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Transforming nurses' ideas into practice: Taking discharge rounds to the bedside

Nursing Progress Notes - Fall-Winter 2008

by Beverly Nelson, Ph.D.

Nurses on G10 East thought there had to be a better way to manage discharge planning rounds. When the planning team came to the unit, they would meet in the conference room and nurses had to keep ducking in and out of the meeting, trying to time it so they could be involved in discussion of their patients. The inefficient and time consuming process not only took them away from the bedside, it also made it difficult for patients and family members to be involved.

Nurses propose a bold new idea

G10 East nurses wanted to know if the discharge planning process would work better if the team came to the patient instead of meeting in a separate room. That way, they theorized, the nurse could stay at the bedside, patients and families could be more involved in the discussion, and the team could ask questions about concerns and obstacles to discharge.

Testing the theory

Inpatient nurses now have a framework in which they can propose ideas for improving their work environment: each unit has its own Transforming Care at the Bedside team. Nurses can bring their ideas to the TCAB team, and those ideas can be put through rapid-cycle tests of change based on the Plan, Do, Check and Act model.

TCAB, a project of the Institute for Healthcare Improvement and Robert Wood Johnson Foundation, is designed to study and develop models of care at the bedside on medical and surgical units, although it is applicable to all areas. The goals are to improve the quality of patient care and service, increase the effectiveness of care teams, improve staff satisfaction and retention, and increase efficiency.

Nurses on G10 East worked with their unit’s TCAB team and other involved disciplines to test their idea, making adjustments when necessary, as the practice spread incrementally on the unit.

A transformation occurs

As a result, time needed for discharge rounds decreased by 30 to 45 minutes when people started meeting “on their feet.” The new model allows nurses to remain at the patient’s bedside until the team arrives, and patients and families are now more directly involved in the process.

Good ideas travel fast

By all accounts, feedback from G10 East patients and staff has been positive thus far, and the process has spread to P9 where staff have been testing and using their own version of bedside discharge rounds. Just another example of how M. D. Anderson nurses are transforming care at the bedside.

Here are some of the many other TCAB ideas that have been put into practice at M. D. Anderson:

Now in use on multiple inpatient units

  • Nurse tranquility rooms
  • Peace and quiet time
  • Laughter yoga
  • Noise reduction strategies, such as Yakker Trakkers
  • “Dear Doctor” notes
  • Patient discharge tickets
  • Use of colored magnets to denote patient needs or characteristics
  • Laminated “Don’t Forget” signs that remind patients to take all their belongings
  • Spanish phrases on laminated signs to assist staff with communicating about basic care until language assistance can be obtained

Now in use on all inpatient units

  • Discharge nurse role
  • Daily goals boards
  • Standardized, online reporting tools such as the electronic change-of-shift report and the nurse-to-nurse patient care hand-off report, both constructed around the Situation, Background, Assessment and Recommendation communication model
  • Easy-to-read, color-coded badge cards identifying six types of staff (e.g., RN, MD, CNA)

Increasing knowledge of a "new" patient population

Doses of chemotherapy

When an inpatient unit starts running short of beds, back-up units often are designated to handle their patient overflow. 

In the case of G9 East’s lymphoma/myeloma patients, units P9 and P10 have assumed that role.

A TCAB project on G9 East resulted in chemotherapy training classes for staff on their overflow units. 

According to Yvette Ong, associate director of clinical nursing on P10, the training has helped new nurses learn how to care for the lymphoma/myeloma patient population from G9 East. P10 has an average of four to six such patients per day, accounting for 15-20 percent of the unit’s patients per month.

Max Modlin, clinical nurse, Nursing Resource Pool, left, and Nkechi Onyedum, clinical nurse, P10

NPN Fall-Winter 2008


© 2012 The University of Texas MD Anderson Cancer Center