fourteeno seveno

Problem: Polypharmacy in the older patient

QSEN Competency Knowledge Skill Attitude

Patient Centered Care -Demonstrates service

delivery in a variety

of settings along a

continuum of care

that can be accessed

at any point -

Identifies components

of nursing process

appropriate to

individual, family,

group, community,

and population health

care needs across the

lifespan

-Recognizes that

consumer values,

preferences,

decisional capacity,

and expressed needs

are part of ongoing

assessment, clinical

interview,

implementation of

care plan, and

evaluation of care

(for example,

reduced prescription

cost)

-Value seeing health

care situations

‘through patients’

eyes’

-Respect and

encourage individual

expression of patient

values, preferences

and expressed needs

-Value the patient’s

expertise with own

health and symptoms

Teamwork and

Collaboration

- Identify system

barriers and

facilitators of

effective team

functioning

-Examine strategies

for improving systems

to support team

functioning

- Acknowledge the

impact of effective

team functioning on

safety and quality of

care

- Lead or participate

in the design and

implementation of

systems that support

effective teamwork

-Identify weaknesses

in electronic record

collaboration across

settings (hospital,

urgent care and

private clinics

-Apply evidence-

based

communication

practices to minimize

risks associated with

transfers between

providers during

Value the influence

of system solutions in

achieving team

functioning

-Recognizes the risks

associated with

transferring

consumer care

responsibilities to

another professional

(“hand-off”) during

transitions in care

transitions in care

delivery using

medication

reconciliation and

standardized EHR

systems.

Evidenced Based

Practice

-Describe reliable

sources for locating

evidence reports and

clinical practice

guidelines

- Accesses evidence-

based reports related

to clinical practice

topics and guidelines

-Informed by AGS of

BEERS Criteria for

potentially

inappropriate

medication in older

adults

-Acknowledge the

importance of

accessing relevant

clinical evidence

Quality Improvement -Describe approaches

for improving

processes and

outcomes of care

- Use a variety of

sources of

information to review

outcomes of care and

identify potential

areas for

improvement to

reduce drug-drug

interactions

-Propose appropriate

aims for quality

improvement efforts

to prevent adverse

drug events and

unnecessary

polypharmacy

-Participates in the

use of quality

indicators and

measures to evaluate

-Recognize the value

of what individuals

and teams can do to

improve care

processes and

outcomes of care

the effect of changes

in the delivery of

care to avoid

medications that may

contribute to

cognitive impairment

·

Safety -Describe how

consumers, families,

individual clinicians,

health care teams, and

systems can

contribute to

promoting safety and

reducing errors

-Describe the benefits

and limitations of

selected safety-

enhancing

technologies (such as

barcodes, Computer

Provider Order Entry,

and electronic

prescribing)

-Participate as a team

member to design,

promote and model

effective use of

strategies to reduce

risk of harm to self

and others by

reducing patient or

caregiver error when

self-administering

medications

-Prioritize predicting

and preventing

adverse drug

interactions

-Avoid prescription

cascading (treating

symptoms from

adverse effect of

another drug) by

using

STOPP/START

Criteria

- Integrated EMR

system development

and application to

reconcile previous

and current

medications lists

across all settings

-Recognize the value

of analyzing systems

and individual

accountability when

errors or near misses

occur

-Appreciate the

importance of being a

safety mentor and

role model

such as the hospital

urgent care and

primary care

- Utilize EMR

software that flags

drug allergies

Informatics -Evaluate benefits and

limitations of

different

communication

technologies and their

impact on safety and

quality

-Recognize lacking

integrated systems

between provider

settings and

pharmacists

-Champion

communication

technologies that

support clinical

decision-making,

error prevention, care

coordination, and

protection of patient

privacy

-Appreciate the need

for consensus and

collaboration in

developing systems

to manage

information for

patient care

-Value the

confidentiality and

security of all patient

records

References:

American Geriatrics Society 2015 Beers Criteria Update Expert Panel

(2015) American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate

Medication Use in Older Adults. Journal of the American Geriatrics Society (63) 2227–2246.

https://doi.org/10.1111/jgs.13702

Maine Partners in Nursing Education and Practice (2013, June). Maine Nurse Core

Competencies [PDF]. Retrieved from: https://www.omne.org/wp-content/uploads/2016/12/ME-

RN-Competencies.pdf

Rochon, P., A. (2018) Drug prescribing for older adults. In J. Givens (Ed) UpToDate. Retrieved

from: https://www-uptodate-com.regiscollege.idm.oclc.org/contents/drug-prescribing-for-older-

adults?search=polypharmacy&sectionRank=1&usage_type=default&anchor=H18186995&sourc

e=machineLearning&selectedTitle=1~71&display_rank=1#H18186995

Quality and Safety Education for Nurses (QSEN). (2019). Graduate QSEN competencies.

Retrieved from http://qsen.org/competencies/graduate-ksas/