Your In-Room Messaging Board

In Room Messaging

Information for the Hospital Team about a Patient with Memory Problems*

PATIENT’S NAME: _______________________________What does he or she like to be called? ___________________________

Patient lives: _______________________________________________________________________________________________(at home? alone, or with you or someone else? in a nursing home or other facility?)

Person completing this form: _________________________________________________________________________________(name and relationship to the patient)

Home phone: ___________________________________ Cell phone: ______________________________________

1. Patient usually drinks these liquids best: _______________________________________________________________________

2. Patient usually drinks from a cup or glass: with a straw? or without a straw? (circle one)

3. Does the patient wear dentures? __________ If so, does the patient have the dentures with him/her? __________

4. Patient usually eats these foods best: __________________________________________________________________________

5. Patient eats best if he/she: (circle all that apply)

a. is helped with tray set up d. is reminded to chew and swallowb. is shown how to use spoon or fork e. is given smaller portionsc. is given finger foods f. is fed

6. Does the patient wear glasses? __________ If so, are the glasses with him/her? __________

7. Does the patient wear hearing aid(s)? __________ If so, are the hearing aid(s) with him/her? __________

8. Does the patient speak and understand English? __________ If not, does the patient speak and understand another language?

If so, what language? ________________________________________

9. Does the patient express his or her needs verbally? (thirst, hunger, go to the bathroom?) __________

10. Does the patient usually go to the bathroom alone or need help or supervision? __________________

11. How does the patient usually express pain? ____________________________________________________________________(verbally? facial expression? agitated body movements?)

12. Does the patient usually need help with: (Please write yes or no for each activity)

a. Bathing?__________ Usual bath time? __________

b. Brushing teeth and mouth care? __________

c. Getting from bed to chair and back? __________

d. Dressing __________

e. Walking__________ Does he/she usually use a cane, walker, or wheel chair? __________

13. Has the patient fallen recently?__________ How often?________________________Why?____________________________

14. How does the patient act when he or she is anxious or frightened? ________________________________________________

15. Does the patient get angry or physically aggressive? ____________________________________________________________

16. What helps to calm or comfort the patient at difficult times? _____________________________________________________

17. Does the patient usually watch TV or listen to the radio?_________________________________________________________

18. Does the patient have an advanced directive? __________________________________________________________________

19. Is there anything else you want us to know about the patient? ____________________________________________________

20. What else does the family want to know from the physician or hospital staff? ________________________________________

*Adapted from forms developed by the Dementia Responsive Care Initiative, Mission Hospitals, Asheville, NC; and Mittleman,M., & Epstein, C. (2003). The Alzheimer’s health care handbook, pp. 179-184. NY: Marlowe & Co.

A SERIES PROVIDED BY

The Hartford Institute for Geriatric NursingEMAIL: hartford.ign@nyu.eduHARTFORD INSTITUTE WEBSITE: www.hartfordign.orgCONSULTGERIRN WEBSITE: www.ConsultGeriRN.org

Improve Personal KnowingFamily Questionnaire

Family Questionnaire for Patientswith Memory Problems

• A tool provided by NICHE with supporting validity and reliability• Improve understanding: – Patient preference in care – Baseline functionality & needs• A GRN project – Pilot in pulmonary/oncology unit by Arsineh Petrosian, RN, GRN & Agnes Pagdilao, RN, GRN• How the tool functioned? – Two way communication between Nursing & Family/Patient – Hand off communication among care providers: Information in electronic record

Healthcare at a Higher Level

Where the 2 and 134 freeways meetGlendaleAdvent ist .com

Know Me: Elder Care at Glendale Adventist Medical Center When NICHE

Meets GAMC

Over 50% of GAMC Admissionsare 65 Years Old & Above!

Geriatric Institutional Assessment Profi leFindings (N = 516 across disciplines)

The At Risk Elders PI Team

• Vision of NICHE: Provide all patients 65 and over, sensitive and exemplary care.

• Mission of NICHE: To import principles and tools to stimulate a change in the culture of healthcare facilities to achieve patient-centered care for older adults.

• Nursing Mission at GAMC: “To love our patients, their families and each other like God does, touching them at their point of need with skill, joy and compassion.”

