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Monday, November 2, 2009: 2:00 PM
Learning Objective 1: identify older patients at risk for functional decline, due to a hospital admission.
Learning Objective 2: make nurses in a highly specialized hospital ward aware of the general needs of the older patient.
The best care for your older patients,
how to make your hospital senior friendly?
Saskia Weldam MsN, RN*
Jita Hoogerduijn, MsN, RN**
Marieke Schuurmans, PhD. RN***
Robert van Barneveld, RN****
*Project manager of the University Medical Centre, Utrecht (UMCU), The Netherlands
**Researcher, ***Professor of the Faculty Chair for Chronically ill, Faculty of Health Care, Hogeschool Utrecht, University of Applied Sciences (HU), Utrecht, The Netherlands, **** Nursing Director, division Heart and Lungs, UMC Utrecht, The Netherlands
Background: Hospital admission is a risky event for older patients. After being hospitalized 30% - 60% of older patients experience functional decline, resulting in a loss of independence in self care activities. The first step in order to prevent this negative outcome is to identify older patients at risk for functional decline followed by a comprehensive geriatric assessment for those at risk. Targeted interventions and an optimally organized continuity of care are the next steps.
Objective: To develop a geriatric assessment, interventions and discharge planning for older patients at risk for functional decline, in order to decrease length of stay and prevent functional decline in older patients.
Design: A best practice project with Delphi rounds for nurses and experts, from Nov 2006-Nov 2008.
Target group and setting: patients aged 65 and older, admitted in the Division Heart and Lungs of the UMCU. Project development was realized by the UMCU in cooperation with the HU.
Actions: Students of the Bachelor program (Nursing) developed:
1 A geriatric assessment, based on predictors found in the literature, the experiences of the nurses of the ward and the opinion of experts. Validated measurement instruments and some extra questions are included in the regular assessment (organized in health patters of Gordon).
2 Targeted interventions, based on literature, the experiences in the hospital and opinion of experts were developed and convenient arranged in a “decision outline”
3 An improved discharge planning was presented, based on the experiences of nurses and many other health care workers.
Implementation: starts in October 2008
Results: an evidence based program to increase the care for older hospitalized patients was developed and organized in the Electronic Patient Dossier (EPD). The program starts with a screening instrument followed by the geriatric assessment and interventions for those at risk. In this project: research, education and quality of care were a source of inspiration for health care workers, the management of the hospital, students and researchers. Not only Bachelor students, also students of the Master programs were involved. The EPD was quicker implemented. In order to be ready for the implementation a movie was made, and a program to test and increase the knowledge of the nurses. Nurses are much more aware of the problems of older patients.
This inspiring project is an example of integration of research, education and improvement of quality of care.