Development of Guidelines to Manage Geriatric Trauma Patients. Kelly Czarnecki MS,FNP

Transcription

1 Development of Guidelines to Manage Geriatric Trauma Patients Kelly Czarnecki MS,FNP

2 No Disclosures Disclosures

3 Project Introduction According to best practice recommendations the geriatric trauma population requires specialized age specific criteria and guidelines for management in order to achieve optimal outcomes due to : Increased morbidity and mortality rates Decrease in normal physiologic reserve Presence of various comorbid diseases Increased risk of complications specifically delirium

4 Data Utilized to Drive Change (TQIP) Fall 2017 TQIP Benchmark Report Risk-Adjusted Mortality by Cohort Elderly UPSTATE Odds ratio fell into the 10 th decile, signifying that our elderly trauma patients are 90% more likely to have negative outcomes then those treated at other TQIP hospitals.

5 Data Utilized to Drive Change (UHC/Vizient Yearly Outcome Report) All Adult Trauma Patients >15 Discharge Year Cases Mean LOS (Obs) Mean LOS (Exp) LOS Index Mean ICU Days Cases With 1 or More (Any) Complications Deaths (Obs) Pct Deaths (Obs) Pct Deaths (Exp) Mortality Index Pct Early Death All Adult Trauma Patients >64

6 Specific Geriatric Trauma Activation Criteria

7 Geriatric Trauma Patient Defined

8 Fragility Scoring Acute Care for the Elderly (ACE) Consultation: An ACE consultation should be obtained for all Medically Complex Geriatric Trauma Patients as well as on Geriatric Trauma Patients with a positive FRAIL score. Fatigue Resistance (inability to walk up a flight of steps) Ambulation (inability to walk length of football field) Illness (5 or more) Loss of weight (5% or more body weight) *An answer of YES to any of the above indicates a positive FRAIL score*. Consult to the Hospitalist will be made on admission for: Consultation of the complex medical geriatric patient for care of acute or ongoing medical conditions. Risk stratification of the complex medical geriatric patients requiring surgical intervention.

9 Nursing Management Delirium Prevention and Management Nursing Interventions Orientation Mobility/Activity Nutrition & Hydration Elimination Socialization Documented Every 8 hours

10 ICDSC

11 CAM

12 ICOUGH

13 Safe Discharge 3. Discharge * Begin planning on admission a. Assessment Home Environment, social supports and possible need for medical equipment and/or home health services. Patient/family acceptance/denial of nursing home or skilled nursing facility placement. Need for physical or occupational therapy b. Provide Clear discharge diagnosis with clear discharge summary Medication and clear dosing instructions as well as possible reactions. Documentation of reconciliation between outpatient and inpatient medications. Directions for wound care if applicable Provide prescriptions for any new medications if going home or assisted living facility Education given caregivers, achieving clear understanding of patients conditions Clear Nutrition plan Establish an appointment(s) Clear documentation of incident findings that require follow-up and pending tests if applicable. c. Consultations Consider repeat pharmacology consult Consult/Update/Confirm follow up with PCP

14 Data Post Process Change Conclusion Vizient/UHC 2018 (QTR 1) Data - Yearly Outcome Report Discharge Quarter Cases Mean LOS (Obs) Mean LOS (Exp) LOS Index Mean ICU Days Cases With 1 or More (Any) Complications Deaths (Obs) Pct Deaths (Obs) Pct Deaths (Exp) Mortality Index Pct Early Deaths All Adult Trauma Patients > Geriatric trauma patients consulted by acute care geriatricians in the first 6 months after initiation 8/1/17-2/1/18

15 Thank you!