- Email: [email protected]
Dementia
Geriatric Nursing 34 (2013) 86e87
Contents lists available at SciVerse ScienceDirect
Geriatric Nursing journal homepage: www.gnjournal.com
NICHE Section
NICHE Solutions e second in a series: Focus on Delirium/Dementia Barbara Bricoli, MPA Nurses Improving Care for Healthsystem Elders, NICHE, New York, University College of Nursing, New York, NY, USA
In the previous issue we introduced the NICHE (Nurses Improving Care for Healthsystem Elders) Solutions Series, success stories based on initiatives developed and tested by NICHE hospitals on the successful application of best practice solutions related to NICHE Clinical Improvement Models and other NICHE resources. Solutions stories are published in both printed format and on the NICHE website. Developed in collaboration with NICHE designated hospitals, the series covers a wide range of clinical and organizational topics. In this second entry, a selection of success stories from the Delirium/Dementia section of the Solutions library is highlighted. Solutions are also available for these other geriatrics-related categories: Catheters, Emergency Department, Environment, Function/ Falls, Geriatric Patient Care Associates, Integrated System Implementation, Medication, Nutrition/Elimination, and Patient/Family Education. New Solutions stories and categories are constantly being added. 1. Delirium/Dementia Delirium is a common syndrome in hospitalized older adults and one of the major contributors to poor outcomes of health care and institutionalization for older patients.1 Delirium has been shown to be preventable by identifying modifiable risk factors and utilizing a standardized nursing practice protocol2 and involving a geriatric specialist.3 If delirium does develop, early recognition is of paramount importance in order to treat the underlying pathology and minimize delirium’s sequelae. Nurses play a key role in both the prevention and early recognition of this potentially devastating condition in older hospitalized adults.2
Clinical Nurse Specialist, Bronson Methodist Hospital, Kalamazoo, Michigan. PROBLEM: Hospitalization is stressful for older adult patients and can lead to severe anxiety and increased cognitive impairment in patients with dementia. SOLUTION: Social interaction and activity via the Best FriendsÔ Approach can allay anxiety and stress. 3. Solution No. 5 Title: Reducing Delirium with a Team Approach. Author: Cathy Hebert, RN, GCNS-BC, Mission Hospital, Asheville, North Carolina. PROBLEM: Delirium has become a major medical crisis facing the older adult patient. SOLUTION: Reduce the incidence of delirium and improve the recognition/diagnosis of delirium through the use of nationally recognized best practices embedded in the electronic medical record. 4. Solution No. 8
2. Solution No. 2
Title: Patient Activity Cart (PAC) for Better Care. Author: Tyleen Smith, BSN, RN, Clinical Manager, ACE Senior Specialty Unit, Saint Francis Hospital, Tulsa, Oklahoma. PROBLEM: Nursing staff was challenged in their efforts to provide care to patients experiencing cognitive impairment, including delirium. SOLUTION: A Patient Activity Cart (PAC) that provides cognitively impaired patients with diversion and comfort. The PAC was incorporated into a multi-faceted delirium protocol that included a delirium order set, educational program for staff, and communication processes.
Title: Collaborating to Provide a Best FriendsÔ Approach to Hospitalized Patients. Author: Rita LaReau, MSN, GNP, BC, Geriatric
5. Solution No. 23
E-mail address: [email protected]. 0197-4572/$ e see front matter Ó 2013 Mosby, Inc. All rights reserved. http://dx.doi.org/10.1016/j.gerinurse.2012.12.004
Title: A Nursing and Occupational Therapy Collaboration to Improve Delirium Care. Authors: Suzanne Brown, OTRL; Barbara
NICHE Section / Geriatric Nursing 34 (2013) 86e87
Forloney, RN, MS; Erin Gallant, OT; Lois Ginsberg, RN, MS; Joseph Gordon-Reznar, RN, MPA; Karen Joost, RN, MS; Lisa Poncin, RN, BSN; Martha Watson, RN, MS, The Miriam Hospital, Providence, Rhode Island. PROBLEM: Delirium was negatively impacting a high percentage of the older adult patients at the Miriam Hospital. SOLUTION: A multidisciplinary protocol that included prevention, detection, and management of delirium improved clinical and financial outcomes.
87
References 1. Siddiqi N, House AO, Holmes JD. Occurrence and outcome of delirium in medical in-patients: a systematic literature review. Age Ageing. 2006;35:350e364 [Evidence Level V]. 2. Milisen K, Lemiengre J, Braes T, Foreman MD. Multicomponent intervention strategies for managing delirium in hospitalized older people: systematic review. J Adv Nurs. 2005;52:79e90 [Evidence Level V]. 3. Siddiqi N, Stockdale R, Britton A, Holmes J. Interventions for preventing delirium in hospitalized patients. Cochrane Database Syst Rev 2007;(2):CD005563 [Evidence Level I].
