NUR 4001

Economic in Health Care

Patient Safety
Group 31
YUEN Tsz Wai (17000864)
LAI I Shan (17000895)
LAM Tsz Ying (17000536)
LAM Wing Ki (17001698)
LAU Ho Yee (17000292)
LAU Kin Ho (17000419)
LEUNG HO YEUNG ANGUS (15002765)
CHIU WING YAN (15000630)

1
Yuen Tsz Wai

➢ Introduction
○ Patient safety
○ Preceptorship
➢ Current situation in Hong Kong
➢ Theories
○ Path-goal theory
○ A patient safety model of health care
○ A regulatory model
Content ➢ How nurses ensure patient safety
➢ Evaluations
○ Current Hong Kong preceptorship
schemes
○ Foreign countries preceptorship
schemes
➢ Recommendations
➢ References

2
Yuen Tsz Wai

● “The prevention of error and adverse

effects to patients associated with
health care”.
● Including
Patient ○ Medication safety

safety ○ Healthcare safety

○ Infection control
● Always the first priority in delivering
health care services.

(WHO, 2020)
3
Yuen Tsz Wai

Clear policies

Organizational Data drive to

leadership Patient safety
capacity improvements
safety

Effective
Skilled health
involvement of
care
patients in
professionals
their care

(WHO, 2020) 4
Yuen Tsz Wai

3 Core elements that ensure transition to practice for new

graduates is focused on patient safety
Leadership support
- Preceptor training
- Mirror roster for preceptors
- Support for the preceptor role
- Orientation days
- Support network facilitation
- Staff education

Patient safety
(Development of
situational awareness)

Require clinical supervision Interprofessional support

- Preceptor allocated to new networks
graduate registered nurse for 6 - Foster interprofessional
month period relationships
- Provide graduated supervision - Medical
for at least 2 years - Allied health
- Provision of effective feedback
(Mellor & Greenhill, 2014) 5
Yuen Tsz Wai
A period of time when the fresh graduated nurses are
guided and supported by senior staff in adjusting the roles
and improving their practical skills in the clinical area.

Preceptorship

(The Nursing and Midwifery Council, 2020) 6

Yuen Tsz Wai

● Increasing proportion of inexperienced nurses

○ High turnover of nurses
○ Expansion of nursing education
● The proportion of young nurses with experience less
than 3 years are increasing that has reached over
30% on a general ward in Hong Kong.
● The number of clinical errors is gradually decreasing.
Current
situation in
Hong Kong

(The Government of the Hong Kong

7
Special Administrative Region, 2018)
Lam Wing Ki

● Improved retention of newly graduated nurses

○ average turnover rates in the first year from
35% to 60% (O’Keeffe, 2013)
○ Increases retention by 64% after
preceptorship program (Webster, 2016)
How can the ○ a greater retention rate than the national
preceptorship ●
average of 13 % to 75% (O’Keeffe, 2013)
Medication errors
program helps ○ Around a half of new graduate nurses report
making medication errors
the newly ○ 50% of participants said they would not
recognize deterioration (O’Keeffe, 2013)
graduated ● Saving turnover cost
nurses? ○ decreased by $186,102 after Preceptorship
Program in the United States (Arbabi &
Johnson & Forgrave, 2018)
● Improve morale

8
Yuen Tsz Wai

Theory
 Yuen Tsz Wai

House’s
revised
Path-goal
theory

● Leader → positive reinforcement → raising motivation of the subordinates → carrying out desired outcomes
● Preceptorship
○ Preceptor = leader
○ Preceptee = subordinate
● Maintaining patient safety = desired outcomes (Akese, et al, 2017)
10
 Yuen Tsz Wai

Patients Preceptorship
A patient programs

safety Newly
model of graduated
staff
health care

(Emanuel, at el, 2020) 11

 LAI I Shan

A
Regulatory
Model

(Spector, & Echternacht, 2010) 12

 LAI I Shan

Transition-to-Practice regulatory model

Preceptorships
● The model promotes preceptors working with the new

A graduates throughout the 6 months transition program

● Preceptors must be skilled in the role
Regulatory Module Characteristics
Model ● Flexibility: Practice settings could develop own
education programs and partnerships of practice settings
(cont.) ● Importance in teaching risk management to new nurses
and most successful transition programs focus on
safety

