Finding Your Way in Continuous Quality Improvement

Quality ImprovementPlease welcome guest blogger, Anita Finkelman, author of Quality Improvement: A Guide for Integration in Nursing, for a new series on quality improvement.

A Beginning: Our Blog

Welcome to the blog Finding your Way in Continuous Quality Improvement! I am going to refer to “quality improvement” as CQI (continuous quality improvement). Upfront, let’s recognize that not only is healthcare a mixed up, changing area but so is CQI—and a new area. I like to use Alice in Wonderland as a background setting to set my mind around the topic of CQI. Why Alice? It actually is not an uncommon source used in leadership and management, but it has implications for CQI, too.

Alice in Wonderland provides a window into a world that is confusing, often viewed as nonsense; where language and terminology are not clear. There is lack of clarity as to who characters are and what they do. They change, and time is not always based on reality. One of the main characters, the Red Queen, makes it clear that you cannot expect to improve if you allow the status quo to continue. Alice, the main character, struggles in this world to find her way, as if in a maze, not knowing where to go or what her destination may be. Alice is full of questions as she tries to make Wonderland clearer to herself and engage others in Wonderland. She does discover that to be shown something improves her understanding. “What is the use of a book,” thought Alice, “without pictures and conversation.” Alice also comments on change, “How puzzling all these changes are! I’m never sure what I’m going to be, from one minute to another.”

So here we are at the beginning—working on making CQI clearer for us and for our students. We want to prepare our students for the real world, as confusing as it might be. We want them to be practicing nurses who engage in CQI.  I will attack various topics for us to consider as we facilitate effective learning and hopefully effective practice and quality care. A dialogue improves our understanding.

What, Another Medication Error?

Medication errors happen every day—and there is much variety in the types and circumstances. Why do we start here? Nurses administer medications. Learning how to do this safely is probably the most critical early learning activity for nursing students. As students get into the clinical area more and more issues come out about medication—increasing risk. What can we do about this?

Getting to Some Solutions

We are busy as faculty. Developing teaching-learning materials take time. As we well know, we sometimes tend to reinvent the wheel or feel we have to start from scratch. I am here to tell you we have a wealth of resources available to us—AND I am sure sharing with colleagues would also go a long way to expedite this prep work and lead to more effective learning.

To begin we must keep at the forefront, at all times, that health care has moved away from the Blame Environment. We know what this is—you make a medication error, and you are blamed with little consideration given to all of the many, many factors that might have led to that error in the system and with individuals. This blog posting is not directed at this major change in error response to a Culture of Safety, but it is important to remember it so that we know this is an overall perspective of errors that now impacts the learning experience.

There are many resources available to us from government resources and through other organizations. I want to begin by highlighting several and what how you might use them.

An Ongoing Update in Medication Administration

We begin with a great resource from the Institute for Safe Medication Practices (ISMP) (http://ismp.org/). This website is rich with resources for us. It not only provides resources but also an update on FDA alerts. For example, here is a list of the tools it features:

  • Special Error Alerts
  • High Alert Medications
  • Confused Drug Name List
  • Error-Prone Abbreviations List
  • Names with Tall Man Letters—to avoid errors with look-alike drugs

Check out the tools on the main website at http://ismp.org/.

An important option on this website: Sign-up for the free Nurse Advise-ERR. This electronic newsletter provides you with resources for effective facilitation of learning about medication administration.

What can you do with these resources? They can be used to provide examples and guidelines that you can incorporate in the cases you develop for students that might be used for individual assignments or team assignments. It is critical to incorporate this type of information in simulation as students engage in learning about medications and administration of medications. Even after they learn about the basics of incorporating them in complex simulation experiences we must remind students that learning about medications and administration of medications is an ongoing process. Students can also be directed to the ISMP website and asked to describe how they might use this information source. These resources are important to us as they reflect current concerns about medications based on evidence from practice and research.

Another resource is the Agency for Healthcare Research and Quality, Patient Safety Network (AHRQ, PSNet). Its Patient Safety Primers offer resources on patient safety, including medication administration, for example, https://psnet.ahrq.gov/primers/primer/23.

Also, when you open the home page at https://psnet.ahrq.gov/ you find a list of current references that are highlighted and abstracts are provided. The topics cover the areas of patient safety, and thus some often relate to medication administration and medications.

This ends our blog for now. What do you do to engage students in the critical need to provide safe and effective medications? How might you use some of these resources to update or change your teaching-learning strategies?

