Nurse-led innovations popular among front-line staff

ST. PAUL, Minn. — Twenty-three care teams from Minnesota hospitals gathered earlier this month to launch an 18-month project to improve care at patients’ bedsides through nurse-led innovations.

“Transforming Care at the Bedside” (TCAB) works to empower nurses and other bedside caregivers to suggest, test, and implement potential solutions to problems.

This is the second TCAB project to be hosted in Minnesota. The first cohort of 23 hospitals started in 2010 and will complete their work this February. In addition, three other Minnesota hospital teams are participating in national TCAB training, bringing the total to 50 teams in Minnesota. That amount is the most of any state.

TCAB is part of a national Aligning Forces for Quality (AF4Q) initiative funded by the Robert Wood Johnson Foundation. The overall Minnesota AF4Q effort is led by Minnesota Community Measurement, which partners with the Minnesota Hospital Association (MHA) to organize and coordinate TCAB. The national organizers of AF4Q say the response to the TCAB offering is a testament to Minnesota’s history of leadership and collaboration in quality and patient safety efforts.

Sheri Peters, an R.N. in the medical/surgical unit at Olmsted Medical Center (OMC) in Rochester and a TCAB leader from the first cohort, is “totally sold on the program,” she said.

“I’ve been a nurse for 33 years, and I think this has been one of the best things I’ve seen as far as giving front-line staff a voice,” Peters said. “It gives us an opportunity to try things and test things. Whereas before, it was, ‘This is the way it is, this is how you’ll do it.’ I just see staff getting much more on board when they realize that. Having worked on the front line, you know up-close-and-personal how things are working.”

One simple change OMC nurses implemented has meant more time for patient care: A nursing admissions form was cut from 7 pages to 2 ½. Now, for instance, nurses no longer document all of the dietary problems patients may have, such as trouble swallowing or recent weight loss. Instead, nurses request that dietary specialists assess any patients with special dietary needs.

“We have worked on over 100 innovations from front-line staff” under TCAB, Peters added. “The president of Olmsted was so excited about the program that he went to the clinic, and the clinic changed to a TCAB project this spring.”

TCAB has demonstrated impressive results in Minnesota and nationwide. Thus far, one or more Minnesota participants have reported:

• half as many falls;
• half as many medication variances, or wrong medication time/dosages, etc.;
• increasing the number of patients triaged upon arrival to the emergency room from 58 percent in August 2010 to 98 percent in March 2011; and
• increased patient satisfaction scores.

Generally, before hospitals implement TCAB, nurses spend not quite one-third of their time at the bedside. After putting TCAB into place, some teams have been able to raise that figure to 60 percent. Minnesota TCAB teams do not yet have data measuring how much time nurses spend at the bedside,but many teams estimate they have improved by 20 percent to 30 percent. In addition:

• one team decreased the time nurses spent admitting a new patient to their unit from an average of three hours to an average of one hour; and
• nurses have significantly decreased the amount of steps they take during shifts, as measured by pedometers. Teams have reported decreases from 20 percent to 45 percent. Many teams did so by moving supplies closer to the bedside, which reduces time spent looking for and gathering appropriate supplies. The improvement allows nurses to have more time at the bedside with their patients.

The program also aims to increase retention of nurses and front-line staff; improve the patient’s experience and improve the effectiveness of the entire care team. Participating nurses will share their successes and lessons learned with other hospitals across the country.

Merleen Knott, director of inpatient services for RiverView Health in Crookston and a TCAB leader from Minnesota’s first cohort, said a major improvement brought on by TCAB was the creation of “admission kits.” The bags contain everything a nurse needs when seeing a newly admitted patient, such as bandages, cotton balls and color-coded arm bands that signal if a patient has a certain medical condition or is at risk for falling. The kits reduce the need for nurses to repeatedly fetch supplies from far-off closets.

Another innovation meant allocating scheduled time fornurses to develop their TCAB suggestions, Knott said.

“But the biggest change overall is that nurses feel that they can speak up and make a difference,” she said. “My job as their leader is not to be a naysayer. A couple of times when I’ve heard their ideas, in my head I think, I don’t like that idea. But 75 percent of the things nurses have wanted to try has been successful. It’s really an eye-opener to listen to what they say.”

For more information, visit www.forcesforquality.org.

Avera Marshall Regional Medical Center, Marshall

Bethesda Hospital, St. Paul

Buffalo Hospital, Buffalo

Chippewa County-Montevideo Hospital, Montevideo

Cook County North Shore Hospital, Grand Marais

Deer River HealthCare Center, Deer River

Douglas County Hospital, Alexandria

Essentia Health Fosston, Fosston

Essentia Health St. Joseph’s Medical Center, Brainerd

Essentia Health St. Mary’s Medical Center, Duluth

Fairview Amplatz Children’s Hospital, Minneapolis

Fairview University Medical Center– Mesabi, Hibbing

First Light Health System, Mora

Gillette Children’s Specialty Healthcare, St. Paul

Glencoe Regional Health Services, Glencoe

Hennepin County Medical Center, Minneapolis

Hutchinson Area Health Care, Hutchinson

Lake Region Healthcare, Fergus Falls

Life Care Medical Center, Roseau

Mayo Clinic Health System – New Prague

North Memorial Medical Center, Robbinsdale

Northfield Hospital, Northfield

Olmsted Medical Center, Rochester

Ortonville Area Health Services, Ortonville

Owatonna Hospital, Owatonna

Park Nicollet Methodist Hospital, St. Louis Park

Paynesville Area Health Services, Paynesville

Prairie Ridge Hospital and Health Services, Elbow Lake

Redwood Area Hospital: RedwoodFalls

Regina Medical Center, Hastings

Regions Hospital, St. Paul

Renville County Hospital, Olivia

Ridgeview Medical Center: Waconia

RiverView Health, Crookston

Riverwood Healthcare Center, Aitkin

Sanford Bemidji Medical Center, Bemidji

Sanford Medical Center, Thief River Falls

St. Francis Healthcare Campus, Breckenridge

St. Francis Regional Medical Center, Shakopee

St. Joseph’s Area Health ServicesInc., Park Rapids

Tri-County Health Care, Wadena

Unity Hospital, Fridley

University of Minnesota Medical Center, Fairview, Minneapolis

Windom Area Hospital, Windom