QSEN (Quality and Safety Education for Nurses) Competencies

1 QSEN (Quality and Safety Education for Nurses) Competencies Continuous quality and safety education is essential in equipping nurses with the knowledge, skills and attitudes necessary for the continual quality and safety improvement in healthcare. Nurses are required to be competent in various aspects of care including the delivery of patient-centered care, implementing evidence based practices, promoting safety, quality improvement and collaborating with other healthcare professionals. This paper presents a concern in healthcare that can be addressed using evidence based practice thus improving quality and safety of care.

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2 Surgical Never Events Several mistakes may happen during surgery that could have been prevented through preoperative measures. Some of these events include surgeries performed on a wrong person, on the wrong surgical site or a wrong procedure done (Kumar & Raina, 2017). Wrong site surgeries are more common and occur across all specialties, the most common being in orthopedics. It is done on the wrong part of the body of a patient, which is more likely to be on the opposite side of which the surgery was to be done initially. Surgeries performed on a wrong person are often attributed to poor patient identification measures used prior to the surgical procedure. This often results to a procedure done to a wrong person and in some instances, done on the wrong part of the body if the person was also to be operated on (Lin, Wernick, Tolentino & Stawicki, 2018).

Never events are medical errors that are entirely preventable and should never occur.

They result in adverse events including poor patient outcomes, significant disability and even death. The effects caused by a never event are clearly identifiable and measureable and therefore, reportable. Surgical never events can be prevented using preoperative, evidence based practices to ensure that the correct surgery is done on the correct patient and at the right site.

Identification and Measuring of Surgical Never Events Surgical never events are easily identifiable and measurable in facilities as they result in significant health outcomes. These events should be reported immediately they occur for easier follow up and immediate actions to be taken. The identification of never events is crucial in improving patient safety. Identification of such events can easily be achieved through voluntary reporting, patient interviews, post-surgical assessments and chart reviews (Kumar & Raina, 2017). These detection systems are applicable to the vast types of surgical never events and are not limited to those that occur due to preoperative mistakes.

3 There is no clearly defined way to measure a never event. In most instances, it is determined by the impact caused. Most healthcare settings have quality measures put in place against surgical never events, which can be used as a measurement. The identification of never events can also be used as guides to measurement as they allow for statistics on their occurrences and impact to be kept. Both identification and measurement of never events makes it possible to track the cause of the event and put in place measures to prevent their occurrence in future.

Evidence Based Interventions against Surgical Never Events Evidence based interventions provides researched approaches that can be applied to clinical scenarios for better outcomes. In the case of surgical never events, evidence emphasizes on effective preoperative measures against most surgical mistakes. Proper preoperative care significantly improves postoperative outcomes and also minimizes the occurrences of never events during surgery.

Proper patient identification is the first preoperative measures that can be used to minimize instances of surgeries done on the wrong patient. Prior to a surgical procedure, the patient should be able to verbally identify himself/herself. In the case that the patient is not able to do so, their caregiver should accompany them and provide full details of the patient. At this point, the identity of the patient should be confirmed before the surgical procedure, and also ensured that the patient information provided matches the details of the surgical procedure to be done (Papadakis, Meiwandi & Grzybowski, 2019).

The second evidence based approach is dubbed ‘sign your site’. This approach recommends that the surgeon performing the procedure should sign the incision site using a permanent marker, before the patient is brought into the operating room. This can also be done by an independent practitioner who can be held accountable for the procedure and must also be

4 available during the procedure. The site marking should be done in an ambiguous manner which should be consistent with the organization. Also, the method used to mark the site should be permanent and remain on skin after skin preparation and draping have been done (Lin et al., 2018).

This measure is used to prevent incidences of surgical procedures done on the wrong side of the body or an incorrect procedure done on the right patient. The surgeon is expected to sign the site after going through the details of the surgery with the patient in the presence of the nurse in charge of the patient. Before marking the site, the patient details should be verified to ensure it’s the correct patient, correct procedure and the correct site. Also, the team should ensure that everything required for the procedure is available at that time including lab results, radiologic findings, blood products, implants and any other requirements, and ensure that they are for the correct patient. The incision site should be signed after everything required for the surgery is in place. All the missing information and discrepancies are addressed at this point (Papadakis, Meiwandi & Grzybowski, 2019).

The last measure is to perform a time out before the surgical procedure is done. This is done at the operating room before the procedure commences. All members of the surgical team including the anesthesiologist, nurse, surgeon, operating room technician and other professionals involved in the procedure should be present during the time out. The time out should be standardized in every organization and should include verification of the patient, the procedure to be done and the surgical site. All these should be documented as per the facility’s protocol (Kumar & Raina, 2017).

Conclusion

5 Quality and safety education enhances the competencies of care providers in delivering quality and safe patient care. Nurses are involved in almost every aspect of patient care and are therefore, the greatest influencers of quality and safe care. Evidence based approaches can be used to address most concerns in healthcare by providing research-proven solutions. This paper utilized the example of surgical never events and how they can be reduced using evidence based approaches.

6 References Kumar, J., & Raina, R. (2017). ‘Never events in surgery’: mere error or an avoidable disaster.

Indian Journal of Surgery, 79(3), 238-244. https://doi.org/10.1007/s12262-017-1620-4 Lin, A., Wernick, B., Tolentino, J. C., & Stawicki, S. P. (2018). Wrong-site procedures: Preventable never events that continue to happen. Vignettes in Patient Safety: Volume 2, 2113. http://dx.doi.org/10.5572/intechopen.69242 National Council of State Boards of Nursing. (2010). Nursing pathways for patient safety (1st ed). St. Louis: MO: Elsevier Saunders. 9780323065177. Chapter 6: Pages 107 – 118.

Papadakis, M., Meiwandi, A., & Grzybowski, A. (2019). The WHO safer surgery checklist time out procedure revisited: Strategies to optimise compliance and safety. International Journal of Surgery, 69, 19-22. https://doi.org/10.1016/j.ijsu.2019.07.006