HELP Newsletter SPRING/SUMMER 2015 Save the date! Gerontological Society of America Annual Meeting November 19 22, 2015 in Orlando, FL Dear HELP Community, A big thanks to everyone who came to the 13 th annual HELP Conference in March our best ever! We had 64 attendees representing 26 HELP sites, 13 US states, and 3 countries. This year we focused on tech innovations and practical tools for advancing HELP. We also added informal networking sessions which we will do again next year. Thank you to UPMC, our fantastic speakers, and everyone else who helped to make this conference a huge success. We hope you enjoyed it as much as we did! We have included summaries of the conference presentations for those who were unable to attend. You can also access the presentations on the HELP website. (www.hospitalelderlifeprogram.org) Exciting things are on the horizon at HELP Central! We were recently awarded a grant from the John A. Hartford Foundation to expand resources for supporting HELP sites and develop a sustainability plan for HELP. We are particularly excited to announce that we are developing a series of e learning tools, a new mentortrainer model for new sites seeking mentoring from experienced sites, and an expanded peer to peer network for sharing resources and ideas. Thank you for everything you do. You are our inspiration. Sincerely, Sharon and Shin-Yi HELP Special Interest Group at the 2015 American Geriatrics Society Annual Scientific Meeting A HELP Special Interest Group (SIG) meeting was held at AGS s Annual Scientific Meeting on May 16 in National Harbor, MD. The highlight of the SIG was a series of brief talks on current delirium research: Characteristics of patients receiving a multicomponent delirium prevention intervention in the nursing home setting: Dr. Kenneth Boockvar, Icahn School of Medicine at Mount Sinai The epidemic of immobility in hospitalized older patients: Sijia Wu, University of Utah Delirium recognition in hospitalized older patients: Dr. Jody Punke, Aurora Health Care Hospital Elder Life Program Updates and lessons learned at Aurora Health Care: Dr. Jonny Macias, Aurora St. Luke s Medical Center We hope to see you at our AGS SIG next year in Long Beach CA!
PAGE 2 Update on HELP Sharon K. Inouye, MD, MPH HELP Founder and Director of Dissemination Dr. Inouye presented updates on HELP from the last year: HELP Special Interest Groups at AGS and GSA encourage scholarship and collaboration The new NICE to HELP protocols expand existing HELP protocols and allow HELP sites to meet NICE guidelines A new grant from the John A. Hartford Foundation will support the development of a selfsustaining model for HELP dissemination Summaries of Presentations from the 2015 HELP Conference Using the Electronic Health Record to Identify Vulnerable Older Patients: The Story of ACE Tracker Michael Malone, MD, Section Head of Geriatrics, Aurora Sinai Medical Center Dr. Malone described strategies to use the electronic health record to identify vulnerable elders: Care should be coordinated across settings and match the individual s needs The Acute Care for Elders (ACE) tracker can be used to facilitate scaling up of the ACE model The ACE tracker can be used to identify older patients who have risk factors for delirium Integrating HELP into an Acute Care for Elders Program at a Large Medical Center Jonny Macias, MD, HELP Fellow Dr. Macias reviewed the process of integrating HELP and ACE: Interdisciplinary team rounds and nursing education are key elements in successful implementation of HELP and integration of HELP and ACE The electronic health record enhances HELP and facilitates the integration of HELP and ACE The HELP program was successfully integrated with ACE at Aurora Health Care and the initial outcomes are positive
IT Transforming the Approach to Hospital Care: Unrealized Dream or Just the Beginning? Vivek K. Reddy, MD, Chief Medical Information Officer, University of Pittsburgh Medical Center Dr. Reddy discussed using electronic health records to redesign clinical processes: The transition from paper charts to electronic health records (EHR) has been imperfect Rather than only focusing on the adoption of EHRs, we should develop new care models and approaches and redesign EHRs to maximize efficiency and improve patient care This process will involve redefining our goals, using big data, and constantly evaluating outcomes PAGE 3 Update on Delirium Sharon Inouye, MD, MPH, HELP Founder and Director of Dissemination Dr. Inouye discussed the state of the field in delirium research and management: Delirium is common, expensive, multifactorial, and associated with negative patient outcomes Delirium is often unrecognized but there are numerous, validated tests for assessing delirium Multicomponent non pharmacologic interventions are effective in preventing delirium Panel Discussion on Electronic Health Records/Information Technology Innovations Miriam Beattie, DNP, GNP BC, APRN; Nancy Joyce; Kevin Urda; Megan Wheeler, MSN, RN, ACNS BC; Heidi Wierman, MD Presentations and discussion on: Using ipads to make volunteer assignments, document volunteer interventions, and as a therapeutic activities tool Using Volgistics to track volunteer information in a userfriendly interface A successful trial of using the Wii gaming system with HELP patients Documenting evaluations and volunteer treatment plans with EPIC Why Should the Biology of Aging Matter to Clinicians? Stephanie Studenski, MD, MPH, Director of the Longitudinal Studies Section, National Institute on Aging Dr. Studenski discussed why the biology of aging is relevant for geriatric clinicians: The new biology of aging shows that aging and multiple diseases share underlying molecular causes, which has implications for diagnosis and management Basic scientists lack knowledge of clinically relevant outcomes and clinicians may doubt the value of basic biology or lack the time to learn about it The field of geriatrics would benefit from universal outcomes (outcomes that are relevant across multiple diseases and reflect active life expectancy) News Flash Recent HELP publications A new meta analysis (Hshieh TT et al., JAMA IM 2015) provides evidence that multicomponent, non pharmacologic delirium prevention interventions are effective at reducing delirium incidence and preventing falls with trends toward avoiding institutionalization and decreasing length of stay. The authors of a recent article (Chen P et al., JAGS 2015) found that HELP sites use the HELP website to implement HELP; develop non HELP delirium prevention programs and guidelines; and for educational purposes, targeting healthcare professionals, patients, families, and volunteers.
