NUR1 222 Patient Safety and Quality of Care Final F 23 for Students PDF

Patient Safety and Quality of Care October 12, 2023 Maria Di Feo B.Sc.(N.), M.A.Ed. Assistant Professor NUR1 222 Strengths-Based Nursing and Professionalism Objectives • Explain the different elements that impact patient safety and quality of care. • Describe how nurses can contribute to patien...

Patient Safety and Quality of Care October 12, 2023 Maria Di Feo B.Sc.(N.), M.A.Ed. Assistant Professor NUR1 222 Strengths-Based Nursing and Professionalism Objectives • Explain the different elements that impact patient safety and quality of care. • Describe how nurses can contribute to patient safety and quality of care. 2 Pa#ent Safety & Quality of Care OUTLINE Nursing Documentation Therapeu#c Nursing Plan 3 • Patient Safety • Effective and High Quality of Care • Improve Health Outcomes Patient Safety is a critical component of high - quality health care. Patient Safety – World Health Organization https://www.who.int/teams/integrated-healthservices/patient-safety https://www.youtube.com/w atch?v=VBuDTTjKHGg&ab_ch annel=WorldHealthOrganizati on%28WHO%29 5 Patient Safety is a priority in Canada 6 Healthcare Excellence Canada Launched in 2021, Healthcare Excellence Canada brings together the Canadian Pa(ent Safety Ins(tute and Canadian Founda(on for Healthcare Improvement. Through collaboration with patients, caregivers and people working in healthcare, we turn proven innovations into lasting improvements in all dimensions of healthcare excellence. Goal: everyone in Canada has safe and high-quality healthcare. https://www.healthcareexcellence.ca/en Patients, families and caregivers Healthcare Excellence Canada Collaborates with a diverse range of individuals and groups including: Healthcare providers and leaders Healthcare quality and safety organiza:ons First Nations, Inuit and Métis Governments and health regions Healthcare Excellence Canada “We are the voice of the patient and bring our healthcare experiences to help improve patient safety at all levels in the health system”. Patients for Patient Safety Canada https://www.patientsafetyinstitute.ca/en/About/Programs/P PSC/Pages/default.aspx Near-fatal medication error leads nurse to make patient safety a priority. • https://www.youtube.com/watch?v=MGT8y oAIun4&ab_channel=PatientSafetybyHealth careExcellenceCanada • Michael Villeneuve retired in May 2022 as the Chief Executive Officer of the Canadian Nurses Association (CNA). 11 The safety of our care when we are in your care needs to be a priority in Canada’s Health Care System. Patient safety is a key professional value and an essential component of daily practice. • Despite the advances in medical knowledge and advances in medical technology over the decades, safety issues remain prevalent. • The number of deaths in Canada due to avoidable medical incidents ranks as the third leading cause of death, after cancer and heart disease. • https://www.patientsafetyinstitute.ca/en/toolsResources/safetyCompetencies/Documents/ CPSI-SafetyCompetencies_EN_Digital.pdf Page 1 of document Patient Harm in Canadian Hospitals (all numbers excludes Quebec and selected mental health diagnoses) h1ps://www.pa2entsafetyins2tute.ca/en/toolsResources/Hospita l-Harm-Measure/pages/default.aspx PaAent Harm in Canadian Hospitals (all numbers excludes Quebec and selected mental health diagnoses) https://www.patientsafetyinstitute.ca/en/toolsResources/Hospita l-Harm-Measure/pages/default.aspx The 2020 Safety Competencies Framework (2nd Edition) is a framework that identifies competencies that can be adopted and adapted by diverse healthcare programs to design curricula to teach safety and quality for any sector or healthcare program. Identifies competencies that Health Care Providers should be able to demonstrate to promote patient safety. Enhancing Patient Safety Across the Health Professions https://www.patientsafetyinstitute.ca/en/toolsResources/safetyCo mpetencies/Documents/CPSI-SafetyCompetencies_EN_Digital.pdf Safety Competencies Canadian Patient Safety Institute (CPSI) 2020 Six Domains: Each domain has key competencies that Healthcare Providers must demonstrate to promote pa2ent safety Safety Competencies - CPSI (2020) Safety Competencies - CPSI (2020) Competencies - CPSI (2020) Competencies - CPSI (2020) Safety Competencies - CPSI (2020) Safety