Manuscript on Using TCAB Process for Medical Emergencies, Research Paper Example

Introduction

In the past, many hospital efforts have centered on the improvement of care in emergency departments, intensive care units and the operation rooms. Even though these efforts are very important, there also should be an initiative to make systematic changes in the hospital medical and surgical units since this is the area where most of the country’s inpatient treatments are made. Registered nurses are highly trained professionals whose workplace revolves around the patient’s bedside. Therefore they should have expertise in monitoring the patient’s health and symptoms so as to offer better clinical services. This also means that their awareness in their area of profession is an essential tool to reduce errors in the medical services. It is however noticed that that their turnover is a major setback to the whole process in terms of quality and costs incurred.

In this regard, Transforming Care at the Bedside (TCAB) was formed. It is a national program that was launched in 2003 by Robert Wood Johnson Foundation (RWJF) and the Institute of Healthcare Improvement (IHI). The RWJF is foundation/organization that is meant to improve health and healthcare to all the American citizens. The American Organization of Nurse Executives (AONE) was charged with a responsibility of spreading the TCAB program in all hospitals nationwide after receiving a funding from the RWJF. The program makes use of the frontline staff in hospitals, their leaders and interdisciplinary teams of organization as a workforce to achieve its objectives.

TCAB is a quality improvement program in the nursing sector that works under four main goals and objectives. They include: Improving patient’s safety and quality in medical and surgical units, increasing the importance and retention of nurses, engaging and improving the patient and his or her family members’ experience of medical care, improving the effectiveness of the whole team in terms of objective achievement and generally increasing the amount of time spent by the nurses in direct patient care to 70%. These objectives offer a framework in which all the activities of TCAB are carried out. They are not mutually exclusive but rather a success in that one complements the other. The IHI believed that the four would bring about the required transformations. Major transformations were intended in the medical/surgical units in terms of care delivery processes, physical environment, organizational cultures and norms, nursing care models, and collaboration and performance in the care team.

Improvement of Patient’s Safety and Reliability of the System

In order to improve the quality of patient’s safety and reliability of care, nurses should be highly trained in their field of application. Their end goal in the act of service delivery according to the TCAB terms is to reduce undesirable events and unforeseen deaths. It has been witnessed that most of the errors in safety and reliability occur as a result of system failures and not ignorance on the part of nurses (James & Linda, 2008). In this regard a number of techniques were used to eliminate the errors in the system; they include end-of-life best practices, the medication system redesign, and the Rapid Response Teams (RRT). The Rapid Response Teams works to ‘rescue’ patients before an unacceptable crisis occurs. For the changes implemented to be effective, they must be done in environment of safety and continuous learning that allows for reports in errors and problems encountered so that effective deliberation on them is made.

Communication models that enhance clear and consistent communication among the care givers, professional support programs such as educational opportunities, liberal diet plans and meal schedules for the patients and a working environment that is efficiency and waste reduction oriented are just but other techniques used.

Importance and Retention of the Nurses

So as to increase the importance and the retention of nurses, they need to be given an opportunity to lead all the processes in the area of application. This idea makes the nurses to acquire enough expertise and experience in administering the TCAB requirements of change. The program enhances administration of change with focus on the improvement of care delivery in medical/surgical units. In which sense, the TCAB program ensures reduced voluntary turnovers on the part of the nurses and increase the time that the nurses use in direct patient care. This aspect helps to improve job satisfaction on the part of nurses which in return also works at motivating the nurses to service delivery (James & Linda, 2008).

Effectiveness of Entire Team

In order to improve effectiveness in the entire care team, there is need for the nurses and other front-line staff to ensure that they involve physicians, pharmacists, social workers, managers of various departments and all other care givers in designing, testing and evaluating the various interventions to improve care. In this sense, all the successful innovations are implemented in all medical/surgical units. There are efforts made to make sure that all every TCAB hospital has at least a school of nursing. This enhances the idea that all student nurses on rotations will benefit from understanding the new improved ways in offering patient care (Linda & Russel, 2008).

Patient Centered Care

For the improvement of the patient’s and his or her family members’ experience of care, there is need that the patient and his or her family members are actively involved in their own care. They participate in the TCAB improvement program to make it a success. The patient needs to recommend the hospital or unit in which he or she has received quality care. Measures should be taken to ensure that readmissions into the hospital or unit of care are minimized.

Uniqueness of TCAB

The TCAB program should not be confused for any common Quality improvement program. It has its own unique characteristics that make it distinct from all the other ordinary quality programs. One of the uniqueness is that it engages a workforce that makes great use of the frontline staff and unit managers. The ideas on how care is administered in the medical/surgical units are developed by the nurses and the other team members who spend most of their time close to the patients and their families (Maureen & Robert, 2006). This idea is not identifiable with all the ordinary quality improvement departments in the sense that, the decisions made in the other quality departments originate from the executives. This kind of structure of operation allows for identification of areas where change is required, suggestions and testing of potential solutions are made, and well thought decisions on whether innovations and implementations are required is made. 

Processes in TCAB Program

In the formation of a TCAB program, one needs to assemble a front-line team that will be responsible for generating new ideas. The teams should be made in composition of people from all the different departments of medical attention. It should be guided by a teamwork spirit of collaboration to allow an atmosphere in which everyone’s ideas will be respected and considered for evaluation. The team should be composed of physicians, pharmacists, social workers, managers from different departments and other care givers. (Robert Wood Johnson Foundation, 2008). A staff of 28 medical surgical units can be able to implement a TCAB program successfully.

