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Jun 07, 2023 346 likes •708 views

Todays webinar will begin soon. Please mute your line by pressing *6. Please do not use the hold option on your phone. Questions and comments may be typed in the chat box at anytime. Lines will be opened during the

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Education and Competency Collaborative Program: Partnering to Improve Patient Outcomes

Supported by a grant from the Tennessee Hospital Association as part of the CMS Partnership for Patients Hospital Engagement Network (HEN) Objectives: 1) Describe collaborative processes utilized to assess, plan, implement and evaluate a shared, problem based learning program to decrease HA-CAUTI; and 2) Locate resources available to implement problem based learning program to decrease HA-CAUTI

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Opportunity

∗ Since 2007 the Tennessee Hospital Association, working through The Tennessee Center for Patient Safety, has provided leadership and direction to improve patient outcomes and safety. ∗ The collaborative actions between healthcare organizations and quality/safety organizations have improved patient safety and

  • utcomes.

http://tnpatientsafety.com/

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Opportunity

∗ Missing from the collaborative are nursing schools and other programs that teach basic patient care skills. ∗ Precedent has been established, the Middle Tennessee Clinical Placement Center workgroups have established shared

  • rientation programs for nursing

and other students on such topics as confidentiality, diversity, emergency preparedness, infection prevention and safety.

http://tcps-tn.org/

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Proposal

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

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Proposal

∗ The following opportunity was identified: ∗ Prevention of hospital acquired catheter associated urinary tract infections (HA- CAUTI)

http://www.wordle.net/

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Proposal

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

http://www.wordle.net/

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

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Opportunity

∗ Program Development (EBP) ∗ Didactic ∗ Simulation ∗ Competency Demonstration ∗ Flexibility to meet needs of learners and

  • rganization

∗ Grant funding for 2014

Objectives:

  • Describe the impact of hospital acquired catheter

associated urinary tract infection

  • Apply recommended evidence-based practices

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

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Partner : Aquinas – Delivery Methods

Didactic: Class Room Simulation: Class Room Competency Demonstration: Live Simulation Incidence and risk Pathogenesis Prevention

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

Insertion

  • Female
  • Male

Insertion

  • Female
  • Male

Maintenance Pre-testing Video Scripted Debrief Video Scripted Debrief Competency checklist Recorded Simulation Reviewed Simulation Scripted Debrief Post-testing

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Partner : Belmont – Delivery Methods

Didactic: Class Room Simulation: Class Room Competency Demonstration: Live Simulation Incidence and risk Pathogenesis Prevention

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

Insertion

  • Female
  • Male

Insertion

  • Female
  • Male

Maintenance Pre-testing Video Scripted Debrief Video Scripted Debrief Competency checklist Recorded Simulation Reviewed Simulation Scripted Debrief Post-testing

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Partner : TCMC – Educational Approach

∗ Live Sessions ∗ Leadership and staff member preference ∗ Impart importance ∗ Evoke affective ∗ Set expectations ∗ Simulation ∗ Demonstration ∗ Practice high risk, low volume skill without consequence ∗ Power of debrief ∗ Audit ∗ Enhance/promote critical thinking

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Partner : TCMC – Delivery Methods

Didactic Class Room Simulation Class Room Competency Demonstration Live Simulation Incidence and risk Pathogenesis Prevention

  • Necessity / use
  • Insertion
  • Maintenance
  • Handoff / handover
  • Surveillance
  • Documentation

Insertion

  • Female
  • Male

Maintenance Surveillance Insertion

  • Female
  • Male

Pre-testing Video Scripted Debrief Video Scripted Debrief Surveillance audit Competency checklist Post-testing

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Education and Competency Materials

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Education and Competency Materials

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Education and Competency Materials

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Education and Competency Materials

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

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Partner : MRMC – Delivery Methods

Didactic: Computer Based Training Simulation: Computer Based Training Competency Demonstration: Live Simulation Pathogenesis Prevention

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

Insertion

  • Female
  • Male

Insertion

  • Female
  • Male

Maintenance CBT Video Post test Completed prior to competency CBT Video Completed prior to competency Competency checklist Surveillance audit

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Partner : MRMC – Educational Approach

