This is part six of the Nursing Research Challenge.

The Article: Valente, S. (2011). Rapid cycle change projects improve quality of care. Journal of Nursing Care Quality, 26(1): 54-60.

Big Idea: Transforming Care at the Bedside (TCAB) is a national initiative to engage frontline nurses to improve care within medical-surgical units. Basically, it involves brainstorming, implementing small ideas, and evaluating them. If they work, the change happens on a bigger scale. If the ideas fail, they get scrapped and another idea is tested. In this study, the Greater Los Angeles Veterans Administration Medical Center, a tertiary care center, selected two units to serve as TCAB units. The TCAB teams focused on: improving storage and access to supplies, reducing wasted time, placing a TCAB banner on the units, improving pain medication order processes for all postoperative patients, a welcome banner for patients (which are Veterans, remember) with their permission, courtesy trays outside of meal hours, a unit quiet hour, an online orientation for physicians and trainees rotating to the TCAB units, hourly patient rounds, “Please Do Not Interrupt the Medication Nurse” poster/process, and several other great projects.

Survey Says!: Improvements have occurred all around – among nurses, patients, and family members. RN turnover for the units have decreased a whopping 58% percent! Direct patient care among TCAB RNs increased 10%, the number of certified nurses on the TCAB units increased 200%, and waste, falls, use of restraints, pressure ulcers, and codes have all decreased.

Quotable: “Rapid cycle change encourages the staff to try a potential change and test its effectiveness with 1 nurse, 1 shift, and 1 patient.”

“Nurse vitality has grown, and nurses have embraced their ability to have power and influence over change to improve care delivery for their patients. They have discovered that they can identify a problem and create, implement, and test the solution. They have also spread these innovative changes…to other units.”

So What?: No one better ask this “So What?” question. There are numerous other articles highlighting the effectiveness of Transforming Care at the Bedside. It is good for healthcare, good for business, and good for nurses. Let’s follow the evidence. Why isn’t every facility implementing TCAB?