nicheprogram.org 2016 Annual NICHE Conference Care Across the Continuum 1 Agenda Objectives

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1 NICHE 101: Measurement & Evaluation: The NICHE Geriatric Institutional Assessment Profile Holly Brown, RN, MSN, GNP-BC, Director, Programs, NICHE Tess Deshefy-Longhi, RN, DNSc, Benchmarking & Evaluation, NICHE Emma Hutchinson, MPAc, Coordinator, Community Engagement and Analytics, NICHE Dennise Lavrenz, MBA, RN, CENP, VP of Clinical Strategy at the Milwaukee Center for Independence Agenda Review of the NICHE Geriatric Institutional Assessment Profile (GIAP) Review of Annual Program Evaluation Panel Discussion / Q&A 2 Objectives Review the purpose and content of NICHE s primary measures: GIAP Program Evaluation Highlight GIAP and Program Evaluation use & interpretation Network to advance excellence in NICHE benchmarking 3 nicheprogram.org 2016 Annual NICHE Conference Care Across the Continuum 1

2 Benchmarking Benchmarking is used for: Strategic planning Design/redesign of existing services Staff/professional development programming Other initiatives 4 The NICHE GIAP The NICHE GIAP is a survey: Completed by facility s staff Assesses institutional environment re: older adult care Comprised of 3 major and many subscales Developed by nurses for nurses and other staff Established Validity, Reliability Undergoes Regular Reassessment 5 Why Conduct the GIAP? Helps prioritize initial operational and clinical activity Provides a vehicle for drilling down Provides a signal for positive change Garners support Tracks and guides future improvement activity 6 nicheprogram.org 2016 Annual NICHE Conference Care Across the Continuum 2

3 The GIAP Provides Staff knowledge and perceptions about older adults Obstacles staff confront in providing effective care Institutional quality/capacity 7 Types of GIAP Questions Demographic gender/position/years of experience data Rated Statements Quantitative (countable) data Example We don t have time to assist our older adults to walk: Strongly Disagree Neither Agree Strongly N/A Disagree Agree or Agree Disagree (Scale Values range 4-0) 8 Types of GIAP Questions Open-ended questions Qualitative data Examples What are the most pressing issues you currently face in caring for older adults? What would help you improve care for older adults? 9 nicheprogram.org 2016 Annual NICHE Conference Care Across the Continuum 3

4 Major Content Areas of Questions 1. Knowledge of best practices in older adult care areas (6 areas) & Attitudes regarding care practices (2 areas) 2. Professional issues (7 areas) 3. Environment for care of older adult patients GCE (4 areas) 10 Your GIAP Results Report 11 GIAP Results Report: Demographic Data 12 nicheprogram.org 2016 Annual NICHE Conference Care Across the Continuum 4

5 GIAP Results Report: THE GCE Graph THE GERIATRIC CARE ENVIRONMENT * * 13 GIAP Results Report: GCE Table THE GERIATRIC CARE ENVIRONMENT Peer Hospitals Peer Your All by Teaching Hospitals by Hospital Hospitals Status Bed Size (n=200) (n=33,656) (n=13,600) (n=17,005) Aging Sensitive * 24.75* Care Delivery Institutional Values re:older * Adults and Staff Resource Availability Capacity for Collaboration Geriatric Care Environment (Total) * The mean of the site surveyed (your hospital) is significantly different from the mean of this comparison group. 14 Total Knowledge vs Total Attitudes KNOWLEDGE VS. ATTITUDE 15 nicheprogram.org 2016 Annual NICHE Conference Care Across the Continuum 5

6 Total Knowledge / Total Attitude Disconnect 1. When Total Knowledge score is markedly LOWER than Total Attitudes score.what does this mean? 2. When Total Knowledge score is markedly HIGHER than Total Attitudes score.what does this mean? 3. What might a NICHE Coordinator do? 16 Using GIAP Quantitative Data Results If scores are low, look at other data to prioritize and target educational efforts If scores are high but hospital clinical outcomes aren t favorable, consider, what may be staff barriers 17 Pressing Concerns & Other Comments GIAP Data Report: U.S. Hospitals # Respondents were asked: What are the most pressing issues you currently face in caring for older adults? Respondents were asked: Do you have any reactions to a particular issue raised by this questionnaire? Respondents were asked: What would help improve care for older adults? 1 Lack of time with each patient to provide excellent care and meet the patients individual needs Increase staff awareness and education regarding older adults needs 2 staffing no staffing 3 Sometimes we are understaffed which make it difficult to spend the extra time needed with elder patients. None Better staffing and having more of the supplies and adaptive devices necessary to elderly population. 4 none no Improved staffing ratio 5. At times not enough staff to care for patients adequately, most of patients are very needy and time consuming, with staffing not able spend the time to care for the patient. more staff 6. Having enough time no Education and not being short staffed so we had time to spend on the older adult that they need 18 nicheprogram.org 2016 Annual NICHE Conference Care Across the Continuum 6

