Diagnosis and Classification of Cancer - hisi.ie Dickon Weir-Hughes.pdf · orientated nursing assessment tools and standardised language 2.Provide an overview of the leadership skills

Clinical leadership and the successful

implementation of evidence-based nursing

assessment tools and standardized language:

key elements of improving patient safety

Professor Dickon Weir-Hughes

The purpose of this interactive

session is to:

1.Provide an overview of the key elements of improving

patient safety by implementing evidence-based and outcome

orientated nursing assessment tools and standardised

language

2.Provide an overview of the leadership skills required to

successfully see through implementation, especially in the

areas of change management and achieving ‘buy in’ from

multi-disciplinary colleagues

International context

Ever increasing patient and public expectations around patient safety: from a good lunch to the ‘zero risk dilemma’

Health technologies that were unthinkable even twenty years ago : cost versus quality and priorities and an aging and more dependent population. This presents serious implications for socialised medicine and Governments

It’s a very small world : nurse education is very variable

Nurses need to be fully functioning as clinical decision makers and not just knowledgeable doers

Evidence-based assessment

and standardized language

The primacy of caring

Developing the nurse – patient relationship

Consistency of assessment, care planning and evidence-based interventions plus outcome evaluation

The capacity to think critically, Critical Thinking and failing to ‘rescue’

Understanding and articulating the knowledge of the discipline : standardised nursing language

Autonomy

Setting the scene for

implementation

Understanding the evidence and the rationale – specialty specific studies

Understanding nursing theory

Link patient safety and efficiency to every element of the initiative (Halloran, 1987 and Frank & Lave, 1985, linked NDx to length of stay). Create a ‘win-win’ with senior managers

Understanding change management

Worldwide perspectives

Gordon’s Functional Health Patterns

Clinical terminologies: NANDA / NIC / NOC

Reference terminologies: ICNP / SNOMED CT

Priorities in different countries

Acceptance and the link to high quality education

Benefits summary

Consistent problem identification (safety)

Improved communication and problem articulation (safety)

Better recognition of phenomena that nurses often struggle to assess: such as psychological, spiritual or sexual issues (enhanced care)

Improved understanding of length of stay and better focus on problematic issues (efficiency)

Multiple organisational governance and educational benefits (efficiency and reputation)

The role of the Registered

Nurse (RN) in decision making

Numerous studies have indicated that nurse staffing has a definite

and measurable impact on patient outcomes, clinical errors, length

of stay, nurse turnover and patient mortality.

Ratios of nurses to patients are key but must be modified according

to the organizations characteristics, the quality of clinical interaction

between and among physicians, nurses and managers. There is a

significant link between a lean night nursing service and long

lengths of stay, as much as 20% in one study.

Level of education is also key: A 10% increase in RN’s / 10%

decrease in HCA’s is associated with 5 fewer deaths per 1000

discharges. A 10% increase in the number of RN’s holding a BScN

is associated with a 5% decrease in death within 30 days of

admission for surgery and the odds of ‘failure to rescue’

Is an ‘all RN’ staff unthinkable?

The role of the Registered

Nurse (RN) – such old (yet

sadly ignored) research!

Curtain, L (2003) An integrated analysis of nurse staffing

and related variables: effects on patient outcomes, OJIN

Aiken, L; Clarke, S; Cheung, R; Sloane, D and Silber, J

(2003) Educational levels of hospitals and surgical

mortality. JAMA, 290 (13), 1617-1623

Rafferty, A; Clarke, S; Coles, J; Ball, James, P; McKee,

M and Aiken, L (2006) Outcomes of variation in nurse

staffing in English hospitals. IJNS

Key leadership skills

Technical / theoretical understanding that you can

articulate with confidence

Systematically identify the pros and cons of your chosen

languages and be open about them

Networking purposefully

Identify ‘win wins’ in concert with organizational goals

Manage upwards

Strategic planning

Delegate

Evaluate

Educate

Reflections on my

implementations

Chelsea & Westminster Hospital

The Royal Marsden Hospital

Barking, Havering & Redbridge

Understanding the knowledge of the discipline

Senior leadership

Assessment and care planning as a task not as evidence of critical thinking

Understanding theory

Patient focus

Linkages to organizational priorities

Patient safety and regulatory

issues related to standardized

language and assessment

Organizational reputation and insurance premiums

Nursing assessment

Conclusion

A living, breathing strategic approach is vital: one that is ‘fleet of foot’ on the key elements of nursing and grounded in the demographic context within which you practice

Focus on the important role of the RN and linkages between patient safety and critical thinking plus organizational priorities

Celebrate and be proud!

Discussion and debate