(Spector, & Echternacht, 2010) 13

 LAI I Shan
Five Modules for Experiential Learning
1. Patient-centred care - emphasize speciality content and
the skills of prioritising and organising care
2. Communication and teamwork - New nurses must have
a good understanding of the scope of practice, and others
on a team
3. Evidence-based practice - nurses are expected to base
A their practice on the evidence
4. Quality improvement - focus in practice settings for
Regulatory enhancing the systems of the settings and promoting
patient safety
Model 5. Informatics - teach new nurses to identify the electronic
information available at the point of care
(cont.)
Feedback and reflection
● Important & should be maintained during the 6 months
transition program and the 6 months that follow
● Without those opportunities → at risk for making the same
mistakes repeatedly

(Spector, & Echternacht, 2010) 14

LAM Tsz Ying
Steps of patient safety
1. Establish a safety culture
2. Lead & encourage the nurses & patient
3. Conform the risk management activity of patients
How
4. Promote nurses & patients reporting
nurses
5. Communicate and interact with patients & the
ensure public
patient 6. Study and share safety lessons to nurses
safety 7. Implement solutions to prevent harm

(National Health Service, 2004) 15

LAU Ho Yee
Preceptor in the role of nurse:

1. Evaluator
- evaluate patient safety
How nurse - provide safe environment

as a
- use critical thinking
- collaborate with colleagues

preceptor 2. Preceptor & Preceptee

ensures -
-
be educator & learner to coach preceptee
perform nursing practice & performance

patient - teach and evaluate the nursing skills of preceptee

safety 3. Socializer
- build relationship between patient & nurse
- as a role model and team leader to guide preceptees

4. Caregiver & Protector

- protect patient & preceptee safety
- consider ethical issues
- advocate the right health concept (Boyer, 2008) 16
Lau Kin Ho

Evaluation
Improvement in current healthcare system
Lau Kin Ho

Hospital Authority preceptorship scheme

● Aims
○ To lower the turnover rate
Preceptorship ○ To enhance patient safety
-Current ● Building up close relationship between
preceptors and preceptees
scheme in
○ Promoting better communication
Hong Kong ○ Assist in performing vital practical
skills

(Hospital Authority, 2016)

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Lau Kin Ho

Hospital Authority preceptorship scheme (Hong Kong)

Pros
Core 1. Mentorship programme
Competence → utilize the clinical environment for the staff

Framework of 2. To provide them a broad range of realistic and complicated

experiences

Registered → on-scene teaching and review on the skills and management

Nurses 3. Increased positive role transition, job satisfaction.

→ to reduce turnover rate

4. Monthly review on the job satisfaction and bonding

(Chan et al., 2019) 19

 Hospital Authority preceptorship scheme (Hong Kong)
Lam Wing Ki
Cons
1. Non-matching Work Shift
→ insufficient time for preceptors to teach or work with preceptees
→ difficult to establish trust relationship

2. Heavy Workload
→ The barrier of successful preceptorship program is excessive workload.
Core (Richards and Bowles, 2012)
→ insufficient time for preceptors to observe preceptees performing
Competence skills
→ As the patient acuity and the major workload from the clinical area

Framework of has resulted in related responsibilities of the preceptor roles

→ deprived the nurse preceptors’ time to supervise the performance of

Registered preceptees and provide necessary comment and suggestions.

Nurses
3. Preceptees Department Rotation
→A rotational programme for graduate nurses to rotated to two clinical
department
‘When the preceptees become more familiar with our department, they
have to swap with another department’

4. Strained relationship with co-workers

→ If preceptees with poor performance, colleagues blame the preceptors

5. Part-time preceptor (Chan et al., 2019;Ohrling & Hallberg, 2001)

→ no fixed preceptor 20
CHIU WING YAN

Hong Kong preceptorship scheme- Kowloon West Cluster (KWC)

❖ The purpose of preceptorship: facilitate newly recruited nurse to familiarize

with the working environment,policies and culture

Features of the programme

◦ Length of programme : 1-2 years with rotation to at least 2 specialties

◦ Preceptor: with >2 years experience , >12 months in the specialty
◦ One to one orientation
◦ A set of checklist to be completed by preceptee
→ (eg OSH, Infection control, clinical management)
◦ Competency form: To observe knowledge, skills and attitude through
behaviour for working performance.
◦ Interview to preceptee every 3 months: For comment from preceptor and the
evaluation from the preceptee.

