Chapter 1: Professional Nursing Practice

The Joint Commission (TJC), the accrediting agency for health care organizations, gathers and reports data on serious errors they call _________ ________.

sentinel events

Safety - Knowledge, Skills, and Attitudes:

• Follow recommendations from national safety campaigns • Appropriately communicate observations or concerns related to hazards and errors • Contribute to designing systems to improve safety

National Database of Nursing Quality Indicators

• Workforce factors: • Nurse turnover • Nursing hours per patient day • RN surveys on job satisfaction and practice environment scale • RN education and certification • Skill mix: RNs, LPNs/LVNs, UAP • Hospital readmission rates • Pain assessment cycle • Peripheral IV infiltration rate • Physical restraint prevalence • Physical/sexual assault rate • Patient falls and falls with injury • Pressure ulcer incidence • Health care-associated infections (HAI): • Ventilator-associated pneumonia and events • Central line-associated bloodstream infection • Catheter-associated urinary tract infection

Three of the most widely used nursing terminologies focus on specific phases of the nursing process:

(1) NANDA International (NANDA-I): Nursing Diagnoses, Definitions, and Classification (2) the Nursing Outcomes Classification (NOC) (3) the Nursing Interventions Classification (NIC). *Patients' responses or problems can be labeled using the nursing diagnoses classified and defined by NANDA-I. Nursing-sensitive patient outcomes can be identified and evaluated by selecting appropriate NOC outcomes and nursing interventions, or treatments, can be selected and implemented from NIC.

What are some of your roles as a nurse?

(1) Offer skilled care to those recuperating from illness or injury (2) Advocate for patients' rights (3) Teach patients to manage their health (4) Support patients and their caregivers at critical times (5) Help them navigate the complex health care system.

What are the 5 phases of the nursing process?

- Assessment - Diagnosis - Planning - Implementation - Evaluation

Long-term care

- Refers to the care of patients for a period greater than 30 days. - It may be required for those who are severely developmentally disabled, who are mentally impaired, or who have physical deficits requiring continuous medical and nursing management (e.g., patients who are ventilator dependent or have Alzheimer's disease). - Long-term care facilities include skilled nursing facilities, assisted living facilities, and residential care facilities.

Services provided by physician assistant:

Conducts physical exams, diagnoses and treats illnesses, and counsels on preventive health care in collaboration with a physician

Entry-level nurses with associate or baccalaureate degrees are prepared to function as

Generalists - At this level, nurses provide direct health care and focus on ensuring coordinated and comprehensive care to patients in a variety of settings. - Nurses work collaboratively with other health care providers to manage the needs of individuals and groups.

What do NANDA-NOC-NIC linkages show?

How the three distinct nursing terminologies can be connected and used together when planning care for patients. - Linkages may assist in determining a nursing diagnosis, projecting a desired outcome, and selecting interventions to achieve the desired outcome. - Because each outcome or intervention has a coded number, the use of NNN facilitates electronic collection of standardized nursing data to evaluate the effectiveness of nursing care.

Safety - Competency:

Minimize risk of harm to patients and providers

Services provided by dentist:

Provides preventive and restorative treatments for problems affecting the teeth and mouth

What is delegation?

Tansferring authority to a competent individual for completing selected nursing tasks in a selected situation. - The delegation and assignment of nursing activities is a process that, when used appropriately, can result in safe, effective, and efficient patient care. - Delegating can allow you more time to focus on complex patient care needs. - Delegating care and supervising others will be one of your fundamental roles as a professional nurse.

What is diagnosis phase?

The act of analyzing the assessment data and making a judgment about the nature of the data. - It includes identifying and labeling human responses to actual or potential health problems or life processes.

What is the implementation phase?

The activation of the plan with the use of nursing interventions.

Case management

"a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual's and family's comprehensive health needs through communication and available resources to promote quality, cost-effective outcomes." - Although health care agencies implement case management in various ways, it involves managing the patient's care with other interprofessional team members across multiple care settings and levels of care. - A professional nurse often serves as the case manager. - In this role, the nurse assesses the needs of patients and/or caregivers, coordinates services for them, makes referrals as appropriate, and evaluates the progress towards meeting care goals.

What in an intervention defined as?

"any treatment, based upon clinical judgment and knowledge, which a nurse performs to enhance patient/client outcomes."

