 years old, is complaining of extreme nausea. Has just vomited twice prior to the nurse arriving. Vomit has bright red blood in it. Stomach hurts very badly. Is allergic to aspirin and Sulfa drugs. History of liver disease. Vital signs are 120/80, 60 Pulse, 20 Respirations, and temperature of 102.5 orally. If you would like a more complex scenario that incorporates oral medication communication to the HCP: Ms McIntyre current medications are: Ibuprophen 800 mg TID, Synthyroid 0.25 mg q day, Fish oil capsules TID SCENARIO B Margaret Miles, 88 year old patient, is complaining of severe ear pain in both ears. Is extremely hard of hearing. A week ago, she was placed on Erthromycin 500 mg QID. She has been taking Motrin for pain in the right ear. She has a history of gout, and high blood pressure. Vitals: blood pressure 110/64, Pulse 65, Respirations 16, Temp 100.2 orally. If you would like a more complex scenario that incorporates oral medication communication to the HCP: Ms Miles is currently taking Tenormin 50 mg Qday, Digoxin 0.125 mg q day, Zyprexa 10 mg q day, and Zyloprim 600 mg q day. SCENARIO C Judy Riley, 60 year old patient, is complaining of severe chest pain. Has hurt the past 3 hours. Has a history of heart disease, and stroke. Is allergic to no medications. Has been taking Aspirin and vitamins for the past 2 months. Vitals: blood pressure 180/88, Pulse 80, Respirations, 20, Temperature 99.1 orally. If you would like a more complex scenario that incorporates oral medication communication to the HCP:Multivitamin Q day, Baby aspirin q day, Antivert 25 mg QID, Crestor 5 mg Q day, Vasotec 20 mg BID, Nitroglycerin SL prn SCENARIO D Kathy Fairling, a 25 year old patient is complaining of a severe lower back pain, which is making it difficult to stay in bed. She has no pain medications ordered. She has a history of gall stones, and is 5 months pregnant with her third baby. Vital signs are blood pressure 190/84, Pulse 98, Respirations 22, Temperature 103.5 orally. If you would like a more complex scenario that incorporates oral medication communication to the HCP:Prenatal vitamins 1 QD, Correctol 1-2 tabs prn Evaluation Description: See attachments: Students are listening for completeness of information: S (Situation): Peer introduced themselves to the physician, calling about ____ (patient’s name and room number), calling because____(brief statement regarding the problem, when it started, severity, etc). B(Background ): Reason for admission, Complete vital isgns, LOC, pertinent assessment findings, other information, such as current medications, laboratory results, code status, etc. A(Assessment): Peer stated what was believed to be the problem, or identified some degree of concern or possibilities as to troubleshooting. R(Recommendation): Peer stated what they would like done, such as when to call physician back, requesting a consult, possibility of HCP coming to evaluate patient condition, transfer to another unit, etc R(Read-Back): Information/ orders were completely and accurately repeated to HCP. 2. Self-assessment tool: This is used during the debriefing period, where the student evaluates his/her performance of SBARR. There are also reflective questions that provide qualitative data to improve the exercise. Faculty and staff find this exercise to be very easy to implement in the simulation setting, as it uses few resources. This exercise may also be enhanced throughout the semester by threading critical thinking into the scenarios to evaluate both communication and management of patient care. We received positive feedback from students, faculty and student mentors.

