Key Strategies to Publishing Your Quality Improvement Work.

BACKGROUND: Improving quality and safety is a goal in health care, and sharing quality improvement (QI) work with internal and external audiences is key to spreading knowledge and ideas for change. Peer-reviewed journals are interested in manuscripts reporting QI work. METHODOLOGY: Although QI work is methodologically different from traditionally published research articles, it can be publishable if conducted in a way that is scholarly and well-planned. The authors suggest that key strategies to producing publishable, scholarly improvement work exist within two broad categories: rigorous work and compelling writing. Rigorous improvement work includes the following four key components: (1) understanding baseline processes, (2) developing a solid methodology and measurement plan, (3) analyzing and describing context, and (4) clearly explaining the intervention. Creating compelling writing includes clear team expectations that are defined early in the process, including authorship and division of the work. The team should identify a journal early in the process and follow a clear plan for team writing that includes an outline and frequent feedback. CONCLUSION: Elements of rigorous QI work and compelling writing align to develop strong material for publishing scholarly QI work.

The Institute for Health care Quality, Safety, and Efficiency: A Comprehensive Approach to Improving Organization-Level Quality Performance.

Despite decades of effort to drive quality improvement, many health care organizations still struggle to optimize their performance on quality metrics. The advent of publicly reported quality rankings and ratings allows for greater visibility of overall organizational performance, but has not provided a roadmap for sustained improvement in these assessments. Most quality training programs have focused on developing knowledge and skills in pursuit of individual and project-level improvements. To date, no training program has been associated with improvements in overall organization-level, publicly reported measures. In 2012, the Institute for Health care Quality, Safety, and Efficiency was launched, which is an integrated set of quality and safety training programs, with a focus on leadership development and support of performance improvement through data analytics and intensive coaching. This effort has trained nearly 2000 individuals and has been associated with significant improvement in organization-level quality rankings and ratings, offering a framework for organizations seeking systematic, long-term improvement.

QSEN Safety Competency: The Key Ingredient Is Just Culture.

Patient safety is a familiar and long-standing competency for nurses. Effective error gap analysis is necessary to improving patient safety. Recent updates in patient safety emphasize just culture as vital to improving patient safety. This article explores how just culture has expanded the understanding of patient safety and offers some take-away tips for nurses. [J Contin Educ Nurs. 2019;50(10):444-447.].

Quality and Safety Education for Nurses Teamwork and Collaboration Competency: Empowering Nurses.

Improving the safety of health care continues to be a high priority for U.S. health care systems. One of the core competencies identified to improve health care safety focuses on improving teamwork. This article focuses on tools nurses can employ to improve health care team communication, thereby enhancing health care teamwork. [J Contin Educ Nurs. 2019;50(6):252-255.].

SQUIRE-EDU (Standards for QUality Improvement Reporting Excellence in Education): Publication Guidelines for Educational Improvement.

The SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence) guidelines were published in 2015 to increase the completeness, precision, and transparency of published reports about efforts to improve the safety, value, and quality of health care. The principles and methods applied in work to improve health care are often applied in educational improvement as well. In 2016, a group was convened to develop an extension to SQUIRE that would meet the needs of the education community. This article describes the development of the SQUIRE-EDU extension over a three-year period and its key components. SQUIRE-EDU was developed using an international, interprofessional advisory group and face-to-face meeting to draft initial guidelines; pilot testing of a draft version with nine authors; and further revisions from the advisory panel with a public comment period. SQUIRE-EDU emphasizes three key components that define what is necessary in systematic efforts to improve the quality and value of health professions education. These are a description of the local educational gap; consideration of the impacts of educational improvement to patients, families, communities, and the health care system; and the fidelity of the iterations of the intervention. SQUIRE-EDU is intended for the many and complex range of methods used to improve education and education systems. These guidelines are projected to increase and standardize the sharing and spread of iterative innovations that have the potential to advance pedagogy and occur in specific contexts in health professions education.

2017 National Quality and Safety Education for Nurses Faculty Survey Results.

The Quality and Safety Education for Nurses (QSEN) national initiative, started in 2005, has supported the adoption and integration of updated quality and safety competencies in nursing education. However, faculty needs regarding QSEN competency integration, and the degree to which QSEN competencies are reflected in current nursing curricula, have not been assessed nationally. This study (N = 2037) reports the findings of the 2017 National QSEN Faculty Survey and discusses implications for nurse educators and programs of nursing education.