About the text:

Quality Improvement: A Guide for Integration in Nursing serves as a comprehensive resource for teaching practicing nurses and nursing students about the importance of improving patient care and reducing errors through quality improvement.  The text focuses on the practical aspects of quality improvement and the nurse’s role in the process, while acknowledging the importance of an inter-professional approach.  In addition, it focuses on the current state of healthcare quality in the US, critical trends in preventing errors, data, analysis, and planning and implementing change to reach improvement. The author connects quality improvement to technology and the role of the patient while emphasizing the importance of engagement and nursing leadership. Learn more at our website.

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Jones & Bartlett Learning Wins Six AJN 2016 Book of the Year Awards

BOTY-seal-2016-GoldWe are so proud to share that we have garnered six prestigious 2016 AJN Book of the Year Awards. Representing the best in nursing publishing, the awards recognize the most valuable texts published between August 2015 and August 2016. Jones & Bartlett Learning recipients include:

Awarded first place: Pharmacology for Women’s Health, Second Edition by Mary C. Brucker and Tekoa L. King in the Maternal-Child Health category

Awarded second place: Clinical Nursing Calculations by Susan Sienkiewicz and Jennifer F. Palmunen in the Medical-Surgical Nursing category and Transition from Clinician to Educator: A Practical Approach by Maria C. Fressola and G. Elaine Patterson in the Nursing Education/Continuing Education/ Professional Development category

Awarded third place: Breastfeeding Management for the Clinician: Using the Evidence, Fourth Edition by Marsha Walker in the Maternal-Child Health category, Leadership for Evidence-Based Innovation in Nursing and Health Professions by Sandra Davidson, Daniel Weberg, Tim Porter-O’Grady, and Kathy Malloch in the Nursing Education/Continuing Education/ Professional Development category, and Advanced Nursing Research: From Theory to Practice, Second Edition by Ruth M. Tappen in the Nursing Research category

Read the full press release.

“Jones & Bartlett Learning is quite humbled by the outcome of the AJN 2016 Book of the Year Awards. We are so honored to have been provided distinction for six of our publications in the areas of Maternal-Child Health, Medical-Surgical Nursing, Nursing Education & Professional Development, and Nursing Research. To be grouped among the best in nursing publishing in these subject areas is a testament to the hard work and dedication of our authors and our publishing team. Receiving these prestigious awards not only confirms the value of our work, but also provides inspiration for future contributions to the field. Many thanks to the American Journal of Nursing for their continued support of publishing in nursing.” – Amanda Martin, Executive Editor, Jones & Bartlett Learning

Pharmacology for Women’s Health, Second EditionPharmacology for Women’s Health, Second Edition is a unique text that discusses pharmacology as it specifically relates to women’s health. Completely updated and revised to reflect the changing field of pharmacology, it includes new pharmacological agents for common conditions, changes in indications, the use of vaccines, updated guidelines from the CDC for treatment of sexually transmitted infections, and the effects of the Affordable Care Act.

Clinical Nursing CalculationsClinical Nursing Calculations is an essential text for teaching dosage calculation to undergraduate nursing students. Using the CASE approach, a step-by-step method for performing dosage calculations, it features all three methods for calculation side-by-side, making it tremendously helpful for students who struggle with math or need a refresher. It covers key topic areas, such as mathematics overview, principles of medication administration, basic dosage and intravenous calculations, and advanced calculations.

Transition from Clinician to EducatorAs the population continues to age and retire, the shortage of qualified nurse educators continues to grow. Simultaneously, student demand is also increasing. In order to address this current and future need, organizations are looking toward practicing clinicians to fill the gap. Transition from Clinician to Educator: A Practical Approach is a hands-on guide to prepare future educators who are entering the world of education.

Breastfeeding Management for the Clinician, Fourth EditionBreastfeeding Management for the Clinician: Using the Evidence, Fourth Edition is an essential and practical reference guide for clinicians. Using a research-based approach, it includes literature reviews while covering incidence, etiology, risk factors, prevention, prognosis and implications, interventions, expected outcomes, care plans, and clinical algorithms. The Fourth Edition provides a new discussion of the vitally important newborn gut microbiome.

Leadership for Evidence-Based Innovation in Nursing and Health Professions Written by healthcare leaders for current and future innovation leaders, Leadership for Evidence-Based Innovation in Nursing and Health Professions addresses the current and emerging issues facing healthcare leaders and practitioners who lead evidence-based innovation. A truly unique text, it systematically addresses innovation and evidence from the perspectives of both a leader and a practitioner within the context of health care.

