1 Implementing a Comprehensive Functional Model of Care in Hospitalized Older Adults Denise Lyons, MSN, GCNS, BC Clinical Nurse Specialist in Gerontology September 24, 2010

2 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)

3 Christiana Hospital Campus

4 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

5 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.

6 Project Goal To develop a model of care to promote physical function in hospitalized older adults

7 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

8 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

9 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

10 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

11 Discharge Destination Home w/no services Home w/home health Assisted living Nursing home Sub acute rehab Acute rehab Other

12 Demographics Age Gender Ethnicity Discharge diagnosis

13 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

14 Project Timeline September 2010 – December 2010 Finalize project/ database Obtain IRB approval Collect pre metrics June 2011 – July 2012 Intervention implemented Post metrics collected August 2012 Complete final report

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16 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

17 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

18 Questions?