Development and Psychometric Analysis of a Nurses' Attitudes and Skills Safety Scale: Initial Results.

Health care organizations have incorporated updated safety principles in the analysis of errors and in norms and standards. Yet no research exists that assesses bedside nurses' perceived skills or attitudes toward updated safety concepts. The aims of this study were to develop a scale assessing nurses' perceived skills and attitudes toward updated safety concepts, determine content validity, and examine internal consistency of the scale and subscales. Understanding nurses' perceived skills and attitudes about safety concepts can be used in targeting strategies to enhance their safety practices.

Nurses' Perceived Skills and Attitudes About Updated Safety Concepts: Impact on Medication Administration Errors and Practices.

Approximately a quarter of medication errors in the hospital occur at the administration phase, which is solely under the purview of the bedside nurse. The purpose of this study was to assess bedside nurses' perceived skills and attitudes about updated safety concepts and examine their impact on medication administration errors and adherence to safe medication administration practices. Findings support the premise that medication administration errors result from an interplay among system-, unit-, and nurse-level factors.

Coproduction of healthcare service.

Efforts to ensure effective participation of patients in healthcare are called by many names-patient centredness, patient engagement, patient experience. Improvement initiatives in this domain often resemble the efforts of manufacturers to engage consumers in designing and marketing products. Services, however, are fundamentally different than products; unlike goods, services are always 'coproduced'. Failure to recognise this unique character of a service and its implications may limit our success in partnering with patients to improve health care. We trace a partial history of the coproduction concept, present a model of healthcare service coproduction and explore its application as a design principle in three healthcare service delivery innovations. We use the principle to examine the roles, relationships and aims of this interdependent work. We explore the principle's implications and challenges for health professional development, for service delivery system design and for understanding and measuring benefit in healthcare services.

Sperm Hy-Liter™: an effective tool for the detection of spermatozoa in sexual assault exhibits.

A fluorescence-based assay specifically targeting human spermatozoa was tested and optimized for best staining results using a variety of mock sexual assault samples. Swab clippings versus whole swabs were evaluated for best sample preparation and to simplify workflow (direct application versus swab extraction). The practicality and sensitivity of Sperm Hy-Liter™ was compared to our current phase contrast microscopy protocol for searching for the presence of spermatozoa. Sperm Hy-Liter™ was more sensitive than phase contrast microscopy and was able to detect spermatozoa more effectively in actual sexual assault samples (recent [N=240] or 24 years old [N=4]) containing few spermatozoa. Correlations were drawn between the Sperm Hy-Liter™ spermatozoa counts and the AmpFlSTR(®) Profiler(®) Plus male profiles generated from the sperm cell DNA fractions of semen containing swabs and swab clippings. In addition, recovered spermatozoa from Sperm Hy-Liter™-stained slides with greater than 40 spermatozoa produced full STR male profiles in 20.3% of slides tested and partial STR male profiles in 52.8% of slides tested. The adoption of Sperm Hy-Liter™ offers a means to standardize and improve the efficiency of the microscopic screening of sexual assault evidence.

Fundamentally updating fundamentals.

Recent educational research indicates that the six competencies of the Quality and Safety Education for Nurses initiative are best introduced in early prelicensure clinical courses. Content specific to quality and safety has traditionally been covered in senior level courses. This article illustrates an effective approach to using quality and safety as an organizing framework for any prelicensure fundamentals of nursing course. Providing prelicensure students a strong foundation in quality and safety in an introductory clinical course facilitates early adoption of quality and safety competencies as core practice values.

Designing education to improve care.

BACKGROUND: Educators in all health care disciplines are increasingly aware of the importance and value of teaching improvement as an integral part of health professional development. Although faculty and learners can often identify needed changes in the clinical setting, many educators are not sure how to teach the improvement principles and methods needed to achieve and sustain those changes. DEFINING AND DEVELOPING COMPETENCY IN QI: Five developmental levels apply to physicians, nurses, and other members of an interprofessional quality improvement (QI) team: novice, advanced beginner, competent, proficient, and expert. For example, the expert develops a vast repertoire of skills and a capacity for situational discrimination, performs tasks on a more intuitive level, and recognizes and immediately addresses essential problems. Improvement is an action, and learning about improvement must be action based. Certain skills and knowledge are required at each stage in this learning process so that students in the health professions achieve competence in QI before entering practice. GENERAL PRINCIPLES FOR EDUCATIONAL EXPERIENCES IN HEALTH CARE IMPROVEMENT: Four principles, which apply at any developmental level, can help answer educators' questions about where to start: (1) The Learning Experience Should Be a Combination of Didactic and Project-Based Work; (2) Link with Health System Improvement Efforts; (3) Assess Education Outcomes; and (4) Role Model QI in Educational Processes. CONCLUSION: As educators teach future health professionals about improving care, the dissemination of exemplary models and emerging best practices will be increasingly important. Sustainability of improvements in patient outcomes will be dependent on both the value systems and skills of health professionals entering practice.

