The Impact of TCAB on Nursing Practice

1
Aligning Forces for QualityTransforming Care at
the Bedside

• The Impact of TCAB on Nursing Practice

Becky Caron, RN and Brittany Layman, RN Staff
Nurse Grant 6 Oncology
2
EMMCs 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

3
EMMCs 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

4
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.

5
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.
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.

• Survey yearly
• 10 questions scored from 1-5.
• All staff surveyed

6
Team Vitality
7
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)

8
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?

9
SNORKEL IDEAS

• Currently working on 8 different innovations
  each a result of a snorkel
• RN/MD Rounding
• Medication Safety Zone
• Missing Medications
• Urinal Holders
• 5. Pre Shift Huddles
• 6. Signs at the bedside
• Bedside Computers
• Thank You Notes

10
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

11
Overall, how do we 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?

12
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 ???

13
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

14
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

15
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

16
QUESTIONS