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SMILE ProgramMaintaining and/or Improving functional ability of elderly patients by SMILE Program
Alidina, Karimah; Kohlberger, Kim; Merchant, Anna-Marie & Stoskopf, MaureenHalton Healthcare Services
Rationale
Purpose
SMILE
The purpose of this project is to maintain and/or improve the functional ability in at least 75%
of our eligible admitted elderly patients age 70+ in our Community Hospitals by introducing
the ‘SMILE’ Program (i.e. Stimulate, Move the Body, Improve Hydration, Limit Caffeine,
Enjoy Better Hearing and Vision).
Conclusions
Outcome Measures Findings
Metrics: Number of volunteers recruited and trained;
Number of staff trained;
Number of patients who were screened and participated in SMILE
program
Functional ability of the eligible patients who had participated in the
SMILE program as measured by the Modified Barthel Scale administered
upon admission and discharge
Patients and/or family satisfaction rate
Staff and volunteer satisfaction rate
Delirium and functional decline are serious, common and preventable
complications of hospitalization
This project used simple tools to empower patients and caregivers to take
an active role in the prevention of both
Further highlights include enhancement of team dynamics and improved
work satisfaction among the project and frontline clinical staff
Embedding the principles of prevention in routine healthcare practice will
support the long term sustainability of this project
References
1. Nigam, Y., Knight, J., Jones, A. Effects of bed rest 3: musculoskeletal and immune systems, skin and
self-perception. Nursing Times, 2009; 105 (23), 18-22
2. Inouye, S.K. Delirium in older persons. New England Journal of Medicine, 2006; 354:1157-65
3. Jiricka, M.K. (2008) Activity tolerance and fatigue pathophysiology: concepts of altered health states.
In: Porth, C. M. (ed) Essentials of Pathophysiology: Concepts of Altered Health States. Philadelphia,
PA: Lippincott Williams and Wilkins
4. Winkelman, C. (2009). Bed rest in health and critical illness: A body system approach. Advanced
Critical Care, I20(3), p. 254-266.
5. Dittmer, D.K. And Teasell, R. Complications of immobilization and bed rest. Canadian Family
Physician, 1993; 39: 1428-1437.
Methods The project was implemented as part of a Senior Friendly Hospital Initiative
Volunteers were recruited and trained to implement the SMILE program
SMILE program was implemented on Medical/Surgical and Complex Care units
Education was provided to frontline staff and volunteers
The volunteers educated patients and families via a brochure
Inclusion criteria: Inpatient elderly patients on Med /Surg. and CCC units who are at
risk for functional decline and immobility, such as: patients > 70 years of age with 1or
more risk factors for functional / cognitive decline or delirium (Risk Factors:
decreased mobility, pre-existing cognitive impairment, dementia, history of delirium,
sensory impairment (vision, hearing), inadequate caloric intake or dehydration, sleep
deprivation)
Exclusion criteria: Outpatient units; too medically unstable, unresponsive, death is
imminent, severe dementia, psychosis, or behavioural problems unsafe for volunteer
interaction; aphasia; patient or family refusal for participation; patient in isolation
49 volunteers were recruited and trained for the SMILE program
67 staff members were trained for the SMILE program
82 patients were enrolled in the program over a 3 month period
82% of patients and caregivers reported that this program had helped
them and had improved their hospital stay
100% of volunteers reported increased role satisfaction with the
implementation of this program
100% of the staff reported that volunteers interacted well with patients
100% of staff reported that this program had benefited patients’ overall
hospital stay
90% of the staff also reported improved work satisfaction
The initial results obtained from Modified Barthel Index Scale indicate
that the functional abilities of patients participating in SMILE program
on a Medical/Surgical unit remained the same at admission to discharge.
However, there was a slight improvement in the functional abilities of
the patients participating in SMILE program on a Complex Care unit
upon discharge
.
Functional Decline Is a lack of activity which leads to the loss of muscle strength and endurance, bone
weakening, altered skin integrity, immune suppression, fatigue and loss of motivation1
Functional decline is identified as the leading complication of hospitalization for the
elderly
Reported rates are between 35-50%2
During hospitalization, the elderly patient often experiences reduced mobility and
activity levels leading to accelerated bone loss, dehydration, malnutrition, delirium,
sensory deprivation, isolation, sheering forces on the skin, and incontinence.
The larger the muscle, the faster the loss of strength, particularly those muscles which
resist gravity in the upright position3
Deconditioning and functional decline from baseline have been found to occur by day
two of hospitalization in older patients4
Following 3-5 weeks of bed rest, almost half the normal strength of a muscle is lost5
Discussion
The implementation of SMILE program can positively impact patients’
by maintaining and/or improving the functional ability in the elder
patients
The implementation of SMILE program can also positively impact
patients/family/volunteers/staff job and role satisfaction
Lower Risk
Communication Devices
Mental Exercise
Physical Activity
Natural Sleep
Nutrition/Hydration
Education Materials
Keep Your Mind and Body Active in Hospital
A Patient and Caregiver Guide to Preventing Delirium and
Functional Decline
S Stimulate your mind
M Move your body
I Increase your hydration
L Limit caffeine
E Enjoy better hearing and vision
FallsPressure Ulcers
Reactive Behaviours
Length of Stay
Healthcare Dollars