1 implementing a comprehensive functional model of care in hospitalized older adults denise lyons,...
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Implementing a Comprehensive Functional Model of Care in Hospitalized Older Adults
Denise Lyons, MSN, GCNS, BCClinical Nurse Specialist in Gerontology
September 24, 2010
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Christiana Care Health System
Private, not-for-profit, tertiary care hospital system
Located in Wilmington and Newark, Delaware Level I Trauma Center One of the largest hospital systems in the
mid-Atlantic region: More than 53,000 patients admitted annually More than 46,000 surgeries, 7,100 births, and
138,000 emergency department visits each year
2 acute care hospitals (1071 beds) 2 Acute Care of the Elderly (ACE) units Home health care organization Magnet facility (2010)
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Christiana Hospital Campus
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Nurses Improving Care for Healthsystem Elders
(NICHE)
National geriatric initiative to improve the care of older hospitalized adults
Program of the Hartford Institute for Geriatric Nursing at New York University College of Nursing
Funded by The Atlantic Philanthropies
Member since 2001
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The Problem
Functional decline during hospitalization is an important clinical problem with potential long lasting adverse outcomes in older adults.
Research has shown that functional loss is often avoidable and nursing interventions can have a significant impact on preventing the decline.
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Project Goal
To develop a model of care to promote physical function in hospitalized older adults
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Target Population
The target population will be patients admitted to a 39 bed Acute Care of the Elderly (ACE) unit at Christiana hospital
The admission criteria on the ACE unit includes: Patients > 70 years of age and patients
(any age) admitted from extended care facilities and assisted living facilities
The average patient age on the ACE unit is 82 years
For FY09, 2,020 patients were discharged from this unit
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Implementing the Program
Form a interdisciplinary team Adopt nursing standards for a
functional model of care Formalize and revitalize the current
walking and mobility (WAM) program Incorporate a functional and cognitive
assessment tool into the nursing assessment process
Provide comprehensive education for the nursing staff
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Implementing the Program
Incorporate function into interdisciplinary rounds/shift to shift report
Assess physical environment modifications/equipment/assistive devices needed
Implement a walking area on the unit with distance markers
Develop, implement, and evaluate patient/family education material
Develop a functional assessment campaign targeted to all health care workers, family members to heighten awareness of functional decline
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Process and Outcome Measures
Functional assessment scores # of consults to Rehabilitative
Services (PT & OT) Fall rate and fall-related injury Prevalence of pressure ulcers Length of stay 30-day rehospitalization rate Discharge destination
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Discharge Destination
Home w/no services Home w/home health Assisted living Nursing home Sub acute rehab Acute rehab Other
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Demographics
Age Gender Ethnicity Discharge diagnosis
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Preliminary Data
Easily Obtainable: # of consults to
Rehabilitative Services (OT)
Fall rate and fall-related injury
Prevalence of pressure ulcers
Length of stay 30-day
rehospitalization rate
Need to collect: Functional
assessment scores # of consults to
Rehabilitative Services (PT)
Discharge destination
Demographics
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Project Timeline
September 2010 – December 2010Finalize project/ databaseObtain IRB approvalCollect pre metrics
June 2011 – July 2012 Intervention implementedPost metrics collected
August 2012Complete final report
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Facilitators/Barriers
Facilitators CEO requested
functional assessment
Project is supported by CNO, Clinical Nursing Director, and the ACE unit leadership team
Aligned with the NICHE program’s priorities
Barriers Training the entire
staff on a unit and creating a “culture change” can be challenging
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Opportunity for Expansion
Replicate project on 2 medical units at a time over a two year time period
Work with VNA to incorporate functional assessment into nursing assessment
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Questions?