Towards a hospitalbroad approach of frail older patients / Senior Friendly Hospital 06.12.2011 Herbert Habets Geriatric Clinical Nurse Specialist / Nurse Scientist Orbis Medisch Centrum, Sittard – Geleen Seniorlecturer, Zuyd University, Heerlen
Initiatives in the Netherlands / Europe - DEFENCE Study Amsterdam www.effectieveouderenzorg.nl - VMS National Safety Program www.vmsveiligheid.nl - National Program Elderly Care - European Nursing Academy for Care of Older persons (ENACO)
• “Silver or Grey Hospitals” • 31% of the patients in het OMC is 70 years or older (Netherlands: main 25%) -2010• The number of frail older patients is growing: 40% of the admitted 70+ patients can be regarded as frail • Frail older patients: - Senior Friendly Hospital concept -
Seniorfriendly Hospital Concept (Parke et al, 2004)
Intregrated Hospitalbroad approach of frailty: 5 C’s (Habets, 2009)
Complication
Coach and
prevention
Familycare
Continuïty Of care
Construction (building)
Communication
Construction:
The building and older patients
Translation and use of the Code Plus (Parke & Friesen, 2007)
■
Use of technology: fall prevention infra red sensors
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Use of technology useful for meaningful activities of older people admitted to the hospital?
Complication prevention
1. Screening Frailty
The ‘Groningen Frailty Indicator (GFI)’ is hospitalbroad integrated in the OMC in the digital nursing assessment Acute hospital admissions and elective planned admissions (Pré Surgical Screening) Each day a hospitalbroad overview of all 70+, newly admitted with a GFI≥4 GFI ≥4: pro-active assessment (CGA) of a geriatric consultation team geriatrie aimed at complicationprevention (VMS) Complicatiepreventie Orbis Medisch Centrum
Complicatiepreventie Orbis Medisch Centrum
Overview Frail Older Patients Orbis Medisch Centrum 2010 total amount admitted patients (70+):
total amount 70+ / assessment: total amount frail older patients: total amount TP1 consultations: Complicatiepreventie Orbis Medisch Centrum
6033 5829 (96%) 2393 (39%) 700 (30%)
Screening: actual facts
Since spring 2011 digital hospitalbroad screening:(VMS, Inspectie): Deliriumrisk Fall risk Malnutrition Risk functional decline bij adding screening questions in the nursing assessment Complicatiepreventie Orbis Medisch Centrum
DELIRIUM OBSERVATIE SCREENING (DOS) SCHAAL (versie 0 - 1) datum: naam patiënt:
dag dienst
late dienst
nacht dienst
nooit
soms - altijd
weet niet
nooit
soms - altijd
weet niet
nooit
soms - altijd
weet niet
0
1
-
0
1
-
0
1
-
is snel afgeleid door prikkels uit de omgeving
0
1
-
0
1
-
0
1
-
heeft aandacht voor gesprek of handeling
1
0
-
1
0
-
1
0
-
4
maakt vraag of antwoord niet af
0
1
-
0
1
-
0
1
-
5
geeft antwoorden die niet passen bij de vraag
0
1
-
0
1
-
0
1
-
6
reageert traag op opdrachten
0
1
-
0
1
-
0
1
-
7
denkt ergens anders te zijn
0
1
-
0
1
-
0
1
-
8
beseft wel welk dagdeel het is
1
0
-
1
0
-
1
0
-
9
herinnert zich recente gebeurtenis
1
0
-
1
0
-
1
0
-
10
is plukkerig (frommelen lakens, kleding, …), rommelig, rusteloos
0
1
-
0
1
-
0
1
-
11
trekt aan infuus, sonde, catheter enz.
0
1
-
0
1
-
0
1
-
12
is gemakkelijk of plotseling geëmotioneerd
0
1
-
0
1
-
0
1
-
13
ziet/hoort dingen die er niet zijn
0
1
-
0
1
-
0
1
-
OBSERVATIES De patiënt:
1
zakt weg (in slaap dommelen) tijdens gesprek of bezigheden
2
3
TOTAAL SCORE PER DIENST (0 - 13)
DOS SCHAAL EINDSCORE = TOTAAL SCORE DEZE DAG / 3
TOTAAL SCORE DEZE DAG ( 0 - 39)
Detection of frailty and risk Complications
Example of a nursing assessment
2. Comprehensive Geriatric Assessment
Disciplines: nurse, geriatrician, fysiotherapist, occupational therapist Analyse and Advice
Frail older patients in the Orbis Medical Centre
Complicatieprevention:
GFI - Score ≥ 4 Frail older patient
Delirium Prevention
Fall Prevention
Functional Decline
Medication
Malnutrition
3. Interventions: TOOLBOX – – – – – –
Senior Friendly Hospital, Frailty Delirium Falls Malnutrition Functional Decline Pain
Small booklet Integrated in digital nursing system E-learning / intranet
Interventions: findings
Few advices Practical advices
Automatic generation of advices when a patient is at risk 5 practical advices for patients and family (selfmanagement) Geriatric Resource Nurse on specific wards
Choice of multifactorial interventions
An concrete example :
- Coach and Familycare: Familymembers are invited to stay with the patients, rooming in option (deliriumprevention)
Continuïty of care / transition
Model of transition preparation for frail older patients Advice 2012
Communication and Older People
Participation of students in innovative projects as: Preparation of discharge Toolbox-design Winter 2011 – 2012: Activities of older patients admitted to the OMC (MINOR ‘Growing Older: designing your own future’)
