ࡱ>  Gbjbj 4?BB<dtddd0d2d2d2d2d2d2dfh2dudduu2dGdGGGu0dGu0dGG$]b! W^4d]d0d(_p1i!1ihb1ibdGNddd2d2d7dddduuuu1idddddddddB K: 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: 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 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. 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. 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: 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). Associate Satisfaction defer to units and nursing leadership. Physician Satisfaction survey is scheduled for this year. No action at this point. Turnover no specific education needs action at this time. 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 Centura Professional Development Council in collaboration with Centura QI/Compliance to identify all requirements. (See Handout) Code Blue/RRT Code Blue Process of Care Exceptions: epinephrine and intubation. Focus is at unit level. 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 Alcohol Withdrawal assessment, interventions, evaluation Suicide Prevention assessment, interventions, resources Critical thinking process Clinical Managers SBARQ/Handoffs between departments or changes in levels of care Accountability Med Reconciliation Floating use of welcome sheet on all units, competency, assignments Epidural and PCA administration new PCA pumps coming soon? Alcohol Withdrawal DTs Blood administration cell saver - 7 and ICU Managing chronic pain 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. I & O importance/relevance (and documentation of Blood Admin in TAR or ?) Oncology nurses staying current with radiation, chemo and biotherapy (Unit education on Cancer Center, Infusion Center, Oncology Unit) VAC Troubleshooting BCMA Scanning PDC/Education Council Accountability managers communicating and holding staff accountable with education requirements Treatment of medical surgical patients with comorbid psychiatric illness Nursing Peer Review/CSI Polypharmacy with elderly patients 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 Pharmaceutical Waste CNA education based on needs assessment CIWA given changes in protocol and practice Nursing Leadership Council Falls Alcohol Detox Certification prep for managers Informatics How to assess for alcoholism CAGE Documentation BCMA why is important and review of process Med Reconciliation, in particular discharge process Pharmacy Pharmaceutical waste Rehab (Pat Matela) Transfers of patients in and out of bed Emphasis on pts with limited weight bearing Infection Control SBARQ and isolation Flu vaccine education 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 Red Rules Labeling specimens Occurrence reporting Post fall documentation Patient Feedback SHARE/Suggestion Cards? Clinical Manager rounds? HCAHPS Physicians See Next Steps for action. NurseAdvise-ERR Dec 2010 (Pharmacy distributes this to nursing monthly) Concern about hooking tubes up accurately (tracing lines) Trauma Chest tubes clamp or not clamp Trauma C Spine Bonnie King doing education TBI there is a TBI work group looking at issue Birth Center (Candace Garko and Lou Ann Cox) L&D critical care skills how to manage chest tubes or NG tubes or central lines CathFlo access, use (Vendor is willing to do unit based education) 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 Neurological Assessment on adults Preventing escalation of patients (mental health, drug abuse issues) CNS Med Surg Educator (Lynne Wahl) Vascular Assessment on 9th unit Back to Basics on 8th floor (preceptors, teamwork, nuturing, communication) Critical Thinking on 7th floor Alcohol Assessment (New protocol) CNS Pain Pre-emptive Pain Control Multi-modal pain medications including RTC Acetominophen Elderly and Polypharmacy CNA Role in general Process How to determine global vs. unit education process? Continue to use TLC for briefs on education. Timing Storyboard vs walking education On Dock NOW Alcohol Withdrawal assessment, interventions Suicide Prevention assessment, interventions LEARN Module assigned now for all nursing associates need to provide some scripting for de-escalation and assessment BLS Update 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 VPs. Office of Civil Rights ADA and LEP LEARN Module being assigned. LEAP South State begins February 15 (10 week program) ENMO Essential of Nurse Management Orientation Nurse Managers referring nurses to this online program. 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 AssessmentSylvia Kurko/Diana PattersonEducation 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: Rounding with patients committee round and request info from patients on what they think nurses need to know Ask Clinical Managers to meet with primary physicians to identify their perceptions of nursing education needs 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) 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? SFMC has new educator position ICU/Medical Surgical Morgan Smith RN Need Mosby Skills implementation Other Issues Preceptor ASCENT Nurses Week Next Meeting Review feedback above, analyze and evaluate issue. Is this a unit based need? Is the need best met by education or other strategies? Have we sought input from all areas? How will we incorporate any educational needs that arise from performance appraisals or new products/protocols during the year? 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 TOPICDiscussionNeed for 2011Code Blue Committee - We follow up with outliersDiscrepancy between Code Blue and Nsg Peer Review Diana follow up. None identifiedEval of Simulation 2009RRTs decreased with ETOH withdrawal repeat in 2010 to evaluate nsg practiceNeed education in 2011 with revision in practicePharmacyPharmaceutical WasteEDPharmaceutical Waste, Inpt Stroke Alert, Med Rec, SBARQPerioperative ServicesKelly and GayleDiana Follow Up South State LeadershipPerf 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 targetOcc HealthWhere 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 CNO Directors Managers Direct Care CNS and Educators Council and Committee Chairs Preceptors 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 New program, Ongoing check off on units. Preceptor education and role and priority -Will be preceptor be given opportunity/time to implement Other Issues Storyboard how to use - What is an appropriate topic for a storyboard? (LYNNE) Discussion and questions -Too busy What is the evidence for use? Adult Learning Principles and Blooms Taxonomy and Novice to Expert Link with our schools of nursing Generational issues Use of technology Mandatory Education per IDP (Part of competency is education piece) Restraint, Epidural, Pain, Blood signs and symptoms, Sedation, BLS Review, Age Specific essential job function, Cultural Competence ADA/LEP module, Medication Administration, Safety Extravaganza infection control, national pt safety goals, isolation, MDRO Integrate documentation, informatics with practice Recommendations to the Nursing Councils (January 25, 2011) THEME FOR 2011: The Fine Art of Nursing: Relationship-Based Care Framework for Nursing Education PPM and Standards Monitor clinical competency on units, ongoing, real time. List types of patients, situations that person must demonstrate competence What are the high risk/low volume skills (UPC, educator, manager decisions) UPC bring reports to NPC so we can identify universal education/competency needs Individual Associate responsibility for competency we decide competencies, due dates and options to demonstrate individual responsible to do. Assign due dates throughout year (quarterly so people know to check and do?) Preceptor Role and Responsibilities new program, role for ongoing competency verification Integrate Peer Review into competency assessment (Need to teach skills for Peer Review) Categorize and Prioritize topics Expand Needs Assessment of leadership, educators, CNS, Coordinators Our recommendations: 1. Rolling due dates on LEARN 2. Storyboards rotating through units 3. Unit Specific Skills Review ED, OR, ICU/CVU 4. Increase use of LEARN for tracking education 5. 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