LEVELS OF NICHE IMPLEMENTATION *Required element Stage 1: Early Stage 2: Progressive Stage 3: Senior Friendly Stage 4: Exemplar Dimensions Guiding Principles The institution has a mission statement that includes the older adult patient.* The NICHE mission statement has been approved by the governing body of the hospital.* Attributes Has met stage 1 & 2 requirements * Has met stage 1 & 2 requirements * Organizational Structures committee includes nursing management, quality management, staff education, and clinical management.* committee has a 2 year action plan. committee includes GRN representation, and representative from the following disciplines (at a minimum): medicine, rehabilitation therapies, pharmacy, and social work.* implemented on at least one unit (including GRN education and mentorship activity).* committee includes representatives from community based programs (e.g., home health provider and palliative care).* The process of interdisciplinary, clinical decision making is implemented on GRN units such as weekly rounds.* implemented on more than one unit or the ACE (Acute Care for the Elderly) model has been implemented.* Older adult patients and caregivers are represented on the NICHE steering committee.* committee leads systemlevel expansion of NICHE programs such as geriatric service line. All applicable (i.e. units with > 40% older adults) units have the GRN model and GPCA training has been provided on these units also.* extended to at least one specialty unit (e.g. orthopedic, neurosurgical).* 1
Leadership The NICHE Coordinator is designated to coordinate the steering committee functions, primary contact with NICHE/NYU, & dissemination of NICHE materials and resources. A nurse (may be a NICHE coordinator) who completed GRN training, completed gerontological certification, or is in process of completing gerontological certification provides oversight of the GRN role.* The NICHE Coordinator and/or other members of the steering committee are represented on clinical practice committee or other body responsible for policy development. GRNs are involved in leadership functions including: quality improvement and GPCA training. The NICHE program has assumed a regional leadership role by hosting a state level or network wide conference OR by taking part in a state wide quality initiative. The NICHE program has assumed a national leadership role through one or more of the following: 1) developed /co developed a staff development program or an organizational strategy in collaboration with NICHE (that was also implemented at their site); 2) reviewer of NICHE resources; 3) member of NICHE Leadership Faculty; 4) NICHE Ambassador (speaker for NICHE at other regional, national, or international conferences); 5) publish example of exemplar NICHE site in an article, book chapter or electronic communication. 2
Geriatric Staff Competence At least one basic, geriatric specific staff education program (e.g., NICHE interdisciplinary training modules) is provided in general orientation of nursing staff working on identified units serving older adults.* The Introduction to Gerontology core curriculum included in general orientation of all clinical and support staff working on units serving older adults.* GRNs complete the GRN training and 8 hours per year continuing education in gero content.* The NICHE Coordinator attended a regional geriatric conference or webinar in the past year. The Geriatric Patient Care Associate Training is provided on all GRN units. Geriatric nursing education (e.g. NICHE GRN Core Curriculum) is provided to RN staff on more than one unit.* Extended geriatric specific staff education is provided to other disciplines (NICHE interdisciplinary training modules) on several units.* Staff development programs specific to the needs of older adults are integrated into clinical ladder or nurse advancement program.* NICHE Coordinator and Managers evaluate the needs of staff to meet the needs of the older adult patients.* Interdisciplinary Resources and Processes Information regarding NICHE is provided to other disciplines. Interdisciplinary evidence based guidelines are implemented on medical, surgical, and medicalsurgical units for the following: falls, restraints, pain, functional decline, skin care/pressure ulcers, infection, delirium, medications, sensory needs, transitional care, and palliative care.* Interdisciplinary protocols are applied to critical care, ED & other specialty units. A method of maintaining geriatric appropriate medication prescribing and/or utilization is implemented. Transitional care processes are implemented. Interdisciplinary care plans for older adults on NICHE units routinely address: falls, restraints, pain, functional 3
decline, skin care/pressure ulcers, infection, delirium, medications, sensory needs, transitional care, and palliative care.* Patient and Family centered Approaches One or more of the following is included in the organization's processes: Education that addresses age sensitive communication; Patient/Family Council; Opportunity (within clinical unit) for family to give feedback to staff and caregivers. Transitional care including handoffs and discharge teaching is standardized and includes validation (the "teach back" method). The facility website reflects geriatric programs and is linked to NICHE consumer site. Policies address family involvement in care. Protocol implementation includes teaching materials for patients and families. Specialty geriatric protocols include patient and family education and support tools. Environment of Care A process to ensure accessibility to adaptive (e.g. meal aids, mobility devices) and/or sensory support (e.g. amplifiers, hearing aid batteries) is implemented. The environment of care is an item on the steering committee agenda. The environment of care (functionality, safety, and comfort) is evaluated by the facility. Physical environment on NICHE units reflects aging sensitive principles such as basic safety provisions in all units serving olderadults: non glare flooring, adequate lighting, grab bars, access to adjustable height beds, call lights and controls, sensor alarms, use of exit alarms.* 4
Quality Two initial self identified measures are identified as priorities.* Evaluates congruence with NICHE mission statement using Quality Measures: 1) GIAP (baseline) used to evaluate nurse knowledge and geriatric practice environment including institutional values, access to geriatric resources, and interdisciplinary collaboration; 2) additional measures including at least one measure of the following areas: patient clinical, financial, & organizational. Expands QM evaluative activity, collected at least annually on 2 or more units to include certification. NICHE QMs evaluated annually post implementation on at least half of all applicable units.* Shares results of program evaluation with staff, physicians and other stakeholders and reports follow up activity.* 5