Quality and Safety Education for Nurses (QSEN) has made a major contribution to nursing by defining specific competencies that nurses need to have to practice safely and effectively in today's complex health care system. These are:

(1) patient-centered care (2) teamwork and collaboration (3) safety (4) quality improvement (5) informatics (6) evidence-based practice

Nursing Outcomes Classification (NOC)

- A list of patient outcomes developed to evaluate the effects of interventions provided by nurses. - The impact of your nursing practice on patient outcomes can be identified and measured when you choose a NOC outcome. - Currently there are more than 490 outcomes. - Each outcome has a designated code, definition, a set of indicators to use to evaluate patient status, and a five-point Likert scale for rating the outcome and indicators. - A rating of a "5" is always the best possible score and "1" is always the worst possible score.

What is the nursing process?

- A problem-solving approach to the identification and treatment of patient problems that is the foundation of nursing practice. - The nursing process framework provides a structure for the delivery of nursing care and the knowledge, judgments, and actions that nurses use to achieve best patient outcomes. - Once started, the nursing process is continuous and cyclic.

What are clinical pathways?

- AKA critical paths, patient care protocols, care maps; are interprofessional care plans that specify care and desired outcomes during a specific time period for patients with a particular diagnosis or health condition. - Think of a clinical pathway as a road map the patient and health care team should follow. - As the patient progresses along the road, the patient should receive specific care and accomplish specific goals. - If a patient's progress differs from the planned path, a variance has occurred. - The exact content and format of clinical pathways vary among agencies and settings. - Each agency usually develops its own pathways based on evidence-based practice guidelines. - In acute care, clinical pathways often describe which patient care components are required at specific times for each day of hospitalization. The case types selected for this type of pathway are usually those that are high volume or high risk and predictable, such as myocardial infarction and surgical procedures (e.g., joint replacements, cholecystectomies, cataract surgery).

Nursing Interventions Classification (NIC)

- Includes independent and collaborative interventions that you carry out, or direct others to carry out, on behalf of patients. - It includes treatments that you perform in all settings and includes direct and indirect care. - NIC includes more than 550 interventions with a label name, a definition, and a set of activities for you to choose from to carry out the intervention. - Each intervention has a list of activities, and you select the appropriate activities from the list to implement the intervention. - NIC does not prescribe interventions for specific situations. - You are responsible for making the important decision of when and which interventions to use for a specific patient and situation based on your knowledge of the patient and the patient's condition.

Team care model

- Involve a group of providers who work together to deliver care. - A professional nurse is usually the team leader. - As team leader, you manage and coordinate care with others, such as licensed practical/vocational nurses (LPNs/LVNs) and unlicensed assistive personnel (UAP). - You have accountability for the quality of care delivered by team members during a work period.

What must the nurse do with collaborative problems?

- Nurse must monitor the patient to detect the onset or change in status of actual or potential complications. - Nurses use physician and nurse prescribed interventions to manage collaborative problems and prevent morbidity and mortality. - During the diagnosis phase of the nursing process, you identify these risks in addition to nursing diagnoses. - Identifying collaborative problems requires knowledge of pathophysiology and possible complications of medical treatment. - Collaborative problem statements are usually written as "potential complication: ______" or "PC: _____" without a "related to" statement. *An example is PC: pulmonary embolism.

Other ways to enhance communication during transitions include:

- Performing surgical time-outs - Using a standard change-of-shift process - Conducting interprofessional rounds to identify risks and develop a plan for delivering care

Universal Protocol (UP) includes:

- Preprocedure verification - Mark procedure site - Performance of time-out • Conduct a time-out before the start of any invasive or surgical procedure. • Confirm correct patient, procedure, and site.

Transitional care

- Settings provide care in between the acute care and the home or long-term care setting. - Patients may receive transitional care at an acute rehabilitation facility after head trauma or a spinal cord injury.

NANDA-I Nursing Diagnoses

- The nursing organization that develops and maintains the standard classification system for nursing diagnoses. - Nursing diagnoses provide the basis for selecting nursing interventions to achieve patient outcomes for which nursing is accountable. - Delivering care based on accurately identified nursing diagnoses results in more effective and safer patient care. - The NANDA-I list is continually evolving as new research results are available and nurses identify new human responses.

Step 2. Search for the best evidence based on the clinical question.

-H ierarchy of evidence. - As you go down the pyramid, the strength of the evidence becomes weaker.

When does a negative variance occur during a clinical pathway?

