Quality and Safety Education for Nurses (QSEN) remains a priority at all levels of nursing education,1,2 but many programs do not have a systematic integration plan for the QSEN competencies within the curriculum. Without established frameworks to direct the process, integration of the competencies within curricula continues to be segmental within programs, offered in some courses and not in others, and varied among institutions.3,4 Creating purposeful learning activities that emphasize new concepts associated with quality improvement (QI) and patient safety allows students to achieve competency. Sustained connection to these concepts scaffolds a strong foundation for the knowledge, skills, and attitudes required in contemporary nursing practice. Establishing frameworks that thread quality and safety education across the curriculum can be challenging, but once in place ensures a continuing structure for student learning. The Institute for Healthcare Improvement (IHI) provides a program that can serve as 1 framework regardless of program type.

The IHI is an international nonprofit organization focused on innovation and improvement with the goal of ensuring that every individual has the best care and health possible (http://www.IHI.org). To that end, it offers education for health care professionals through the Open School, a program without costs for health professions educators and students. The program consists of 33 interactive course modules, developed by experts, designed to teach the user key concepts in short 90-minute segments. Topics include patient safety, leadership, the triple aim for populations (improving experience, improving health of populations, and reducing costs), improvement capability, and patient- and family-centered care. Each segment is further divided into 2 to 3 lessons that include short readings, videos, and blogging, ending with a short postlesson assessment that requires a minimum score of 75% to progress to the next lesson. Participants may retake a lesson if needed. At completion, each course awards 1.5 continuing education credits; although not important to prelicensure nursing students, it is an additional benefit for nurse educators and students in RN-BSN and graduate programs. In addition, the program offers a Basic Quality and Safety Certificate for the completion of 13 specific course modules.

To enhance prelicensure nursing students' understanding of new concepts related to QI and patient safety, the IHI modules can be used as a vehicle for QSEN integration across the curriculum. Students would complete 1 or 2 modules in each nursing course. The modules would strengthen student development of knowledge, skills, and attitudes about quality and safety through sustained exposure, with each student graduating from the program having earned an IHI Basic Quality and Safety Certificate.

Using the IHI Open School modules as a framework to integrate the QSEN competencies was introduced in the author's school of nursing by the Curriculum Committee and brought to the full faculty for adoption. Although the faculty supported the initiative, significant challenges included developing a uniformed approach to applying the modules and pairing them to appropriate courses within the curriculum. The IHI Faculty Guide for Best Practices in Curriculum Integration,5 a free resource offered by IHI, steered the process. Modules were aligned with course content and student learning objectives to complement coursework. It was determined that although other modules could be added, the 13 essential course modules for the basic certificate would be mandatory and assigned in strategic progression to build on previous learning. Faculty negotiated through multiple revisions of the implementation plan over a 9-month period. The outcome was an innovative quality and safety framework threaded across the curriculum that progressed from introductory to complex concepts (Table, Supplemental Digital Content, http://links.lww.com/NE/A501). Faculty reserved autonomy to implement the assigned modules for their courses based on individually preferred methods; some faculty assigned them as online work in lieu of class time and others as homework.

The program was piloted during the 2015 fall semester in several nursing courses and was fully implemented across the curriculum in the 2016 spring semester. Students were introduced to the initiative during their first nursing course. They were shown how to register and access modules. For ease of tracking, faculty had students submit their certificate of completion for each module via the electronic course system or by hard copy, requiring a simple check-off by faculty. Students placed their certificates of completion in their portfolios. The IHI modules were noted favorably by students on course evaluations. Students began to report to us that as they interviewed for positions as nurse externs, employers were impressed by their certificates. Faculty kept the curricular integration of the IHI course modules on the agenda of department of nursing meetings for several months to identify benefits and challenges of threading this framework through the curriculum.

Some faculty added content to examinations to evaluate student learning. Knowing this would be a challenge to measure, a significant motivation for this implementation was to impact student attitudes by creating a sense of value and meaning for engagement in patient safety and QI initiatives. Anecdotal evidence included that students were increasingly using safety language and referring to improvement in class and during clinical. A year after implementation, a senior nursing student submitted an article about the implementation of the IHI courses across the curriculum for the school's Quality and Safety Matters Newsletter (Figure, Supplemental Digital Content, http://links.lww.com/NE/A502). The student's publication emphasized the importance of the IHI program in nursing education and described the impact the learning activity had on her nursing career thus far.

Among the lessons learned through this process is that large-scale curriculum implementations require a shared vision by faculty. The long-standing emphasis on patient safety in nursing education can serve as the impetus for more robust integration of QSEN in nursing education programs. Launching a packaged curriculum such as the IHI's Open School, which includes evidence-based patient safety strategies, a focus on the triple aim, systems thinking, and QI methods, can support faculty that may feel less confident about how to teach these updated concepts. For our program, implementing a well-developed and validated framework addressing these important topics provided a strong QSEN thread through the curriculum.

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