Author: Louise A. Fura, MSN, CRNP
Title: Assistant Professor of Nursing
Institution: Alvernia University
Coauthors: Cynthia Rothenberger, MSN, RN, ACNS, BC
– Explore impact of national patient safety standards on an acute care unit.
– Utilize national patient safety standards to evaluate patient safety in acute care.
– Value application of national patient safety standards in an acute care environment.
This learning activity has been used early in the semester of the first acute care clinical experience.
• Distribute and review current National Patient Safety Goal (NPSG) Worksheet with clinical instructors during orientation of the first clinical course.
• Encourage clinical instructors to review the NPSG Clinical Worksheet with students during orientation to the acute care facility and during pre-conference on the designated clinical day.
• Direct students to monitor and evaluate safety practices in the clinical setting.
• Instruct students to document observations and recommendations on NPSG Clinical Worksheet and direct activity questions and safety concerns to the clinical instructor.
• Instruct each student to develop a plan of care during the clinical day based on analysis of observations.
• Discuss observations, recommendations, and plan of care with clinical group during post-conference.
The critical thinking activity engaged students in application of patient safety principles in the acute care clinical setting. Students completed a brief evaluation of the learning activity (included on the attached document). Informal student feedback indicated the learning activity was helpful in applying patient safety standards and care plan development using the nursing process. Faculty implementing the strategy supported the use of the learning activity to facilitate application of patient safety concepts, care plan development, and critical thinking in the clinical setting. The worksheet can be updated easily to reflect changes in the NPSG. In addition, the learning activity can be modified for usage in a variety of practice settings.
Author: Beverly Capper, MSN, RNC-NIC
Institution: Case Western Reserve University Frances Payne Bolton School of Nursing
Classroom, Clinical Setting, Skills or Simulation Laboratories
1. Describe how the National Patient Safety Goals help identify quality improvement initiatives and impact patient safety
2. Demonstrate ability to apply patient safety skills in a classroom group exercise
3. Identify how information and technology (IT) is used to communicate, support decision-making, and mitigate error
4. Reflect on self-observations during an interprofessional activity to make connection between the National Patient Safety Goals and safe practice
5. Describe the role(s) of the student nurse in patient safety
Knowledge: Discuss potential and actual impact of national patient safety resources, initiatives and regulations
Knowledge: Describe the benefits and limitations of selected safety-enhancing technologies
Skills: Use national patient safety resources for own professional development and to focus attention on safety in care settings
Attitudes: Value own role in preventing errors
The purpose of this assignment is to help nursing students gain an understanding of their role in patient safety and provide an opportunity to apply the knowledge, skill, and attitude essential to provide safe, quality care. The one six-hour assignment is for pre-licensure students in the third year of their nursing program. The students participate in a (a) one hour didactic classroom lecture, (b) 90 minute group exercise, and (c) a three hour collaborative hands-on experience with other healthcare professionals. The lecture consists of information on national organizations involvement and support of patient safety, review of the National Patient Safety Goals, the JCAHO tracer methodology, and the QSEN patient safety KSAs.
Students will divide into groups of 4-5 for the group exercise. Students will view the first three parts of the Lewis Blackman Story video. This video is one of several available on the QSEN website and can be accessed via URL http://qsen.org/faculty-resources/videos/the-lewis-blackman-story/. Following the video, each group will receive a case study and asked to participate as a member of the healthcare team. The group will identify safety risks in the case study associated with healthcare team members’ behavior and technology and identify appropriate actions to take to eliminate safety risks.
