Minnesota Hospital Association


September 27, 2012

Nurses lead small changes to spend more time at the bedside

Staff achieves more than 300 days without a patient fall

A few small changes, initiated by nurses, have helped improve patient satisfaction, nurse satisfaction and patient safety at Hutchison Area Health Care. The staff in the medical-surgical unit teamed up with MHA through the Transforming Care at the Bedside (TCAB) initiative to achieve a feat in patient safety: 300 days without a patient fall.

When CEO Dr. Steven Mulder got word that MHA was forming a new cohort of hospitals to implement TCAB, he encouraged his staff on the medical-surgical unit to get involved. “When Dr. Mulder told us about TCAB, we didn’t fully understand what we were signing up for,” said Clinical Nurse Leader Dana Ratike, RN, BSN. “We’re all glad we did.”

The medical-surgical (med-surg) unit at Hutchinson Area Health Care is a complex unit that treats patients with a variety of conditions, from appendectomy and knee replacement to patients with heart conditions or cancer. Treating so many different conditions and meeting the varied patient needs takes commitment from the entire team.

One of the hallmarks of TCAB is to empower nurses and front-line staff to find solutions that allows them to increase the amount of time they spend in direct patient care. At Hutchinson, med-surg nurses were spending a significant amount of time filling out paperwork, hunting for supplies and other tasks that took them away from the bedside. The TCAB team “snorkeled” — TCAB’s version of a brainstorming session — for ideas on how to streamline their work and improve efficiencies. As a result, supplies are now kept at the bedside so nurses don’t have to “hunt and gather” what they need to treat a patient. Other improvements include updating the family/visitor waiting room to make visitors feel more welcome and process improvement changes that allow patients to rest better due to fewer interruptions.

Spending more time at the bedside has led to impressive improvements in patient safety. The med-surg unit recently achieved more than 300 days without a patient fall. Together, the small changes initiated by nurses have allowed them to create a tremendously safe environment for patients. According to Kattie Bear-Pfaffendorf, MHA regional clinical leader for TCAB, most units set a goal of reaching 60-90 days without a fall. ”Patient safety — and specifically preventing falls — is something everyone on the med-surg unit at Hutchinson feels responsible for,” Bear Pfaffendorf said.

TCAB has also had a positive impact on staff morale. Nurses understand that being a med-surg nurse is important to the hospital and feel a renewed sense of purpose. “TCAB is far more practical, patient-centered, nurse-centered and focuses on the patient experience,” said Ratike. “It empowers all of the staff to make changes and everyone has an idea worth exploring.”

Although TCAB is a front-line staff initiative, it helps to have the support of hospital administration. Dr. Mulder says he is the biggest cheerleader for the TCAB team and wants to ensure they have the resources necessary to succeed. “I have communicated that the resources committed to this project will be returned many times over in the form of better efficiency, quality, safety, patient experience and staff engagement,” said Mulder. “Our underlying culture of quality and safety has fostered acceptance of the TCAB process, even though it is a departure from business as usual.”

Ratike credits the team’s success to not being afraid to try new approaches. “We’ve been most successful by working on the small things first. It’s important to know that it doesn’t have to be a huge project. You can start small and the momentum builds.”

According to the Hutchinson TCAB team, the most validating source of motivation for the TCAB process is when patients, visitors or staff identify a change that they enjoy or celebrate.