The environment of care is a standing item
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- Susanna Johns
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1 s Environment of Care (EC) Human (HR) Information Management (IM) Leadership (LD) Medication Management (MM) Nursing (NR) Performance Improvement (PI) Provision of Care (PC) Rights and Responsibilities of the Individual (RI) Environment of Care (EC) Principle: The Environment of Care for Older Adults Care of the hospitalized older adult requires a physical and social environment adapted to age-related changes. EC The hospital establishes and maintains a safe, functional environment. EC Staff and licensed independent practitioners are familiar with their roles and responsibilities relative to the environment of care. Physical environment on units reflects aging sensitive principles such as basic safety provisions in all units serving older adults: non-glare flooring, adequate lighting, grab bars, access to adjustable height beds, call lights and controls, and appropriate use of sensor alarms, and exit alarms. The environment of care is a standing item on the steering committee agenda. Chapter 2: Developing an Action Plan 2. Planning and Implementation Guide Chapter 4: The Geriatric Institution Assessment Profile (GIAP) Guide 3. Planning and Implementation Guide Chapter 8: The Acute Care of the Elderly (ACE) Model 1. Webinar: Hospital Designs to Support the Older Patient (2010 Conference Webinar) EC The hospital improves its environment of care. The environment of care (functionality, safety, and comfort) is integrated into the Performance Improvement Committee. HARTFORD INSTITUTE FOR GERIATRIC NURSING NEW YORK UNIVERSITY COLLEGE OF NURSING 1
2 s Human (HR) Principle: Geriatric Staff Competence Care of hospitalized older adult requires specialized knowledge and skill. HR The hospital provides orientation to staff. HR Staff participate in ongoing education and training. HR Staff are competent to perform their responsibilities. HR The hospital evaluates staff performance. Staff orientation addresses the specialized needs of hospitalized older adults. Interdisciplinary continuing education addresses the needs of hospitalized older adult. Nursing staff receive specialized, competency-based training in the care of hospitalized older adults. Coordinator and Managers evaluate the learning needs of staff related to care of the hospitalized older adult. Chapter 4: The Geriatric Institutional Assessment Profile (GIAP) Guide 2. Planning and Implementation Guide Chapter 5: The Staff Development Guide 3. Planning and Implementation Guide Chapter 7: The Geriatric Resource Nurse Model 4. Certification Toolkit Core Curriculum 2. The Geriatric Resource Nurse Competency Evaluation 3. Geriatric Patient Care Associate (GPCA) Curriculum 4. Introduction to Gerontology Interdisciplinary Curriculum 5. The Hartford Institute Gerontological Nurse Certification Review Course Clinical Tool and ConsultGeriRN, Continuing Education Information Management (IM) Principle: Evidence-Based Geriatric Practice at the Bedside Staff have access to resources that reflect geriatric-specific evidence-based practice. IM Knowledge-based information resources are available, current, and authoritative. The facility website reflects geriatric programs and is linked to resource site of authoritative resources for geriatric evidence-based care. Clinical Tools and 1. Evidence-Based Geriatric Nursing 2. Website Geriatric Resource 3. Encyclopedia (annotated) HARTFORD INSTITUTE FOR GERIATRIC NURSING NEW YORK UNIVERSITY COLLEGE OF NURSING 2
3 s Leadership (LD) Principle: Leadership Leaders integrate the needs of the hospitalized older adult in strategic planning, implementation, and evaluation. LD The mission, vision, and goals of the hospital support the safety and quality of care, treatment, and services. LD Leaders create and maintain a culture of safety and quality throughout the hospital. LD The hospital uses data and information to guide decisions and to understand variation in the performances of processes: supporting safety and quality. LD Leaders use hospital-wide planning to establish structures and processes that focus on safety and quality. LD Leaders implement changes in existing processes to improve the performance of the hospital. LD The hospital communicates information related to safety and quality to those who need it, including staff, licensed independent practitioners, patients, families, and external interested parties. LD The hospital makes space and equipment available as needed for the provision of care, treatment, and services. LD Patients with comparable needs receive the same standard of care, treatment, and services throughout the hospital. LD New or modified services are well designed. LD The hospital considers clinical practice guidelines when designing or improving processes. The mission statement includes guiding principles, addresses the rights of the older adult patient. The steering committee guides initiatives to improve the safety and quality of the hospitalized older adult. initiatives are guided by geriatricspecific (process and outcome) measures. The Coordinator and/or other members of the steering committee are represented on hospital-wide planning committees responsible for developing and evaluating processes and structures that