Geriatric care model centers on nurse leadership

Nurse Leader Insider, July 19, 2012

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Alexandra Wilson Pecci, for HealthLeaders Media, July 17, 2012

Once again, a nurse-led program is proving to be a model for hospitals that want to improve healthcare quality.

A study from Johns Hopkins University School of Medicine, which examined the early results of the Medicare Innovations Collaborative, suggests that the Nurses Improving Care to Healthsystem Elders (NICHE) program could be an effective model for improving hospital quality and safety for older adults.

The Medicare Innovations Collaborative is currently working with six health systems to test innovative programs that aim to improve care for Medicare patients with multiple chronic conditions.

One of those programs is NICHE, which provides clinical and organizational tools to improve hospital care of older patients. The program aims to add geriatric-specific equipment, supplies, and other resources to the nurses' practice. It also implements protocols and techniques that promote interdisciplinary collaboration.

Advancing nurses' knowledgeand encouraging leadership is at the program's heart. Hospitals that implement NICHE appoint a geriatric resource nurse (GRN) who becomes a leader for other nurses on the unit. GRNs receive specialized education about nursing care of older adults, as well as ongoing mentorship and clinical support from advance practice nurses and an interdisciplinary team.

Their training involves identifying and addressing specific geriatric issues, such as falls and confusion, as well as learning how to implement individualized care strategies that discourage the use of restrictive devices and promote patient mobility.

The GRNs also pay their knowledge forward: They're the go-to clinical point persons when nurse colleagues encounter geriatric issues.

According to the Medicare Innovations Collaborative, NICHE helps hospitals achieve reductions in complications such as falls, incontinence, medication errors, and pressure ulcers. It also helps to improve in nursing retention and satisfaction.

Of course, NICHE isn't the only answer for hospitals that are seeking to improve elder care, and the Johns Hopkins study actually aimed to find out whether hospitals could implement different geriatric health care delivery models simultaneously.

All of the hospitals and health systems included in the study already had one of the Medicare Innovations Collaborative models in place, and each was required to implement another one.

The researchers found that organizations "did, in fact, adopt and implement multiple complex care models simultaneously; that these care models were appropriately integrated and adapted so as to enhance their adoptability within the hospital or health care system; and that these processes occurred rapidly, in less than one year."

"Over the years, many evidence-based models of geriatric care have been developed, but few have been widely implemented. Our study developed the theory that putting multiple geriatric models into a geriatric service line or 'portfolio,' and providing technical assistance to an adopting organization in a learning collaborative, would make these models attractive for adoption by health systems from both a clinical and economic standpoint," lead researcher, Bruce Leff, MD, a professor of medicine at the Johns Hopkins University School of Medicine, said in a statement.

"We are hoping to turn the participating health systems involved in this study into expert centers to provide technical assistance to more health systems to adopt the models, and working to expand beyond the hospital to include post-acute and ambulatory areas."

In the meantime, hospitals without such models in place might look to the programs being studied by the Medicare Innovations Collaborative for inspiration, and for nurse leaders, NICHE sounds like a great place to start.

Source: HealthLeaders Media

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