Issue link: https://viewer.e-digitaledition.com/i/63200
SPECIAL FEATURE The Senior's Partner S ENIOR INPATIENTS ENCOUNTER a variety of hospital stay issues unique to their age group. Many regularly transition from acute care to multiple clinical care providers, and a number of these patients aren't equipped to handle medical messages from multiple sources. Others become depressed or con- fused from a lack of mental stimulation or socialization. Still others don't have access to mobility opportunities, sometimes causing a decline in physical function. Many simply don't understand the health care system and what is required of them for self-management upon discharge. Each of these issues needs to be dealt with individually — which, for hospitals, translates into heavy workloads. With so many variables adding complexity to senior care, many facilities will require a complete program overhaul. "At Crouse Hospital, we already identi- fied specific areas of senior care that could be enhanced and developed a training program to prepare the staff for a geriatric focus," says David H. Dube, M.D., CMD, Medical Director at the Centers at St. Camillus and physician advisor to the Aging and Complex Care service at Crouse Hospital. "We found focal points that we wanted to improve and used them as a base from which we could alter the overall culture of care." Borrowing Best Practices Rather than reinvent the wheel when it Diane Nanno, transition coach, works with a hospitalized patient. comes to geriatric services, Crouse Hospital determined which best practices from across the country could be adapted to INCREASED OVERALL PATIENT LONGEVITY HAS WEIGHTED HOSPITAL CENSUSES TOWARD THE OLDER-THAN-65 AGE GROUP IN RECENT YEARS. IN RESPONSE TO THIS SHIFT IN PATIENT POPULATIONS, CROUSE HOSPITAL HAS DEVELOPED SEVERAL DISTINCTIVE PROGRAMS AIMED AT MEETING SENIORS' NEEDS IN A HOLISTIC MANNER. the current system. Working with Nurses Improving Care for Healthsystem Elders (NICHE), an organization within the Hartford Institute for Geriatric Nursing at New York University College of Nursing, the staff at Crouse noted the greatest needs and implemented programs designed to cater to them. "The collaboration with NICHE allowed us to access a toolkit of educational programming, patient assessments and best practice protocols so our nursing and ancillary care staff could have specific training and tools for geriatric services," says Christy Bond, M.S., FACHE, Director of Aging and Complex Care at Crouse Hospital. "With a strong support system in place for older patients, physicians can provide acute care with better outcomes." An Acute Care for the Elderly (ACE) team oversees the implementation of NICHE protocols. The interdisciplinary ACE team is made up of a geriatric nurse practitioner, a physical therapist, a clinical dietitian, a pharmacist, care coordinators, bedside nurses, spiritual care personnel and all team members connected to the Aging and Complex Care service. Specialty services like palliative medicine and diabetes education are also utilized when the clinical caseload includes patients who can benefit from those services. One protocol introduced through The Aging and Complex Care team, from left: Diane Nanno, transition coach; Christy Bond, Director; David Dube, M.D., physician advisor; Sharon Martin, clinical program coordinator/transition coach; and Judy Hamlin, clinical nurse manager 16 | Central New York MD NEWS s MDNEWS.COM NICHE was intended to prevent falls. Since many older patients are at high risk for falls — particularly if they feel ill or have been in bed for multiple days — nurses receive training on appropriate questions to ask and warning signs to watch for as patients rise from their beds. Although it seems counterintuitive, patients are encouraged to ambulate. This protocol has helped reduce falls while adding extra safety measures. PHOTOS COURTESY OF CROUSE HOSPITAL