A negative variance occurs when specific goals are not met. - The nurse usually identifies when a negative variance is present and works with the interprofessional team to create a plan to address the issue.

What is an advanced practice registered nurse (APRN)?

A nurse educated at the master's or doctoral level, with advanced education in pathophysiology, pharmacology, and health assessment and expertise in a specialized area of practice. - APRNs include clinical nurse specialists, nurse practitioners, nurse midwives, and nurse anesthetists. - APRNs play a vital role in the health care delivery system. - In addition to managing and delivering direct patient care, APRNs have roles in leadership, quality improvement, evidence-based practice, and informatics.

Sentinel events

A patient safety event not related to the patient's illness or underlying condition that reaches a patient and results in death, permanent harm, or severe temporary harm. - Events are "sentinel" because they signal the need for immediate investigation and response. - Many sentinel events are also serious reportable events. - If the patient undergoes a wrong-site or wrong-procedure surgery, experiences an assault in the health care setting or receives an incompatible blood product, the occurrence is both a sentinel event, reportable to TJC, and a serious reportable event, reportable to NQF (National Quality Forum).

What is evidence-based practice (EBP)?

A problem-solving approach to clinical decision making. Using the best available evidence (e.g., research findings, QI data), combined with your expertise and the patient's unique circumstances and preferences, leads to better clinical decisions and improved patient outcomes. - EBP closes the gap between research and practice, providing more reliable and predictable care than that based on tradition, opinion, and trial and error. - EBP depends on you to take an active role in using the best available evidence when delivering care. - You need to have an ongoing curiosity about what are the best nursing practices and routinely ask questions about your patient's care. - Recognize when you need more information. - When you base your practice on valid evidence, you are solving problems and supporting best patient outcomes.

What is a nursing-sensitive patient outcome?

An individual, family, or community state, behavior, or perception that is measured along a continuum in response to a nursing intervention(s)

Evidence-Based Practice - Competency

Integrate best current evidence with clinical expertise and the patient/family preferences and values for delivery of optimal health care

Telehealth Nursing

Is using the nursing process to provide nursing care to patients through telecommunication technologies, including high-speed Internet, wireless, satellite, and video communications. - Among the many uses of telehealth are triaging patients, monitoring patients with chronic or critical conditions, helping patients manage symptoms, providing patient and caregiver education and emotional support, and providing follow-up care. - Telehealth increases access to care. - The nurse engaged in telehealth can assess the patient's health status, deliver interventions, and evaluate the outcomes of nursing care while separated geographically from the patient

Services provided by occupational therapist:

May assist patient with fine motor coordination, performance of activities of daily living, cognitive-perceptual skills, sensory testing, and the construction or use of assistive or adaptive equipment

Services provided by respiratory therapist:

May assist with oxygen therapy in the home, provide specialized respiratory treatments, and instruct patient or caregiver regarding the proper use of respiratory equipment

__________ often occurs during transitions of care.

Miscommunication

What tasks may not be delegated?

Nursing interventions that require independent nursing knowledge, skill, or judgment (e.g., initial assessment, determining nursing diagnoses, patient teaching, evaluating care) are your responsibility and cannot be delegated. - State boards of nursing and agency policies identify activities that you can delegate to LPNs/LVNs and UAP. - You need to use professional judgment to determine appropriate activities to delegate based on the patient's needs, the LPN/LVN's and UAP's education and training, and extent of supervision required. - The most common delegated nursing actions occur during the implementation phase of the nursing process. For example, the nurse can delegate measuring oral intake and urine output to UAP, but the RN uses nursing judgment to decide if the intake and output are adequate.

Right Task

One that can be delegated for a specific patient Ask yourself: - Is it appropriate to delegate based on legal and agency factors? - Has the person been trained and evaluated in performing the task? - Is the person able and willing to do this specific task?

Services provided by physician:

Practices medicine and treats illness and injury by prescribing medication, performing diagnostic tests and evaluations, performing surgery, and providing other medical services and advice

Services provided by pharmacist:

Prepares medications and infusion products

Services provided by dietitian:

Provides general nutrition services, including dietary consultation regarding health promotion or specialized diets

What are transitions of care?

Refer to patients moving among health care practitioners, settings, and home as their condition and care needs change. - As a nurse, you are an essential part of care coordination by stressing actions that meet patient's needs and facilitate safe, quality care. - Collaborating with other members of the interprofessional team is critical. A lack of communication can result in an ineffective care transition, leading to medication errors and higher hospital readmission rates. *For example, you are a nurse in acute care admitting a long-term care patient who has been receiving propranolol 20 mg/5 mL twice a day. The admitting orders read "propranolol 20 mg/mL, give 5 mL twice a day."