support the safety and quality of care provided to hospitalized older adults. Educational materials for staff, patients and families. are included in safety and clinical protocols. Consumers are provided with information on the program. The hospital website provides consumer information for older adults. Staff, patients, and families have access to adequate space and geriatric-specific equipment. Process measures evaluate quality and consistency of care and services provided to hospitalized older adults. The Steering Committee or designee(s) systematically evaluates congruence between guiding principles of geriatric care and facility policies and practices. Performance improvement activity integrates evidence based practice guidelines into administrative and patient care decisionmaking. Chapter 2: Developing an Action Plan 2. Clinical Improvement Models A. Reducing the Risk of Fall-Related Injuries B. Restraint Reduction Program C. Pressure Ulcer Prevention Program 3. Evidence-Based Geriatric Nursing 4. Media Kit 1. Leadership Program HARTFORD INSTITUTE FOR GERIATRIC NURSING NEW YORK UNIVERSITY COLLEGE OF NURSING 3
4 s Medication Management (MM) Principle: Evidence-Based Geriatric Practice at the Bedside Interdisciplinary protocols are integrated into patient care processes. MM The hospital monitors patients to determine the effects of their medication(s). Medications are administered and prescribed for older adults, consistent with evidence-based practice. 1. Solutions #1, Improving Medication Safety in Older Adults at the University of Alabama at Birmingham Hospital 1. Geriatric Nurse (GRN) Core Curriculum: Medications 2. Try this: Beers Criteria for Potentially Inappropriate Medication Use in The Elderly Part I II 3. Hartford Institute for Geriatric Nursing, ConsultGeriRN, Continuing Education Topic: Medication Nursing (NR) Principle: Institutional Values The needs of the hospitalized older adult, as well as the staff who serve them, are valued. NR The nurse executive establishes guidelines for the delivery of nursing care, treatment, and services. The nurse executive includes in the nursing department s strategic planning. The Geriatric Resource Nurse model is implemented and evaluated. Chapter 2: Developing an Action Plan 2. Planning and Implementation Guide Chapter 7: The Geriatric Resource Nurse Model Clinical Tools and ConsultGeriRN, Continuing Education 2. Evidence-Based Geriatric Nursing 2. Geriatric Patient Care Associate (GPCA) Curriculum HARTFORD INSTITUTE FOR GERIATRIC NURSING NEW YORK UNIVERSITY COLLEGE OF NURSING 4
5 s Performance Improvement (PI) Principle: Metrics of Quality Geriatric acute care programs warrant performance improvement activity that addresses both the needs of the older adult patient as well as the staff who serve them. PI The hospital collects data to monitor its performance. PI The hospital compiles and analyzes data. PI The hospital improves performance on an ongoing basis. The hospital evaluates the outcomes, processes of care, and experiences of the hospitalized older adult. The hospital evaluates the geriatric practice environment. The hospital shares results of geriatric program evaluation with staff, physicians, and other stakeholders and supports followup activity. Chapter 4: The Geriatric Institution Assessment Profile (GIAP) Guide 2. Planning and Implementation Guide Chapter X: Measurement and Performance Improvement Provision of Care (PC) Principle: Evidence-Based Geriatric Practice at the Bedside Interdisciplinary protocols are integrated into patient care processes. PC The hospital assesses and reassesses its patients. PC Qualified staff or licensed independent practitioners assess and reassess the patient. PC The hospital assesses and manages the patient s pain. PC The hospital assesses and manages the patient s risk for falls. The interdisciplinary team utilizes evidencebased assessment practices and individualized interventions to prevent and manage pain, falls/related injuries and other geriatric syndromes. 1.Clinical Improvement Models: Reducing the Risk of Fall-Related Injuries 2. Evidence-Based Geriatric Nursing A. Chapter 9: Preventing Falls in Acute Care B. Chapter 10: Pain Management Clinical Tools and ConsultGeriRN, Continuing Education Try This Series A. Pain B. Fall 2. Geriatric Patient Care Associate (GPCA) Curriculum HARTFORD INSTITUTE FOR GERIATRIC NURSING NEW YORK UNIVERSITY COLLEGE OF NURSING 5
6 s Provision of Care (PC) Principle: Evidence-Based Geriatric Practice at the Bedside Interdisciplinary protocols are integrated into patient care processes. PC The hospital provides interdisciplinary collaborative care, treatment, and services. PC The hospital coordinates the patient s care, treatment, and services based on the patient s needs. PC The patient s comfort and dignity receive priority during end-of-lifecare. PC The hospital provides patient education and training based on each patient s needs and abilities. The care, treatment and services provided to hospitalized older adults is interdisciplinary. Implement successful transitions to settings outside the hospital for older adult patients. The unique needs of older adult patients are integrated within palliative care and end of life care services. The learning needs of hospitalized older adults and their families are addressed during the hospitalization and when planning for discharge. 