Transcript TCABexperience

Aligning Forces for Quality:
Transforming Care at the Bedside
The Impact of TCAB on
Nursing Practice
Becky Caron, RN and Brittany Layman, RN
Staff Nurse – Grant 6 Oncology
EMMC’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 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 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 Vitality
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.
• Survey yearly
• 10 questions
scored from 1-5.
• All staff
surveyed
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 Vitality
Team Vitality Results
6
5
4
3
2
1
0
1
2
3
4
5
Initial
6
2011
2012
7
8
9
10
TCAB 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 IDEAS
Currently working on 8 different innovations …
each a result of a snorkel:
1. RN/MD Rounding
2. Medication Safety Zone
3. Missing Medications
4. Urinal Holders
5. Pre Shift Huddles
6. Signs at the bedside
7. Bedside Computers
8. Thank You Notes
SNORKEL IDEAS
• 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
Overall, how do we
measure our success?
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•
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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 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 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?
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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
QUESTIONS