Supporting Quality CareSupporting Quality CareNURS 274 NURS 274

Nursing LeadershipNursing LeadershipDarlene LoPresto, BSN, RN,CDarlene LoPresto, BSN, RN,C

Graduate Student FSUGraduate Student FSU

Standards of Care

Structural Process/Performance Outcome

Nursing Specific Standards

MICHIGAN LEGISLATURE   95th Legislature Regular Session  

Michigan Compiled Laws Complete Through PA 169 and includes 172-184 and 204 of 2010   PUBLIC HEALTH CODE (EXCERPT)

Act 368 of 1978Part 172 NURSING

Section 333.17201SectionDefinitions; principles of construction.Section 333.17208SectionLicensed practical nurse; health profession subfield.Section 333.17209SectionRenewal of license to practice as trained attendant; eligibility; “practice as a trained

attendant” defined; original license prohibited; licensed psychiatric attendant nurse considered licensed practical nurse.

Section 333.17210SectionRegistered professional nurse; issuance of specialty certification; qualifications.Section 333.17211SectionPractice of nursing or as licensed practical nurse; license or authorization required;

use of words, titles, or letters.Section 333.17212SectionRegistered professional nurse; ordering, receiving, or dispensing complimentary

starter dose drugs.Section 333.17213SectionLicensure as registered professional nurse; graduate of nurse education program

located outside of United States; requirements.Section 333.17221SectionMichigan board of nursing; creation; number and qualifications of members; terms.Section 333.17224, 333.17225SectionRepealed. 1989, Act 201, Imd. Eff. Oct. 23, 1989.Section 333.17231SectionHonorary license; "advanced illness" defined; name of section.Section 333.17241SectionNursing education program; application to conduct; evidence required; evaluation;

inspection; report; approval; continuation of existing programs; accreditation by national board or organization; education program for psychiatric attendant nurses or trained attendants prohibited.

Section 333.17242SectionInspection of approved nursing education program; report; notice of deficiency; removal from list of approved programs; hearing.

Accrediting Agency Standards

committed to improving health care safety continuously improve quality of care accreditation of health care organizations accreditation is a risk-reduction activity reduce the risk of adverse outcomes

HFAP determines a facility’s ability to deliver high quality patient care by using our CARE methodology.

This process includes an in-depth review of both open and closed patient records as well as direct observation of care provided.

http:www.ahrq.gov

Clinical Information Clinical Practice GuidelinesCurrent and archived Clinical Practice Guidelines — beta blockers practice advisory — treating tobacco use and dependence

•Tobacco CessationU.S. Public Health Service Clinical Practice Guideline: Pathfinder page links to materials that help tobacco users quit.Surgeon General Reports: The latest information to help people quit smoking, and to help health care professionals treat tobacco use and dependence.

Public Transparency

Broad scale quality initiative Consumers compare facilities Informed choices Better public information

Public Transparency

www.healthgrades.com www.mihospitalinform.org www.hospitalcompare.hhs.gov www.hospitalconnect.com www.wedmd.com

Public Transparency

http://www.healthgrades.com/hospital-directory/michigan-mi/patient-safety-HGSTA7662386230092

The Consumer Assessment of Healthcare Providers and Systems (CAHPS):

Health care organizations use CAHPS results to: Assess the patient-centeredness of care; Compare and report on performance Improve quality of care. standardized surveys of patients' experiences

http://www.hospitalcompare.hhs.gov/hospital-compare.aspx?hid=230037&lat=41.8933451&lng=-84.6269824&stype=GENERAL&&stateSearched=MI

Quality Improvement

Benchmarking

A benchmark is a specific quantitative standard for an outcome with which you compare your own institution.

(Ellis & Hartley, 2009)

Sources of Date

Key Indicators QA (Incident Reports) Audits Surveys

QI/PI Process

Sentinel Event

Risk Management

Policies, procedures, & practices involved in identification, analysis, assessment, control, and avoidance, minimization, or elimination of unacceptable risks. (www.businessdictionary.com)

RM Focus

Studies QA findings and trends Think ahead about defense strategies Proactive identification and elimination of

risk areas institution wide Patient and family are informed

Incident Report Process

Root Cause Analysis:Goal = Answer: What happened? Why did it happen? What do you do to prevent if from

happening again?

Incident Report Process: Five Why’s Technique

Example:Problem Statement: You are on your way home from work and your car stops

in the middle of the road.

1. Why did your car stop?   - Because it ran out of gas.

2. 2. Why did it run out of gas?   - Because I didn't buy any gas on my way to work.

3.3. Why didn't you buy any gas this morning?   - Because I didn't have any money.

4. 4. Why didn't you have any money?   - Because I lost it all last night in a poker game.

5. 5. Why did you lose your money in last night's poker game?   - Because I'm not very good at "bluffing" when I don't have a good

hand.

Incident Report Process: Systems Focus

Not one person’s fault Involves people and/ or processes System failure results in error

Never Events:•Effective October 1, 2008•No reimbursement•Must note if ‘Present on Admission”•Requirements of ‘Never Event’ occurs: -Report event -Root cause analysis -Waive costs -Apology

Magnet StatusRecognition of

nursing excellence

14 Forces of Magnetism

GoalsBenefits

Michigan Magnet Status

Beaumont Hospital Troy MI  2009  Bronson Methodist Hospital Kalamazoo MI  2009  Children's Hospital of Michigan Detroit MI  2008  DMC Huron Valley Sinai Hospital Commerce Township MI  2009  Detroit Receiving Hospital and University Health Center Detroit MI

 2009  Holland Community Hospital Holland MI  2007  Munson Medical Center Traverse City MI  2006  Oaklawn Hospital Marshall MI  2009  Sparrow Hospital Lansing MI  2009  Spectrum Health-Blodgett Hospital Grand Rapids MI  2009  Spectrum Health-Butterworth Hospital Grand Rapids MI  2009  Spectrum Health-Helen DeVos Children's Hospital Grand

Rapids MI  2009  William Beaumont Hospital Royal Oak MI  2004 

Questions?Questions?

As the professional nurseAs the professional nurse

You make the difference!You make the difference!