Published Back to Strategy Search Strategy Submission Mr. Potato Head: A LEAN, Mean Quality Improvement Teaching Machine! Author: Beth Murphy, MD Department of Medicine Title: Medical Doctors Coauthors: Eric Alper, MD and Eric Dickson, MD (*Inventor) Institution: University of Massachusetts Memorial Hospital and University of Massachusetts Medical School Email: elizabeth.murphy@umassmemorial.org Competency Categories: Patient-Centered Care, Quality Improvement, Safety, Teamwork and Collaboration Learner Level(s): Continuing Education, Graduate Students, New Graduates/Transition to Practice, Pre-Licensure BSN, RN to BSN, Staff Development Learner Setting(s): Classroom, Skills or Simulation Laboratories Strategy Type: General Strategy Learning Objectives: Strategy objectives: 1. Participants will understand concepts of Lean Process Management including “waste”, non-value added work, elimination of non-value added tasks in a work process, role of “the system” in quality, and importance of team based care. 2. Participants will understand steps in a PDSA cycle. 3. Participants will understand that with small changes in system, both quality and efficiency can be improved. 4. Applying insights gained from this interactive and fun exercise, participants will be energized to bring new Quality Improvement skills and knowledge back to their clinical settings to begin or enhance improvement efforts. QSEN graduate competencies: 1. Describe strategies for improving outcomes at all points of care. 2. Identify useful measures that can be acted on to improve outcomes and processes. 3. Demonstrate leadership in affecting the necessary change. 4. Value the contribution of standardization and reliability to safety. 5. Analyze self and other team members strengths, limitations and values. 6. Value the influence of system solutions in achieving team functioning. 7. Understand the roles and scope of practice of each interprofessional team member including patients, in order to work effectively to provide the highest level of care possible. QSEN pre-licensure competencies: 1. Describe examples of the impact of team functioning on safety and quality of care. 2. Identify system barriers and facilitators of effective team functioning. 3. Describe strategies for learning about the outcomes of care in the setting in which one is engaged in clinical practice. 4. Appreciate that continuous quality improvement is an essential part of the daily work of all health professionals. 5. Recognize that nursing and other health professions students are parts of systems of care and care processes that affect outcomes for patients and families. 6. Design a small test of change in daily work (using an experiential learning method such as Plan-Do-Study-Act). 7. Value own role in preventing errors. 8. Understand the roles and scope of practice of each interprofessional team member including patients, in order to work effectively to provide the highest level of care possible. Strategy Overview: This is a simulation teaching strategy used to illustrate Quality Improvement. This strategy can be used with: 1. Medical Students, Residents, Faculty, Nurses, other health care providers and team members 2. Anyone! Has been done successfully with 9 year learners at summer camp, as well as industrial engineers! Number of Participants Needed: 1. Ideal number is 7-8 members per team 2. Has been done with as few as 4 participants, or 125 students in teams of 8-10 members. A bus filled with 16 Potato Head family members is in a terrible crash! At the scene of the accident, Emergency Medical Services arrives to find only scattered body parts. Luckily, one of the family members was carrying a photo album with a photo of each family member. There are men, women, children, and pets on the bus. A health care team is waiting in the emergency room to correctly assemble as many family members as possible in 7 minutes. On the health care team, two of the members are designated “Implantation Specialists” (a.k.a. trauma surgeons). Only they can “implant” the parts into the potato bodies. The number of correctly assembled Potato Heads and the number of errors are tracked through each PDSA cycle. Submitted Materials: MrPotatoHeadLeanExerciseSlides.pptx - https://drive.google.com/open?id=11A7xMZE6Ii8AUiAG-YhSdPjaBl71Yzhf&usp=drive_copy Additional Materials: Evaluation Description: During the debrief, students should identify the following points: 1. The system is a critical determinant of performance; usually more significant than the skills or efforts of the people. 2. Good communication is essential for a high-functioning team. 3. Good ideas for improvement can come from anyone on the team. 4. Data is essential to drive improvement efforts. 5. Repeating PDSA cycles is a valuable process in Quality Improvement. 6. Efficiency is enhanced when waste is reduced. 7. All steps should add value. Strive to eliminate all steps that do not add value. 8. With very simple changes in system, you can improve both quality and efficiency! 9. QUALITY IMPROVEMENT CAN BE FUN!

