Download Care of Older Adults at JMH

Care of Older Adults at JMH
October 9th, 2012
Facilitator: Patrick Watson, Interim Sr. VP of Care
Coordination and Integration
Agenda
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Care of Hospitalized Older Adults
CHF * Chest Pain * Cardiac Rehab
Break
Diabetes Education, Inpatient and Outpatient
Discharge Process
Lunch
Afternoon at JMH Physician Network
Disease Management/ Medical Home
Home Health
Senior Services
Women’s Health Center * Community Health
John Muir Health – proprietary and confidential
About Us
Our Mission
We are dedicated to
improving the health of
the communities we serve
with quality and
compassion.
Our Vision
We will exceed our
patients' expectations for
seamless, consistently
positive experiences with
all aspects of John Muir
Health.
Programs and Services
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Cancer Institute
Cardiac Rehabilitation
Cardiovascular Institute
Certified Stroke Center
CHF Clinic
Chest Pain Program
Continence Program
Diabetes Center
Health & Wellness
Health Education Classes
Medical Home
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Neuroscience Institute
Occupational Health
Palliative Care
Pulmonary Rehabilitation
Rehabilitation Services
Senior Services
Transforming Chronic Care
Case Management
• Women’s Health Center
• Wound Care Center
http://www.johnmuirhealth.com/index.php/services.html
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John Muir Health – proprietary and confidential
Awards
• Ranked one of the nation’s top hospitals by U.S. News & World Report
for the fourth consecutive year
• Named one of nation’s top 51 health systems for clinical quality and
safety by Thomson Reuters
• Both of our hospitals, Walnut Creek and Concord have earned Magnet status. We
are two of four hospitals in N. CA earning this distinction. The Magnet Recognition
Program® recognizes health care organizations that demonstrate excellence and
adherence to national standards for the delivery of nursing services
• HealthGrades study denotes both our hospitals for the “Distinguished
Hospital Award for Clinical Excellence.” We were two of three hospitals
in the Bay Area.
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John Muir Health – proprietary and confidential
Definition of an Elder Friendly Health System
 Responsive to developmental needs of older adults
 Holistic focus combining a gerontological developmental
approach with a diagnostic approach to care
 Care is patient and family centered
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John Muir Health – proprietary and confidential
Four Dimensions of an
Elder Friendly Health System
1. Physical Design / Environment
2. Social Behavioral Climate
3. Policies and Procedures
4. Services, Care Systems and Processes
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John Muir Health – proprietary and confidential
Elder-Friendly Care in the Hospital
Why focus on older adults?
• Population growth of those >65 yrs old
• Improving quality care to geriatric patients identified as
health system strategic initiative
• Gain community recognition as an elder-friendly health
system
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John Muir Health – proprietary and confidential
Elder-Friendly Care
in the Hospital
Why focus on older adults?
• Complexity of care
• Geriatric Syndromes
• Fast paced Health Care
Environment
• Educational needs of nursing and
medical staff
Elder-Friendly Care in the Hospital
For the Patient
Each patient is a unique individual and should be evaluated
as such:
– Assessment process
– Outside of acute care setting
– Patient’s baseline function
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John Muir Health – proprietary and confidential
Elder-Friendly Care in the Hospital
For the Staff
• Nurses demonstrate clinical competence in geriatric nursing
• Nurses Improving Care for Health System Elders (NICHE)
Geriatric Resources Nurse (GRN)
Acute Care of the Elderly unit (ACE)
• Certification in Geriatric Nursing is encouraged and supported
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John Muir Health – proprietary and confidential
Elder-Friendly Care in the Hospital
For the Staff
SPICES
• Sleep
• Problems with eating or feeding
• Incontinence
• Confusion
• Evidence of Falls
• Skin
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John Muir Health – proprietary and confidential
Elder-Friendly Care in the Hospital
For the Staff
Excellent communication that is
tailored to meet the needs of
the geriatric patient:
•Age sensitivity training
• Keeping the patient
and family informed
•Case Management role
• Interdisciplinary
contribution
Elder-Friendly Care in the Hospital
For the Staff
The organization provides resources that support best practice in
geriatric nursing care
• Geriatric Clinical Nurse Specialist (CNS)
• Geriatric Resource Team
• Palliative Care
• Volunteer Program
• Music and Pet Therapy
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John Muir Health – proprietary and confidential
Elder-Friendly Care in the Hospital
For the Environment
The physical environment supports the needs of the geriatric patient
and family and staff
– Hearing Enhancers
– White Boards
– Clocks
– Chairs with arms
– Bed and chair alarms
– Walkers, commodes
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John Muir Health – proprietary and confidential
Elder-Friendly Care in the Hospital
The elder-friendly environment is embraced hospital-wide:
• Older adults identified as one of the communities we
serve
• The Geriatric Resource Team (GRT) provides input to
senior leadership regarding care of geriatric patients
• Goal is for education regarding the needs of the older
patient be provided to all staff
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John Muir Health – proprietary and confidential
Stroke Program at JMH
• Joint Commission: Disease Specific Certification
• Concord and Walnut Creek awarded certification – 2005
• On-site Review every 2 years
• Follows National Patient Safety Goals
• Stroke Program Awards
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John Muir Health – proprietary and confidential
Admission Protocols
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Stroke/TIA Admission Orders
ICH Admission Orders
Neurosurgical Orders ( WC campus only)
Stroke units at both campuses
Nurses required to have 8 hours Stroke Education/Year
Critical Care post tPA: minimum 24 hours
Rehabilitation initiated
Patient Care standardized to prevent complications
Discharge Planning
John Muir Health – proprietary and confidential
Multi-Disciplinary Stroke Rounds
• Neurologist
• Stroke Unit Nursing
• Rehabilitation Services: PT, OT, Speech
• Acute Rehab Referral
• Case Management
• Dietician
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John Muir Health – proprietary and confidential
Stroke Education
• Teach Signs and Symptoms of Stroke
• Call 911 if stroke symptoms return, not their MD
• Review risk factors of stroke; recommend lifestyle
changes
• Review medications and why important to continue
• Smoking cessation, if indicated
• Follow-up Appointments:
– Physicians
– Rehabilitative services
– Lab or Diagnostic Testing
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John Muir Health – proprietary and confidential
In-Patient Acute Stroke
• New onset of Neurological Symptoms:
• Last Known Normal is < 6 hours
• Call:
• Rapid Response Team
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John Muir Health – proprietary and confidential
An elder friendly
health system is
.....
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John Muir Health – proprietary and confidential