nicheprogram.org 2015 Annual NICHE Conference Innovation Through Leadership Background

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1 Wii Can Too! Using Gaming Technology with Hospital Elder Life Program Patients Megan Wheeler, MSN, RN, ACNS-BC Janice F. Moore, PhD, CFLE Background Grant Proposal Hospital Elder Life Program (HELP) proven and replicated What about Critical Care? Gaming Technology in Outpatient and Rehab settings What about acute care? Research Project Unit selection Historical Control Group HELP Standard Intervention Group HELP + Wii Intervention Group 1

2 Inclusion and Exclusion Criteria Inclusion Criteria: 70 years of age or older Admit to HELP units Projected Length of stay > 48 hrs Must be able to communicate verbally or in writing English or Spanish speaking only At least one of the following factors: Cognitive Impairment MMSE-2 Score 13/16 Vision Deficit use of glasses or contacts Hearing Deficit - <3 of 6 whispers in each ear on Whisper Test and/or use of hearing aid Dehydration BUN/Cr ratio 18 Any mobility or ADL impairment Exclusion Criteria: Coma Mechanical Ventilation Aphasia (Expressive or Receptive) Terminal Combative/dangerous behavior Severe psychotic disorder Severe dementia MMSE-2 Score 0 Airborne isolation Neutropenia Discharge within 48 hours Refusal History of Seizures/Epilepsy Prisoners Research Project Power analysis revealed n=320 Consent IRB Approval HELP Patient Information Card What is HELP? The Hospital Elder Life Program is a new service provided by this facility to improve the hospital experience of older adult patients. Who are we? A team of staff who make sure older adults get the special consideration they need to get the best results from their hospital stay. The team includes a Clinical Nurse Specialist, Manager of Volunteers, Registered Nurse, Physician, and carefully trained Volunteers. This team works with regular hospital staff in all departments to meet each older patient s needs. Clinical Nurse Specialist: Megan Wheeler, MSN RN ACNS-BC Manager of Volunteers: Janice F. Moore, PhD CFLE Registered Nurse: (specific to site) Being in the hospital upsets normal routines of mental and physical activity just at the time a person is coping with illness. This disruption can cause older hospitalized people to lose their general mental and physical ability to function. The Hospital Elder Life Program helps keep the mind and body as active as possible in spite of illness. This benefits older patients and helps speed their full recovery. 2

3 Day, Time, Place, Environment, Call Light One-to-One, Current Events, Reminiscence, Music, Trivia, Games, Relaxation, Arts & Crafts Active Range of Motion exercises Wearing glasses, hearing aids, using magnifying lenses, brightly colored tape to identify call light MM DD YYYY MM DD YYYY Patient Preference Information Therapeutic Activities Screening Instructions to Interviewer: The Therapeutic Activities Screening helps identify patients interests and provide activities to stimulate cognitive and social abilities during hospitalization. 1. Date of Interview: / / 2. What is your occupation (current or past)? Instructions to Participant: You will sometimes have unoccupied time while you are in the hospital, and we would like to provide you with enjoyable activities to keep you physically and mentally active. 3. a. Do you have any routines, interests or hobbies that we could help you continue while you are here in the hospital? Yes No 3. b. If yes, what are they? Activity 4. I am going to tell you about some (additional) materials that we have available in the hospital. Please tell me some things you might enjoy.* YES NO a. Daily Newspaper b. Music c. Books d. Magazines e. Cards f. Board Games g. Puzzle h. Arts and crafts forms adapted from: The Hospital Elder Life Program ( 2000, Sharon K. Inouye, MD, MPH) Patient Protocol Form Protocol Prescription Yes No 1. Daily Visitor/Orientation a. One time per day b. Two times per day c. Three times per day 2. Therapeutic Activities 3. Sleep Enhancement/Relaxation 4. Hearing/Vision 5. Volume Repletion 6. Early Mobilization 7. Wii Protocol If yes, please indicate what position is recommended based on the functional assessment: a. Supported Sitting b. Unsupported Sitting c. Static Standing Assessment completion date: / / Assessment completion time (HH:MM) 24 Hour: : forms adapted from: The Hospital Elder Life Program ( 2000, Sharon K. Inouye, MD, MPH) Volunteer Data Collection Tool Hospital Elder Life Program Volunteer Assignment Form Patient Name: Room/Bed: Date: *If intervention is not done, why? (No time left; witnessed someone else doing it; patient out for test; patient through with meal, etc) Morning Shift Afternoon Shift Evening Shift Intervention (9 a.m. 1 p.m.) (1 p.m. 5 p.m.) (5 p.m. 9 p.m.) Daily Visitor Orientation *Is the board updated? *Had orienting conversation? Therapeutic Activities *What did you try? *What did you do? Early Mobilization *What movement occurred? Hearing/Vision Complete BOTH sides of form for each patient visited 3

4 Fluid intake encouragement /during meals Relaxation music, hand massage, warm beverage, light reading; can be used as a therapeutic activity for evening shift if necessary. REMINDER: Wipe down Wii games Baseball Bowling Golf Tennis Baseball Bowling Golf Tennis Baseball Bowling Golf Tennis Volunteer Data Collection Tool cont. Intervention Meal Assistance Breakfast-8:30 a.m. Lunch-12:30 p.m. Dinner-5:30 p.m. Complete BOTH sides of form for each patient visited Morning Shift Afternoon Shift Evening Shift (9 a.m. 1 p.m.) (1 p.m. 5 p.m.) (5 p.m. 9 p.m.) *How much did patient eat /drink? Relaxation *How well did the patient sleep last night? If poorly, ask why. Wii Games *Did the patient play Wii? *How long did they play? Other Comments *Please note why time was cut short during any of the interventions. *Please note the time when you last saw this patient for any of the above activities. Volunteer Name (Please Print) Seven Volunteer Intervention Programs Daily Visitor Therapeutic Activities Early Mobilization Hearing/Vision Mealtime Assistance Relaxation Wii Games Therapeutic Activities 4

5 Volunteer Recruitment College Service Learning fairs and university events Word of mouth, existing volunteer corps, and staff Websites Independent schools Summer only high school and college students Brochures at local city libraries Volunteer Training One day hands on session with activities, case studies, and unit tour HELP Training per website Aging Simulation Sensitivity Training IRB Human Subjects Protection Documentation and data collection Paired with current volunteer Data Collection Patients are screened for eligibility Consented, randomized Baseline assessments performed Volunteer assignments made Discharge assessments performed Data recorded into database 5

6 Data Collection Admit and Discharge: MMSE-2, Modified Barthel s Index Ongoing throughout hospitalization: CAM/CAM-ICU, LOS, cost/case, adherence Results Control (n=183) HELP (n=216) HELP + Wii (n=58) Delirium Rate 12.6% 6.5%* 7% Cognitive Status Δ Decline of 2+ points 8.7% 9.7% (12%) 4.6% (-53%) Functional Status Δ Decline of 2+ points 23.2% 25.8% (11%) 28.6% (23%) Cost/Case $11,000 $9,992 $9,834 *Statistically significant Successes and Challenges Delirium Screening standardized across health care system Interdisciplinary team champions Targeted interventions for 70+ year old patients Leadership support is key Program intended at facility level Obtaining informed consent Ever changing volunteer schedule Wii usage 6

7 Spread Addition of facilities throughout the health care system Project sustainability Integration of HELP and NICHE GPCA for pilot project Contact us Megan Wheeler, MSN, RN, ACNS-BC Janice F. Moore, PhD, CFLE Thank You!! 7