NICHE: Innovations and Nursing Practice

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1 NICHE: Innovations and Nursing Practice nicheprogram.org Linda Bub MSN, RN, GCNS-BC Director of Education and Program Development, NICHE

2 Objectives Describe the NICHE program and the impact on nursing care Outline implementation of evidenced based practice in the care of older adults Describe NICHE in the continuum of care

3 Geriatric Nursing and Innovation 2010 IOM The Future of Nursing: Leading Change, Advancing Health report; 6 areas to transform the nursing profession Advance Nursing education Remove barriers to practice Cultivate nursing leaders Diversify the profession Collet better data about the workforce Promote interprofessional collaboration and education

4 Geriatric Nursing and Innovation The report highlights nursing impact on the following populations: Chronic disease Aging population Care coordination Increase BSN nursing to 80% by 2020 $200 Million in education programs

5 Geriatric Nursing and Innovation The IHI Triple Aim is a framework that describes an approach to optimizing health system performance. New designs must be developed to simultaneously pursue three dimensions, which we call the Triple Aim : Improving the patient experience of care (including quality and satisfaction) Improving the health of populations Reducing the per capita cost of health care

6 Geriatric Nursing and the Triple Aim

7 How do these ideas become innovation in practice?

8 NICHE Program Goal Vision Mission Achieve systemic nursing change that will benefit hospitalized older adults Provide geriatric sensitive and exemplary care to all hospitalized adults 65 years and over Import principles and tools to stimulate change in the culture of healthcare facilities and achieve patient-centered care for older adults

9 NICHE Program Goals 1. Improve patient outcomes 2. Improve the patient experience 3. Promote staff effectiveness and satisfaction 4. Establish leadership as a provider of care to older adults 5. Provide fiscally responsible care 6. Increase collegial networks

10 Why a program focused on older adults?

11 Older Adults Are CORE Consumers By 2050, the older adult population will number nearly 89 million, than double the current population in Reason for the increasing population: People living longer Baby Boom population becoming 65 and older Every day until 2031; 10,000 Baby Boomers turn 65 By 2030 healthcare expenditure will increase by 25% for older adults Medicare spending will go from $555 billion yearly to $903 billion by

12 The Quality Imperative: Improve Clinical and Fiscal Outcomes! Older adults 13% of the population: Maine is # 3 But comprise 37% of hospital discharges and 43% of hospital days Have longer lengths of stay (7.8 days vs. 5.4 days) Higher rates of 30 day hospital re-admissions Higher rates of functional decline and medical errors Reference: U.S. Dept. of Health and Human Services, Centers for Disease Control. Trends in Health and Aging. Retrieved October 31, 2008 from Hall, M.J., DeFrances, C.J., Williams, S.N., Golosinskiy, A., & Schwartzman A. (2010). National Hospital Discharge Survey: 2007 summary. National health statistics reports; no 29. Hyattsville, MD: National Center for Health Statistics. 2010

13 Aging Population 80% of Older Adults have 1 chronic disease, 50% have 2+ Persons over 65 account for > 50% of the health care market 80% of Home Care is >65yo 90%+ in LTC >65yo

14 Aging Population

15 Aging Population

16 Aging Population

17 Aging Population

18 Why does NICHE Focus on care of the older adult across the continuum? Long Term Care (Skilled Nursing, LTC, Home Health and residential care) costs currently range from $210.9 Billion to $306 Billion annually Approximately 59,000 residential providers care for roughly 8 million older adults Long Term Care service recipients will increase from approximately 15 million in 2000 to 27 million in /3 of older adults will need Long Term Care services at some point

19 Why does NICHE Focus on care of the older adult across the continuum? On any given day, 1.4 million people are cared for in nursing homes 85% of nursing home residents are 65 and older, 42% are % of Home Health patients are 65 and older 48.5% of nursing home residents are depressed 48.5% of nursing home residents have dementia 30% of Home Health patients have dementia

20 Vulnerable Population Differentiate effects of aging from disease process Altered presentation of illness Coexistence of multiple diseases Over diagnosis vs. under diagnosis Polypharmacy