Advanced Nursing Research, Second EditionAdvanced Nursing Research: From Theory to Practice, Second Edition is an ideal graduate-level text for teaching students how to prepare research proposals and carry out research studies using a practical approach. With a greater emphasis on the connection to evidence-based practice, quality improvement, and the use of aggregate data, the text features a reality-based approach to the actual conduct of research. It also reflects current practice and thinking about research while integrating qualitative and quantitative methods, including emerging mixed methods.

We would like to thank AJN for this outstanding honor!

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Technology – A Disruptor and Catalyst for Change

Leadership for Evidence-Based Innovation in Nursing and Health Professions Welcome back guest blogger, Daniel Weberg, co-author of Leadership for Evidence-Based Innovation in Nursing and Health Professions for a new post on technology.

Although difficult, unraveling the care process across the healthcare system is necessary in order to identify specific areas where technology can enable care for the future and meet the triple aim.  Healthcare systems that scrutinize this process can incorporate technology to decrease cost, improve patient experience, and improve overall population health. To affect change, leaders must be able to lead through ambiguity in order to see the patterns that signal change.  Technology is a disruptor and it can motivate teams to create novel solutions to long held problems like those in the Triple Aim.  The key for any leader is to understand how technology fits in.  It’s seldom the only solution but rather a facilitator and catalyst to systemic change.

Decrease Cost:

  • Improved efficiency by facilitating fewer steps to complete needed care, such as reducing hunting and gathering tasks using real time location technology which allows for time to be spent on care rather than non-value added tasks.
  • Improved decision making through better data. Data analytics and real time decision-making support tools allow frontline care givers to access the right information at the right time for the right care thus optimizing system utilization and caregiver effort.
  • Improved coordination of care through better connections among the care team allows patients to transition through the system seamlessly reducing time, unnecessary testing, and improved patient outcomes.

Improve Patient Experience:

  • Informing the patient and family about their care journey through interactive patient care systems that put the patient at the center of their care and allows for better participation in care options.
  • Intelligent routing of patient requests shifts non-nursing tasks, such as changing the room temperature and ordering lunch, to more appropriate care team members thus improving request follow-through and outcomes.
  • Personalizing care through facilitating patient reported information such as pain level through interactive systems not only when a caregiver rounds on the patient.

Improve Population Health:

  • Social networks that reach beyond the four walls of care and into the patient’s home and everyday life.
  • Remote monitoring that allows care givers to assess and intervene when patterns of vital signs, lab values, and activity indicate the need for outreach when the patient is not in the clinic.
  • Linking hospital care to home care through longitudinal plans of care and shared data from inpatient settings to outpatient follow-up care.

The five categories of technologies described here address multiple areas of improvement:

The five categories of technologies described in this report address multiple areas of improvement

About the text:

Written by healthcare leaders for current and future innovation leaders, Leadership for Evidence-Based Innovation in Nursing and Health Professions addresses the current and emerging issues facing healthcare leaders and practitioners who lead evidence-based innovation. A truly unique text, it systematically addresses innovation and evidence from the perspectives of both a leader and a practitioner within the context of health care.

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Review: 2017 Nurse’s Drug Handbook “is excellent”

2017 Nurse's Drug HandbookTerrific news to share– the recently published 2017 Nurse’s Drug Handbook just received a 4-star review. According to Carol E. Agana, MNSc, RNP, APRN, from the University of Arkansas, writing for Doody’s Review Service,

“As a reference, this one is excellent and it also serves the purpose of a textbook. What differentiates [it] from other drug references are the nursing considerations and patient teaching points.”

Jones & Bartlett Learning 2017 Nurse’s Drug Handbook is the most up-to-date, practical, and easy-to-use nursing drug reference. Updated annually, it provides accurate and timely facts on hundreds of drugs from A-Z. Written in a no-nonsense style that speaks your language in terms you use every day, it offers concise and consistently formatted drug entries organized alphabetically.

