Providing “Exemplar” Safer Elder Care

Oakville Trafalgar Memorial Hospital institutes NICHE program for Geriatric Patients

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Providing “Exemplar” Safer Elder Care
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Suzanne Hallsworth

Suzanne Hallsworth

Suzanne Hallsworth is the Director of Community Giving & Communications for the Oakville Hospital Foundation since January 2011. Suzanne was previously the Director of Marketing and Communications for the Credit Valley Hospital Foundation.

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Mr. Glasbey sits safely secured in his wheelchair on his care unit at Oakville Trafalgar Memorial Hospital (OTMH) actively watching the hallway activity in front of the nursing station. Mr. Glasbey is an elderly patient who arrived in hospital with delirium three months ago, confused, combative and very agitated. Today he is very calm and content, as he patiently waits for a volunteer to take him to the recreational area where he looks forward to playing some games.

Halton Healthcare Services (HHS) has made great strides in developing a culture of care that is sensitive to the unique needs of its geriatric patient population. What started out as a delirium prevention initiative in 2007 quickly evolved into a comprehensive and extremely successful Safer Elder Care Program; one that has since been recognized both nationally and internationally.

“More than half of our patients are over the age of 65 and as such, face a variety of health risks specific to elders,” explains Kim Kohlberger, HHS Program Director, Rehabilitation and Geriatrics. “We wanted to focus on the unique and complex needs of our elderly population so we partnered with NICHE (Nurses Improving Care for Healthsystem Elders), an internationally renowned geriatric program, designed to help hospitals improve the care of older adults. In 2009, our three community hospitals were the first in Ontario to achieve a NICHE designation.”

Since then, HHS established a Safer Elder Care steering committee and successfully implemented a wide range of clinical assessment tools, management protocols and best practices including delirium prevention and management strategies and a comprehensive falls prevention program. In addition, HHS developed a strong network of Elder Care Mentors and Champions among its frontline interdisciplinary staff.

“More than half of our patients are over the age of 65 and as such, face a variety of health risks specific to elders,” explains Kim Kohlberger, HHS Program Director, Rehabilitation and Geriatrics.

NICHE arms nurses with the tools and educational training to promptly detect and treat common and interrelated geriatric problems such as depression, immobility or urinary tract infections that can often result in the onset of delirium, so they can quickly intervene and prevent a patient’s further health decline,” continues Ms. Kohlberger. “The adoption of the NICHE Program sets a new mindset in motion throughout our hospitals which has resulted in more geriatric sensitive care, better outcomes and greater satisfaction for patients and their families. It has allowed us to create a more senior friendly environment.”

Since NICHE was introduced, HHS nurses have acquired a better understanding of how the elderly population can be affected by their hospital stay.

“Working together proactively to keep this population safe is always in the forefront of our minds. We keep a close watch on their medications as some can cause confusion or dizziness. We are also on guard for potential falls and any sudden changes in behavior that might signal the onset of delirium,” explains Kristin Yarnell, HHS Registered Nurse. “Keeping them well-hydrated, establishing a regular routine with physical movement and lots of activities to keep their minds active is essential in preventing delirium and functional decline.”

Mr. Glasbey’s son, Bob, attributed his dad’s progress to the geriatric centred culture of care on the unit.

“The nurses have taken great care of my dad over these past few months, always treating him with patience, compassion and respect, despite his many frequent outbursts. They are sensitive to his needs and are constantly looking out for him, offering him fluids, making sure he has all his personal things, securing him in bed or his chair with a falls alarm and making sure that he is comfortable and engaged. My dad really feels at home here,” explains Bob. “The healthcare team has also been very good about keeping our family updated on my dad’s progress and they’ve even taken the time to teach us how to take care of him.”

HHS’ Safer Elder Care Program was designated as a Leading Practice by Accreditation Canada in 2010, and most recently, the corporation achieved the NICHE Exemplar status in both 2013 and 2014.

“Exemplar status, the highest of four possible program levels, recognizes your facility’s ongoing, high-level dedication to geriatric care,” stated Barbara Bricoli, NICHE Executive Director and Linda Bub, NICHE Director, Education and Program Development, in their congratulatory letter. “…The NICHE designation and the “Exemplar” status signal your organization’s resolve to provide outstanding patient-centred care for older adults.”

“Working together proactively to keep this population safe is always in the forefront of our minds. We keep a close watch on their medications as some can cause confusion or dizziness. We are also on guard for potential falls and any sudden changes in behavior that might signal the onset of delirium,” explains Kristin Yarnell, HHS Registered Nurse.

More About NICHE:

NICHE (Nurses Improving Care for Healthsystem Elders) is an international program of the Hartford Institute of Geriatric Nursing at the New York University College of Nursing designed to help hospitals improve the care of older adults. Its mission is to provide principles and tools to help healthcare facilities achieve exemplary patient-centred care for older adults. Based at New York University College of Nursing, NICHE consists of 575 hospitals and healthcare facilities throughout North America. For more information, visit www.nicheprogram.org

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