Assessment of patient simulation use in selected baccalaureate nursing programs in the United States.

INTRODUCTION: Newly graduated nurses are expected to possess clinical skills and the ability to critically judge quality in patient care. There are an increasing number of baccalaureate nursing (BSN) schools that are integrating the use of patient simulation (PS) in the educational experience of their students. This descriptive study examines the use of PS technology in selected BSN programs in the United States. METHODS: This study targeted National League for Nursing-accredited BSN schools with an online survey related to the current use of PS in course curriculum and how it is being used. Two hundred nine BSN schools were identified and 78 schools responded (37.3% response rate). RESULTS: Sixty (78.9%) BSN schools responded to the survey reported using patient simulators in core clinical nursing courses: health assessment, nursing fundamentals, medical/surgical nursing I and II, pediatrics, and obstetrics courses. Approximately 31% of schools reported using high-fidelity scenarios in more than 51% of their clinical courses. The responding schools indicate that they are using PS in the usual undergraduate nursing courses that coincide with clinical settings. The replacement of actual clinical hours with PS remains controversial and unresolved. Responses to an open-ended question indicated interest in using PS but that many schools are limited by not having a dedicated faculty to champion the way and resources to purchase the technology. CONCLUSIONS: Although there were limitations to this study, it is one of the first to describe the patterns of using PS in nursing schools for clinical education. As the use of this technology grows in BSN programs, addressing the issues resulting from this study are essential to understanding the use of this technology in nursing education.

Using quality and safety education for nurses to enhance competency outcome performance assessment: a synergistic approach that promotes patient safety and quality outcomes.

As nursing programs respond to vital initiatives such as Quality and Safety Education for Nurses (QSEN), nursing faculty will discover important shared values exist between competency-based curricular models and the latest call for stronger foci on safety and quality. This article describes how one university is using the QSEN competencies to enhance its competency outcome performance assessment (COPA)-based curriculum, thereby updating and strengthening its graduates' skills in quality improvement and safety. Faculty at the school found QSEN and COPA share the same concerns for promoting student competence and continuing competence in nursing practice to safeguard patient safety and quality care. Nursing faculty whose teaching is focused in a competency-based curriculum are well positioned to respond to the call to integrate QSEN competencies into their curricula.

The new fundamentals in nursing: introducing beginning quality and safety education for nurses' competencies.

This article describes the redesign of the fundamentals of nursing course using an organizing framework and teaching strategies identified in the Quality and Safety Education for Nurses (QSEN) initiative. Six QSEN competencies (patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics) are essential for nursing practice. Beginning knowledge, skills, and attitudes (KSAs) associated with each competency were identified in a preliminary Delphi survey as important to incorporate early in prelicensure nursing curricula. Redesign requires a shift in focus from task-training and psychomotor skills development to incorporation of a systems context, reflecting redefined values and interventions associated with safety, quality, and professional nursing roles. A course revision, based on the QSEN competencies definitions, selected beginning KSAs, exemplar resources, and teaching strategies, is described. The reframing of fundamentals of nursing is essential to prepare new graduates for contemporary practice.

A national Delphi to determine developmental progression of quality and safety competencies in nursing education.

Quality and Safety Education for Nurses (QSEN) faculty outlined 6 competency domains: patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics. In this study, 18 subject matter experts participated in a web-based modified Delphi survey between October 2008 and February 2009 to determine whether there was consensus on the developmental progression of knowledge, skill, and attitude elements within the QSEN competencies. Support for creation of curricular threads to facilitate student progressive achievement of the QSEN competencies was validated. Competency development related to the individual patient was emphasized early in the curriculum, whereas teams and systems were emphasized later. Complex concepts such as teamwork and collaboration, evidence-based practice, quality improvement, and informatics were emphasized in advanced courses. Experts outlined a developmental approach in curriculum design, which would potentially encourage practice, reinforcement of learning, and recognition of context of care.