7 Possible Template for Reporting GIAP Pressing Issues Data 016niche/Qualitative+Data+ Synopsis_Template.pdf 19 Summary of GIAP Pressing Issues Report Overview of GIAP Pressing Issues Data: Out of 40 respondents who addressed this survey, 26 respondents provided at least 1 response to at least one of the 3 questions asked. NOTE: Occasionally a respondent made more than one comment in her/his answer thus the number of comments does not necessarily equal the number of respondents. Question #1. What are the most pressing issues you currently face in caring for older adults? Total number of respondents addressing this question: N=26 Total number of comments made: N=39 n= 14 comments: More Education n= 10 comments: Lack of time n= 8 comments: Need for more realistic RN to Patient ratios n= 7 comments: Need for more ancillary staff to assist RNs Examples of Quotes elucidating Question #1: Re: Education needed - topics suggested included Falls/Risk of Injury; Sundowning/Delirium; Use of Sedatives/Improving Patient Sleep; Community Education; Use of Appropriate Communication Tools The most pressing concern for me is the increased number of falls associated with caring for the elderly and what processes we can do to prevent or limit the amount of falls that occur at Good Care Hospital. Educating others on ways to calm older patients down without use of medication. 20 NICHE Annual Program Evaluation A Measure to Evaluate NICHE Implementation WHO : NICHE Coordinator WHAT: Self Evaluation WHEN : After 1 st Year and Annually WHERE: NICHE Website WHY: Benchmark Year to Year, Set Goals, Communicate Progress Empirical Basis: Research with Key Stakeholders Nine Dimensions to Assess NICHE Program Implementation 21 nicheprogram.org 2016 Annual NICHE Conference Care Across the Continuum 7

8 9 Dimensions of the NICHE Program Geriatric Staff Competence Quality Measures Patient/Family Centered Approaches Interdisciplinary Resources & Processes NICHE Guiding Principles Aging-Sensitive Practices Physical Environment Leadership Organizational Structures 22 Dimension 1 Vision/Mission statements include older adults Approved by governing body/key stakeholders NICHE Guiding Principles 23 Dimension 2 Steering committee Develop action plans Build awareness/marketing/funding Develop GRN model including education/mentorship Establish process of interdisciplinary clinical decision making i.e. rounds Organizational Structures 24 nicheprogram.org 2016 Annual NICHE Conference Care Across the Continuum 8

9 Dimension 3 NICHE Coordinator role NICHE Steering Committee role & participation in clinical practice/hospital committees, system leadership GRN role description/responsibilities Quality improvement GPCA training Evidence-based practice Leadership 25 Dimension 4 Assess geriatric specific environment of care: Function Safety Comfort Physical Environment 26 Dimension 5 NICHE information provided to other disciplines Implement interdisciplinary evidence-based guidelines and care plans Electronic Medical Record Method for geriatric-appropriate medication prescribing/utilization Transitional care processes Interdisciplinary Resources & Processes 27 nicheprogram.org 2016 Annual NICHE Conference Care Across the Continuum 9

10 Dimension 6 GRN education certification plan Clinical ladder performance appraisal Recognition Orientation Introduction to Gerontology GPCA training Geriatric Staff Competence 28 Dimension 7 Identify priority quality measures and outcomes GIAP survey Gero certification Program Evaluation Quality Measures 29 Dimension 8 Patient family advisory council Transitional care Teaching materials Website Family involvement Patient/Family Centered Approaches 30 nicheprogram.org 2016 Annual NICHE Conference Care Across the Continuum 10

11 Dimension 9 Adaptive and Sensory Equipment Aging-Sensitive Practices 31 9 Dimensions of the NICHE Program Geriatric Staff Competence Quality Measures Patient/Family Centered Approaches Interdisciplinary Resources & Processes NICHE Guiding Principles Aging-Sensitive Practices Physical Environment Leadership Organizational Structures 32 Leverage Yearly Program Evaluation Setting Goals Tracking Progress Sustaining Progress Made Continuing Growth and Improvement Communicate to key stakeholders 33 nicheprogram.org 2016 Annual NICHE Conference Care Across the Continuum 11

12 Attaining Levels of NICHE Implementation Early Progressive Senior Friendly Exemplar 34 Levels of NICHE Implementation 35 After Completing Your NICHE Program Evaluation NICHE Will: 1. Review all program evaluations 2. Provide final score and level attained or provides a call to review the site 3. Give a final score and level after call/review completed 4. Complete recommitment process with annual fee payment 5. Encourage you to CELEBRATE your NICHE level and achievements!!! 36 nicheprogram.org 2016 Annual NICHE Conference Care Across the Continuum 12

13 NICHE Designation/Recognition BENEFITS: NICHE Portfolio Knowledge Center including real time networking! Webinars Need to Know Series Speakers Bureau AND.. 37 NICHE Annual Conferences nicheprogr am.org/informati on/ 38 nicheprogram.org 2016 Annual NICHE Conference Care Across the Continuum 13