SE5 - Professional Development Council: Education Needs Assessment SubGroup - 01 12 2011
Present: Diana Patterson BSN, RN Educator; Sylvia Kurko BSN, RN, Education Coordinator; Lynne Wahl MSN, CNS-BC, CNS Educator PH West Wing; Lou Ann Cox BSN, MA/ED, Educator Post Partum/Nursery Unit; Deb Nussdorfer MSN, PMHCNS-BC, Magnet Coordinator; Candace Garko MSN, RNC-OB, CNS Educator Birth Center
Absent: Olinda Spitzer MSN, CNS, CCRN; Todd Farina RN.
1. CY vs. FY? Manager training on appraisal process starts Friday, January 14, 2011. Centura Prof Dev Council (CPDC) debated CY vs. FY on January 11 – no decision though discussion of whether system would have the same due dates for mandatory training or different dates (currently different and works).
2. Needs Assessment
From Global Skills Review:
o Pharmaceutical Waste primary challenge during Global Skills Review – this is being discussed at the Centura level but are not directly tied to bedside nursing. Centura is focused on interpretation of the law and discrepancies between the different laws. Many issues – multiple black containers, different places for meds vs med packaging vs partial meds. Fines are possible though many nurses do not know there is a cost to disposing incorrectly. Loren Schroeder, Safety, met with CVU Unit Practice Council to seek input on decisions regarding specific packaging. Each Centura facility is doing different things with training. Bedside need is “What goes into what container?” – challenges with isolation patients –
o Emergency Mgt – Where do I report in a disaster? Where do Urgent Care staff report? Pam Assid has told her staff to report to emergency room.
o Sedation level monitoring – maybe related to question wording but given feedback from chart audits, Code Blue/RRT, Narcan reviews and Patient Safety Risk Management sedation monitoring is still an issue.
o CNA role in pain management – CNAs could state report pain to nurse but could not identify actions they can take to reduce pain
From Centura Nursing Strategic Plan:
o HCAHPS – are there trends across all areas that we want to consider in nursing education. Should this be a unit focus vs across our system. There is a Pt Satisfaction Committee at Centura level which includes representatives from all levels of nursing at PSFHS. In addition, NPC has set improvement in HCAHPS as annual goal. Consider integrating this within education as appropriate (Pain mgt on medical surgical units).
o Associate Satisfaction – defer to units and nursing leadership.
o Physician Satisfaction – survey is scheduled for this year. No action at this point.
o Turnover – no specific education needs action at this time.
o NDNQI –
Awareness of QI metrics, ability to analyze. Beginning Jan 2011 brief NDNQI and PDCA review will be included for all new hires. Initiated Nursing Quality Patient Safety Council to review all metrics.
Falls – from Pt Safety Risk Mgt need to improve post fall documentation.
Pressure Ulcers – Unit Based Skin Experts receive quarterly education, Peer Review process includes PUP. What is the data? PU has decreased per NDNQI reporting.
VAP – Metrics good.
CLABSI – interventions revised in 2009. Will defer to Nursing Quality Pt Safety Council for any recommendations for CLABSI education.
CAUTI – improved Foley removal per Core Measures on post op units.
Mandatory Education
o Centura Professional Development Council in collaboration with Centura QI/Compliance to identify all requirements. (See Handout)
Code Blue/RRT
o Code Blue Process of Care Exceptions: epinephrine and intubation. Focus is at unit level.
o RRT Data – neurological changes result in majority of RRT calls. In 2010 we increased stroke education and awareness. Follow Up: Request feedback from the committee on any specific education needs identified through this committee work.
Kate McCord, CNO
o Alcohol Withdrawal – assessment, interventions, evaluation
o Suicide Prevention – assessment, interventions, resources
o Critical thinking process
Clinical Managers
o SBARQ/Handoffs between departments or changes in levels of care
o Accountability –
o Med Reconciliation
o Floating – use of welcome sheet on all units, competency, assignments
o Epidural and PCA administration – new PCA pumps coming soon?
o Alcohol Withdrawal – DT’s
o Blood administration – cell saver - 7 and ICU
o Managing chronic pain
o Wound Vac trouble shooting – KCI Wound In-service is excellent per Lynne Wahl – she has taught two units at Penrose and teaches new graduates. Need to clarify who changes dressings – help available 24/7.
o I & O importance/relevance (and documentation of Blood Admin in TAR or ?)