Published Back to Strategy Search Strategy Submission Clinical Evaluations Using KSA's:Developing Tools and Strategies Author: Cindy Grandjean Phd Title: Assistant Professor Coauthors: Dr. Mary Paterson & Dr. Teresa Walsh Institution: Catholic University of America-School of Nursing Email: grandjean@cua.edu Competency Categories: Evidence-Based Practice, Informatics, Patient-Centered Care, Quality Improvement, Safety, Teamwork and Collaboration Learner Level(s): Pre-Licensure BSN Learner Setting(s): Clinical Setting Strategy Type: General Strategy Learning Objectives: Uses all of the knowledge, skills, attitudes (KSA’s) published by QSEN as a key template in the basis of a clinical evaluation tool. Hence, the tool is accurate in reflecting the clinical capabilities of each student in an objective, quantitative fashion with a focus on quality and safety in health care. Each competency is described below with the student objects defined. Provides Patient-Centered Care a. Demonstrate and elicit patient professional and caring values to clients as expressed in the process recordings, and complete health assessment. b. Elicit and communicate with patients, as related to the patient’s needs, values, and preferences. Express these effectively with confidentiality to other members of health care team. c. Complete a comprehensive health history incorporating and appraisal of psychosocial and physiologic issues. d. Assess levels of physical and emotional comfort. Exhibits Teamwork and Collaboration a. Demonstrate awareness of own strengths and limitations as a team member. b. Functions with assistance and direction as a member of the health care team. c. Initiate requests for help when appropriate to situation. d. Communicate with team members, in professional manner. Communicates in effective verbal and written manner, adapting one’s own style of communication and adapting that style to needs of the team and situation. Incorporates Evidence-Based Practice a. Demonstrate knowledge of basic scientific methods and processes in basic nursing skills (examples: Infectious Disease prevention, Body Mechanics). b. Base individualized plan of care on patient values, clinical expertise and scientific evidence. c. Read evidence based reports related to area of practice and implement the same effectively. 4. Understands & Applies Quality Improvement Methods a. Describe strategies for learning about the outcomes of care in the setting in which one is engaged in clinical practice. b. Recognize that nursing and other health professions students are parts of systems of care and care processes that affect outcomes for patients and families. c. Recognize that there can be tension between professional autonomy and system functioning in providing quality patient care. d. Recognize that there are different approaches for changing processes of care. 5. Promotes Safety a. Demonstrate effective use of technology and standardized practices that support patient safety and quality (body mechanic skills, infectious disease management, etc.). b. Demonstrate effective use of strategies to reduce risk of harm to self or others. c. Use of appropriate strategies to reduce reliance on memory (such as, forcing functions, checklists). d. Communicate observations or concerns related to hazards and errors to the instructor, members of the health care team, patients, and families. Understands & Utilizes Informatics a. Explain why information and technology skills are essential for safe patient care. b. Obtain access to the electronic health record. c. Document patient care in an electronic health record. d. Recognize the time, effort, and skill required for computers, databases and other technologies to become reliable and effective tools for patient care. Strategy Overview: The Clinical Evaluation tool is outlined in the attachment. Each core competency in the tool has a template or key, which describes the course and learner objectives using a high level of specificity under the umbrella of each clinical course and syllabi. The detailed measures are examples of instances of the common threads in terminology that is utilized in the tool. The keys for each clinical course are based upon level of skill and matriculation outlined in each clinical course year and subject material as stated in the syllabus. The areas of specialization are as follows: Medical Surgical, Psychiatric, Obstetric and Community Health Nursing. Developmental syllabus and clinical goals within each competency is established by literature review and faculty experts, as well as the objectives from The Essentials for Baccalaureate Nursing Education (American Association of College of Nursing, 2008) and the School’s mission. Each student fills out an evaluation at mid-term and at final. The score is PASS/FAIL and continuance in the course and the program is dependent upon passing this clinical aspect with a grade of PASS. The overall strategy is to create a succinct, relevant, objective clinical evaluation tool that is appropriate and pertinent for the student, as well as the clinical faculty and the overall mission of the school, while being founded in the core competencies of QSEN. Submitted Materials: 84.ClinicalEvalUsingKSAs.ppt - https://drive.google.com/open?id=1YFTvxXzLZd9eH0F9LB_lEiFdFbDR1zmY&usp=drive_copy Additional Materials: Evaluation Description: The clinical evaluation tool was used this summer (2008) in a pilot during a Medical-Surgical Clinical Course. Student evaluations were given and the majority of the feedback was positive, yet the return rate was poor (< 50%). The unanimous feedback from the 4 clinical faculty was all positive. There were no suggestions for improvement. This tool is being implemented this Fall Semester in a Medical-Surgical Clinical Course. At the end of semester, we will again distribute student evaluations and clinical faculty evaluations and at the end of the academic year, we will evaluate the feedback and solidify the tool in the curriculum.