One structured model used to improve communication is the _______________________________ technique.

SBAR (Situation-Background-Assessment-Recommendation) - This technique provides a way to talk about a patient's condition among members of the health care team in a predictable, structured manner. - SBAR is a model for effective transfer of information by providing a standardized structure for concise factual communications from nurse-to-nurse, nurse-to-physician, or nurse-to-other health professionals. - Before speaking with a physician or other health care professional about a patient problem, assess the patient yourself, read the most recent physician progress and nursing notes, and have the patient's chart available.

SBAR - S

Situation • What is the situation you want to discuss? What is happening at the present time? • Identify self, unit. State: I am calling about: patient, room number. • Briefly state the problem: what it is, when it happened or started, and how severe it is. State: I have just assessed the patient and I am concerned about: identify why you are concerned

What is the most important health care legislation since the creation of Medicare in 1965?

The 2010 Patient Protection and Affordable Care Act (ACA) - The ACA's main goal is to increase access to health care. - Other provisions affect how health care is delivered, expand wellness and preventive care, and promote quality and efficiency in the health care system. - The ACA supports nursing through funding for education and nurse-based clinics. - The ACA has triggered changes throughout the health care system. - As a nurse, you must take a leadership role in creating health care systems that provide safe, quality, patient-centered care.

What is critical reasoning?

Using critical thinking to examine and analyze patient care issues. - It involves understanding the medical and nursing implications of a patient's situation when making decisions regarding patient care. - You use clinical reasoning when you identify a change in a patient's status, take into account the context and concerns of the patient and caregiver, and decide what to do about it.

What is critical thinking?

Your ability to focus your thinking to get the results you need in various situations, has been described as knowing how to learn, be creative, generate ideas, make decisions, and solve problems - Critical thinking is not memorizing a list of facts or the steps of a procedure. - Instead, it is the ability to make judgments and solve problems by making sense of information. - Learning and using critical thinking is a continual process that occurs inside and outside of the clinical setting.

SBAR - R

Recommendation/Request • What should we do to correct the problem? What is your recommendation or request? State your request. • Specific treatments • Tests needed • Patient needs to be seen now

What is assessment phase?

The collection of subjective and objective patient information on which you will base your plan of care.

What is the planning phase?

The nursing diagnosis directs developing patient outcomes or goals and identifying nursing interventions to accomplish the outcomes.

The Five Rights of Delegation

The registered nurse uses critical thinking and professional judgment to be sure that the delegation or assignment is: 1. The right task 2. Under the right circumstances 3. To the right person 4. With the right directions and communication 5. Under the right supervision and evaluation

What is the essential core of nursing practice?

To deliver holistic, patient-centered care. - It includes assessment and evaluation, administering a variety of interventions, patient and family teaching, and being a member of the interprofessional health care team.

Quality Improvement - Competency:

Use data to monitor the outcomes of care and to improve the quality and safety of health care systems

Informatics - Competency

Use information and technology to communicate, manage knowledge, reduce errors, and support decision making

Services provided by physical therapist:

Works with patients on improving strength and endurance, gait training, transfer training, and developing a patient education program

Total patient care models

You are responsible for planning and providing all care.

Possible member of the interprofessional team:

- Dentist - Dietitian - Occupational Therapist - Pastoral Care - Pharmacist - Physical Therapist - Physician (MD) - Physician Assistant - Respiratory Therapist - Social Worker - Speech Pathologist

Steps of Evidence-Based Practice (EBP) Process

1. Ask the clinical question using the PICOT format: - Patients/population - Intervention - Comparison or comparison group - Outcome(s) - Time (as applicable) 2. Search for the best evidence based on the clinical question. 3. Critically appraise and synthesize the evidence. 4. Implement the evidence in practice. 5. Evaluate the practice decision or change. 6. Share the outcomes of the decision or change.

