TCAB- Transforming Care at The Bedside

tookalongtime · Nov 10, 2009

We have started implementing this at our facility in Fort Wayne, Indiana. It seems to work well, a lot of patients like the bedside report. It has also helped in making sure the patients are set up for the next shift, ie..turned, dry, and IV fluids OK. Some nurses don't like it, but it seems to be working out. There are still some things you don't want to mention in front of the patient, such as their family being a pain the the you know what. Good luck with it and let us know how it works out at your facility.

jaccimv · Nov 10, 2009

Thats great. Where in Fort Wayne- I used to work @ Lutheran. We have been doing bedside report for about 2 years...I cant imagine doing it any other way. We started implementing quite time from 2-3, similar to what the ICU does. And, we have a lot more that we want to start... Thanks for your reply!!!

tookalongtime · Nov 11, 2009

I work at the other hospital, one that Lutheran calls the "Mean green machine". Our management has been rolling out new ideas from the TCAB bit by bit. Our nursing assistants are even starting the bedside reporting. We have had no negativity days, where we cannot say anything negative or roll your eyes or anything like that. It has been kind of fun. We got stickers to put on each other's badges if we were really nice to someone. We have been implementing new fall risk procedures also. I did my clinicals in the Lutheran ICU.

Katie5 · Nov 11, 2009

Is this both in hospitals and nursing homes?

jaccimv · Nov 11, 2009

right now just in hospitals..

inshallamiami · Nov 11, 2009

hmmm, wouldn't transforming staffing ratios also be an effective way to transform care? I mean, when I work in the ICU with three patients, no secretary, no pca/nurse's aide, I feel i have the right to roll my eyes. I do understand that being negative all the time is horrid for all involved, but let's treat the CAUSE eh?

I don't want a sticker, I don't want free pizza, I want to be able to do my job.

inshallamiami · Nov 11, 2009

oh my, did I kill this thread? didn't mean to! I just believe in prioritizing: adequate staff BEFORE stickers.

pandora44 · Nov 11, 2009

I worked for a year on a TCAB floor. The floor had tried bedside report before I arrived but it didn't work too well for us. We ended up doing an abbreviated bedside report. Most of report was done privately but we always introduced the on-coming nurse to the patient and mentioned at bedside concerns the patient had and major things that had happened over the shift

However, we used TCAB for all sorts of projects. It was great. The staff thought of many different was to improve the floor and then would design specific trial runs to see if the ideas worked. Some did, some didn't but everyone was encouraged to get involved. If an idea worked especially well it would be implemented all over the facility.

jaccimv · Nov 11, 2009

Thanka Pandora! Thats what we are seeing- the staff has so many little simple ideas that are making great impact and the hospital is now as a whole catching on. inshall- yes ideally staffing, matrix etc would fix soooooooooo much but we all know the higher ups dont give us that...so, this is to start where we can.. thanks everyone for your feedback.

maineyRN · Nov 11, 2009

I am both excited and concerned about bedside reports, just wanting to be certain we can deliver/recieve accurate reports in a short period of time. Some patients are talkers, some families are intrusive, or are not aware of the extent of the patients illness. Where does patient privacy (and dignity) come in when the patient in the adjoining bed can hear the entire report? What happens when we want to do a bedside report and the patient has visitors? We are looking at having the nursing techs in on the bedside reports, which I think would contribute to continuity of care and increase cohesiveness between nurse and the NT. I look forward to any changes that will provide better care for the patient, but I would love to see the process in action. One of the most disruptive aspects I've found in providing care at the bedside is the unit secretary calling into the room to tell me another patient was asking for me, there has to be a better way! Any ideas?

Tait, MSN, RN · Nov 11, 2009

With the new reform in Magnet governance (floor up instead of CEO's down) we are implementing TCAB as well. At first it seemed to be one magnet rep floor nurse, randomly trying to change process overnight, but now we are starting to get teams together to start tacking more realistic floor goals that everyone agrees on.

Tait