21 Improving Care for Older Adults Is Good Business Optimal care requires appropriate skills Aging demographics Geriatric skill gap High cost of inaction Coordination of care Older adult patients are everywhere Need for flexibility Ongoing training and coaching roles Cost effective train the trainer virtual services

22 Improving Care for Older Adults Is Good Business Proactive & skilled nursing care avoids costly problems Never events Complications that increase LOS and costs Patient and family satisfaction Better functional status at discharge Smoother transitions Improved nurse satisfaction & efficiency, less turnover Improved MD satisfaction and improved efficiency

23 What Is the Focus of NICHE? focuses on programs and protocols that are predominately within the scope of nursing practice.

24 In Other Words Nursing interventions have a substantive and positive impact on patient care outcomes

25 Geriatric Resource Nurse (GRN) Model Began in Boston Early 1980 s at Beth Israel Unit based experts using existing resources Expanded at Yale New Haven Hospital Rationale - Those who voluntarily chose to participate in the effort would provide better care to older adults Central to the role - Geriatric education, competency evaluation, and mentoring

26 History of the GRN Model: Early Vision NURSES are The primary caregivers for older patients in hospitals Generally not fully prepared to care for older patients Nursing Models can improve older patients care and decrease hospital costs Can be the focal point for stimulating interdisciplinary care

27 Rewards Related to the GRN Model Clinical ladder Novice expert growth Respect within the role Deeper geriatric expertise Parsimonious use of resources Outcomes described by NICHE sites Improved clinical outcomes Increased staff skill Increased satisfaction, both staff and patient

28 What is the impact of NICHE?

29 Nursing Education Decrease in amount of nursing schools offering specific geriatric content ANCC no longer offers APN Board Certification in Geriatrics in 2014 Adult-Geriatric NPs and Programs are not prepared for this change Most APNs have significant amount of older adults in their practice Auerhahn, C. Mezey, M., StanleyJ., Dodge, L. (2012). Ensuring a nurse practitioner workforce prepared to care for older adults: Findings from a national survey of adult and geriatric nurse practitioner programs. Journal of the American Academy of Nurse Practitioners 24 (2012)

30 National Trends with NICHE Healthsystems are coming to NICHE No longer only the nurse interested in the program Executives and systems are coming to NICHE Meet the needs of the older adults in a variety of settings including Acute Care Long Term Care, Sub-Acute Rehab Home Health Assisted Living

31 National Trends with NICHE Hospitals NICHE programs have 6 areas of implementation Determine strength of program Demonstrate consistency across sites Show level of commitment of leadership and engagement of staff Reveal level of patient and family involvement in hospital level initiatives and general care

32 Guiding Principles Mission statements and Vision Statements Separate statement or interwoven into system work Is approved by key stake holders Understanding of the impact of program development and support of staff on the care of older adults

33 Organizational Structures How NICHE organizations create a culture of care for older adults Team is multidisciplinary GRNs (staff nurse) involvement Patient representatives Includes community based program representatives Integrates the geriatric nurse in initiatives and protocol/program development Geriatric Service lines

34 Leadership Nursing is leading the work along with an interdisciplinary team Policy development Clinical practice Quality initiatives Regional and National leadership All levels and types of staff are included in this work

35 Geriatric Staff Competence Nurses and other allied staff are not prepared for the care of this population GRN Courses Units with 40+% older adults are trained in basic care Education for other disciplines Clinical ladder for nurses include GRN training Certification initiatives

36 Interdisciplinary Resources and Processes Sites have demonstrated commitment to the entire team as well as patients and families All disciplines have geriatric education/training EBP includes interdisciplinary care-plans CAM in the ED Beers List protocols, pharmacist protocols Project RED, BOOST, INTERACT

37 Patient and Family Centered Care NICHE Facilities work to create patient and family centered care Organizational processes Transitional Care Teach back Protocol implementation

38 Environment of Care Your facility, health system reflects elder sensitive initiatives Accessibility to adaptive equipment Environment of care is evaluated Aging sensitive principles are reflected in the actual environment

39 Quality NICHE sites evaluate and maintain a congruence between their Mission and Vision for older adult care and Quality Measures GIAP Quality Measures that impact clinical, financial and organizational areas

40 Nursing Innovation and NICHE How do NICHE sites across the country implement geriatric best care practices? How are NICHE sites improving outcomes of older adults and families?