o Oncology nurses – staying current with radiation, chemo and biotherapy (Unit education on Cancer Center, Infusion Center, Oncology Unit)
o VAC Troubleshooting
o BCMA Scanning
PDC/Education Council
o Accountability – managers communicating and holding staff accountable with education requirements
o Treatment of medical surgical patients with comorbid psychiatric illness
Nursing Peer Review/CSI
o Polypharmacy with elderly patients
o Alternatives to medication for pain management
I would like to see some education about unstable patients on the regular floors. Specifically, if a patient is on a 100% non-rebreather mask + O2/nc and sat in the 80's this patient should be recognized as unstable and sent to a critical care unit immediately. How to recognize an unstable patient. When does it start to click that this patient is in trouble?
CSI committee would like to encourage the use of the rapid response team earlier rather than later to evaluate patients or assist in care and transfer to a critical care area. We would like people toNOT be afraid to call the rapid response team to assist in evaluating the needs of very ill patients. Don't wait until it's too late.
The one thing that I am most astounded by is the lack of charting. Often when we review a chart there is not a clear picture of what actually has happened to the patient. I'm not sure why people don't write a brief note when something unusual occurs. Is it because they don't have enough time, they don't know they can write a note, they forget, they think the charting by exception is adequate?
Charting on the code blue paper is usually inadequate. As far as codes the nurses need to know who is responsible for what. IE the patients nurse should stay and the charge nurse should stay as well.
Nurse Practice Council
o Pharmaceutical Waste
o CNA education based on needs assessment
o CIWA given changes in protocol and practice
Nursing Leadership Council
o Falls
o Alcohol Detox
o Certification prep for managers
Informatics
o How to assess for alcoholism – CAGE
o Documentation
o BCMA – why is important and review of process
o Med Reconciliation, in particular discharge process
Pharmacy
o Pharmaceutical waste
Rehab (Pat Matela)
o Transfers of patients in and out of bed
o Emphasis on pts with limited weight bearing
Infection Control
o SBARQ and isolation
o Flu vaccine education
o Exposures to BBP – given number of exposures need to review standard precautions however, we are wondering if this is education or supervisory issue? Lynne Wahl identified policy related to isolation – bagging, equipment, teamwork or time issue?
Patient Safety/Risk Management
o Red Rules
o Labeling specimens
o Occurrence reporting
o Post fall documentation
Patient Feedback
o SHARE/Suggestion Cards?
o Clinical Manager rounds?
o HCAHPS
Physicians
o See Next Steps for action.
NurseAdvise-ERR Dec 2010 (Pharmacy distributes this to nursing monthly)
o Concern about hooking tubes up accurately (tracing lines)
Trauma
o Chest tubes – clamp or not clamp –
o Trauma C Spine – Bonnie King doing education
o TBI – there is a TBI work group looking at issue
Birth Center (Candace Garko and Lou Ann Cox)
o L&D critical care skills – how to manage chest tubes or NG tubes or central lines
o CathFlo access, use (Vendor is willing to do unit based education)
o Central Lines (Cheat sheet – Care and Feeding of a Central Line) – need to be consistent with our policy and Mosby Skills – no date for implementation on Mosby Skills
o Neurological Assessment on adults
o Preventing escalation of patients (mental health, drug abuse issues)
CNS Med Surg Educator (Lynne Wahl)
o Vascular Assessment on 9th unit
o Back to Basics on 8th floor (preceptors, teamwork, nuturing, communication)
o Critical Thinking on 7th floor
o Alcohol Assessment (New protocol)
CNS Pain
o Pre-emptive Pain Control
o Multi-modal pain medications including RTC Acetominophen
o Elderly and Polypharmacy
CNA Role in general
Process
o How to determine global vs. unit education process?
o Continue to use TLC for briefs on education.
o Timing
o Storyboard vs walking education
On Dock NOW
o Alcohol Withdrawal – assessment, interventions
o Suicide Prevention – assessment, interventions – LEARN Module assigned now for all nursing associates – need to provide some scripting for de-escalation and assessment
o BLS Update
o Performance Appraisal System/Process – Leader, Manager Training on 1/14/2011. Performance Feedback and Development – Associate side of Perf Appraisal System. This will be live training beginning next week. This will expand some of the unit peer review and portfolio reviews currently occurring. First Class will be recorded and then on LEARN for associates who cannot attend the classes. Class will be given by VP’s.
o Office of Civil Rights – ADA and LEP LEARN Module being assigned.
o LEAP – South State begins February 15 (10 week program)
o ENMO – Essential of Nurse Management Orientation – Nurse Managers referring nurses to this online program.
o Mosby Consult implementation. Mosby Consult – 6 minute video will be pushed out with due date June 30, 2011 – this will not be mandatory but encouraged. Assignment improves access to education on Mosby Consult.