∗ Blended Learning – ∗ Adult learners prior knowledge ∗ Cost effective ∗ Increase number of staff ∗ Set expectations prior to demonstration ∗ Demonstration – ∗ Engage muscle memory ∗ Simulate “real life” ∗ Peer Review - culture ∗ Set expectations ∗ Audit – “real cases”

∗ Non-nursing staff

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LMS Assignment Example

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Audit

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

∗ Pre-test : 41.05 ∗ Post-test: 68.94

2 tailed Paired Sampled Test Sig: .00

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

19 Graduating BSN Students 2014-Summer

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

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

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

∗ More than 30 point improvement from pre-test to post-training test scores ∗ Prime opportunity to discuss difference between “real” nursing and correct nursing ∗ Benefits from contrasting incorrect catheter placement to correct methods.

10 Graduating ADN Students 2014-Fall “ I f eel like, if anyt hing, t he course allows f or us all t o be more conf ident and ef f ect ive advocat es f or excellence in inf ect ion prevent ion; which we should all be passionat e about .” S tudent

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Partner: MRMC – Metrics (2015 )

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Partner: MRMC – Processes & Outcomes

∗ Develop: Evidence Based Practice/Policies ∗ Educate: Unlicensed & allied health care staff (Urinary catheter care – NTs, Transporters, Respiratory Therapy, Imaging). ∗ Culture: High Risk procedure ∗ Incorporate: Competency into RN orientation. ∗ Implement: Nurse Driven Removal Protocol – Nursing ownership! ∗ MD involvement: order sets ∗ Document: Urinary status every shift

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Partner: MRMC – Processes & Outcomes

∗ Discuss: Status in Interdisciplinary Care Team Conference. ∗ Monitor: Status Board of urinary catheters every unit. ∗ Audit: Processes – address in real time. ∗ Evaluate: Alternatives & processes by frontline staff ∗ Expect: MRMC goal =Zero CAUTI ∗ Next steps: Urinary catheters in community/population

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

Target Units: ∗ Tower ED ∗ Tower ICUs (adult) ∗ Tower OR ∗ WH/CH OR ∗ WH L&D Other Units: 14 N = RN 322 / Other 40 Pretest ∗ Mean: 49.50 ∗ SD: 22.36 Posttest ∗ Mean: 79.3 ∗ SD: 19.08 Two-tailed P value < 0.0001 (paired)

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

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

Assessment & Documentation Tools Real Time Prompts & Reminders Assessment & Documentation Tools Real Time Prompts & Reminders 31

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Lessons Learned

∗ Leadership is an integral part of cultural and patient outcome and safety change. ∗ Relationships and trust impact rate and success of change. ∗ Conflicting priorities are a part of our state (current/future). ∗ Collaboration is an investment that requires resources. ∗ Differences between stakeholders may impact resources (funding/human resources) and outcomes (number of programs attempted/offered). ∗ Educational interventions alone will not improve patient outcome and safety. ∗ Evidenced based practices must be efficiently and effectively implemented to improve patient outcomes and safety change. ∗ Assessment and Documentation Tools (Continued Need) ∗ Nurse Driven Protocol to Remove Urinary Catheter ∗ Real Time Prompts and Reminders (Audits, Status Boards, etc.) ∗ Healthcare provider must adapt to cultural and practice changes. ∗ Healthcare providers must own patient outcomes and safety.

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Human Resources

Organization Name E-Mail Address

Aquinas College • Catherine Cantrell, MSN, RN cantrellc@aquinascollege.edu Belmont University

  • Beth Hallmark,

PhD, MSN, RN

  • Tracy Johnson, DNP,

FNP-BC beth.hallmark@belmont.edu tracy.johnson@belmont.edu MRMC

  • Susan K. MacArthur

Ed.D, MSN, FNP, RN- BC SmacArthur@mauryregional.com TCPS

  • Chris Clarke,

BSN, RN cclarke@tha.com TCMC

  • Gayle Jones,

MS, RN

  • Lee Ann Hanna,

PhD, MSN, RN-BC Gayle.Jones@hcahealthcare.com LeeAnn.Hanna@HCAHealthcare.com

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

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

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