The 2017 Nurse’s Drug Handbook also includes:

  • Index of all generic, trade, and alternate drug names
  • Chemical and therapeutic classes, FDA pregnancy risk category, and controlled substance schedule
  • Indications and dosages, as well as route, onset, peak, and duration information
  • Incompatibilities and contraindications
  • Interactions with drugs, food, and activities
  • Adverse reactions
  • Nursing considerations, including key teaching points for patients
  • Mechanism-of-action illustrations
  • Warnings and precautions

New drug entries include alirocumab, brexpiprazole, cangrelor, cariprazine, edoxaban, eluxadoline, evolocumab, flibanserin, idarucizumab, ivabradine, and mepolizumab. Updates to the appendices include parenteral insulin preparations, selected ophthalmic drugs, selected topical drugs, selected antivirals, selected antineoplastic drugs, and interferons.

Take 2017 Nurse’s Drug Handbook wherever you go with an affordably priced app for Android, iPhone, and iPad. Try the app free for 30 days!

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Just Published Nurse Anesthesia Pocket Guide, Third Edition Is a Vital Resource for Students and Clinicians

Nurse Anesthesia Pocket Guide, Third EditionBusy nurse anesthetists need quick access to essential information. That’s what makes our just published Nurse Anesthesia Pocket Guide: A Resource for Students and Clinicians, Third Edition by Lynn Fitzgerald Macksey so indispensable.

The Third Edition provides easy-to-use and concise information that nurse anesthetists working in the operating room need to know. It includes general anesthesia principles, obstetrics, pediatrics, regional anesthesia, and medication charts.

  • Provides additional information on anesthetic complications and intraoperative monitoring
  • Expanded content on positioning ramifications and nerve injury
  • Updated pharmacology chapter, new peripheral nerve blocks, and additional math and pulmonary/cardiac formulas

Would you like to learn more? Just visit our website.

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Recently Published RN’s Study Guide Helps Nursing Students Thrive

RN's Study GuideAs nursing school enrollments continue to grow, it’s important for nursing students to know the basics. The just published RN’s Study Guide: Nursing Essentials by Vicky Li is a unique and user-friendly resource that presents students with need to know information to help them thrive on their path to becoming a nurse.

Unlike other texts, it condenses vast amounts of knowledge into manageable basics to help nursing students and professionals understand difficult material, prepare for rigorous tests, and provide optimal care for patients and their families.

  • Concise and practical approach
  • Offers simplified introductions to the major health problems of different systems with important nursing tips and explanations
  • Includes useful medical terms, anatomic pointers, points to consider, and precautions

Would you like to learn more? Preview a sample chapter now or visit our website.

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World AIDS Day Strives for Leadership, Commitment, and Impact

world_aids_day_2016facebook-instagramDecember 1 marks World AIDS Day, a global initiative that acknowledges the progress made in AIDS treatment and prevention. This year the theme is “Leadership. Commitment. Impact.” It encourages “leaders to strengthen their commitment to using evidence-based HIV interventions, prevention tools, and testing efforts to help us stop HIV.”

According to the CDC, about 1.2 million people are living with HIV in the U.S. Globally, that number jumps to 36.7 million, with two-thirds of new HIV infections occurring in sub-Saharan Africa. Prevention efforts have made strides worldwide, including CDC programs that:

  • Scale up the use of antiretroviral treatment among people living with HIV
  • Strengthen local governments’ ability to provide effective, sustainable HIV services
  • Deliver the most effective prevention tools to those at high risk for HIV infection
  • Use data to reach high-risk groups, inform public health policies and strategies, and measure the impact

In the U.S. new diagnoses are declining in some populations. The CDC reports that from 2005 to 2014, the number of new cases “fell 19%…with large declines among heterosexuals and persons who inject drugs (PWID). Gay and bisexual men continue to be the most affected population, accounting for two-thirds of new diagnoses.” Prevention, of course, is a huge focus. As such, the CDC works with partners to focus efforts on at-risk populations, with activities like:

  • Providing funding and technical assistance to health departments and community-based organizations
  • Conducting HIV surveillance and prevention research
  • Developing guidelines for HIV treatment, prevention, surveillance, and laboratory procedures
  • Evaluating prevention programs
  • Providing training and capacity building assistance in HIV prevention interventions and strategies
  • Focusing attention on HIV in the United States through Act Against AIDS communications campaigns, including Let’s Stop HIV Together, Doing It, Start Talking. Stop HIV, and HIV Treatment Works

Please join us in recognizing the importance of World AIDS Day and the work we all still need to do to eradicate HIV/AIDS worldwide.

