The
Key to Transforming Bedside Care? Start Small
Industry leader Tracy Jacobs encourages nurses to take the
lead in implementing changes to reduce waste and improve the
patient experience.
(7/27/2010)
All health care leaders want to improve care
at the patient's bedside, but many wonder what steps they can
take to keep this initiative moving forward, in the midst of
today's overwhelming workloads. Tracy Jacobs, RN, BSN,
national collaborative director at the Institute of
Healthcare Improvement, suggests that by winning the hearts
and minds of clinicians through a supportive working
environment, hospitals can transform the care they provide on
a day-to-day basis as well as improve clinical outcomes.
"Research shows that most medical/surgical nurses are
spending only one third of their time caring for the patient,
and about 42 minutes on average each day addressing non-care
occurrences, such as locating supplies and dealing with
system failures," says Jacobs. "This not only has
the potential to cause harm to the patient, but also
contributes to hospitals having a difficult time retaining
qualified nurses. But by taking a team approach to health
care, and empowering your frontline staff to make positive
changes to core processes, you can improve morale while also
making patients safer."
Empowering
Nurses, Inspiring Change
Encouraging nurses to challenge the current way of doing
things, and find new solutions to recurrent issues in care
practice, can go a long way towards motivating them to
transform care for their patients.
"It's all about establishing a unified vision for
quality, and removing the barriers that prevent nurses from
becoming true leaders," says Jacobs. "Urge your
staff to question the status quo and consider: Does this
process really help my patients? What can we just stop doing?
Engage nurses in your improvement initiatives, and trust in
their ability to eliminate waste and fix flaws in their own
workflows."
Even small changes to care processes can have a big impact on
the patient experience, notes Jacobs. For example, many
hospitals she works with have discovered that reliably using
risk assessments and visual cues can help caregivers to
prevent falls. "The nurses assess patients for specific
clinical criteria or behaviors that would put them at high
risk for injury due to falling. Through the use of visual
cues—such as colored socks, armbands, or signage on the
door—family and friends can also act as 'nurse extenders,'
and help keep a close eye on patients at risk before anything
potentially harmful happens," she says.
Some facilities use "intentional" or hourly
rounding as a way to address patients' needs in a proactive
manner, often catching behaviors which could place patients
at high risk for injury or other types of harm. "By
using this proactive approach, nurses feel a greater sense of
control over the course of their daily practice," says
Jacobs. A few other hospitals have also implemented "peace
and quiet" periods, during which the staff dim lights
and close doors in order to give patients one hour of
uninterrupted healing time.
"One hospital put a life-size cardboard "shhhh"
lady at the entrance to the floor, to let people know to keep
the noise level down during that period of time," Jacobs
says. "In some ways, these creative solutions do force
nurses and other hospital personnel out of their comfort
zones, but when everyone is focused on a common
goal—improving the patient experience—the changes
can also be very energizing."
Improving
Care through Technology, Customization
Streamlining documentation through technology also adds value
to many hospitals' overall care processes, adds Jacobs.
"Computers on Wheels (COWs), wireless laptops, and hand-held
devices all help to keep the nurse directly at the patient's
bedside," she says. "Involving the patient during
the documentation process, by showing them the data we're
entering into the system and asking for feedback, has also
proven to be very beneficial as a means to involve patients
in their care. Conducting the nurse shift change reports at
the bedside is yet another effective way to engage patients
and families."
Most importantly, Jacobs believes that the key to
transforming care involves finding ways to allow nurses to
move away from reactive or non-value added tasks, to spend
more of their days customizing care based on patient needs.
"We shouldn't have nurses spending their time putting
Band Aids on a broken system," she says. "They
should, and can, be a true driving force for
change—their patients' lives depend on it."