Competencies - CPSI (2020) Safety Competencies Canadian Pa@ent Safety Ins@tute (CPSI) 2020 Six Domains: Each domain has key competencies that Healthcare Provider must demonstrate to promote patient safety Framework Informs our Curriculum Near Fatal: A Patient Safety Story • https://mycourses2.mcgill.ca/d2l/le/content/533761/viewContent/57 70400/View AH-223 form MSSS (Quebec) Guidelines for Incidents/Accidents Repor:ng Déclara'on des incidents et des accidents Lignes directrices Patient Safety Officers/ Quality and Risk Management Departments in Health Establishments • Provide consultations • Deliver in services to employees 27 Reporting of Preventable Incidents and Accidents A Legal Obligation Repor:ng Preventable pa:ent safety incidents and accidents • Incidents: events that did not reach the paKent but could have caused harm • Accidents: events that reached the paKent whether causing harm or not Primary Purpose reducing the risk of occurrence of pa\ent safety incidents in the future. • Analysed by healthcare insKtuKons • h"ps://www.pa*entsafetyins*tute.ca/en/toolsResourc es/Pa*entSafetyIncidentManagementToolkit/Pages/Glo ssary.aspx Reporting of Preventable Incidents and Accidents Comple5ng INCIDENT OR ACCIDENT REPORT In what circumstances? The events to be reported are those that occur in the course of providing care and services to a user, i.e. any unwanted, dreaded or undesirable situation that has or could have harmed the users’ health must be reported by means of this form. When? As soon as possible after recognising/discovering event. Who? Any employee of an institution, who witnesses, discovers or is directly involved in an incident or accident. Including nursing students. In what circumstances would an Incident/Accident Report be completed? 31 Complete AH-223 form Complete AH-223 form Guidelines MSSS (Quebec) Different forms are used for: Work related accidents of staff & professionals Abuse by a user against an employee Abuse by an employee against a user Foreseeable complica9ons of treatment, procedure, test.. Nosocomial infections (hospital acquired) Transfusion incidents & accidents 34 Disclosure Legal Obliga0on https://www.patientsafetyinstitute.ca/en/tools Resources/PatientSafetyIncidentManagementTo olkit/Pages/Glossary.aspx Disclosure MSSS (Quebec) Guidelines MSSS (Quebec) Forms Raport de déclaration des Incidents ou Accidents (AH- 223 -1) • Incident/Accident Reporting Form Raport d’analyse des Incidents ou Accidents (AH- 223 -2) • Analysis of Incidents/Accident Form Raport de divulgation d ’Accident (AH- 223 -2) • Disclosure Form 37 Also need to document incident/accident in the patient’s chart 38 Additional Notes Incidents and accident are reported to the MSSS via Système d’informa:on de santé et services sociaux (SISSS) Although the AH-223 forms are in French, they could be completed in English. 39 Événement sentinelle - Un événement qui demande une analyse approfondie parce qu’il révèle des failles dans un processus qui ont entraîné ou auraient pu entraîner des conséquences graves. Sentinel Event MSSS Quebec DefiniAon - An event that requires an In - Depth Analysis because it is evident that there are flaws in the process that resulted or could have resulted in serious consequences. Examples - Medication error that causes neurological consequences/death - Surgical error: wrong limb operated on - Suicide attempt/suicide Father’s death fuels quest for healthcare improvement https://www.youtube.com/watch?v=BVK WQn83ZgA&t=315s&ab_channel=Patient SafetybyHealthcareExcellenceCanada Disclosure Everyday is Patient Safety Day Three Ways to Provide Safe Care and Health Services 44 How do nurses communicate to healthcare professionals the patient’s clinical situation and required follow up? Verbal Communication Nursing Documentation Documentation polices will vary between institutions BASIC Principles do apply Nursing Documentation • A Professional Responsibility • Helps ensure protec5on of the public Relevant OIIQ Principles Nursing Documentation Concise Complete Organized 49 Reflects the nurse’s thinking process - Clinical Reasoning Nursing Documentation • Observations and assessments • How patient’s clinical situation evolves • Nursing Analysis - Health problems & goals • Nurse’s interpretation of what the health problem is • Care that was delivered (Interventions) • Evaluation of