The Impact of TCAB on The Impact of TCAB on Nursing PracticeNursing Practice

Aligning Forces for QualityAligning Forces for Quality::Transforming Care at the BedsideTransforming Care at the Bedside

Becky Caron, RN and Brittany Layman, RNStaff Nurse – Grant 6 Oncology

EMMC’s History with TCABEMMC’s History with TCAB

• Grant 6 Respiratory and Grant 6 Oncology was chosen to participate in the national collaborative in 2009.

• Acute Rehab, Merritt 3 Surgical and Grant 5 Ortho/Neuro were chosen to participate in the Maine State Collaborative which began in August 2011

EMMC’s History with TCABEMMC’s History with TCAB

• Each group attended 2 ½ days of initial training to learn the tools and techniques.

• Ongoing support for the teams have occurred in the form of Semi-Annual Meetings Monthly Conference Calls

Reason for Success at EMMCReason for Success at EMMC

• Leadership– CEO– CNO– Nurse Managers

• Staff Engagement– Key: Understanding that the TCAB Team is all staff on the

floor who are being lead by those who have been selected to participate in the formal training.

Team VitalityTeam Vitality

• Survey yearly

• 10 questions scored from 1-5.

• All staff surveyed

1. I have easy access to the supplies and equipment I need to do my work on this unit.

2. The support services to this unit respond in a timely way.

3. I can discuss challenging issues with care team members on this unit.

4. My ideas really seem to count on this unit.

5. I speak up if I have a patient safety concern.

6. Care team members on this unit feel free to question the decisions or actions of those with more authority.

7. Important patient care information is exchanged during shift changes.

8. If I have an idea about how to make things better on this unit, the manager and other staff are willing to try it.

9. Care professionals communicate complete patient information during hand-offs.

10. Essential patient care equipment is in good working condition on this unit.

Team VitalityTeam Vitality

TCAB AIM StatementTCAB AIM Statement

• To increase nursing time at the bedside to:

– 50% by October 2010– 60% by October 2011– 70% by October 2012

– (The National Average was 30% as of November 2009)

SNORKELING

• Over 235 snorkel ideas were suggested during a recent snorkel session.

• 1. What do you need to meet your patients’ pain management expectations?

• 2. How can you provide a quieter and more restful environment and disturb sleeping hours only when necessary?

SNORKEL IDEASSNORKEL IDEASCurrently working on 8 different innovations …

each a result of a snorkel:

1. RN/MD Rounding2. Medication Safety Zone3. Missing Medications4. Urinal Holders5. Pre Shift Huddles6. Signs at the bedside7. Bedside Computers8. Thank You Notes

• The Snorkel items which have already increased nurses time at the bedside:

• Nurse Servers Block Assignments

• Rising Stars Bedside Report

• 4 eyed Assessment Physician Rounding

SNORKEL IDEASSNORKEL IDEAS

Overall, how do we Overall, how do we measure our success?measure our success?

• Tracking the 24 hour nurse

• Every other month

• What tasks are value added?

• What can be leaned out of our nursing practice?

Calculating Nursing Time at the Bedside

• Study:– National Average: 35% at the Bedside– Prior to TCAB on Grant 6: 40%– October 2010 on Grant 6: 55%– October 2011 on Grant 6: 64%– October 2012 on Grant 6: ???

Staff GrowthStaff Growth

What TCAB has done for the Staff Nurse Team Leaders •Empowerment to problem solve and improve broken process that will result in increased time at the bedside•Personal Growth

– As Informal Leaders– As Formal Presenters– As Innovative Leaders in Care

Staff Pride and OwnershipStaff Pride and Ownership

• For Innovation Management – Driving Improvement

• For Spread and Providing Support to new TCAB Teams

• For Sharing Success with Senior Leadership and Board Members

Where do we go from here?Where do we go from here?

• Hospital wide “Roll Outs”

• Continuing to Engage Frontline Staff

• Fostering and Mentoring new ideas

• Teaching others the TCAB philosophy

• Spreading TCAB throughout EMMC and beyond

QUESTIONSQUESTIONS