Published Back to Strategy Search Strategy Submission Admission Health History: Assessment Pocket Card Author: Angela D. Jones DNP, RN Title: Assistant Professor Coauthors: Savana Eaton, SFASU Student Nurse Institution: Stephen F. Austin State University Email: jonesas7@sfasu.edu Competency Categories: Informatics, Patient-Centered Care, 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: 1)Patient-Centered Care: a.Skills- 1) Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan, and evaluation of care. b.Attitudes - 1) Value the patient’s expertise with own health and symptoms. 2)Safety: a.Skills – 1) Use appropriate strategies to reduce reliance on memory (such as, forcing functions, checklists). b.Attitudes – 1) Appreciate the cognitive and physical limits of human performance. 2) Value vigilance and monitoring (even of own performance of care activities) by patients, families, and members of the health care team. 3)Informatics: a.Knowledge – 1) Identify essential information that must be available in a common database to support patient care. b.Skills - 1) Document and plan patient care in an electronic health record. Strategy Overview: The Admission Health History: Assessment Pocket Card is clinical tool that was collaboratively developed by an undergraduate nursing student and faculty member. This tool is intended to promote quality, safe, patient-centered care in beginning nursing students as students seek to gather the patients’ health history information. As first semester nursing students are developing their nursing knowledge and skills, it is imperative to offer guidance in the clinical setting (laboratory, simulation, and actual human patient care). Students are challenged to apply concepts from the classroom to clinical practice which can be overwhelming and stressful at times. In an effort to promote the highest quality patient care along with valuable student learning experiences, a pocket card was developed to meet the needs of the learner while fostering comprehensive assessment data collection. The Admission Health History pocket card is intended for beginning nursing student use with each clinical experience (actual human patients, laboratory, and simulation) serving as a reminder of the essential components included in a basic patient health history. The information contained on the pocket card is common to nursing practice and meets the learning needs of a first semester fundamental student. It is also congruent with simulated electronic health records commonly used by many nursing programs. By providing first semester pre-licensure nursing students with the Admission Health History pocket card, this clinical tool reduces reliance on memory and promotes communication of relevant health history information between the patient, student, and medical team. This tool is to be used in conjunction with clinical documentation as required by individual nursing programs. The information gained from interviewing the patient based on the cues provided by the pocket card can then be transferred to the electronic health record (EHR) fostering the use of informatics. Directions for use: The Admission Health History: Assessment Pocket Card is printed on card-stock paper and laminated for student use in all clinical settings (actual human patients, laboratory, and simulation). The pocket card will be given to students at the beginning of the first clinical course for use throughout the semester. Student Instructions: - Use the pocket card to help guide your health history interview. This promotes patient centered care as you elicit responses from the patient valuing their experiences and expertise. It also reduces reliance on your memory which promotes safety and comprehensive assessment. The pocket card serves as a reminder of essential health history information that must be included in the simulated EHR to support care plan development and implementation. - Make notes regarding patient’s statements about their health history maintaining your focus on the patient. You will use these notes when entering the data in the simulated EHR as assigned. You will also need to report your findings to the patient’s primary nurse and to your instructor if your findings are not congruent with or are in addition to information gained during report. This facilitates quality, safe, patient-centered care. Submitted Materials: Admission-Health-History-Pocket-Card-QSEN-2018.doc - https://drive.google.com/open?id=1RSBUddpWf4EG7bCsiDVP1gGHkiLDVNs-&usp=drive_copy Strategy-Info-Admission-Health-History-Pocket-Card-QSEN-2018.docx - https://drive.google.com/open?id=18MyFMBTAuuNPMqTMbbq-QuYYWtv1YX7e&usp=drive_copy Additional Materials: http://qsen.org/bedside-assessment-and-documentation-basics-a-pocket-card-for-beginning-nursing-students/ Evaluation Description: The Admission Health History pocket card was implemented by one clinical cohort and found to be useful in gathering more specific and comprehensive health history. There were fewer gaps in essential data collection and documentation. Anecdotal evidence supports the use of this tool in developing a knowledge base of patient health history information. Furthermore, this tool was used in conjunction with the Bedside Assessment and Documentation Basics pocket card that is also published on the QSEN website providing a comprehensive approach to patient assessment in beginning nursing students.