PAGE 4 Hackensack UMC HELP interns, Nadine Benoit (ELS), and the Assistant Administrator of Care One Updates from HELP sites Hackensack University Medical Center Nadine Benoit, ELS, and her team at Hackensack University Medical Center are piloting a joint venture with Care One Ridgewood Avenue Rehabilitation Center. HELP summer interns will be assigned a weekly shift at Care One in addition to their shifts at Hackensack UMC. The program at the rehabilitation facility will mirror the program at Hackensack UMC. Volunteers will provide therapeutic activities, orienting conversation, feeding assistance, and mobility interventions. They hope to follow patients that have been discharged from Hackensack UMC and then admitted to the sub acute facility. They will be conducting patient satisfaction surveys at Care One. If the program is a success, the rehabilitation facility hopes to start their own HELP program in the near future. Thunder Bay Regional Kudos! HELP at Thunder Bay Regional is 9 months into its service and going strong. They are seeing 14 18 patients daily on 2 medical units with a team of 45 skilled volunteers. In May 2015, HELP at Thunder Bay Regional took part in the filming of CBC s documentary series titled Keeping Canada Alive. HELP at Thunder Bay was chosen among a variety of other healthcare programs across the country to show the many services that are in place to assist in keeping Canada healthy. The series is set to air in September 2015. HELP volunteers and staff nurses at Trinitas with Hannah Banana Bags Trinitas Regional Medical Center At Trinitas Regional Medical Center, HELP volunteers and staff nurses are handing out Hannah Banana Bags from the Hannah Banana Foundation, which contain adult coloring books, markers, a word search book, a note pad and pen, and a deck of cards. Local high school students work with patients every few months to create a seasonal craft. Trinitas has started using audio readers for patients with vision impairments. The reader can download most books and magazines and will read them at whatever pace the patient is comfortable with. Trinitas also requested and received makeup from a major makeup company which is a huge pick me up for some of the ladies in their HELP program.
University of Michigan The University of Michigan HELP program has grown from having eight volunteers Monday through Friday to 72 volunteers who work all seven days. They have also added another unit for a total of six units (approximately 190 beds). The increase in the number of volunteers committing to one year allowed them to expand their program and serve more patients. University of Utah HELP volunteer Brittany Lo graduated this May from the University of Utah's College of Nursing with a Bachelor s degree in Nursing. For her nursing capstone project she created an informational poster on HELP for nursing staff on the Surgical Specialty and Transplant Unit (SSTU). Her objective was to improve HELP volunteer and nursing staff communication by increasing nursing staff s awareness of HELP. Brittany was awarded a Hartford Center of Geriatric Nursing Excellence Award for Outstanding Poster. Although she has been accepted into the Doctor of Nursing Practice program, Brittany has decided to postpone graduate school and has accepted a job offer to work as a nurse on the SSTU, where she intends to continue as a HELP champion promoting awareness of HELP among nursing staff and improving communication between nurses and HELP volunteers. UPMC Shadyside PAGE 5 Patient Voices When I was first admitted to the hospital, I didn t think I was getting out of here on my own will. The HELP program was a blessing, and is the reason I am going home today. 95 year old patient from Thunder Bay Regional HELP at UPMC Shadyside recently hosted a graduate physiotherapy student from Monash University Hospital in Melbourne, Australia. Alethea Ang is conducting a research study as part of her Master s program. The study is titled The barriers and facilitators of functional maintenance programs for hospitalized older adults. Ms. Ang spent 3 days at UPMC Shadyside, observing all aspects of HELP, including shadowing a HELP volunteer. Prior to her visit to Pittsburgh, Ms. Ang visited a pilot HELP site in Taiwan. I came from Australia to learn about how to improve care for the hospitalized elderly and was very inspired by the passion, dedication and efficiency of everyone that I met in the team. The visit was so well organized and the team was very patient with teaching me about the core aspects of the program that make it so successful. I've come away with fresh ideas and greater enthusiasm to improve the care for elderly patients at my hospital back in Australia. To the HELP Team at Shadyside, keep up the fantastic work that you're doing and thank you for having me. HELP Shadyside volunteer Heather Barfield (L) and Alethea Ang (R)
