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 1
Opportunity ∗ Since 2007 the Tennessee Hospital Association, working through The Tennessee Center for Patient Safety, has provided leadership and direction to improve patient outcomes and safety. ∗ The collaborative actions between healthcare organizations and quality/safety organizations have improved patient safety and outcomes. http://tnpatientsafety.com/ 2
Opportunity ∗ Missing from the collaborative are nursing schools and other programs that teach basic patient care skills. ∗ Precedent has been established, the Middle Tennessee Clinical Placement Center workgroups have established shared orientation programs for nursing and other students on such topics as confidentiality, diversity, emergency preparedness, infection prevention and safety. http://tcps-tn.org/ 3
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. 4
Proposal ∗ The following opportunity was identified: ∗ Prevention of hospital acquired catheter associated urinary tract infections (HA- CAUTI) http://www.wordle.net/ 5
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/ 6
Resources available at: http://tnpatientsafety.com/simulation/cauti/ 7
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Opportunity ∗ Program Development Objectives: (EBP) • Describe the impact of hospital acquired catheter ∗ Didactic associated urinary tract infection • Apply recommended evidence-based practices ∗ Simulation (bundles) for preventing hospital acquired catheter ∗ Competency associated urinary tract infections Demonstration ∗ Flexibility to meet needs of learners and organization ∗ Grant funding for 2014 10
Partner : Aquinas – Delivery Methods Didactic: Simulation: Competency Demonstration: Class Room Class Room Live Simulation Incidence and risk Insertion Insertion Pathogenesis • Female • Female Prevention • Male • Male • Necessity / use Maintenance • Insertion • Maintenance • Handoff / handover • Surveillance Pre-testing Video Competency checklist Video Scripted Debrief Recorded Simulation Scripted Debrief Reviewed Simulation Scripted Debrief Post-testing 11
Partner : Belmont – Delivery Methods Didactic: Simulation: Competency Demonstration: Class Room Class Room Live Simulation Incidence and risk Insertion Insertion Pathogenesis • Female • Female Prevention • Male • Male • Necessity / use Maintenance • Insertion • Maintenance • Handoff / handover • Surveillance Pre-testing Video Competency checklist Video Scripted Debrief Recorded Simulation Scripted Debrief Reviewed Simulation Scripted Debrief Post-testing 12
Partner : TCMC – Educational Approach ∗ Live Sessions ∗ Simulation ∗ Leadership and staff ∗ Demonstration ∗ Practice high risk, low member preference ∗ Impart importance volume skill without ∗ Evoke affective consequence ∗ Power of debrief ∗ Set expectations ∗ Audit ∗ Enhance/promote critical thinking 13
Partner : TCMC – Delivery Methods Didactic Simulation Competency Demonstration Class Room Class Room Live Simulation Incidence and risk Insertion Insertion Pathogenesis • Female • Female Prevention • Male • Male • Necessity / use Maintenance • Insertion Surveillance • Maintenance • Handoff / handover • Surveillance • Documentation Pre-testing Video Competency checklist Video Scripted Debrief Post-testing Scripted Debrief Surveillance audit 14
Education and Competency Materials 15
Education and Competency Materials 16
Education and Competency Materials 17
Education and Competency Materials http://www.laerdal.com/us/doc/94/Interchangeable- 18 Catheterization-and-Enema-Task-Trainer
Partner : MRMC – Delivery Methods Didactic: Simulation: Competency Demonstration: Computer Based Training Computer Based Training Live Simulation Pathogenesis Insertion Insertion Prevention • Female • Female • Necessity / use • Male • Male • Insertion Maintenance • Maintenance • Handoff / handover • Surveillance CBT Video CBT Video Competency checklist Post test Completed prior to Surveillance audit Completed prior to competency competency 19
Partner : MRMC – Educational Approach ∗ Blended Learning – ∗ Demonstration – ∗ Adult learners prior ∗ Engage muscle memory ∗ Simulate “real life” knowledge ∗ Cost effective ∗ Peer Review - culture ∗ Increase number of staff ∗ Set expectations ∗ Set expectations prior to ∗ Audit – “real cases” demonstration ∗ Non-nursing staff 20
LMS Assignment Example 21
Audit 22
Partner: Belmont – Metrics (2014 - 4 th QRT) 19 Graduating BSN Students “The demo video that was viewed previously was very 2014-Summer helpful… Students watching ∗ Pre-test : 41.05 themselves perform procedures ∗ Post-test: 68.94 and finding their own mistakes...why hasn't this been done before?” 2 tailed Paired Sampled Test Sig: .00 Instructor 23
Partner: Belmont – Metrics (2015 – 1 st QRT) ∗ 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 24
Partner: Aquinas – Metrics (2014 - 4 th QRT) 10 Graduating ADN Students “ I f eel like, if anyt hing, t he 2014-Fall course allows f or us all t o be more conf ident and ef f ect ive ∗ More than 30 point advocat es f or excellence in improvement from pre-test to inf ect ion prevent ion; which we post-training test scores should all be passionat e ∗ Prime opportunity to discuss about .” difference between “real” S tudent nursing and correct nursing ∗ Benefits from contrasting incorrect catheter placement to correct methods. 25
Partner: MRMC – Metrics (2015 ) 26
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 27
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 28
Partner: TCMC – Metrics (2014 - 4 th 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) 29
Partner: TCMC – Metrics (2015 – 2nd QRT) Assessment & Documentation Tools 2015 Real Time Prompts & Reminders Nursing Orientation ∗ 273 2015 AFZ: HA-CAUTI ∗ 101 Assessment & Documentation Tools 01-01 to Real Time Prompts & Reminders 08-31-2015 30
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. 31
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