Older Patients:

are 40-54% of admissions at the four Piedmont Healthcare facilities

have increased length of stay, more frequent hospitalizations, and increased severity of illness

enter the healthcare system through the Emergency Department

Reality

Hospital Nursing staff have minimal training and resources to manage complex geriatric patients

Areas in the hospital, such as the Emergency Department, are not “elder friendly”

The older population in Georgia is growing faster than the national average- more older adults and they are living longer

Nursing homes / rehab facilities are common discharge destinations are a hospital stay; 75% of the NH staff were found to be inadequately prepared by their initial nursing education to manage the clinical challenges of frail, complex elderly patients.

Awarded an HRSA Grant: July 2009 to June 2012

Over the three-year grant period, Piedmont HealthCare intends to build on its successful three-year geriatric training of acute care inpatient nurses at the Piedmont Hospital Atlanta facility.

Adapting the Hartford Institute’s NICHE training model, PHC will expand training at its Atlanta hospital into the Emergency Department and will also launch training programs in its other three hospital facilities and at two long-term care facilities, all of which are located within the 20-county Atlanta EMA

Methods

Comprehensive Geriatric Education ProgramDee Tucker RN, MS, GCNS-BC, Monica Tennant RN, MSN, CCNSThis program is 100% funded by the Health Resources and Services Administration grant: $450,000

This grant funds a Clinical Nurse Specialist position to work with current Gerontological CNS in providing education, mentoring / support, developing / measuring outcomes for knowledge, practice change and patient outcomes by:

1)Expanding NICHE training at Piedmont Hospital in Atlanta beyond Acute Care nurses to include Emergency Department nurses;

2) Introducing NICHE training at Piedmont Fayette, Piedmont Newnan and Piedmont Mountainside for Acute Care and Emergency Department nurses;

3) Introducing NICHE training for nursing staff at two of our Long-Term Care facility partners; and

4) Disseminating program materials and information to other healthcare entities throughout Georgia and the U.S. through local workshops and presentations at national healthcare conferences.

By expanding current nurse training to include staff at the initial point of contact (Emergency Department) and to a common point of discharge (Long-Term Care / Rehabilitation facilities), the PHC Geriatric Education and Training Program will increase access to quality geriatric care across the healthcare continuum.

Introduction Outcomes

Piedmont Hospital Mountainside Hospital

Fayette Hospital Newnan Hospital

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Progress

Bibliography

The evaluation of this programs efficacy will be determined through 4 methods:

1) validation of skills at yearly check. Nursing competency for skills associated with patient care are revalidated annually. During this period, PHC will allow the bedside nurse that has participated in the training program to demonstrate key topics presented from the original course.

2) surveying nurses who have completed our class, for their knowledge and skills six months post class completion. This written survey will have basic questions regarding important information that is vital to serving an elderly population. The retention of knowledge will be determined from the scores that are received from the survey. A nurse that receives eighty percent or above, for the purpose of this survey, will be considered to have retained basic knowledge and skills with regard to eldercare. These evaluation processes will allow us to assess the nurses’ ability to properly identify needs of an elderly patient as well ensure that the skills knowledge taught in the class are being performed at the bedside correctly. Areas of weakness found during this skill validation and post testing will prompt a review of class material to ensure that the material and teaching methods used appropriate for the target audience.

3)the Press Ganey satisfaction survey results from the 1st quarter after completion of the first series of classes. We will analyze data regarding questions associated with the patients’ perception of the Nurse’s knowledge base, ability to explain disease and diagnosis and general communication skills with the patients. An increase in satisfaction quantified by higher scores will indicate an improvement in clinical knowledge regarding elderly concepts and care.

4) monitoring clinical outcomes. The methodology in which identifier to improved clinical outcomes. We will initially start by looking at broad outcomes such as length of stay, reduction of medication induced delirium and advance directive communication. As we continue the program we will re-examine and add additional outcomes as they reveal themselves to be significant to elder care.

Carpezuti, E., Zwicker, D., Mezey, M., & Fulmer, T. (2008). Evidence-Based Geriatric Nursing Protocols for Best Practice. 3rd edition. Springer Publishing Company.

Fulmer, T. (1991). He Geriatric Nurse Specialist Role: A New Model. Nursing Management. 22(3), 91-93.

Geriatric Emergency Nursing Education (GENE) course from Emergency Nurses Association 2004.

GeroNurse; www.geronurseonline.org

Graf, C. (2006). Functional decline in hospitalized older adults. American Journal of Nursing. 106(1) 58-67.

Nurses Improving the Care of the Healthsystem Elders. NICHE project. Hartford Institute for Geriatric Nursing. www.hartfordign.org

Classes for Inpatient staff were 2 days in length and offered twice a year at each of the 4 Piedmont Healthcare facilities.

Classes for the ED and Outpatient staff were 1 day in duration and offered twice a year at each of the 4 Piedmont

Healthcare facilities.

Feedback from class attendees, managers, directors, and administration suggested shortening the classes. Inpatient

classes are currently 1 day in length and ED/Outpatient classes are currently 4 hours in length. Classes placed in the

online learning system allow staff to access the classes at any time and earn education credits.

Video in-services rotated class topics in short 10minute videos to staff who could not attend other educational

opportunities. As requested, the full version of these videos were posted on the hospital intranet site for access by any

staff on any shift in any of the 4 sites.

Bedside mentoring of staff by a Geriatric Clinical Nurse Specialist (CNS) at all 4 facilities has provided valuable support of the knowledge gained during both formal and

informal educational opportunities.

Posters in each facility covers topics such as: Geriatric skin: aging differences and prevention techniques Delirium versus

Dementia: know the difference Incontinence in Older Adults/ Prevention of CAUTI Transitioning: Geriatric

Functional Assessment

Visibility of the Comprehensive Geriatric Education Program grant has been increased through participation in Research Fairs hosted by each facility as well as CNS participation in

Skills/Competency days for staff.

Geriatric simulation scenarios have been used with the New Graduate program and will be utilized for all staff at facilities

with Simulation mannequins.