• Knowledge Score – Slightly below benchmark – High risk areas: 1. Pressure ulcer 2. Restraint 3. Incontinence Management 4. Sleep Management

• Attitudes Score – High above benchmark – Staff expressed interests in learning more

% of HospitalAdmission LOS

HospitalAcquiredPressure

Ulcer Prevalence

US2008

50% of total hos-pital admissions

Acute: 4.79Rehab:14.16

The CALNOCbenchmark: 3.38%

GAMCAcute Units

2008

55.95% of acuteadmissions

5.97 days 82.42% of stage II and above PUsoccurred in >65 groupGAMC

Rehab Unit2008

73.15% of Rehab admissions

14.81 days

A Common Theme Emerged:A focused, individualized, multidisciplinary approach that is based on knowing older patients personally (life stories), aesthetically (aes-thetic knowing), empirically (knowledge of specifi c older patient needs), & ethically (their ethical, moral & spiritual standards)is need-ed in the organization.

• What is the ARE Team? – The GRN model proposed by NICHE – The At Risk Elders Performance Improvement Team: • Shared governing structure proposed by Gwen Mattews, RN, CNO to meet the call of improving care for older patients at GAMC.• Who are on the Team? – The team is composed of the unit based Geriatric Resource Nurses (GRN): 2/shift/unit – The team meets 1 time/month since January, 2010. – GRNs team up into small working groups to answer the clinical needs of unit staff in improving care for older hospitalized patients. Example of projects: • 1 pager practice pearls for new nurses • Practice audit • Champion evidence based tools such as (CAM) for delirium screening & family questionnaire for patients with memory problems• Aim of the ARE PI Team: The ARE PI initiatives are aimed to eliminate preventable hospi-

tal acquired conditions commonly experienced by hospitalized older adults such as delirium, fall and infection by continuously improving the quality of care supported by up to date evidences.

Establishing ARE Team

Don’t Lose

Muscle Strength!!!

Studies show that many patients start to lose muscle strength after 48 hours of bedrest

“Sit up for meals whenever possible!”

Constipation•Pnemonia & Difficulty •BreathingDeveloping Blood Clots•

Bed Sores / Pressure •SoresChoking Hazard•Swelling of the Legs•

“UP 4 Meals” campaignGAMC At Risk Elders Performance Improvement Team recommends

Sitting Up Will Help to Reduce Your Risk For:

300.108

Up 4 Meals Campaign

Care Planning Via SPICES

Care Planning Via SPICES

ARE News & Geriatric Gold Standard

ARE News & Geriatric Gold Standard

• SPICES (Fulmer, 2007)* – The framework that identifi ed “marker conditions” of geriatric syndromes experienced by hospitalized elders• A framing tool: – Of care planning in the Cerner Electronic Documentation System• For RNs who review plan of care daily: – Easy to navigate – A visual reminder to address elders changing needs – “One Spot” care planning resource

* Fulmer, T. (2007) How to try this: Fulmer SPICES, American Journal of Nursing, 107(10), p 40-48.

• ARE News – A monthly newsletter presented by the ARE PI team • Target audience: staff & family – An information dissemination tool: • From the monthly ARE PI meeting to all unit staff – Topics selection: • Aimed to answer practice issues encounted by care providers• Geriatric Gold Standard – A 1 page practice pearls • Provide information essential to specifi c issues to new & fl oat nurses • Evidence based • Authored by experienced GRNs • Published on online Nursing Portal for easy & timely access

“This is your whiteboard, easily viewed on the wall across from your bed. This is a place for you and your family to fi nd out information about your caregivers while you are here. It is also a place for your nurses and therapists to communicate with you and each other about your care. If you want to share information about yourself or contact numbers from your family, please feel free to put it up here.”

By: Winnie Calvario, PT, DPT, GCS, ARE Co-Chair

Monica Koskey, MA-CCC, SLP, ARE Champion

• The Goal – To promote early ambulation & to prevent functionality decline during hospitalization

• The Program & The Protocol – Active education to staff, patients and family: fl yer in laymen’s term – Baseline function assessed & documented on admission: family questionnaire

• Nursing to initiate communication: family, patient & across disciplines • Up for Meal sign: admission packet & in-room posting • Patient ambulated at regular intervals & Sit up to eat for ALL Meals • Geriatric Powerplan in Cerner documentation: multidisciplinary referral • Lift team involvement By: Vanessa Gilbertson, GRN, 3 East Cardiac Telemetry Unit

By: Elsa Cameron, GRN, Acute Rehab

By: Agnes Pagdilao, GRN & Arsineh Petrosian, GRN, 2 East Oncology

By: Zoe Chen, GRN, Medical Surgical Educator & Emillie Battig RN, CIS Educator