Interventions (Outcomes) • Required follow up Reflects the nurse’s scope of practice (Nurse’s Act) Patient’s Chart/Client File (OIIQ) (electronic or hard copy) • Is a legal document that is used to record the comprehensive assessment and care a person receives within the health care system. The chart is an official means of communication among health professionals to ensure patient safety and continuity of care. Documentation Terms Progress Notes (part of a patient's chart) • Progress notes should focus on the nurse’s clinical decisions. Whether these decisions pertain to the nurse’s clinical assessment or the client’s clinical follow-up, nurse provides clinical justification in reference to the client’s evolving condition. The nurse bases their decisions on available evidence, when appropriate. https://www.oiiq.org/documents/20147/237836/222A_doc.pdf Introduction and Origin of the TNP Bill 90, enacted in January 2002, brought about a new definition of a nurse’s scope of practice which legally acknowledges a nurse’s competence and responsibility with regards to clinical assessment. The amendments made in the Nurses Act regarding clinical assessment include three reserved activities:. • Assessing the physical and mental condition of a symptomatic person; • Providing clinical monitoring of the condition of persons whose state of health is problematic, including monitoring and adjusting the therapeutic nursing plan; • Providing nursing follow up for persons with complex health problems The TNP was introduced to track a a nurse’s clinical decisions Introduction and Origin of the TNP (cont.) The three reserved acts are interrelated achvihes associated with a nurse’s everyday clinical decision making. • Assessing the physical and mental condi2on of a symptoma2c person; • Providing clinical monitoring of the condi2on of persons whose state of health is problema2c, including monitoring and adjus2ng the therapeu(c nursing plan; • Providing nursing follow up for persons with complex health problems The TNP was created to document a nurse’s clinical decisions which are based on the nurse’s assessments, and which are crucial to a person’s follow up. vThe TNP is important to ensure the safety and quality of nursing care Standard (OIIQ) • Using a separate documentation tool (TNP form) within the client’s file, nurses records the TNP they determine, along with any subsequent adjustments that they make based on the client’s clinical course and the effectiveness of the care and treatment. • Kept in the client’s file, the TNP is determined and adjusted by nurses on the basis of their clinical assessment. It provides an evolving clinical profile of the client’s priority problems and needs and states the nursing directives issued for the client’s clinical follow up, particularly as it regards clinical monitoring, care and treatment. v Nurses alone are responsible for completing and updating the therapeutic nursing plan TNP Document How can student nurses contribute to a patient’s TNP – to the patient's care TNP • The nurse must determine a therapeutic nursing plan (TNP) for each client. • Exceptions include one-time client interventions (e.g., immunization campaigns or ear irrigations). TNP • If it is not the client’s first care episode and the client already has a TNP on file, the nurse must consult it to determine if any elements of the previous TNP are relevant to the new care episode. TNP • Every nurse whether or not they have determined the TNP must apply its directives unless they have to adjust the TNP in account of changes on the clients’ condition, occurrence of a new event or the client’s reactions or care and treatment outcomes. • If a nurse makes adjustments to the TNP they must explain the adjustments in the client’s progress notes. TNP Document Priority Problem/Need Is based on Assessment Findings 63 Priority Problem or Need • A problem or need that requires a particular clinical follow-up • A problem or need that will affect the client’s clinical follow-up • A problem or need that presents a significant clinical change on the client’s clinical follow –up • A priority problem may be the presentation of a new problem or need arising during an episode of care, or the deterioration of a previously noted problem v Minimal Information - the reason (Health Problem) for the client’s admission to hospital/long