Curriculum Redesign Rapid Cycle Improvement Reliable Planning Implementation
Curriculum Redesign Rapid Cycle Improvement Reliable Planning, Implementation and Evaluation Julie Marfell, DNP, APRN, FNP-BC, FAANP, Dean of Nursing, Professor, Frontier Nursing University Joan Slager, DNP, CNM, CPC, FACNM Program Director Doctor of Nursing Practice, Frontier Nursing University
INTRODUCTION
Frontier Nursing University DNP • Post-masters DNP started 2008 • Companion DNP program 2016 • Focus on vulnerable, underserved and rural populations • Community based DNP • As of February 2017, 349 graduates
2014 FNU DNP Curriculum Redesign • Planning: – DNP Workgroup to Evaluate AACN Competencies • Administration and faculty together • Core competency mapping: AACN DNP Essentials Graduate QSEN Competencies NONPF Core Competencies ACME Core Competencies IHI Knowledge Domains for Health Professional Students: Continual Improvement and Innovation – 2013 Teaching for Quality, AAMC Core Recommendations – – –
2015 FNU DNP Curriculum Redesign FNU DNP Workgroup Backwards Curriculum Design 2015 Context, AACN White Paper and IHI Open School 3 term DNP Clinical Project
Redesign Through Partnerships FNU IHI Clinical Sites Reliable Planning, Implementation, Evaluation and Dissemination
Redesign: Rapid Cycle Improvement DNP Clinical • Term 1: Planning • Term 2: Implementation • Term 3: Evaluation and Dissemination • Lead by the expressed desires of the clinical site • Data Driven Change • Rapid Cycle Improvement- 11 week Implementation • Patient Population Outcomes
Results: Clinical Implementation
Program Evaluation • Term Developmental Assessment Tool (TDAT) (DNP Essentials) • Science of Improvement Survey (SOI) • Timelog with Qualitative Input • Core Metrics: – – – Attrition Cycle Time/Completion % Implementation % Dissemination T tests comparing mean each term (TDAT and SOI)
Redesign Logistics • Institutional Review Board Process – University – Clinical Site • Clinical Credentialing – Compliance – Contracting • Scholarship – Faculty Expertise – Chair as Distinguished Role – Rapid Cycles, Robust Ramps
Redesign: IRB Review • • • DNP Faculty Workgroup IRB, Research Committee and DNP Clinical Faculty Reliable Systems Design Distinguishing QI Checklist Lean Systems Process: – Charter – QI Checklist – IRB Expedited Exemption Review Between Planning and Implementation Term • 3/50 Sites Require Site IRB in addition University Process
Redesign Clinical Credentialing CSAF Complete/Term 120 Goal Percentage 100 80 60 Median 40 20 0 Jan-16 Apr-16 Jun-16 Term Oct-16 Jan-17 Mar-17
PDSA #4 3 A 2 A 1 A 1 B 4 C 4 B 4 A 3 B 3 C 2 B 1 C 2 C 1 D 4 D 3 D 2 D
Redesign: Scholarship
Distance Education from the Birthplace of Nurse-Midwifery and Family Nursing in America
Screening for ACEs Adverse Childhood Experiences
By March 17, 2017, the aim is to increase ACEs screening by 25% at the Adolescent Family Center using a trauma-informed, patient-centered approach.
R E S I L I E N C Y
� Staff would gain knowledge about trauma informed care and the significance of ACEs � With time, materials, screening, and doing the brief intervention would steadily increase in %. � Possible unintended consequences: patient and staff satisfaction appointment time would not increase more than 20%.
ACE Score: 10 ACE Score: 9 ACE Score: 8 ACE Score: 7 ACE Score: 6 ACE Score: 5 ACE Score: 4 ACE Score: 3 ACE Score: 2 ACE Score: 1 ACE Score: 0 0% 10% 20% 30% 40% 50%
� On average 56% of eligible patients were screened - significantly above the goal of 25%. � 100% received Brief Intervention by PDSA 2 – goal of 100% achieved. � Patient satisfaction, staff satisfaction and appointment time were not significantly affected
- Slides: 38