1. The Impact of TCAB on Nursing Practice Aligning Forces for Quality: Transforming Care at the Bedside Becky Caron, RN and Brittany Layman, RN Staff Nurse – Grant 6 Oncology

2. 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

3. 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

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

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: 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

10. The Snorkel items which have already increased nurses time at the bedside: Nurse ServersBlock Assignments Rising StarsBedside Report 4 eyed AssessmentPhysician Rounding SNORKEL IDEAS

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