As a final activity, students will engage in an exercise with a systems thinking approach during a hands-on project in the hospital setting. Members of the healthcare team and students will assess the quality and safety of care delivery. The focus of the interprofessional experience will relate directly to a current safety initiative based on the National Patient Safety Goals (NPSGs). The collaborative activity utilizes the tracer methodology used by The Joint Commission during accreditation surveys. The tracer methodology follows the care experience and treatment of patients throughout the health care experience and provides a way to assess compliance with standards and evaluate the care delivery. The course instructor contacted the nurse manager of a hospital division where nursing students were completing their clinical rotation. The meeting provided opportunity to discuss the objectives, identify a date and time convenient for students and division nurses, identify bedside nurses to participate, identify the divisions NPSG initiatives, and review the divisions current audit process that utilizes a tracer tool. The objective for the division is to evaluate the nurses’ ability to correctly answer questions on the tracer tool and helps the nurse manager in identifying potential gaps in practice. The tool used for this activity is not the same one used during The Joint Commission Survey. Instead it was a tool adapted by the division as an education tool to familiarize nurses with the tracer tool and survey preparedness. Comments and suggested questions are added to the tracer tool to help the student of what to ask and guide the nurse through the process. Information about the tracer methodology and sample tracer tools are available on The Joint Commission website.
The three hour activity started with an introduction of the students and the participating nurses. The introduction was followed by a review of the objectives, role for the student and nurse during the activity, the process and use of the tracer tool, and anticipated outcome. Each student was paired with a nurse. The student assumed the role of the interviewer/surveyor asking questions from the tracer tool. The nurse answered questions and navigated through the medical record of her assigned patient to locate documentation needed to complete parts of the tracer tool. The student documented the nurses’ answers and findings during the exercise on the tracer tool. At the end of the exercise, the completed tracer tool was given to the nurse manager for use in their continued process improvement efforts. Students will have time to reflect on the interprofessional exercise and potential impact on quality and safety outcomes.
The interprofessional activity will require preplanning to identify the site, participants, date, time, and the tracer tool. This is best accomplished by identifying nurse manager willing to have nursing students participate in a methodology tracer audit on the clinical division. Coordinate a date and time for the activity that is mutually agreed upon between the manager and instructor. The manager will provide the tracer tool and recruit nurses to participate on the day of the activity. The course instructor will review the activity objectives, process, and use of tracer tool with students.
The interprofessional activity can easily be adapted into simulation or a breakout session at a conference. The length of this exercise can be adjusted to fit the allotted time for simulation or a conference breakout. The goal of the exercise is to identify key factors in the case study that are associated with standards and safe practice and identify missing practice steps that pose a potential safety risk. Prior to the scheduled exercise date, the facilitator will develop a case study that reflects one of the NPSGs and adapt the tracer tool to include questions that follow the case study. At the start of the exercise, the facilitator will describe the objectives focused on patient safety, the tracer methodology, the NPSGs, the role of each participant, and the process of the exercise.
The case study will substitute for the medical record and include information that can be located or answered during the exercise and reflect safety elements that go along with the NPSG. The tracer audit tool can be adapted to reflect questions based on information present in the case study or missing which could pose as a safety risk. Participants can be randomly assigned to the role of the nurse or role of the auditor. Participants in the nurse role read the case study and locate information when asked questions by the auditor. Those in the auditor role will use the tracer tool to prompt questions. When the tracer tool is complete, both participants can identify potential safety risks identified during the exercise and discuss safety measures to implement and reduce the risk in the future.
The additional materials attached include the evaluation forms for the different safety activities. Please contact me if you would like additional information. Email: email@example.com
Evaluation of the assignment is done through self-assessment using a pre and posttest learning survey, direct observation, peer feedback, and self-reflection.
At the start of the session, each student will be asked to answer four questions to establish the students’ baseline understanding of safety. Conversely, the same four questions will be answered at the end of the course. Answers on the first questionnaire will be compared with answers on the second questionnaire to measure changes in knowledge.
The instructor will observe the group exercise and peer feedback to evaluate knowledge application. A rubric is used to evaluate student learning using a yes-no answers to five questions.
The interprofessional experience and tracer methodology will be evaluated with students answering four short answer questions about the experience. Students will complete a reflective minute paper for the course curriculum. The reflective minute paper asks three questions using a 5-point agree-disagree Likert scale and 3 open-ended reflective questions about the content and usefulness of the learning activities.