From Nursing Leadership/Management Council Minutes - 11 2010
Needs Assessment—Sylvia Kurko/Diana Patterson / Education on finance, budget, productivity, vision, HR, hiring, Stars, substance abuse,Cautioned to hold on evaluations for LDI – new system – probably going back to fiscal year – more to come / Deb Nussdorfer
Kate McCord
Next Steps:
o Rounding with patients – committee round and request info from patients on what they think nurses need to know
o Ask Clinical Managers to meet with primary physicians to identify their perceptions of nursing education needs
o Safety Extravaganza is mandatory every year. We need to review and revise questions specific to Infection Control/isolation to increase focus on situation and critical thinking. (isolation? There is no data to support cross contamination concerns)
o Get with Heidi Bouwens and Sherri Gray – is there an increase in needlesticks, exposures? What are the issues and current actions to improve workplace safety? Are there educational needs? What EBP do we need to integrate? Do we aspirate insulin? Heparin?
o SFMC has new educator position – ICU/Medical Surgical – Morgan Smith RN
o Need Mosby Skills implementation
Other Issues
o Preceptor
o ASCENT
o Nurses Week
Next Meeting
o Review feedback above, analyze and evaluate issue. Is this a unit based need? Is the need best met by education or other strategies?
o Have we sought input from all areas?
o How will we incorporate any educational needs that arise from performance appraisals or new products/protocols during the year?
o Create report for Nursing Professional Development Council, Leadership/Management Council and Practice Council.
Minutes submitted by Deb Nussdorfer MSN, RN, PMHCNS-BC, Magnet Coordinator
01 17 2011
Present: Todd Farina, Lou Ann Cox, Sylvia Kurko, Patricia Spoerl, Diana Patterson, Deb Nussdorfer, Lynne Wahl
Absent: Olinda Spitzer, Candace Garko
TOPIC / Discussion / Need for 2011Code Blue Committee
- We follow up with outliers / Discrepancy between Code Blue and Nsg Peer Review – Diana follow up. / None identified
Eval of Simulation 2009 / RRT’s decreased with ETOH withdrawal – repeat in 2010 to evaluate nsg practice / Need education in 2011 with revision in practice
Pharmacy / Pharmaceutical Waste
ED / Pharmaceutical Waste, Inpt Stroke Alert, Med Rec, SBARQ
Perioperative Services / Kelly and Gayle / Diana Follow Up
South State Leadership / Perf Appraisal separated from ongoing competency Plan for Performance Appraisal –
1. Goals cascade from above
Pt Satisfaction – HCAHPS –
Staff Satisfaction - Press Ganey
Costs
Evaluation at end of a period is how well did you meet your goal? Measure by documentation and manager rounding
2. Performance related to standards of behavior
Raises will be based on satisfaction and financial target
Occ Health / Where are we with workplace safety issues and needs? / Diana Follow Up
Unit Practice Council role – identify education needs for the unit – unit specific education
Individual Manager and Director Needs Assessment
Orientation of managers and directors (responsibility of Learning and Leadership Dev at Centura and HR)
Preceptor, Mentoring program, LDI, Link with succession planning
Currently have online modules, ENMO, some classes from Centura
HR does have a list for new manager orientation –
What part of your manager role do you need further education, skill, training? Pull job description for manager to review - Needs Assessment – CNO, Directors, Managers, Coordinators, Educators, CNS. Recommend use the Standards Nsg Admin and design competency
CNO - NE-BC required for managers.
If manager does clinical care, then need to demonstrate clinical competence? Is it possible to have consistency with this? Do we assign clinical topics so manager is aware of clinical education?
Groups
o CNO
o Directors
o Managers
o Direct Care
o CNS and Educators
o Council and Committee Chairs
o Preceptors
o Coordinators
Effective Training – 10% formal education, 70% through experiential, 20% coaching
True competency assessment is being observed in the real world – can I set up a PCA
How do we assess accountability? During this year, you need to take care of these types of patients…… ongoing competence. Check off by Charge Nurse or a Preceptor. Build in Peer Review. Skill review – high risk, low volume ONLY
Preceptor Role – orientation and ongoing competence