Published Back to Strategy Search Strategy Submission Implementation of a Math Simulation in First Semester Nursing Students in PreLicensure Programs Author: Maria Calhoun RN, MSN, CPNP Title: Coauthors: Shunda Wilburn, RN, MSN, DNP Institution: Troy University- Montgomery Campus Email: mkk702@jagmail.southalabama.edu Competency Categories: Quality Improvement, Safety Learner Level(s): Pre-Licensure ADN/Diploma Learner Setting(s): Skills or Simulation Laboratories Strategy Type: General Strategy Learning Objectives: Upon completion of the math simulation, students will: 1. Utilize math formulations learned throughout the semester to perform mathematical calculations. 2. Explain the process of mathematical calculations throughout the simulation experience. 3. Apply mathematical concepts to understand their role in quality improvement for patient safety. 4. Students will demonstrate how to accurately perform mathematical calculations by achieving a 90% or higher score. Strategy Overview: Strategy Overview The math simulation experience is designed to meet the needs of first-semester undergraduate nursing students in a Pre-Licensure Program. The simulation is a quality improvement project within the educational setting to prepare students for future nursing semesters. The simulation is designed to improve student retention of mathematical skills which leads to safer clinical practices through accurate calculations. This simulation includes opportunities for students to practice mathematical skills learned throughout the semester (preparing oral and parenteral medications, programming IV pumps, etc.) and apply them to real-life scenarios. This application helps to better prepare students to practice safely in future clinical settings. Further, implementation of this simulation is to provide a learning experience that is non-stressful and fun. Not only will students identify areas of weakness in his or her mathematical calculation abilities, but also reduce medication errors. A nursing student that can adequately calculate medication doses will not only provide safe patient care but also decrease medication errors in the clinical setting. Strategy/Simulation Activity Students will be given the opportunity to participate in a math simulation before the dosages and solution final exam. The math simulation will have five stations (IV, oral tablets, oral liquid, household/metric conversions, & parenteral injections) with five students starting at each station (total of 25 students). Each student will be assigned a color-coded folder labeled A through E (example: Folder A is red). The students will keep the same assigned letter and color throughout the entire simulation (folders will remain at each station). Each folder will contain dosage calculation problems and student answer sheets. Students will be given 10 minutes to complete the problems and simulation. Once the student reaches the simulation aspect, the answer sheet will be given to the instructor to evaluate completion of math problems. The instructor will evaluate the simulation after grading the student’s answer sheets. Graded sheets will be collected at the end of the simulation experience. After students have completed all five stations, an evaluation form will be given to each student regarding the math simulation experience. Remediation will be offered to students who make less than 90%. Submitted Materials: Math-Simulation-Questions-Folder-A.pdf - https://drive.google.com/open?id=1jqz6LaxeHdxtcbpDXR8FYoR-ubHeMtXU&usp=drive_copy Math-Simulation-Student-Answer-Sheet-Folder-A.pdf - https://drive.google.com/open?id=1jp0ClFSMAKaz6NqGZHq79ha7exaJ1aJe&usp=drive_copy Math-Simulation-Folder-A-Instructor-Answer-Key.pdf - https://drive.google.com/open?id=1jLXgHtqKZUVaqlA5mXM87ZM20nL13O8A&usp=drive_copy Math-Simulation-Student-Evaluation.pdf - https://drive.google.com/open?id=1k4SdyRUI3GA-syY09JX4O7xinZg9-yBD&usp=drive_copy Additional Materials: Strategy Materials Attach: evaluation tools, grading rubric, Problem examples (Group A) Evaluation Description: The evaluation of the math simulation will include successful completion of math problems and simulation (to be graded by an instructor). Instructors will be given a grading rubric to assist with evaluating mathematical calculations. The goal will be that students who complete all parts of the calculations and simulations will achieve a score of 90% or higher. At the end of the simulation, students will have an opportunity to evaluate the simulation experience and provide his or her recommendations for improvement.