The front-line teams should meet on weekly basis for the purpose of generating new ideas through various ways like rigorous systematic thought, suggestions on ideas from other industries and conducting numerous site visits to ensure a collection of many ideas for deliberation. The staff has the responsibility to test the available ideas and evaluate the outcomes of the tests. The successful changes are then immediately adopted and implemented in the various medical/surgical units.

The model for improvement is used to test the identified idea. Through this model, qualitative and quantitative data is generated. The data is evaluated through various techniques to establish the decision on the idea. This is determined in terms of whether the idea should be adopted, adapted or better abandoned. Trending of data for major outcome measures over some period of time is tracked so as to establish the final effect of all changes for the desired goals and objectives. In this area of evaluation, reliable results are very crucial for evaluating the successes of interventions made. The evaluation process is done through routine reviews on the result of the tests even after the implementation of the new ideas to establish their effectiveness as interventions in the patient care processes. It is the mandate of every hospital to provide reports on the measured outcomes of the implemented ideas to the TCAB Design team at IHI for evaluation and analysis.

For implementation of an idea to be made, the idea must have been carefully and thoroughly assessed with a focus on the improvement of patient’s care; the idea should promote safety and reliability of the care to patients. It should also improve the working environment and reduce wastage. If it is established that the idea is viable in all considerations, then it should be implemented on the pilot unit and evaluated for sustainability. If sustainability is established, then the idea is documented and it is spread to other hospital departments. It now calls on the individual units of the hospital to find ways in which the changes in the document can be adapted into its own unique circumstances.

The nature of the TCAB program requires that all TCAB hospitals enhance the spirit of collaboration and sharing of learning. The TCAB hospital in which the new idea is generated and processed into a viable change in the patient care is referred to as the pilot hospital. The pilot hospital has to collaborate with other hospitals in terms of sharing new ideas. To enhance this spirit, each TCAB hospital has to have at least one nursing school partner. This ensures that the student nurses on rotation will acquire the new knowledge and take it back to their schools. In this sense, the TCAB program will enhance improvement in patient care in the entire country as expected. The idea also ensures that the next generation nurses are well introduced to the processes and that the culture will be effectively enhanced even in future. The students are made to acquire the expertise just as the nurses that are already on the staff.

The program is meant to employ every new discovery that emerges. It is a dynamic process that takes into consideration all the upcoming concepts in the approach to improve the patients care in the medical/surgical units. The program is currently at phase III in its continued development. The process of development was initially carried out by thirteen hospitals but only ten of them were elected to participate in this third phase of development (Robert Wood Johnson Foundation, 2008). The remaining three only continue to apply the principles that were initially developed. After its completion, phase III of the TCAB program will be evaluated to establish whether the program deserves to be subjected to a research process so as to elicit reliable evidence of its effectiveness.

For quality measures, the TCAB encourages all the involved parties to be focused and dedicated in redesigning the processes involved in the medical/ surgical units to enhance better clinical services and improve the quality of care administered to patients. In this, it makes use of the nurses, the front-line staff and other care givers to design the new processes and adapt already existing ideas from others so as to improve the patient care.

The TCAB program employs a number of working measures all of which according to the nature of the program are subject to change in regard to the up coming innovations; they include adverse events, patient falls, unanticipated deaths, unplanned returns to the ICU, Hospital-acquired pneumonia prevalence, pressure ulcer prevalence, care team satisfaction, voluntary turn over, costs per DRG, and percentage of time spent in documentation, patient care and in value-added work.

The principles that are brought out in this program are formally spread through the IHI IMPACT community, the Transforming Medical/Surgical care, and the national project that is sponsored by RWJF and AONE. Therefore every hospital that is interested in taking part in the processes of the TCAB program can readily acquire the information through the fore mentioned means.

In the track record of the program so far as shown by the Robert Wood Johnson Foundation (2008), TCAB records nine of their pilot units that have gone for five months and above without a full resuscitation code. Three of its pilot units have gone six months and above without severe or moderate damage from falls. The time that nurses spent in direct patient care at the TCAB hospitals rose from 40% in 2004 to above 50% in 2006. The turnovers on the advanced practice nurses and registered nurses on TCAB pilot units countrywide made a general 58% decrease r.

They also record some successful innovations that include systems which reduce falls by indicating the patients that portray higher risks of falls, creation of a rapid response team that effectively intervenes when a patients condition worsens and relocation of equipments, supplies and medication in or close to the patients room so as to increase the time nurses spend with the patients.

Conclusion

The TCAB program is one of a kind that should be implemented in all the medical institutions in the world as it recognizes the effective utilization of the nurses in improving the quality of patient care. This aspect of the program ensures that the nurses who are responsible for the patient’s care participate in creating the most favorable conditions in the administration of patients care in medical/surgical units. The manner in which it is planned and administered with special considerations on the four main objectives in is an effective strategy to ensure that all the targets set by the Institute of Medicine are met. These aims include making the patient care safer, effective, patient centered, efficient, timely, and provision of favorable working cond9itions to the care givers.

References

James, L. & Linda, R. (2008) Initiating and Sustaining the Clinical Nurse Leader Role: A practical Guide. New York: Johns & Bartlett Publishers.

Linda, R. & Russel, S. (2008). Management and Leadership for Nurse Administrators (Paperback). New York: Jones & Bartlett Publishers

Maureen, A., Robert, C., & Dan, S. (2006) 10 Powerful Ideas for Improving Patient: Book 3 (Paperback). Chicago: Health Administration Press

Robert Wood Johnson Foundation. (2008). The Transforming Care at the Bedside (TCAB) toolkit. Retrieved March 5, 2009