An Organizational Plan to Become Geriatric Friendly that Employs Evidence-Based Geriatric Best Practices to Enhance the Care of Hospitalized Geriatric Patients

Thursday, 15 July 2010: 3:45 PM

Claudia DiSabatino Smith, PhD, RN, NE-BC
Nursing Research, St. Luke's Episcopal Hospital, Houston, TX
Petra Grami, BSN, RN
Nursing Department, St. Luke's Episcopal Hospital, Houston, TX

Learning Objective 1: Discuss innovative evidence-based strategies that enhance the care of geriatric patients through staff education and clinical support.

Learning Objective 2: Describe the scope, function and interprofessional membership of an effective Geriatric Best Practice Team.

Significance: Small interprofessional teams addressed opportunities to improve geriatric clinical issues, implemented necessary changes, and evaluated outcomes. Staff nurses played an active role in implementing evidence-based practices to improve patient care quality and outcomes, which promoted the professional development of staff and facilitated staff buy-in of the practice change.

Strategy and Implementation: The interprofessional team reviews internal and external benchmark data and focuses on opportunities to improve outcomes for geriatric patients. Subcommittees were formed to implement best practices in areas of: sepsis; polypharmacy; staff education on principles of geriatric care; and reducing falls. Literature was reviewed in each subcommittee with the Director of Nursing Research. Subcommittees used an evidence-based practice model to refine clinical questions, search for relevant evidence, and determine the applicability and feasibility of proposed changes. Strategies have included: development of a staff nurse-led education program in which acute care and ICU nurses partnered to teach staff about early recognition and goal-directed therapy of SIRS and sepsis using evidence-based national best practice guidelines; opened a Rapid Turnaround Unit to provide clinical support for acute care nurses providing early sepsis treatment outside the ICU setting; and development of a two-fold geriatric education program for staff nurses and patient care attendants (PCAs) on principles of geriatric evidence-based nursing care.

Evaluation: Internal and external benchmarking demonstrated a seven percent decrease in sepsis mortality; a total of eighteen education sessions were offered during the last twelve months to nurses and PCAs on geriatric-focused topics. A funded geriatric workshop for staff nurses, which includes two eight-hour days of didactic and 40 hours of evidence-based project development time for each participant, is currently underway.

Implications for practice include expanding the focus to include additional clinical opportunities to improve care of the elderly, and to mentor staff nurses to disseminate findings both internally and externally.