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New Text Examines Why Heath Promotion Is a Key Component of Nursing Practice

Contemporary Health Promotion In Nursing Practice, Second EditionAccording to the World Health Organization (WHO), health promotion “enables people to increase control over their own health. It covers a wide range of social and environmental interventions that are designed to benefit and protect individual people’s health and quality of life by addressing and preventing the root causes of ill health, not just focusing on treatment and cure.” As such, health promotion has long been a central part of nursing practice. Increasingly, nurses have needed to adopt an active role in promoting the health of individuals, families, communities, and nations.

The recently published Contemporary Health Promotion in Nursing Practice, Second Edition by Bonnie Raingruber focuses on why health promotion is an integral part of nursing practice while examining health promotion theories and genetic and social determinants of health. Using a strengths-based approach, it addresses patient care with an emphasis on the importance of shared decision-making, health literacy, and health disparities.

Rooted in a thorough discussion of health promotion theories, historical documents, and policies that have shaped health promotion practice, it covers a wide range of topics, including smoking cessation, chronic disease management, stress reduction, obesity, and examples of health promotion measurement.

What else makes the Second Edition special?

  • New nursing and non-nursing theories
  • Updated content on health policy and nursing informatics
  • Healthy People 2020 goals
  • Creative approaches to health promotion, including soap operas, street theater, and art therapy
  • Each new print copy includes Navigate 2 Advantage Access that unlocks a comprehensive and interactive eBook, student practice activities and assessments, a full suite of instructor resources, and learning analytics reporting tools

Can’t wait to learn more? Preview a sample chapter now or visit our website.

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Just Published: PCCN Certification Review, Third Edition

PCCN Certification Review, Third Edition Are you or someone you know preparing to take the Progressive Care Certified Nurse (PCCN) exam administered by the American Association of Critical-Care Nurses (AACN)? Our just published PCCN Certification Review, Third Edition by Ann J. Brorsen and Keri R. Rogelet is the ideal study guide.

According to the AACN,

“As healthcare becomes increasingly complex and challenging, the value of certification as a mark of excellence is more important than ever. Achieving certification demonstrates to patients, employers and the public that a nurse’s knowledge, skills and abilities meet rigorous national standards – and reflects a deep commitment to patient safety.”

PCCN Certification Review, Third Edition includes more than 1,100 questions and comprehensive answers with rationales. What’s more, it has been updated and revised in all sections to reflect changes in the new PCCN test plan, including gerontological issues, cardiac surgery, pacemakers, infectious diseases, and palliative care. Each new print copy includes Navigate 2 Preferred Access that unlocks a comprehensive and interactive eBook and Navigate 2 TestPrep with questions generated from the book.

Would you like to learn more? Visit our website.

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Jones & Bartlett Learning Publishes 2017 Oncology Nursing Drug Handbook

2017 Oncology Nursing Drug HandbookFantastic news to share– we just published 2017 Oncology Nursing Drug Handbook by Gail M. Wilkes and Margaret Barton-Burke. Written especially for nurses caring for patients with cancer, it uniquely expresses drug therapy in terms of the nursing process: nursing diagnoses, etiologies of toxicities, and key points for nursing assessment, intervention, and evaluation. Updated annually, this essential reference provides valuable information on effective symptom management, patient education, and chemotherapy administration.

Completely revised and updated, the 2017 Oncology Nursing Drug Handbook includes separate chapters on molecular and immunologic/biologic targeted therapies. These chapters provide fundamental reviews to assist nurses in understanding the cellular communication pathways disrupted by cancer. It also offers simplified content, attention to understanding the immune checkpoint inhibitors, new information about immunotherapy, new drugs and their indications, and updated indications and side effects for recently FDA approved drugs.

New drugs include: alectinib (Alecensa), atezolizumab (Tecentriq), cabozantinib tablets (Cabometyx), cabozantinib capsules (Cometriq), cobimetinib tablets (Cotellic), colistin/polymixin B, clotrimazole, daratumumab (Darzalex), elotuzumab (Empliciti), irinotecan liposome injection (Onivyde), ixazomib (Ninlaro), melphalan for injection (Evoela), necitumumab (Portrazza), osimertinib (Targrisso), pentamidine, posaconazole, peramivir, rolapitant (Varubi) , talimogene laherparepvec (Imlygic), Tamiflu, trabectedin (Yondelis),  uridine triacetate (Vistogard granules),  venetoclax (Venclexta), vincristine liposome injection (Marqibo), and zanamivir.

Get a head start on the new year with 2017 Oncology Nursing Drug Handbook. Learn more at our website.

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