Published Back to Strategy Search Strategy Submission Student Innovator Award Author: Sharen Ziska MSN, RN Title: Nursing Instructor I Coauthors: Darla Mack, MSN, RN, Nursing Instructor I Elaine Patalski, CRNP, MSN, Nursing Instructor II Institution: University of Pittsburgh Medical Center (UPMC) Shadyside School of Nursing Email: ziskasa@upmc.edu Competency Categories: Quality Improvement Learner Level(s): Pre-Licensure ADN/Diploma Learner Setting(s): Classroom, Clinical Setting Strategy Type: Case Studies Learning Objectives: Learning objectives Students will: Demonstrate a comprehensive understanding of rapid-cycle improvement concepts Identify clinical implications for improving safety and quality of patient care Implement work redesign initiatives for improving patient safety in the practice environment Function as a change agent while working within an active quality collaborative Practice leadership behaviors that strengthen teamwork and promote patient safety QSEN Quality Improvement KSA’s: K = Describe approaches for changing process of care. S = Design a small test of change in daily work (using an experiential learning method such as Plan-Do-Check-Act) S = Use measures to evaluate the effect of change A = Appreciate the value of what individuals and team can do to improve care Strategy Overview: A student innovator award was developed to recognize the professional role transition student who demonstrated a commitment to improving the quality and safety of patient care by showing outstanding initiative and leadership qualities in the development and evaluation of a test of change project. The award was modeled after the nationally recognized Josie King Patient Safety Award and provides a foundation for professional development. TCAB rapid-cycle quality improvement concepts have been integrated into classroom and clinical educational methods during this senior-level course. Classroom instruction consists of a brainstorming session designed to help the students identify clinical implications for improving safety and quality of patient care. Students are then instructed on the PDSA rapid-cycle improvement concepts to create work redesign initiatives for improving patient safety in the practice environment. During clinical application, students function as change agents as they collaborate with nursing and inter-professional teams to implement and evaluate their identified test of change project. The students perform a poster presentation of their test of change projects to the class as a course requirement. At the completion of the class presentations, faculty nominate students for the student innovator award based on specific process improvement criteria. The student nominees are then required to present their test of change projects to a selection committee consisting of two nurse mangers from TCAB designated units, one improvement specialist, and two professional role transitions course coordinators. The winner is chosen based on specific process improvement criteria, collaboration and sustainability of test of change and is presented with an award during the graduation ceremony. Submitted Materials: QSEN_Upload__Student_Innovator_Award.pdf - https://drive.google.com/open?id=1VdE9NQpNjwEkvInRT3tXq6MtADYWimHk&usp=drive_copy Additional Materials: Evaluation Description: Since January 2007, there have been 221 graduate nurses exposed to the TCAB process improvement methodologies, completing 91 improvement projects on 35 nursing units in 7 different system hospitals. With the introduction of a student innovator award in June 2008 faculty have documented a significant improvement in the quality of improvement projects, level of student commitment and a greater impact on improving patient care. Students have demonstrated a more comprehensive understanding of process improvement principles with the ability to carry these concepts into their professional practice. The nurse managers and improvement specialist who participated on the selection committee were impressed by the students’ passion for creating a safer environment for patients and plan to implement the student project ideas on their own units.