1. Geriatric Interdisciplinary Team (GITT) Program 2. Clinical Improvement Models A. Reducing the Risk of Fall-Related Injuries B. Restraint Reduction Program C. Pressure Ulcer Prevention Program 3. Webinars: Poh Lim, ACIT (Attention to Care Interdisciplinary Teams): A Quest for Clinical Excellence, Special Target: Pressure Ulcers, Kim Sadlier Utilizing the Safety Bundle: A New Model for Patient Safety 1.Evidence-Based Geriatric Nursing A. Chapter 23: Health Care Decision Making B. Chapter 24: Advanced Directives 2. Try this Series: Hospital Discharge Criteria for High Risk Older Adults 1. Clinical Improvement Model for Palliative Care (under development) 2. Webinar A Geriatric and Palliative Care Integration Model (under development) Clinical Tools and ConsultGeriRN, Continuing Education Try this Series: Assessments and Best Practices in Care for Older Adults 2. Evidence-Based Geriatric Nursing A. Chapter 4: Assessing Cognitive Function B. Chapter 8: Family Caregiving 1. Geriatric Nurse (GRN) HARTFORD INSTITUTE FOR GERIATRIC NURSING NEW YORK UNIVERSITY COLLEGE OF NURSING 6
7 s Provision of Care (PC) Principle: Patient Centered Care Function-focused care and self-direction of the older adult patient are promoted. PC The hospital uses performance improvement processes to identify opportunities to reduce risk associated with the use of restraint for non-behavioral health purposes. PC The hospital uses restraint or seclusion only when it can be clinically justified or when warranted by patient behavior that threatens the physical safety of the patient, staff, or others. PC The hospital uses restraint or seclusion safely. PC The hospital initiates restraint or seclusion based on an individual order. PC The hospital monitors patients who are restrained or secluded. PC The hospital has written policies and procedures that guide the use of restraint or seclusion. PC The hospital evaluates and reevaluates the patient who is restrained or secluded. PC The hospital continually monitors patients who are simultaneously restrained and secluded. PC The hospital documents the use of restraint or seclusion. PC The hospital trains staff to safely implement the use of restraint or seclusion. PC The hospital reports deaths associated the use of restraint and seclusion. Monitors patients who are simultaneously restrained and secluded. PC The hospital documents the use of restraint or seclusion. PC The hospital trains staff to safely implement the use of restraint or seclusion. PC The hospital reports deaths associated the use of restraint and seclusion. Policies and practices support alternatives to physical restraints. 1. Clinical Improvement Models: Restraint Reduction Program 2. Associated Tools-Restraint Documentation in Electronic Health Record-Restraint order and Nursing Documentation-Sample Patient and Family Brochure on Restraints Clinical Tools and ConsultGeriRN, Continuing Education Try this Series: A. Restraints, Hartford Institute B. CAM Confusion Assessment Method for ICU 3. Evidence-Based Geriatric Nursing A. Chapter 22: Physical Restraints and Side Rails in Acute and Critical Care Settings: Legal, Ethical, and Practice Issues HARTFORD INSTITUTE FOR GERIATRIC NURSING NEW YORK UNIVERSITY COLLEGE OF NURSING 7
8 s Provision of Care (PC) Principle: Patient Centered Care Function-focused care and self-direction of the older adult patient are promoted. PC The hospital has a process that addresses the patient s need for continuing care, treatment, and services after discharge or transfer. PC The hospital discharges or transfers the patient based on his or her assessed needs and the organization s ability to meet those needs. PC Before the hospital discharges or transfers a patient, it informs and educates the patient about his or her follow-up care, treatment, and services. PC When a patient is discharged or transferred, the hospital gives information about the care, treatment, and services provided to the patient to other service providers who will provide the patients with care, treatment, or services. The older adult s (and family s) transitional care needs are addressed through comprehensive assessment, planning and interventions. Clinical Tools and ConsultGeriRN, Continuing Education Try this Series, Hospital Discharge Screening Criteria for High Risk Older Adults, Hartford Institute Rights and Responsibilities of the Individual (RI) Principle: Institutional Values The rights of older adults are respected. RI The hospital addresses patient decisions about care, treatment, and services received at the end of life. RI The patient has the right to be free from neglect; exploitation; and verbal, mental, physical, and sexual abuse. RI The patient has the right to an environment that preserves dignity and contributes to a positive self-image. The unique needs of older adult hospitalized patients are addressed from a legal, ethical, and practical perspective. 1. Evidence-Based Geriatric Nursing A. Chapter 24: Advance Directives B. Chapter 28: Issues Regarding Sexuality 2. AONE: Guiding Principles for Creating Elder Friendly Hospitals 2. Hartford Institute for Geriatric Nursing, ConsultGeriRN, Continuing Education Advanced Directives HARTFORD INSTITUTE FOR GERIATRIC NURSING NEW YORK UNIVERSITY COLLEGE OF NURSING 8
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