Patient-Centered Care - Competency:

Recognize the patient and caregiver as full partners in providing compassionate and coordinated care based on respect for patient's preferences, values, and needs

Community-based health care settings include:

- Ambulatory care - Transitional care - Long-term care

Step 1. Ask the clinical question using the PICOT format:

- Developing the clinical question is the most important step in the EBP process. - A good clinical question sets the context for integrating evidence, clinical judgment, and patient preferences. - In addition, the question guides the literature search for the best evidence to influence practice. *An example of a clinical question in PICOT format is, "In adult abdominal surgery patients (P = patients/population) is splinting with an elasticized abdominal binder (I = intervention) or a pillow (C = comparison) more effective in reducing pain associated with ambulation (O = outcome) on the first postoperative day (T = time period)?" A properly stated clinical question may not have all components of PICOT. Some only include four components. The (T) timing or (C) comparison components are not appropriate for every question. The (C) component of PICOT may include a comparison with a specific intervention, the usual standard of care, or no intervention at all.

To address specific patient safety concerns, TJC issues National Patient Safety Goals (NPSGs). NPSGs promote patient safety by providing evidence-based solutions to common safety problems. These goals are:

1. Identify patients correctly. 2. Improve communication among the health care team. 3. Use medications safely. 6. Use clinical alarm systems safely. 7. Prevent health care-associated infections. 15. Identify the safety risks inherent in the agency's patient population. - Universal Protocol (UP)

What is the evaluation phase?

A continual activity in the nursing process. - Evaluation determines whether the patient outcomes have been met as a result of nursing interventions. - If the outcomes were not met, a review of the steps of the process is necessary to determine why not. - Revision may be needed in assessment (data collection), nursing diagnoses, planning (determining patient outcomes), or implementation (nursing interventions).

Serious Reportable Events (SRE)

Also called a "never" event, to describe adverse events that are serious, largely preventable, and of concern to the public and health care providers. - These events include such things as a patient acquiring a stage III or greater pressure ulcer while hospitalized and death or disability from a fall or hypoglycemia. - To reduce the occurrence of these events, the NQF provides a list of effective Safe Practices that should be used in health care settings to improve the safety of care. - You are implementing NQF practices when you perform a time-out prior to a surgical procedure, complete accurate medication records, and implement interventions to prevent catheter-associated urinary tract infections, pressure ulcers, and falls.

Right Supervision and Evaluation

Appropriate monitoring, evaluation, intervention, and feedback Ask yourself: - Do you know how and when you will interact about patient care with the delegatee? - How often will you need to provide direct observation? - Will you be able to give feedback to the staff member if needed?

Right Circumstances

Appropriate patient setting, available resources, and considering relevant factors, including patient stability Ask yourself: - What are the patient's needs right now? - Is staffing such that the circumstances support delegation strategies?

SBAR - A

Assessment • What do you think the problem is? What is your assessment of the situation? State what you think the problem is: • Changes from prior assessments • Patient condition unstable or worsening

How is assignment different from delegation?

Assignment is the work each staff member is to accomplish during a given work period. - Staff members can only be assigned activities that are within their scope of practice. - Therefore the term assign is used when you direct a person to do something that he or she is authorized to do.

Services provided by social worker:

Assists patients with developing coping skills, meeting caregiver concerns, securing adequate financial resources or housing assistance, or making referrals to social service or volunteer agencies

SBAR - B

Background • What is the background or circumstances leading up to the situation? State pertinent background information related to the situation that may include • Admitting diagnosis and date of admission • List of current medications, allergies, IV fluids • Most recent vital signs • Date and time of any laboratory testing and results of previous tests for comparison • Synopsis of treatment to date • Code status

Conceptual Care Maps:

Blend a concept map and a nursing care plan. - On a conceptual care map, assessment data used to identify the patient's primary health concern are centrally positioned. - Diagnostic testing data, treatments, and medications surround the assessment data. - Positioned below are nursing diagnoses that represent the patient's responses to the health state. - Listed with each nursing diagnosis are the assessment data that support the nursing diagnosis, outcomes, nursing interventions with rationales, and evaluation. - After completing the map, you draw connections between identified relationships and concepts.

Right Directions and Communication

Clear, concise description of task, including its objective, limits, and expectations Ask yourself: - Have you clearly communicated the task? With directions, limits, and expected outcomes? - Does the delegatee know what and when to report? Does the delegatee understand what needs to be done?

What are common components of clinical pathways?

Common components include assessment guidelines, laboratory and diagnostic testing, medications, activity, diet, and teaching.

A _______ ________ is another method of recording a nursing care plan.

