Building elder friendly elements into acute hospital care – a pilot project

Dr Carolyn Kng Consultant Geriatrician Ruttonjee Hospital HKEC Community Symposium 11 July 2015

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1986 1996 2006 2016 2026 2036

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Background – Elderly Demographics

No. older adults 65+ years old % population 65+ years old

HONG KONG Population 2016 & Future Trend • 56% of hospital bed-days occupied by the elderly (15% of population) • Older people have longer ALOS ( length of hosp stay), more complications

Hazards of hospitalisation

• Up to 1/3 elderly - functional decline • Decline not related to acute illness but

due to …adverse effects of – Hostile Environment – Modern therapy – Hospital practices

Creditor MC Ann Intern Med 1993

marks beginning of a downward trajectory

Concept – “Elder-friendly’ Hospital

Background story - Ruttonjee Hospital “Ward C8” Pilot Project

2011 HAHO 2013-2014 HKEC Annual plan

– ‘to de-congest our acute wards’

Elder friendly services Promote good hospital care of the elderly by Hardware : Structures & Design Software : Process of Care

Objectives - To enhance 1. Independence in activities of daily living 2. Fall prevention with minimal Physical Restraint 3. Maintenance of Function 4. Carer Engagement 5. Patient Dignity 6. Staff Workflow and Monitoring

to produce elder friendly Outcomes

C8 (42 beds, acute admissions) Layout

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1 2 3 4 5 6 7 8

TV+F

TV

TV TV TV TV

F F F TV

TV TV

NS NS

Multi-function

pantry

Line

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ore

G. Store WM

of

fice

MO

offi

ce

Cle

ansi

ng u

tility

Staf

f toi

let

Mee

ting

EOL

Sing

le

Refuse

Slui

ce R

m

1 2 5

4

3 Day Area

Seating Alcove

Day Area with rehab. Facilities

Patient Toilet/Shower Room

Nurse Station

F CMS Filmless System

I. Enhance Independence in Activities of Daily Living

Enhance senses and orientation

Enable patients with adaptations

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Contrasting Colors for Way Finding

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Adequate Lighting Level

• Seniors require 30% more light for equivalent vision

• 400-500 lux in general • 600-700 lux in activity areas • Dimming light function to promote rest

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Large Graphical Indication/Signage

Unisex Patient Toilet 11

Large Wall-mounted Music Clock with Chime on day time

Enable Patient to Maintain Function

X 12

Fine Motor Twisted Lock Easy One Hand Door Opening

Modified Door Lock Design

II. Prevention of Fall with minimal Physical Restraint

Home like flooring with Handrails along the corridors

14 Resilient ‘padded’ vinyl floor sheet

Spacious Assisted Bathroom

Toilets / Shower room

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No threshold kerb / step

at entrance to toilet / shower

Prevention of fall/

minimal physical restraint

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Electric low beds 20 cm vs 37.5 cm away from floor

Fall Prevention Monitor

(Alarm Mat) cordless,

connect to Nurse Call System

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Prevention of fall

minimal physical restraint

Anti-wandering Door Bars

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Allow demented patients walk-around without using physical restraints

III. Promote Maintenance Function

Early Ward-Based Rehabilitation (instead of or supplement gym)

Enable Patient

Engage Carer

• Day room – Sit out for meals • Ward based rehab facilities in

day room - Hoist, Computer, VR, walking strip

• DC planning - Variety of equipment suitable for home use

• Bedside - Hand function games

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• Ward- based Rehabilitation facilities

Strengthening and Mobilizing Exercise

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Timed Up and Go Test

Gait Assessment and Training at ward

Pre-discharge Preparation Functional Assessment

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Adjustable height bar /toilet bowl

Promote maintenance of function Ward based rehabilitation

• Team better understand the rehab progress

• Increase therapy time • Engage carers

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IV. Promote Carer Engagement

Day Room & Sitting Alcove

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Spacious environment

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Designated End-of-Life Room with family area

Less congested environment 5.8 m2 per bed

V. Respect Patient Privacy & Dignity

Satellite Nurse Station

Satellite Nurse Station Main Nurse Station

VI. Facilitate staff workflow and monitoring

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Facilitate staff workflow and monitoring

Satellite Nurse Station Modern Furniture & Equipment

Electric bed Alarm mat

Anti-wandering door bar Pressure relieving devices Ceiling hoist with weight

Tele-monitoring unit

Elder-friendly Hospital Care Framework

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Physical Environment

Process of Care

Emotional & behavioral

climate

Source: Senior Friendly Hospital Care Across Ontario, LHIN Sept 2011 http://rgps.on.ca/key-elements-senior-friendly-hospital-framework

Process of Care

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D Team (Delirium/ Dementia/

Depression)

E Team (EoL) Family

Engagement Program

Flexible Visiting Hour

Joint Medication

Management

Hydration & Supplement

Schedule

‘D’ Team round lead by a doctor Guidelines on patient and carer engagement activities in geriatric wards– by extending flexible visiting hours

THINK out of the BOX !

Weekend Rehabilitation Activities

Patients C8 Motto

Provide a level of care and service good

enough for our own Mothers

Enable Staff to ‘convert’ Routine Labour Meaningful Work Happy staff

Thanks – Special Team • Dr CP Wong • Joan Ho, Florence Ng • C8 (RH Geriatric Dept) doctors & nurses

& allied health & frontline staff • Flora Mak, MY Sin, PY Li, Peggy Lui,

Yvonne Po, YW Chan, Sabrina Ho • Dr CC Lau, Dr David Lam • RH admin staff, facility managers, IT team

• HAHO Dr SV Lo’s team • HAHO architects Shelia Mair, Angela

Leung

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