Care Plan for the Older Adult: Training

Faculty Scholars ProgramNovember 1, 2013

Kathleen T. Foley, PhD, OTR/LAssociate Professor, Occupational Therapy

College of Health SciencesBrenau University—North Atlanta Campus

• Discuss the importance of care planning for the older adult.

• Identify differences between multi-, trans-, & interdisciplinary teams in health care.

• Describe the rationale for interprofessional care and interprofessional training given current healthcare trends.

• Describe a comprehensive education approach for teaching interprofessional care planning.

Learning Objectives

• Characteristics of their health care?

Older Adult Health Care

• What is the overarching goal?• What are the older adult’s issues & impact on health & quality

of life?• What are strengths & resources? Additional information

needed?• What is the plan of care?

– What needs to be done; – Who will do it; – When will it happen? – What is the priority of each issue?– What outcome(s) should be expected for each issue?

Vignette-Guiding Questions

• Optimal use of health workforce• Cost effectiveness• Efficient transition of care• Safety of patients (IOM, 2007)

– JCAHO reports nearly 70% of patient adverse events cite the lack of collaboration and communication between providers as a main cause of error.

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Concerns in Health Care

Sentinel event statistics. http://www.jointcommission.org/NR/rdonlyres?FA465646-5F5F-4543-AC8F-E8AF6571E372/0/root_cause_se_jpg

• Is developed from a complete assessment that evaluates the current and future medical, social, emotional, environmental, and financial needs of the older adult

• Includes issues/problems, interventions, and expected outcomes

• “Road map” for care; it should all aspects of care

• Traditional to nursing

Care Plan for the Older Adult

Care Plan for the Older Adult

• Caring for the complex older adult is important– Multiple diagnoses combined with normal aging

processes– Results a complex care requiring multiple services

• Care plan coordination should be:– Client-centered;– Supportive of family and informal caregivers– Focus on chronic care and health care transitions;– Bridge medical and social services;– Employ a comprehensive assessment; and– Implement and monitor a flexible care plan.

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• The integration of healthcare teams has lead to:– Stronger continuity of care,– Improved health outcomes, and– Lower costs. (Jencks et al, 2009; Hirth et al, 2009)

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Benefits of Teams

• Differing approaches and expectations toward client treatment

• Lack of knowledge of roles within team• Negative attitudes and stereotyping• Conflicts concerning accountability and

responsibility (Freeman et al, 2000; Garmen et al, 2006; Mickan & Rodger, 2000)

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Issues in Health Care Teams

Type of Health Care Teams-Review

• Multidisciplinary• Transdisciplinary • Interdisciplinary

Multidisciplinary– Discipline oriented goals– Each member responsible for work within their

discipline’s boundaries – Outcome is sum of each member’s efforts

Type of Team Review

Client

OT

PT RN

Psych

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Transdisciplinary– Based on patient needs, one member is team

leader– Leader delivers care – Other members contributing information &

recommendations

Type of Team Review

ClientOT

PT

RN

SLP Dietary

MD Respiratory

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Interdisciplinary– Members involved in problem-solving beyond

their discipline– Team identified goals– Works toward goals with respect to their

discipline– Collaboration replaces communication

Type of Team Review

ClientOT

PTRN Psych

SW

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MD

• Multidisciplinary teams• Transdisciplinary teams • Interdisciplinary teams

• Interprofessional teams?

Types of Teams

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• Similar to interdisciplinary; latest term• “When multiple health workers from

different professional backgrounds work with patients, families, caregivers, and communities to deliver the highest quality care”. (WHO, 2010)

• “Care delivered by intentionally created…small work groups in health care…having a collective identity and shared responsibility for a patient…” (IPEC, 2011, pg. 2)

The Interprofessional Team

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• Benefits of the Interprofessional team (IPT): – Client-centered care– Safer– Timelier– Improved efficiency– Improved effectiveness (Coleman, 2009)

– Equitable (IOM, 2001)

– Future of health care

Why Interprofessional Teams

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• Team members who:– Bring respective specialized knowledge and skills;– Recognize and appreciate contribution of each

member;– Take part in decision-making;– Assume responsibility for their own decisions and

team decisions;– Have good communication skills; and,

• Seamless team cooperation and coordination(Xyrichis & Lowton, 2008; Priegel & Kupperschmidt, 2009)

Effective IPT Characteristics

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• Interprofessional education (IPE) is recommended; defined as:– “When students from two or more professions

learn about, from and with each other to enable effective collaboration and improve health outcomes.”

(WHO, 2010)

• Goals:– Improve communication– Increase cooperation

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Educating Professionals

• Core Competencies for Interprofessional Collaborative Practice (Interprofessional Education Collaborative, 2011)

• Four Core Competencies:– Values/ethics for interprofessional practice– Roles/responsibilities– Interprofessional communication– Teams and teamwork

The Future Professional

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http://www.aota.org/Business/Partner/41738.aspx

• Goal is to experience what it is like to:– Participate on an interdisciplinary team– Develop a care plan in collaboration with other

health care professionals

• Sponsored by the UAB Center for Aging and Geriatric Education Center

• 9 disciplines totaling 300 trainees observe an interdisciplinary interview of an older adult

• Develop a care plan in smaller trainee groups

Interdisciplinary Team Training (IDT)

• Goal is to experience what it is like to:– Communicate with OAs to address problems from medical,

emotional, social, environmental and economic perspective– Work effectively in an IDT appreciating differences and

values of various disciplines

• Sponsored by the UAB Comprehensive Center for Healthy Aging & Geriatric Education Center

• Student trainees rotate weekly• Interview a resident as a group • Meet as a team to develop a care plan; facilitated by a

geriatrician

Interprofessional Clinical Experience (ICE)

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• Ford, CR, Foley, KT, Ritchie, CS, Sheppard, K, Sawyer, P, Swanson, M, Harada, CN, & Brown, CJ. (2013). Creation of an interprofessional clinical experience for healthcare professions trainees in a nursing home setting. Medical Teacher,35(7), 544-8. doi: 10.3109/0142159X.2013.787138. Epub2013April30.

Reference for ICE

• Interprofessional Collaboration Framework

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Integrating the IPT(Reeves et al, 2009)

• Education/training level:– Incorporate IPT training into orientation and/or annual

training; include didactic and practical components– Disseminate information on the various professions—OT ,

Nursing, PT, SW, Month

• Practice level:– Model behavior– Distribute reminders on the characteristics of a “good

team”

• Organizational level:– Policies and procedures for the IPT– Recognize “good” teamwork

What can you do?

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Interprofessional Team

“Build for your team a feeling of oneness, of dependence on one another, and of strength to be derived by unity.” –Vince Lombardi

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• The University of Alabama School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The University of Alabama School of Medicine designates this educational activity for a maximum of 1 AMA PRA Category 1 credit(s). Physicians should only claim credit commensurate with the extent of their participation in the activity. The University of Alabama School of Medicine is an equal opportunity/affirmative action institution.

• The University of Alabama School of Medicine (UAB) is committed to the provision o f CME that is balanced, objective, and evidence-based. The University of Alabama School of Medicine adheres to Accreditation Council for Continuing Medical Education (ACCME) Essentials and Standards. Accordingly, all parties involved in content development have disclosed any real or apparent conflicts of interest relating to the topics of this educational activity and the disclosure summary follows. The University of Alabama School of Medicine Division of CME has established mechanisms to resolve conflicts of interest should they arise. Participants in UAB CME programs are afforded the opportunity to provide feedback on the quality of individual programs at the conclusion of the activity. Comments can also be sent directly to the Division of CME at cme@uab.edu.

Notes…