Concept map - In a concept map the nursing process is recorded in a visual diagram of patient problems and interventions that illustrates the relationships among clinical data. - Nurse educators use concept mapping to teach nursing process and care planning. - There are various formats for concept maps.

What does the National Database of Nursing Quality Indicators (NDNQI) provide?

Data on nursing-sensitive measures to evaluate the impact of nursing care on patient outcomes. - Patient outcomes are nursing sensitive if they improve with a greater quantity or quality of nursing care. - NDNQI outcomes are unique because they identify how nursing workforce factors, including nurse staffing and skill mix, directly influence patient outcomes. - NDNQI data show the incidence of falls and health care-associated pressure ulcers and infections decreases with adequate staffing and increased nurse education and satisfaction with the work environment.

Services provided by speech pathologist:

Focuses on treatment of speech defects and disorders, especially through the use of physical exercises to strengthen muscles used in speech, speech drills, and audiovisual aids that develop new speech habits

Teamwork and Collaboration - Competency:

Function effectively within nursing and interprofessional teams

Services provided by pastoral care:

Offers spiritual support and guidance to patients and caregivers

Right Person

Right person is delegating the right task to the right person to be performed on right person Ask yourself: - Is the prospective delegatee a willing and able employee? - Are the patient needs a "fit" with the delegatee?

What is a program that supports nurses?

The American Nurses Credentialing Center's Magnet Recognition Program.

Other care models include _________ and _________.

case management; telehealth

The largest use of informatics is _______________

electronic health records (EHRs), also called electronic medical records. - An EHR is a computerized record of patient information. - It is shared among all health care team members involved in a patient's care and moves with the patient—to other providers and across care settings. - The ideal EHR provides a single place for team members to review and update a patient's health record, document care given, and enter patient care orders, including medications, procedures, diets, and diagnostic and laboratory tests. - The EHR should contain a patient's medical history, diagnoses, medications, treatment plans, immunization dates, allergies, and test results

Nurses provide patient-centered care using an organizing framework called the ______________.

nursing process

Patient-centered care is interrelated with ________ and ________.

quality; safety

Goal 15: Identify the safety risks inherent in the agency's patient population.

• Assess patients at risk for suicide. • Assess any risks for patients who are getting home oxygen therapy, such as fires.

Goal 3: Use medications safely.

• Label all medicines that are not already labeled. Discard any found unlabeled. • Use appropriate precautions with patients who take anticoagulants. • Find out what medications each patient is taking. Make certain that it is safe for the patient to take any new medicines with his or her current medicines. • Give a list of the patient's medicines to the patient and his or her caregiver before they go home. Explain the list.

Informatics - Knowledge, Skills, and Attitudes:

• Protect confidentiality of patient's protected health information • Document appropriately in electronic health records • Use communication technologies to coordinate patient care • Respond correctly to clinical decision-making alerts

Patient-Centered Care - Knowledge, Skills, and Attitudes:

• Provide care with sensitivity and respect, taking into consideration the patient's perspectives, beliefs, and cultural background • Assess level of comfort and treat appropriately • Engage the patient in an active partnership that promotes health, well-being, and self-care management • Facilitate patient's informed consent for care

Goal 2: Improve communication among the health care team.

• Quickly get critical test results to the right staff person.

Evidence-Based Practice - Knowledge, Skills, and Attitudes:

• Read research, clinical practice guidelines, and evidence reports related to area of practice • Base individual patient care plan on patient's values, clinical expertise, and evidence • Continuously improve clinical practice based on new knowledge

Goal 6: Use clinical alarm systems safely.

• Respond to alarms in a timely manner. • Do not turn alarms off.

Goal 1: Identify patients correctly.

• Use at least two ways to identify patients (e.g., have them state full name and date of birth). • Give the correct patient the correct blood with every blood transfusion.

Quality Improvement - Knowledge, Skills, and Attitudes:

• Use quality measures to understand performance • Identify gaps between local and best practices • Participate in investigating the circumstances surrounding a sentinel event (never event) or serious reportable event (SRE)

Goal 7: Prevent health care-associated infections.

• Use soap, water, and hand sanitizer before and after every patient contact. • Use evidence-based practices to prevent infections related to central lines, indwelling urinary catheters, and multidrug-resistant organisms.

Teamwork and Collaboration - Knowledge, Skills, and Attitudes

• Value the expertise of each interprofessional member • Initiate referrals when appropriate • Follow communication practices that minimize risks associated with handoffs and transitions in care • Participate in interprofessional rounds