Palmetto Health Richland - South Carolina Hospital Association

Palmetto Health Richland

NICHE
Nurses
Improving
Care for
Health system
Elderly
Tonya Parcell, RN BSN OCN
Nurse Manager Orthopedics

• Describe the positive effects of having NICHE
certification
• Overview of the NICHE certification process
• Reducing harm with a team approach
• Discuss how to apply key concepts for
effective communication with older adults and
their families
Objectives

NICHE is a national leader in improving
geriatric care in hospitals. Currently, over 270
hospitals have adopted NICHE programs.
They share a common vision of providing
exemplary care to older adults through
implementing NICHE’s systemic approach to
creating organizational change across
disciplines.

Practice
EB
Protocols
Patient
Environment
Patient Safety
Experience (HCAPS)
Service
Care Delivery for the Elderly Patient

• What is delirium
◦ An acute syndrome
◦ Fluctuating course
◦ Disturbance of consciousness
◦ Disorganized thinking
◦ Perceptual disturbances
◦ Precluded by underlying physiological or medical condition
◦ Not the same as dementia
Delirium

• Who is at risk
◦ Advanced age 65 or older
◦ Patients with dementia
◦ Male gender
◦ Medical illness
◦ Poly-pharmacy
Delirium

• What is the impact of delirium
◦ 10‐fold risk of death in hospital
◦ 3‐to 5‐fold increase risk of nosocomial complications,
prolonged stay, post acute nursing‐home placement
◦ Poor functional recovery and increase risk of death up to
2 years following discharge
◦ One year mortality is 40%
Delirium and Morbidity

• Nursing Directors
• Nurse Managers
• Physicians
• Pharmacy
• Education
• Patient Placement
• Case Management
• Rehabilitation
• Quality
• Patient Safety
• Volunteer Services
• Emergency Room
Multidisciplinary Team

Step 1
•Plan for the Leadership Training Program
•Select participants (a minimum of three) - including a Nurse Clinical Leader, Clinical Educator, Quality
Manager or Administrator
Step 2
•Presentation to your facility.
•Engage the support of additional stakeholders and expand your steering committee.
Step 3
•Register for the NICHE Leadership Training Program
Step 4
•Participate in the Leadership Training Program
Step 5
•Develop and submit your NICHE Action Plan during stage 3 of the Leadership Training Program
Step 6
•Pay the registration fee

• Participate in live webinars
• Engage in online activities complemented by practicebased
assignments that reflect behavioral outcomes
• Work with NICHE faculty who can facilitate online
discussion forums and webinars, answer questions, and
share experiences
• Access comprehensive NICHE program topics
• Participate in a mentoring program
• Earn 38 contact hours for continuing education credit
• Develop an action plan for your hospital with NICHE
mentor
Leadership Training Program

CONGRATULATIONS!
First NICHE Hospital in South Carolina

Clinical Issue
Elderly Patient
• Arrives at hospital
• Admitted to NICHE trained patient care unit
• Begin discharge planning
Practice
Integrated and
Evidence based
•Evidenced based order sets, focus on key clinical issues for elderly; pain
management, poly-pharmacy, ambulation, socialization and delirium prevention
•Multidisciplinary Team approach led by Geriatrician/HIM
•HELP volunteer assist patient
Return
home
•Discharged home
•Has follow up with home care- medical home
Palmetto Health Process Flow
for the Care of the Elderly Patient

• Steering Team met every 2 weeks
• Identified a unit to begin implementation
• Developed 4 hour geriatric education program for all staff
• Provided ongoing coaching at bedside, clinical rounds and
monthly resource meetings
• Began review and implementation of HELP Program
• Promoted NICHE awareness
• Promoted GRN certification, 1-2 nurses per unit
• Developed and implement nursing protocols for the elderly
Early Initiatives

• What is CAM
◦ Confusion Assessment Method
◦ Simple four part assessment
◦ Standardized method to identify delirium quickly/accurately
◦ Helps distinguish delirium from other cognitive impairment
◦ Assessed every 12 hours
◦ Positive
Implement Nursing Protocol
Confusion Assessment Method

• Improve the percent of always "Response of Hospital
Staff"
• Improve the percent of always "Nurses
Communication"
• Quality-Reduce the cumulative indices score for
inpatient harm by 4% in FY 11
• Implement Hip Fracture order set
Time to surgery 24 hours
Pain management to reduce delirium
LOS 5 days
• Prepare to expand training to all other units
• 1-2 certified GRN’s per unit
Anticipated Outcomes

250
HCAPS
200
150
100
Response of hospital staff
Communication with nurses
Recommend Hospital
50
0
1st qter 2nd qter 3rd qter

Axis Title
100
90
80
70
60
50
40
30
20
10
0
214
NICHE Implementation
1st Qts 2nd Qtr 3rd Qtr 4th Qtr
Poct
Falls
CaUTI
HaPUP
CaBSI
Harm Index

• Delirium Risk Assessment and Nursing Protocol
• Hip Fracture order set
• Delirium Kits on all units
• 90 nurses certified GRN
• 12 HELP volunteers
• GRN nurse team developing best practice strategies
• Developed Strategic Plan for a Geriatric Service Line
• Participated in 7th Annual Aging Research Day
“Aging and Mobility”
• Spread CAM to 4 patient care units
Additional Outcomes

Part 1
• Annual Institutional Survey- Provides data on your
organization’s characteristics as well as the scope of the
NICHE Program
Part 2
• Annual Program Self-Evaluation* - Used by NICHE hospitals
to evaluate their level of NICHE implementation: early phase,
progressive, senior-friendly, or exemplar implementation
• Pay the Annual Fee
Part 3
Annual Recommitment Process

You are cordially invited to attend the
Medical Surgical Specialties Department
Recognition
For all
Geriatric Resource Nurses (GRN)
Friday, September 30, 2011
9:00 AM
9 Medical Park Suite 130
Geriatric Resource Nurse Celebration

• Continue Spread
• Baptist Campus Certification
• Delirium Risk identification
• Walking Protocol
• ACE Unit
Next Steps