Editors: Shin Yi Lao and Asha Albuquerque Visit our website at www.hospitalelderlifeprogram.org Contact us at elderlife@hsl.harvard.edu HELP Presentations at the 2015 NICHE Conference April 14 17 in Orlando, FL How Education Improves Delirium Outcomes: Christine Bradley, MSN, RN, CNL, AGPCNP BC; Rita Leinheiser, MA, ELS; Jaspreet Virdi, MD, Abington Health The Impact of the Hospital Elder Life Program (HELP) on Patient, Operational, and Staff Outcomes: Laura Shanks, MSN, MHA, RN BC, ACNS BC; Susan Heisey, MSW, LCSW, ASW G, Inova Mount Vernon Hospital Successful Integration of HELP Within ACE and NICHE Units: Christine Wallis MS, RN, CCRN; Danielle Zamani RN, Aurora Health Care Wii Can Too! Using Interactive Gaming Technology with Hospital Elder Life Program Patients to Prevent Cognitive Impairment and Functional Decline: Megan Wheeler, MSN, RN, ACNS BC; Janice F. Moore, PhD, CFLE, Baylor Scott & White Health Article Summary: Doing damage in delirium - The hazards of antipsychotic treatment in elderly people Jonny Macias, MD, HELP Fellow In the article Doing damage in delirium: The hazards of antipsychotic treatment in elderly people (Inouye, Marcantonio, Metzger, 2014) the authors discuss the dangers of using antipsychotic medications to treat delirium in older adults. Occurring in up to 50% of hospitalized older adults, delirium is costly and associated with poor outcomes. Patients may experience behavioral disturbances such as agitation, inappropriate behavior, delusions, and hallucinations. These behavioral manifestations can cause distress to patients and families and potentially affect the care and safety of hospitalized older adults. Clinicians and researchers are starting to focus on antipsychotics to prevent and treat delirium as evidenced by the significant increase in the number of studies in this area over the last 20 years. Current evidence for the benefit of antipsychotics in delirium is inconsistent. Systematic literature reviews have shown conflicting results, small sample sizes, high risk of bias, and inaccurate measurements in current studies. A clinician may see antipsychotics as a quick and easy treatment for a patient with hyperactive delirium without realizing the potential adverse side effects linked to these drugs in vulnerable hospitalized older adults. Common side effects of antipsychotics are due to anticholinergic activity and alpha receptor blockade and include confusion, cognitive and functional decline, sedation, hypotension, falls, and urinary incontinence. Extrapyramidal effects, dysphagia, QT prolongation, and ventricular arrhythmias have also been associated with antipsychotic use. Another danger is the inadvertent chronic administration of antipsychotics that are initiated in the hospital. Fragmented care across different providers and care settings exacerbates this problem. It is also concerning that patients with delirium may have underlying dementia, which is associated with a substantially increased risk for side effects with antipsychotic use. The use of antipsychotics should be reserved for patients with severe agitation or distress that interrupts essential medical therapy or endangers patient safety. When prescribed, the therapy must be moni tored closely and prescribed at the lowest effective dose for the shortest possible duration. Delirium is a complex condition that requires interdisciplinary expertise to prevent and treat. Addressing reversible contributors is key when managing delirium followed by a careful assessment of medications, focusing on psychoactive drugs that can cause oversedation or anticholinergic side effects. Nonpharmacologic strategies such as the Hospital Elder Life Program have been shown to be effective for the prevention and management of delirium without the use of physical or chemical restraints. Large scale efforts will be required to reduce the use of antipsychotics for delirium. This may include educating healthcare professionals, incentives against prescribing, and changing physician order entry systems. Reference: Inouye SK., Marcantonio ER., & ED Metzger. (2014). Doing damage in delirium: the hazards of antipsychotic treatment in elderly people. Lancet Psychiatry, 1, 312 315.