Contents lists available at SciVerse ScienceDirect
Geriatric Nursing journal homepage: www.gnjournal.com
NICHE Section
NICHE Solutions e second in a series: Focus on Delirium/Dementia Barbara Bricoli, MPA Nurses Improving Care for Healthsystem Elders, NICHE, New York, University College of Nursing, New York, NY, USA
In the previous issue we introduced the NICHE (Nurses Improving Care for Healthsystem Elders) Solutions Series, success stories based on initiatives developed and tested by NICHE hospitals on the successful application of best practice solutions related to NICHE Clinical Improvement Models and other NICHE resources. Solutions stories are published in both printed format and on the NICHE website. Developed in collaboration with NICHE designated hospitals, the series covers a wide range of clinical and organizational topics. In this second entry, a selection of success stories from the Delirium/Dementia section of the Solutions library is highlighted. Solutions are also available for these other geriatrics-related categories: Catheters, Emergency Department, Environment, Function/ Falls, Geriatric Patient Care Associates, Integrated System Implementation, Medication, Nutrition/Elimination, and Patient/Family Education. New Solutions stories and categories are constantly being added. 1. Delirium/Dementia Delirium is a common syndrome in hospitalized older adults and one of the major contributors to poor outcomes of health care and institutionalization for older patients.1 Delirium has been shown to be preventable by identifying modifiable risk factors and utilizing a standardized nursing practice protocol2 and involving a geriatric specialist.3 If delirium does develop, early recognition is of paramount importance in order to treat the underlying pathology and minimize delirium’s sequelae. Nurses play a key role in both the prevention and early recognition of this potentially devastating condition in older hospitalized adults.2
Clinical Nurse Specialist, Bronson Methodist Hospital, Kalamazoo, Michigan. PROBLEM: Hospitalization is stressful for older adult patients and can lead to severe anxiety and increased cognitive impairment in patients with dementia. SOLUTION: Social interaction and activity via the Best FriendsÔ Approach can allay anxiety and stress. 3. Solution No. 5 Title: Reducing Delirium with a Team Approach. Author: Cathy Hebert, RN, GCNS-BC, Mission Hospital, Asheville, North Carolina. PROBLEM: Delirium has become a major medical crisis facing the older adult patient. SOLUTION: Reduce the incidence of delirium and improve the recognition/diagnosis of delirium through the use of nationally recognized best practices embedded in the electronic medical record. 4. Solution No. 8
2. Solution No. 2
Title: Patient Activity Cart (PAC) for Better Care. Author: Tyleen Smith, BSN, RN, Clinical Manager, ACE Senior Specialty Unit, Saint Francis Hospital, Tulsa, Oklahoma. PROBLEM: Nursing staff was challenged in their efforts to provide care to patients experiencing cognitive impairment, including delirium. SOLUTION: A Patient Activity Cart (PAC) that provides cognitively impaired patients with diversion and comfort. The PAC was incorporated into a multi-faceted delirium protocol that included a delirium order set, educational program for staff, and communication processes.
Title: Collaborating to Provide a Best FriendsÔ Approach to Hospitalized Patients. Author: Rita LaReau, MSN, GNP, BC, Geriatric
5. Solution No. 23
E-mail address: [email protected]. 0197-4572/$ e see front matter Ó 2013 Mosby, Inc. All rights reserved. http://dx.doi.org/10.1016/j.gerinurse.2012.12.004
Title: A Nursing and Occupational Therapy Collaboration to Improve Delirium Care. Authors: Suzanne Brown, OTRL; Barbara
NICHE Section / Geriatric Nursing 34 (2013) 86e87
Forloney, RN, MS; Erin Gallant, OT; Lois Ginsberg, RN, MS; Joseph Gordon-Reznar, RN, MPA; Karen Joost, RN, MS; Lisa Poncin, RN, BSN; Martha Watson, RN, MS, The Miriam Hospital, Providence, Rhode Island. PROBLEM: Delirium was negatively impacting a high percentage of the older adult patients at the Miriam Hospital. SOLUTION: A multidisciplinary protocol that included prevention, detection, and management of delirium improved clinical and financial outcomes.
87
References 1. Siddiqi N, House AO, Holmes JD. Occurrence and outcome of delirium in medical in-patients: a systematic literature review. Age Ageing. 2006;35:350e364 [Evidence Level V]. 2. Milisen K, Lemiengre J, Braes T, Foreman MD. Multicomponent intervention strategies for managing delirium in hospitalized older people: systematic review. J Adv Nurs. 2005;52:79e90 [Evidence Level V]. 3. Siddiqi N, Stockdale R, Britton A, Holmes J. Interventions for preventing delirium in hospitalized patients. Cochrane Database Syst Rev 2007;(2):CD005563 [Evidence Level I].