OADNOADN02/15/21
QSEN Competency #3: Safety
This content area emphasizes the key elements of safety that the pre-licensure graduate should be competent in upon graduation.
QSEN Definition: Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.
The patient safety movement was spurred forth following the 1999 publication of the Institute of Medicine’s To Err is Human. The report shockingly noted that as many as 98,000 people were dying in hospitals each year as a result of preventable medical errors (IOM, 1999, p. 1). Despite efforts to improve these statistics, the BMJ recently reported that medical error is the third leading cause of death in the US (The BMJ, 2016). Nurses, who have the opportunity and challenge to work at the “sharp end of care”, must begin to develop the competencies necessary to promote a culture of safety early in their nursing educational journey. Below are some examples of curricular activities with an emphasis on safety.
Classroom
Enhancing Medication Safety through remediation and reflection submitted by Donna McCabe, DNP, APRN-BC, GNP. This strategy seeks to improve acquisition of safety KSAs with medication dosage calculation through remediation and reflection.
https://www.qsen.org/learning-modules
A learning module contributed by Carol F. Durham, EdD, RN, ANEF and Jennifer Dwyer, MS, RN, BC, CNRN, FNP BC, entitled “Learning Module 17- Patient Safety: Our Intent Is To Do No Harm- So Why Do Errors Happen?”, highlights QSEN competencies which promote safe patient care and provides video, handout, and tools for classroom use.
Request access here: https://drive.google.com/open?id=0B6FwEbBhzK9iRTF3VGozOC0wSEk
A Just Culture Safety Exercise for faculty and/or students: Contributed by Mary Anne Tagulinao RN, BSN, MN, CRH and Joanne Iverson RN, BSN, MN. This exercise provides a case study approach and discussion around Just Culture.
https://www.youtube.com/watch?v=uBSc80puIMU&feature=youtu.be
This ANA video, “Nursing: The Infrastructure of Safety (Reducing Nurse Fatigue)”, provides an excellent background to spur student discussion of the role of nurse fatigue on the provision of safe care.
Clinical
http://qsen.org/quality-and-safety-monitor-assignment-2/
The Quality and Safety Monitor Assignment submitted by Laurie J. Palmer, MS, RN, AOCN provides a structured checklist which allows the student nurse an opportunity to analyze potential and actual risks which affect the provision of safe care, communicate observations related to safety hazards, and to value one’s role in preventing error.
https://nursetimtube.com/qsen_i_sbar_r
This video is located on the NurseTim site, created by Karen Rotolo, MSN, RN and Debbie Riggs, MSN, RN, CCRN who are on the faculty at the Mercy College of Nursing and the University of Pittsburgh Medical Center. They collaborated on the development of the QSEN strategy expanding SBAR as a communication strategy. This activity, created for medical surgical nursing students, can be completed in the conference setting.
Just Culture
The North Carolina Board of Nursing has extensive training regarding the concept of a “Just Culture”. The site has a list of concepts and definitions, in addition to a “Compliant Evaluation Tool”.
Lab/Simulation
http://sirc.nln.org/file.php/1/Supplemental_Materials_for_Integrating_QSEN_and_ACES.pdf
An NLN created resource, entitled, “Supplemental Materials for Integrating QSEN and ACES: An NLN Simulation Leader Initiative”, that incorporates QSEN competencies into the “Millie” unfolding case study that was developed for the NLN’s Advancing Care Excellence for Seniors (ACE.S) project. Tables that correlate the KSAs for each QSEN competency with the learning activities suggested in each scenario are provided, along with enhanced simulation templates for the three scenarios. Access to the ACES “Millie” unfolding case study can be found here: http://www.nln.org/professional-development-programs/teaching-resources/ace-s/unfolding-cases/millie-larsen
Enhancing Patient Safety in Nursing Education through Patient Simulation
https://www.ncbi.nlm.nih.gov/books/NBK2628/
This chapter in Patient Safety and Quality: An Evidence-based Handbook for Nurses (2008) (see Additional Resources below) specifically addresses the use of simulation as a teaching tool for patient safety. A sample simulation scenario is included.
NurseTim presents…NCLEX ® Nuggets: Safety as an Emphasis in Lab and Simulation
https://nursetimtube.com/nclex-nuggets-safety-lab-sim
This is a short video that provides a strategy that can be used in the simulation/lab setting that links the use of the NCLEX blueprint to what is being taught in the lab/simulation setting.
Additional Resources
Agency for Healthcare Research and Quality
The Agency for Healthcare Research and Quality (AHRQ), with additional funding from the Robert Wood Johnson Foundation, prepared this handbook for nurses on patient safety and quality. The Handbook also includes a section on nurses’ work environment and working conditions.
https://psnet.ahrq.gov/primers
This site offers definitions of commonly used patient safety terms and additional information about the source and context of the term.
The AHRQ Health Literacy Universal Precautions Toolkit, 2nd edition, can help primary care practices reduce the complexity of health care, increase patient understanding of health information, and enhance support for patients of all health literacy levels.
https://www.ahrq.gov/professionals/quality-patient-safety/patient-safety-resources/index.html
Features the Patient Safety Network case reports of safety errors from a variety of settings. Each case study includes expert commentary, take home points, and references.
https://www.ahrq.gov/teamstepps/instructor/index.html
TeamSTEPPS is an evidence-based teamwork system aimed at optimizing patient care by improving communication and teamwork skills among health care professionals, including frontline staff. It includes a comprehensive set of ready-to-use materials, including video clips and scenarios for discussion, and a training curriculum to successfully integrate teamwork principles into a variety of settings. Topics addressed include traits for effective leadership, situation awareness, protecting the team with mutual support, and effective communication.
https://www.ahrq.gov/professionals/education/curriculum-tools/cusptoolkit/index.html
CUSP contains a series of modules which can be modified for individual needs. Each module contains training tools and resources to make care safer by improving the foundation of how your physicians, nurses, and other clinical team members work together. It builds the capacity to address safety issues by combining clinical best practices and the science of safety for the goal of quality improvement. The CUSP Toolkit module “Implement Teamwork and Communication” helps learners understand the importance of effective communication and transparency, identify barriers to communication, and isolate and apply the effective teamwork and communication tools.
https://www.ahrq.gov/professionals/education/curriculum-tools/cusptoolkit/modules/implement/index.html
The Joint Commission:
https://www.jointcommission.org/assets/1/23/Quick_Safety_Issue_34_2017_Safety_briefings_FINAL.pdf
Shares the importance, benefits, and safety actions of daily safety briefings, also known as safety huddles.
https://www.jointcommission.org/topics/patient_safety.aspx
Learn about the Joint Commission’s patient safety focused initiatives.
World Health Organization:
http://www.who.int/patientsafety/education/curriculum/who_mc_topic-1.pdf
Resources from WHO to aid in the implementation of a patient safety curriculum.
References
The BMJ. (2016). Medical error is the third biggest cause of death in the US, say experts. [Press release]. Retrieved from http://www.bmj.com/company/wp-content/uploads/2016/05/medical-errors.pdf)
IOM (Institute of Medicine). 2000. To Err Is Human: Building a Safer Health System. Washington, DC: National Academy Press.
Originators of competency highlight: Laurie Palmer, MSN, RN, AOCN; Madelyn Danner, MSN, RN, CCRN, CEN, CNE; Julie Benson, MHA, MN, CNE, ARNP; Mary Adams, MSN, RN, CNE