41 NICHE Knowledge Center ^ Members Only Resources ^ Open Resources

42 Knowledge Center Nurses have access to the resources and education to provide exemplary care to older adults Building block to innovation and development of practice Mentoring of other staff and professional and informal caregivers

43 We produce over 20 live webinars each year. Each webinar is then archived for later viewing. Along with the highly popular Solutions Series we offer Organizational Strategies, Clinical, Interdisciplinary and new for 2014, the Long Term Care Series. Webinars

44 Webinars Opportunity to highlight innovation at the ground level at NICHE sites across the country Ability to replicate or make your own version in your facility Interdisciplinary Examples: A Multidisciplinary Effort to Improve Patient Care and Satisfaction with Pain Management Decreasing Hospital Acquired Pressure Ulcers by Focusing on Decreasing Moisture Associated Skin Damage (MASD) 'Uh-Oh' to 'Oh-Yeah!': A Nurse Driven Urinary Catheter Removal Protocol

45 Each Organizational Strategy & Clinical Improvement Model includes background, implementation, evaluation, tools & resources along with support documents. Complimentary webinars are also developed. Org Strategies & Clinical Improvement Models

46 Organizational Strategies and Clinical Improvement Models Creative ways to meet the needs of organizations, staff and patient/family needs Highlight program innovations across the country Step by step information on how to implement at individual sites Patient and Family advisory council Certification Initiatives Research based CIM demonstrate nursing practice and the impact on patient outcomes Pressure Ulcer Restraints Falls

47 These concise PowerPoint in-services focus on clinical care issues and trends pertinent to the Geriatric Resource Nurse (GRN) and bedside caregivers' ability to provide evidencebased care. Ed Briefs

48 Ed Briefs Allow sites to implement programs and innovations based on the needs of their facility. Focus areas are for clinical and support staff COPD Self Neglect Assessing for Palliative Care

49 The "Solutions" Series is designed to convey "success stories" related to elder care. These stories are based on the successful application of best practice solutions related to NICHE Clinical Improvement Models and other NICHE resources. Solutions

50 Solutions Series Our ability to highlight nursing innovation at the bedside, at the hospital and system level. Topics include: Catheters Critical Care Delirium/Dementia ED Environment Fracture/falls GPCAs Medication Integrated System Implement Nutrition Patient/Family Education A nurse driven urinary catheter removal protocol Reducing Delirium with a Team Approach Purposeful Visits for Hospitalized Older Adults: Impact on Orientation and Mood

51 The NICHE Hospitals Reports are published to identify the positive outcomes and innovative initiatives experienced at NICHE designated hospitals in their care of older adult patients. Hospitals Report

52 Hospitals Report Highlight programming to improve patient outcomes and experiences in the following areas: Operationalizing NICHE Function Delirium Dementia

53 Simple, easy-to-understand information bulletins designed to help prepare patients and families for the realities of hospitalization. Series Include: The Basics for Older Adults Dementia: Transitions Older Adults with Illness Palliative Care Need to Know

54 Need to Know Concise education tools created by nurses across the country to educate older and adults and their families on hospital safety. Falls Restraints Discharge Emergency room Palliative Care (with CAPC) Dementia Transition Series (with Alz Assoc MO)

55 Geriatric Nursing and Innovation This is who we are This is who we take care of This is nursing This is our opportunity to own our practice, own our impact

56 Thank you! 2013 NICHE All rights reserved. The information contained in this module is provided for informational purposes only. The content has been developed by NICHE participants and the NICHE staff at New York University s College of Nursing and is protected by copyright under the laws of the United States and foreign laws. Under no circumstances may these materials be reproduced for sale or profit. Any use of content not expressly permitted may violate copyright, trademark, and other laws.

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