Langara College School of Nursing Student Experience: Piloting the PREVIEW-ED© Tool in Fraser Health Authority El Bestawi, M.R., Kohm, C., Mak, A., Mutter, M., Thomas, D., Viernes, T.R. Affiliations: Fraser Health Authority and Langara College Abstract • • • • • In 2016, Fraser Health (FH) partnered with the Langara School of Nursing and senior nurse consultant, Marilyn El Bestawi and to pilot the PREVIEW-ED© tool. Two (2) term 8 Bachelor of Science in Nursing (BSN) students facilitated implementation of the tool with Fraser Health’s first cohort of 176 residents across 4 Fraser Health Care Homes. Students worked with Care Aides who completed the PREVIEW-ED© tool to prevent transfers to the Emergency Department for: pneumonia, congestive heart failure, urinary tract infections and dehydration. A noted 71% reduction in Emergency Departments (ED) transfers for tool sensitive conditions. This is now a best practice for Fraser Health Residential Care Homes. Figure 1. FH/Langara pilot team composition Implementation Discussion • Literature review: 10 articles were summarized in a literature review matrix A 13 week change project integrates knowledge and empowers students to become change agents in the practice setting • 3 student led & facilitated Skype and teleconferences with the Ontario based senior nurse consultant and key stakeholders Langara College BSN Term 8 Student • Project plan: a 12-week project charter with a project timeline that was updated weekly • Weekly summaries: Facilitated weekly project summary emails to all team members Langara College BSN Term 8 Student • Provided hands-on real-time support to care aides for completion of tools and to enhance their understanding Fraser Health Authority Project Director • Worked with site leaders to increase tool completion rates Nursing students reported:  an increase in their application of professional communication skills through teleconferences, Skype meetings and face to face meetings with project leaders and key stakeholders  Enhanced communication skills in assisting care-aides and in addressing their concerns about difficulties in completing the tool  Increased confidence in presentation skills through delivery of education sessions  Advanced computer skills through data entry with Excel spreadsheets and analysis skills Ontariobased Senior Nurse Consultant Langara College Nursing Faculty Introduction • Bachelor of Science in Nursing education looks for innovative ways of preparing student nurses for the workplace. Benner et al (2010) highlight the need to better support students to develop projects in the clinical setting that use evidence-based nursing to support their growth toward being change agents in the health care system. • Langara College’s N4163 Bachelor of Science in Nursing (BSN) practice course provides students in Term 8 the opportunity to apply their skills and knowledge and connect theory to practice in caring for society as a client. • Fraser Health provided an opportunity for such change through the piloting of the PREVIEW-ED© tool in four (4)residential care homes: Figure 3. Vancouver-based team: (from left to right) Catherine Kohm, Anita Mak, Toni R. Viernes, Denise Thomas • Provided on-site support of the implementation in conjunction with: the unit champions, directors of care, executive director, project leaders and allied health care team members and:  Adapted the data entry training package to be site specific with the use of spreadsheets  Provided data entry training to site leaders for continuity of data entry  Introduced the filing folder for management and storage of the tools  Provided short summaries of the results using posters to motivate the staff 1. Fellburn Care Centre, Burnaby, BC  Analysis of the results & chart review follow up on all PREVIEW-ED tools that were triggered 2. Carlton Gardens, Burnaby, BC  Coordinated the printing of 2,000 copies of the tool for all four (4) sites (500 per site) 3. Fleetwood Care Life, Surrey, BC, and  Worked with staff to successfully launch their ‘Go-Live’ dates 4. George Derby Centre, New Westminster, BC  Finalized project summary report including recommendations for future spread of PREVIEW-ED© to Fraser Health Figure 5. PREVIEW-ED© tool Background Outcomes Conclusions • Nursing Students: • Tailored implementation approaches for LTC home support specific to leadership styles: authoritarian, bureaucratic and democratic • Led education sessions resulting in four (4) times the anticipated participants • Applied new knowledge in ‘how to run an effective meeting’ • Successfully completed ten (10) case-based training sessions about using PREVIEW-ED© with Care Aides and RNs in all four (4) LTC homes using principles of adult learning theory prior to implementation • Used different teaching styles in student-led education sessions • Tailored the training to sites, ie. One site did not have a projector; flip Figure 4. Fraser Health care aides charts and handouts were used to provide hands on training. • Applied teaching skills, observed leadership styles and adapted implementation approaches respectively. Pilot outcomes: • Fraser Health Authority implemented region-wide into 80 residential care homes. • Quality improvement projects and pilots are an excellent opportunity for BSN students to apply their knowledge and skills and to work with health authority project leaders to implement their change project The Fraser Health pilot was to support the overarching goal of the PREVIEWED© tool which is “to improve to the quality of life of elders living in long term care (LTC) homes by improving their care” (El Bestawi, 2016):  To reduce the # of transfers of residents to the ED for four preventable conditions  To validate the tool; and  Help staff identify and intervene when the signs and symptoms of decline are identified. The Rationale: To detect early decline in health status of Long Term Care (LTC) residents related to prevent the four (4) ED conditions in Long Term Care (LTC) residents: to avoid transfer to Emergency for: 1.Pneumonia 2.Dehydration 3.Congestive heart failure 4.Urinary tract infection ` Figure 2. Anita Mak presenting using flip charts in response to limited technology access. • BSN students gain valuable insight into the challenges and rewards of implementing change in the clinical environment • BSN students benefit from the opportunity to apply leadership, communication and project management skills with change projects • BSN student led pilot project provided influential data for Fraser Health’s CEO decision to approve broad implementation of the tools in all 80 Long Term Residential Care homes. References Benner, P., Sutphen, M., Leonard, V., & Day, L. (2010). Educating nurses: A call or radical transformation. Stanford, CA: Jossey-Bass. We would like to acknowledge the participation of the staff and leadership at the four (4) Fraser Health care homes who participated in this initiative.