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Interdisciplinary Geriatric Rounds Identify Current Patient IssuesPam Abraham, MSN, RN, CNL, Linda Bryant RN, Denise Davenport, MSN, RN
Outcomes
Conclusion and Future PlansGeriatrician, Dr. Shekar Chakravarthi Testimonial
NICHE Activities Clinical Pharmacy
Acknowledgements and Contact Information
In-services will be provided by the PharmD residents on medication updates related to older adults Communication will continue across the disciplinesPhysical Therapy, Nutrition Support, Wound Care will be invited to joinRounding on each individual geriatric patient with the interdisciplinary team was suggested by Ashmi Philips PharmD, Clinical CoordinatorRe-evaluation of Physical Therapy and timing of medication administrationExpand Geriatric rounds to all other nursing unitsContinued identification of Geriatric issues and patients at risk by staff RNs and interdisciplinary team membersIdentification and development of best practice related to improved care of the geriatric population
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Process
Thank YouPat Steingall, MS, RN, NE-BC, Vice Pres. Patient Care Services, CNOKristy Alfano, Director 5 SouthDr. Shekar Chakravarthi, Geriatrician Ashmi Philips, PharmD, Pharm D residents, Mini Varghese, Pharmacovigilance, Patient Care Managers, Staff RNs of 5 SouthLynne Danik, Director of Volunteer Services/NICHE volunteers
Pam Abraham MSN, RN, CNL, [email protected] Bryant, RN [email protected] Davenport, MSN, RN, [email protected]
The Director of Center for Healthy Aging, Linda Bryant, and Geriatrician, Dr. Shekar Chakravarthi, identified an opportunity to improve geriatric care.
Weekly Geriatric Rounds was initiated on the Intermediate Care Unit (5 South) in June 2010.
Participants:Geriatrician, Dr. Shekar ChakravarthiDirector of Senior Services Linda Bryant, RNDirector of Staff Development, Denise Davenport, RNClinical Nurse Leaders, Cathy Edmonds, MSN, RN
Pam Abraham, MSN, RN Patient Care Manager, Rose Sieglen, RNPharmacovigilance, Mini Varghese, PharmDClinical Coordinator, Ashmi Philips,Pharm D, Pharm D residents Staff Nurses of 5 SouthPatient Advocate, Ellen StanislaskiStaff RNs present their patient as a case study which enables the interdisciplinary team to address complex geriatric patient and family issues.Immediate implementation of solutions to geriatric issues promotes improved patient care, increasing nurse autonomy and satisfaction.
Literature suggests that a regular discussion of geriatric issues by an interdisciplinary team fosters identification of pertinent issues using a multifaceted approach to solutions. Each discipline holds information that is useful to others when deciding upon treatments and plan of care. This collaboration encourages continuity of patient care and prevention of disparities.Collaboration works best in an environment that respects the opinions and professional contribution of all participants.Geriatric Rounds promote mutual respect through group problem solving, cohesiveness, and creativity, which are characteristics of a synergistic healthcare team..
The aging of the American population and its effects on healthcare require innovative programs to ensure patient safety and best practice for older patients.
Healthcare providers seek ways to address and manage the complex issues that are presented by the older population upon arrival to the acute care setting.
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Introduction
Increased communication between all disciplines where pertinent information is shared
Patient safety issues are reviewed and addressed in real time
Beers Criteria was introduced in the Hunterdon Medical Center formulary
Geriatric consult checklist was created for all healthcare providers
Nurse-initiated bowel regimen protocol began in October 2010
Amplifiers for hearing were made available
Orthostatic vital signs are now completed on all ‘at risk’ or syncopal patients before Physical Therapy
Encouraged regular timed administration of analgesics
Increased consults to Ethics, Palliative Care, Speech and Hearing, and Geriatrics on complex patients
Advanced Directives are addressed
Nurse autonomy occurs due to immediate collaboration and response
Complex patient-family issues, capacity, and guardianship are addressedNurses serve as patient advocates and communicate their wishes to the treating team
Meets Joint Commission Standards: PC.02.01.05 The hospital provides interdisciplinary collaborative care, treatment, and services. NICHE standard: The care, treatment, and services provided to hospitalized older adults is interdisciplinary.
The Geriatric Interdisciplinary Team
Clinical Pharmacist Activities:Analyze patients on Intermediate Care Unit (5 South) for weekly NICHE rounds Drug Interaction check performed
Calculate creatinine clearance (CrCl) and adjust medications accordingly based on renal function
Identify possible medications that should not be prescribed in the elderly-Beers Criteria
Look for possible Adverse Drug Reactions and MedicationErrors
Clinical Pharmacy Team Created the Following Reference Charts for Nursing, Pharmacy, and Prescribers:Inappropriate medications used in the elderlyDrug-induced dysphagia “Do Not Crush” list as per Hunterdon Medical Center formulary
(as per The Institute of Safe Medication Practices) Class overviews: Statins, Bisphosphonates
Pharmacy and Therapeutics Meetings to be followed by Medical Executive Committee:Auto-substitution
Zolpidem (Ambien®) 10 mg PO at bedtime to zolpidem (Ambien®) 5 mg PO at bedtime in patients 65 years of age and older
Remove alendronate (Fosamax®) from formulary in order to prevent adverse reactions such as esophageal erosions, particularly in the geriatric population who are at greater risk
Prepared by:Ashmi A. Philips, Pharm.D. Mini Varghese, Pharm.D. BCPSClinical Coordinator PharmacovigilanceClinical Assistant Professor Rutgers, The State University of New Jersey
Clinical Pharmacy CoordinatorDirector, Pharmacy Residency Program (PGY-1) Hunterdon Medical Center
Literature Review
References
Curley, C. & McEachern, J.Edward (1998) A firm trial of interdisciplinary rounds on the inpatient medical wards. Medical Care. 36 (8), 2-3
Halm, M., Gagner, S., & Goering, M., et al. (2003)Interdisciplinary rounds: Impact on patients, family and staff. Clinical Nurse Specialist. 17, (3). 133-142
Newell, B. (1999) Best practices. Interdisciplinary rounds. Creative Nursing. 5, (1) 1-2
Edwards, C.(2008) Using interdisciplinary shared governance and patient rounds to increase patient safety. Medical Surgical Nursing. 17 (4) 255-257
Patient Care Manager, Rose Sieglen, TestimonialGeriatric Rounds provides education for the patient, family, and members of the healthcare teamIndividual patient issues are addressed and resolvedPhysician to Physician discussion is fostered
Source: “The John A. Hartford Foundation Institute for Geriatric Nursing, New York University, College of Nursing. Photography by James Schuck.
Provide a Geriatrician’s perspective and insight into the team discussionAcknowledge and validate ideas and concerns of the nursing staff and provide supportFunction as a liaison between the interdisciplinary team and the treating physicians Be a resource to the interdisciplinary team
