a journey to learning… organization structure niche –the leading nurse-driven program designed...
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Nurses Improving Care for Health System Elders
NICHE and the
Long Term Care Community
2014-2015
Phase I
A journey to learning…
Formation of Geriatric Collaborative Care Services (GCCS), LLC
Instructors APRN-CNS, Board Certification in Gerontological
Nursing RN, Board Certified in Hospice/Palliative Care Nursing
and Gerontological Nursing Directors’ of Nursing from both NHs, Director of
Nutrition, Nutrition Consultant and both Managers’ofTherapy
Critical Thinking/Leadership Course with author’s permission
(Educator at Oklahoma State University MedicalCenter)
Organization structure
nicheprogram.org • 2016 Annual NICHE Conference • Care Across the Continuum
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NICHE – the leading nurse-driven program designed to help health care systems, such as Long Term Care: Provide a Geriatric Education Program
Improve the care of older adults
Provide principles and tools
Stimulate a change in the culture to embrace Evidence Based Practice (EBP)
Achieve patient/family centered care for older adults
NICHE Portfolio, 2013
Purpose of the project
Eldercare Workforce Alliance (2015)
Geriatrics education and training remains inadequate
Geriatric principles insufficiently represented in schools of nursing curricula
Clinical experiences lack strength
Direct care staff –CNAs-low confidence and ineffectively trained and provide 70-80% of “hands-on” care in LTC.
Why did we need to do this project?
Institute of Medicine (IOM) REPORT 2001 AND 2008 Major challenge for 21st century healthcare Prepare the healthcare workforce with skills and
new models to improve quality of care NICHE PROGRAM, Fulmer, 1991
Addressing prevalent problems experienced by older adults – Understand Geriatric Syndromes
Ability to anticipate/recognize avoidable problems -Implement preventive/therapeutic interventions -Understand Geriatric Syndromes
Staff needs an in-depth knowledge of subtle geriatric presentations
Why did we need to do this project?
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“The NICHE Program deepens geriatric knowledge and caregiving skills of the CNA, LPN, and RN working in long term care addressing basic gerontological tenets such as access and quality of care, especially for vulnerable populations.” (Boltz, et al, 2012)
The NICHE core curriculum
Improve communication and collaboration between care team members
Proactive/preventive focus
Increased recognition of risk factors
Improve early recognition of geriatric syndromes and chronic disease changes in the frail older adult
Addressing these changes through:
Admission process
Interdisciplinary/intraprofessional rounding
Care plans
Handoff report
NICHE core curriculum - Goals
Ultimately extends to and directly affects the nursing home/household resident
The Certified Nurse Aide (largest % of direct care givers)
The Certified Medication Aide
The Licensed Practical Nurse
The Registered Nurse
Executive Nurse Leaders
Population this project will serve
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“Our intention was/is to complement the Oklahoma State Department of Health Certified Nurse Aide Course with the NICHE GPCA Program.”
Education and Training: Meeting the needs of the older adult
How Many Facilities Participated? Oklahoma Methodist Manor
Member of the Eden Alternative Philosophy of Care
82 Elders (max)
CCRC
4 LTC Households
2 Skilled Households
Tulsa Jewish Retirement and Healthcare Center 56 Elders (Max)
CCRC
3 LTC/SNF Units
Scope of the project
Additional funding
Conferences/meetings-
Eden Alternative Philosophy of Care
NGNA & NICHE Conferences
Governor’s Healthy Aging Summit
Discussions with Saint Francis Hospital, designated NICHE Hospital
“Dementia Beyond Drugs” Conference
Oklahoma Foundation for Medical Quality (OFMQ) Culture Change meetings
Other occurrences that influenced the project
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On-line State Surveyor Reports
Discussion with Director, State Surveyors
Leading Age reports at OFMQ
Advancing Excellence reports at OFMQ & NGNA
NICHE Leaders
Oklahoma Board of Nursing
Other occurences that influenced the project
ITEM OUTCOME
NICHE CORE CURRICULUM
Completed at both NHs (Jan 6 – Jul 31, 2015)
Summation of Phase I Completed (Aug 3 – Aug 28, 2015) & hand delivered
90 staff (students) completed the Core Curriculum
OMM – 33 CNA/CMA21 LPN’s & 11 RN’s
TJRHCC – 15 CNA/CMA10 LPN’s
90%, or more, of all NH staff will complete the NICHE Core Curriculum
OMM – CNA/CMA33 Completed course (100%)2 Terminated after course2 Left to return to school
EXPECTED OUTCOMES
ITEM OUTCOME
OMM – LPNs21 Completed course (100%)
1 Terminated after courseOMM – RNs11 Completed course (100%)11 continue to practice at OMM
TJRHCC – CNA/CMA17 Total students began
2 Terminated before completing15 Completed the course (88%)
3 Completed course, wereterminated after the course
12 Completed and continue topractice at TJRHCC
TJRHCC – LPNs10 Completed the course (100%)10 Completed and continue to
practice at TJRHCC
EXPECTED OUTCOMES
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Integration of evidenced-based practice
Incorporate NICHE education into daily practice
Example: hand-off reports, team approach to
care
Incorporate shared governance concepts into PIP
teams to improve processes and care associated
geriatric syndromes and other outcome measures
NICHE Coordinators
Incorporate NICHE training in orientation for new
employees
Host “train the trainer” classes for other SNF/LTC’s
EXPECTED OUTCOMES
Dream big..........can you imagine a world in which LTC means EXCELLENCE in nursing care???!!!
