Abstract

The Institute of Healthcare Improvement (IHI) and Robert Wood Johnson Foundation responded to the Institute of Medicine’s report of thousands of lives lost due to adverse events including medication errors, unexpected infections or falls by establishing the Transforming Care at the Bedside (TCAB) program for model hospitals and schools of nursing. The goals of TCAB are to enable staff nurses, guided by their clinical leaders, to identify areas of incremental change that can affect expected outcomes. After 4 years of multiple sites integrating concepts of TCAB, the nursing staff has embraced the ability to solve problems in a self directed and incremental manner. The transformative care implementation innovations include; quiet time during shift change, medication reconciliation, tranquility rooms for nursing, and enhanced communication through “huddles” that use multidisciplinary representatives. Physician nurse collaboration was the primary predictor of successful safety and quality initiatives.

The outcomes of the various units changed significantly in the categories of:

• medication reconciliation

• number of falls

• decreased number of codes

• vitality of nursing staff

• voluntary turnover

• patient satisfaction indicators

• increased time for direct nursing care.

• decreased adverse events

Data is presently being analyzed to determine the most significant outcomes.

The primary overarching finding of TCAB is that all health care providers need to unite in an intense effort to prevent the thousands of preventable deaths per year. TCAB is an excellent model to achieve this goal.