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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?