term facility/referral to home care must be included in the TNP Priority Problem or Need (cont.) • The Assessment Findings involve the nurse’s judgement and they are based on their analysis and interpretation of the relevant information gathered from various sources. (Clinical Reasoning) • The client’s priority problems and needs are determined on the basis of the nurse’s assessment. TNP Document Nursing Directive Linked to a Priority Problem/Need 67 Nursing DirecAve • Nursing directives contain crucial indications (interventions) to ensure that clinical monitoring, nursing care, treatment and other interventions the client requires are carried out. • Each directive must be linked to a priority problem/need stated in TNP • Minimal Information – directives for the client’s reason for admission (Health problem) to hospital/long-term facility/referral to home care can include standard intervention/clinical pathway Example: Priority Problem - Arthroplasty R knee Nursing Directive – Apply clinical pathway for Arthroplasty R knee Delegation of Activities Delegation Field of Practice Ø Roles & responsibilities of different health care workers vary among institutions! Delegation & TNP • The nurse ensures that the plans are carried out by assigning tasks to team members after verifying that they have the legal authority, knowledge and skills required to perform the activities in question. Delegation & TNP Some direcKves in TNP may concern all members of the nursing team (Nurses, Nursing Assistants and Non – professionals (PaKent A\endants/orderlies) When working with Nursing Assistants (LPN’S), the nurse must specify in her direcKves which acKviKes are to be carried out only by a nurse. Example: • AcKviKes pertaining to a nurse’s field of pracKce • AcKviKes that nurses deems essenKal to do themselves in view of the client’s condiKon or the complexity of the nursing care or treatment involved Delegation & TNP Directives to préposé aux béneficiaires (PAB) – orderlies • PAB’s are non-professionals, so the nurse takes into account the fact that they don’t have access to the client’s file. • Directives on PAB’s work plan Delegation in Clinical Practice Roles & Responsibilities Patient Attendant (PAB)/Orderly Unregulated Health Care Worker § § Helps patients with basic grooming and dressing, mobility, nutritional intake, and contributing with the other members if the healthcare team in the observation of any changes in the patient's physical, emotional, or mental condition. Communicates the status of the patient, including any changes, to a supervisor, case manager, or nurse. Licensed Practice Nurse (LPN)/Nursing Assistant Regulated Professional § Field of practice Under article 37p) of the Quebec Professional Code Ordre des infirmières et infirmiers auxiliaires du Québec (OIIAQ). ØLicensed Practical Nurse (LPN) ØNursing Assistant (NA) ØRegistered Nursing Assistant (RNA) Field of Prac=ce: Lists of clearly defined ac=vi=es of the profession Fields of Practice for Nurses & for Nursing Assistants (LPNs) In Quebec NURSES Nursing Assistants Ordre des infirmières et infirmiers auxiliaires du Québec (OIIAQ) Quebec Nurse The prac:ce of nursing consists in assessing health, determining and carrying out the nursing care and treatment plan, providing nursing and medical care and treatment in order to maintain and restore the health of a person in interac:on with his environment and prevent illness, and providing pallia:ve care. Nursing Assistant “Par/cipate in the assessment of a person’s state of health and in carrying out of a care plan, provide nursing and medical care and treatment to maintain or restore health and prevent illness, and provide pallia:ve care.” TNP Highlights • TNP separate documentation tool • TNP part of a client’s chart • TNP contains only the priority health problems and needs (not routine care) that affect the client’s clinical follow up and the nursing directives identified to address the priority health problems and needs. • In addition to TNP, there are other documentation tools depending on healthcare institution - such as nursing care and treatment plans, clinical pathways, flowsheets.. The nurse must support the contents of the TNP and any adjustments made to the TNP in the client’s progress notes (chart). Commit to Patient Safety Help Create a Safety Culture Where all Patients are Safe