NICHE educations becomes the springboard for the launch of shared governance, professional development through clinical ladders, an employer of choice, and working with hospital partners to improve transitions in care!
EXPECTED OUTCOMES
Disparity between traditional nursing leadership models vs. a transformational leadership style and approach.
NICHE becomes the standard for geriatric-specific education to LTC staff
Clinical outcomes are improved
LTC’s become an attractive environment for professional nurses to work
People looked forward to living out their lives in a our LTC’s throughout the nations
Focus on Leadership
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FALLS UTIs
UNNECESSARY/AVOIDABLE HOSPITALIZATIONS
PRESSURE ULCERS
DATA AND QUALITY GOALS
Oklahoma Methodist Manor
0
5
10
15
20
25
30
35
40
Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec
Falls
CNA/CMA class-Jan thru Apr 2015 LPN/RN class-July 2015
Oklahoma Methodist Manor
0
5
10
15
20
25
30
Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec
Pressure Ulcers
CNA/CMA class-Jan thru Apr 2015 LPN/RN class-July 2015
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Oklahoma Methodist Manor
0
5
10
15
20
Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec
Hospitalizations
CNA/CMA class-Jan thru Apr 2015 LPN/RN class-July 2015
Oklahoma Methodist Manor
0
5
10
15
20
Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec
UTI's
CNA/CMA class-Jan thru Apr 2015 LPN/RN class-July 2015
Tulsa Jewish Retirement & Healthcare
Center
0
5
10
15
20
Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec
Falls
CNA/CMA class - Jan thru Apr 2015 LPN/RN class - June 2015
9
Tulsa Jewish Retirement & Healthcare
Center
0
2
4
6
8
10
Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec
Pressure Ulcers
CNA/CMA class - Jan thru Apr 2015 LPN/RN class - June 2015
Tulsa Jewish Retirement & Healthcare
Center
0
2
4
6
8
Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec
Hospitalizations
CNA/CMA class - Jan thru Apr 2015 LPN/RN class - June 2015
Tulsa Jewish Retirement & Healthcare
Center
0
2
4
6
8
10
Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec
UTI’s
CNA/CMA class - Jan thru Apr 2015 LPN/RN class - June 2015
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“The nurse armed with information on the unique ways in which older adults present with subtle signs and symptoms may actually avert complications. Additionally, the nurse equipped with knowledge about and implementation of proactive assessment and interventions may actually prevent these complications in the first place.”
Boltz, Capezuti, Fulmer & Zwicker, (2012)
Niche - a nurse-driven program
Boltz, M., Capezuti, E., Fulmer, T., Zwicker, D. (2012). Evidence-Based Geriatric Nursing Protocols for Best Practice. Springer Publishing Company, LLC
Eldercare Workforce Alliance 2015 –www.eldercareworkforce.org
Fulmer, T. (2007). AJN October 2007, Vol. 107, No. 10
Inter/Intra Professional education/collaboration –www.utexas.edu www.aacn.nche.edu
IOM Reports 2000 and 2008 –www.acestar.uthscsa.edu
NICHE Portfolio (2013). www.nicheprogram.org NICHE Program – www.nicheprogram.org
References
NURSES IMPROVING CARE FOR HEALTH SYSTEM ELDERS
AND THE LONG TERM CARE COMMUNITY
HOW DID WE BEGIN?
Spoke with Administrators of two LTC Residencies in Tulsa and requested their
support for the NICHE Program to be introduced to their staff.
Research Funding Proposal (RFP) from the Oklahoma State Department of
Health, Protective Services (OSDH) announcement.
Submission of application to OSDH.
Grant was awarded by CMS and OSDH and funded with Civil Money Penalties
(CMP).
Phase I was developed
o The program was discussed with all staff
o Administration gave consistent support
o Non-clinical staff – Introduction of Gerontology
o CNAs & CMAs – GPCA Course
Monday – Sunday, both LTC residences, each shift, 4 months
Two days each week – administrative work and continual class
preparation, scoring of tests and recording grades
o LPNs & RNs – GRN Course
Same schedule, two classes each day
o Each student received 2 hours of clinical that provided application of
classroom learning to the bedside
Inclusion of all staff members in Project Improvement Programs (PIPs)
Inclusion of “Huddles” at the beginning of each shift
Involving all staff in decision-making and accountability for outcomes
Graduation of 86 students at the NICHE Designated Hospital in Tulsa with
family, friends, NICHE staff, OSDH staff, Nursing VP of NICHE Hospital,
D.O.N.’s of both residencies, Ex. Directors and VP of Health and Wellness from
both residencies.
NEXT ON THE AGENDA:
Submission of application to ODSH for Phase II in 2016
Consistency of NICHE education and program building in both residencies
CMS has approved Phase II. We are awaiting OSDH approval to begin.