21
(Ho, et al., 2007)
CHIU WING YAN

Hong Kong preceptorship scheme- SPRING Program (In PMH)

“Social & Professional Reality Integration for Nurse Graduate

Program”
❖ The purpose of preceptorship:
➢ To provide support to new recruiting nurse in first 10th month
➢ To promote the professional nursing practice model of PMH and share the
concept of virtue of nursing
➢ To nurture the caring attitude among nurses in PMH

❖ Length of programme : 10th-month

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(Hospital Authority, 2009)
CHIU WING YAN

Hong Kong preceptorship scheme- SPRING Program (In PMH)

“Social & Professional Reality Integration for Nurse Graduate Program”

Feature of Programmes :
➢ One mentor will take 2-4 RNs

➢ Topics delivered in different months

■ Provide orientation on use of CMS and different ward situations
● Points out nursing quality indicator and application of care delivery model
■ Medication safety
■ OSH
■ Positive psychology
➢ reunion meeting and sharing on 5th month
entation and
√ Monthly for ori
role
transition a new
role transition
→ Accelerate the
gress of new RN
→ Integration pro

(Hospital Authority ,2009) 23

Leung Ho Yeung

Foreign preceptorship scheme -

Capital Nurse Preceptorship Standards (in London)
❖ The purpose of preceptorship: provide support during this transition
➢ Programmes include : classroom teaching and attainment of
role-specific competencies
➢ Length of programme : 12-months
❖ Feature of programme
➢ Protected time→ both preceptor and preceptee work together for at
least 4 working days in first month
➢ Meeting are held at every 3 months
■ For preceptee to reflect on progress and experience
➢ The programme focus on 9 domains

1) Clinical Practice 2) Communication 3) Teamwork 4) Leadership 5)

Professionalism and Integrity 6) Research and Evidence 7) Safety and
Quality 8) Facilitation of learning 9) Development of self and others

(Morton, Halse, & Cox, 2017) 24

Leung Ho Yeung

Evaluation of Preceptorship Program between Hong Kong and London

Schemes
Hong Kong Capital Nurse Preceptorship
preceptorship scheme Standards (in London)

Length of program 10 months 12 months

Regular meeting On 5th month Every 3 months

Self checklist yes no

Preceptor and preceptee 1：4 1：1-2

ratio

(Hospital Authority, 2009; Morton, Halse, & Cox, 2017)25

Leung Ho Yeung

Recommendation
✓ Reference to previous preceptorship schemes, we suggest some recommendation

❖ Length of programme
➢ Flexible for some in terms of individual needs or organisational requirements
❖ Protected time
➢ Preceptee and preceptor works together until preceptee perform a safe practice
➢ To build up confidence, competence and resilience
❖ Regular review meeting
➢ Monitor progress and share reflections

➢ Evaluate further developmental needs

❖ Regulation of preceptorship protocol among clusters

➢ Protocol should be the same among clusters to standardize the practice of new staff

➢ Sharing the view of the programme among clusters and evaluate for improvements

➢ To ensure all of the newly graduated nurse have same qualities of training

26
Leung Ho Yeung

Conclusion

The Effectiveness of the Preceptorship Program

∵ Newly graduated nurses will be more independent and confident

→ provide effective patient-centred care
→ enhance patient safety
→ improve new nurse retention rate

∵ Well preceptees’ performance

→ decrease the ward’s workload and the staff’s stress
→ reduce the turnover rate of experienced nurse
→ solve talent gap

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 References
Arbabi, H., Johnson, J.M., & Forgrave, D. (2018). The effect of preceptorship on nurses' training and
preparation with implications for Qatar: A literature review.

