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.
MN TCAB Cohorts I and II Participants
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