Board #219 - Program Innovation Patient Safety

Abstract

Objectives Nursing programs are challenged to produce nursing students who can provide safe, competent and quality care while struggling with limited clinical placements and restrictions in what students can actually do in their clinical practice. The American Association of Colleges of Nursing (AACN) and Quality and Safety Education in Nursing collaborative (QSEN) developed safety competencies for graduate-/entry-level nurses to guide nursing curricula as well the development of simulation experiences that provide for targeted, repetitive practices to enhance safety competence. We describe a capstone, immersion simulation course based on these competencies to provide multiple opportunities for students to explore and refine their knowledge, skills and attitudes related to safe practice. A behavioral checklist applied in the course measures the impact of the course on safety practices, with individual student assessments completed at mid- and end-points of the course. This presentation describes the components of the course, the evolution of the assessment tool, and the assessment outcomes of the course as they relate to safety competencies. This innovative course can serve as a model for nursing programs to enhance safety competence of their graduates. Description Senior nursing students are immersed in 40 hours of acute care simulation over 15 weeks, with ongoing focus on safety competence. With this format, students become very comfortable in the simulation setting, working with teams and analyzing performance. Students practice communication skills in codes, patient hand-offs/interprofessional communication using SBAR, patient communication, as well as safe medication administration. Students are challenged to apply safety principles in every simulation encounter. Debriefing always includes discussion of the effectiveness of communication, actual or potential errors, and strategies to improve safety. Written reflections following the simulations specifically address the safety issues encountered. Scenario implementation occurs with two-nurse teams. However, at the mid- and end-points of the course, each individual is assessed, using a behavioral checklist which targets safety competencies. These assessments are highly revealing of the extent to which safety has been ingrained in each student’s practice. The use of two positive identifiers, determining allergies, medication administration safety and effective communication is emphasized on the behavioral checklist, with specific recommendations given to each student. Conclusion Students exhibit measurable growth in safety awareness and competence, as assessed by the behavioral checklist, and by reflection comments. At the beginning of the course, many safety infractions were seen, (not verifying patient identity/allergies, omissions in medication safety, and poor communication). At the mid-point assessment, safety behaviors were improved but not consistent, with 35.9% committing safety errors. At the final assessment, 23% committed safety errors. The percentage of possible error violations decreased from 12.8% to 8%. Student reflections and evaluation comments reflect greater awareness of their own safety behaviors, and ability to constructively reflect on the behaviors of others as well as system issues, such as medication labeling (e.g. 0.04 mg of naloxone was ordered; the vial was not well marked. The full two mg was given. It is important to take time needed to ensure safe medication administration. This is a great reminder that packaging can also play a significant role in causing medical errors and should be considered whenever administering medications). Consistent and repetitive focus on safety competence and an assessment scoring sheet that quantifies errors does make a difference in nursing student performance and attitudes toward safety. Disclosures None