Akese, et al. (2017). Using the path-goal theory of leadership to enhance administration of nursing care service.
Retrieved from https://www.johronline.com/issue/20170630-010406.167.pdf

Boyer, S.A. (2008). Competence and innovation in preceptor development: Updating our programs. Journal for
Nurses
in Staff Development, (24)2, E1-E6. doi: 10.1097/01.NND.0000300872.43857.0b

Chan, H. Y., So, W. K. W., Aboo, G., Sham, A. S., Fung, G. S. C., Law, W. S. L., Chair, S. Y. (2019). Understanding
the needs of nurse preceptors in acute hospital care setting: A mixed-method study. Nurse Education in
Practice, 38, 112-119. doi:http://dx.doi.org.www.edb.twc.edu.hk/10.1016/j.nepr.2019.06.013

Emanuel L, Berwick D, Conway J, et al. What Exactly Is Patient Safety? In: Henriksen K, Battles JB, Keyes MA, et al.,
editors. Advances in Patient Safety: New Directions and Alternative Approaches (Vol. 1: Assessment). Rockville
(MD): Agency for Healthcare Research and Quality; 2008 Aug. Figure 1, A patient safety model of health care.

Hospital Authority. (2016). Hospital authority convention 2016. Retrieved from

http://www.ha.org.hk/haconvention/hac2016/ebook/abstracts_Day2/files/basic-html/page76.html

Hospital Authority.(2009) Social & Professional Reality Integration for Nurse Graduate Program.Hospital Authority

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 References
Ho, L., Chan, R., Leung, O., Yuen, S. H., Siu, K., Kwong, H., … Wan, G. (2007). Kowloon West Cluster Preceptorship
Scheme for Newly Graduated Nurse. Hospital Authority.

Lockwood-Rayermann, S. (2003). Preceptor leadership style and the nursing practicum. Retrieved from
https://www.ncbi.nlm.nih.gov/pubmed/12649817

Mellor, P. & Greenhill, J. (2014). A patient safety focused registered nurse transition to practice program. Retrieved
from
https://www.ncbi.nlm.nih.gov/pubmed/25267127

Morton, L., Halse, J., & Cox, D. (2017). Preceptorship Framework. National Health Service. Retrieved from
https://www.hee.nhs.uk/sites/default/files/documents/CapitalNurse Preceptorship Framework.pdf

National Health Service. (2004). National Patient Safety Agency. Retrieved from
http://www.nrls.npsa.nhs.uk/resources/collections/seven-steps-to-patient-safety/?entryid45=59787

Ohrling, K., & Hallberg, I. R. (2001). The meaning of preceptorship: nurses lived experience of being a preceptor.
Journal of Advanced Nursing, 33(4), 530–540. doi: 10.1046/j.1365-2648.2001.01681.x

O’Keeffe, M. (2013). Transition-to-practice programs may contribute to new grad success. Nurse.com

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 References
Richards, J., Bowles, C., (2012). The meaning of being a primary nurse preceptor for newly graduated nurses.
Journal for Nurses in Professional Development 28, 208-213.

Spector, N., & Echternacht, M. (2010). A Regulatory Model for Transitioning Newly Licensed Nurses to Practice.
Journal of Nursing Regulation, 1(2), 18-25.

The nursing and midwifery council. (2020). Preceptorship for newly qualified staff. Retrieved from
https://www.nhsemployers.org/your-workforce/plan/workforce-supply/education-and-training/precepto
rships-for-newly-qualified-staff

Webster. A. L. (2016). Preceptor Program for New Graduate Nurses. Retrieved from
https://pdfs.semanticscholar.org/8ba5/3d3bc310d4bc1f1d8cba06a7420353b1a682.pdf

World health organisation. (2020). Patient safety. Retrieved from https://www.who.int/patientsafety/en/

The Government of the Hong Kong Special Administrative Region. (2018). LCQ13: Medical incidents in public
hospitals.
[Press release]. Retrieved from https://www.info.gov.hk/gia/general/201812/05/P2018120500365.htm

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