How to Get There: A Regional Approach to Senior Friendly Hospitals Kathleen Graham RN MN CHE VP Pati

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How to Get There A Regional Approach to
Senior Friendly HospitalsKathleen Graham RN
MN CHEVP Patient Care CNOQueensway Carleton
HospitalOttawa
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Genesis of the SFH Initiative
Ottawa RGAP developed Vision for Care
Strategic Plan One of the initiatives arising
from the plan Effective efficient treatment
of the elderly in the hospital
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Implementing a Strategy for SFHs

• Steering Committee mandated by RGAC to
• Improve patient outcomes
• Reduce suboptimal use of resources
• Improve patient/family satisfaction
• Recruited a chairperson and a consultant to help
  develop a conceptual framework
• Partnered with the Council on Aging to collect
  information on the broader aspects from consumers
  providers with focus groups and a conference

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5 Major Elements and Key Questions
1. Physical Environment Is the physical
environment sensitive to the capacities of
elderly clients and visitors? 2. Emotional/Behavio
ural Environment Do the staff interact with the
elderly client in a respectful, supportive and
caring way?
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Major Elements (cont)
3. Process of Care Does the care and treatment
take into consideration research and evidence
regarding the physiology and pathology of aging
as well as the social science research? Is the
knowledge gained through orientation and
education translated into practice?
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Major Elements (cont)
4. Organizational Support Does the organization
show its support for being a senior friendly
hospital in its organizational structures and
processes? 5. Ethics in Clinical Care and
Research Do care providers, researchers and
others ensure that ethical issues are fully
addressed with elderly clients or research
subjects?
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Senior Friendly HospitalMajor Elements
Process of Care

• Assessment and diagnosis with special emphasis
  on age related changes
• Planning emphasis on avoiding hazards of
  hospitalization
• Implementation-use of aids to compensate for
  sensory losses
• Evaluation - consider response to
  hospitalization, impact of treatment

• Emotional and Behavioural
• Environment
• Courtesy of staff
• Respect
• Information sharing and listening
• Individualized approach to each patient
• Culturally and gender sensitive

• Ethics in Clinical Care and Research
• Confirm patients understanding of informed
  consent
• Use of Advanced Directives
• Thoughtful discussion of treatment options and
  palliative care options

• Organizational Support
• Relevant policies and procedures
• Inclusion into program development
• Staff recruitment, orientation, ongoing
  education
• Membership and TOR for committees dealing with
  patient outcomes

• Physical Environment
• Visual aspects
• Physical space including external
  surfaces/crosswalks,speed bumps, sidewalks /
  grounds
• Sensory Comfort
• Furniture

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Getting StartedBuilding Organizational
Commitment
Letters to CEOs introduced the Senior Friendly
Hospital concept Extended invitation to be
involved and have a representative on the
Steering Committee Coincided with introduction
of the Accessibility Act Provided helpful
documentation Strong endorsement received from
local and Ottawa Valley hospitals
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Physical Environment Criteria

• Overall Environment
• Lighting
• Noise / Sound
• Décor
• Orientation / Wayfinding

• Specific Functional Areas
• Bedrooms
• Telephone
• Light Switches
• Hallways, Waiting Rooms, Washrooms

• Safe Mobility
• Flooring
• Doors

• Other Factors
• Large print on written materials
• Hearing amplifiers for all staff
• Consider nutrition needs

• Furniture
• Tables
• Beds, and bedside tables
• Chairs

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From Theory to Practice (Embedding the
Environment Work)
Joanne OKeefe O.T. developed senior friendly
guidelines for physical environment (Geriatrics
Today, www.rgapottawa.com) Free expert
consultation for building plans St. Josephs
Buying Group Algonquin College Design Program
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Emotional Behavioural Environment
Patients and their families report a need to
improve the way we communicate and demonstrate
respect Respect/dignity is an illusive element
to measure Clustered around questions in the NRC
Hospital Patient Satisfaction Survey Patient
Satisfaction Survey Reports will inform quality
improvement Built on Accreditation Standards
Is there a correlation between the hospitals
patient satisfaction score and the checklist
score
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Merging SFH with Quality
OHA Patient Satisfaction Survey Accreditation
Standards Hospital specific indicators/balanced
score cards Best Practice Guidelines
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Building on NRC Patient Satisfaction

Process of Care

• Access
• Continuity and Transition
• Coordination of Care

• Physical Comfort
• Overall Impressions
• Additional Items

• Emotional and Behavioural Environment
• Emotional support
• Information and education
• Respect for Patient Preferences
• Involvement of Family
• Overall Impressions

Ethics in Clinical Care and Research Item not
included in NRC(Picker/Smaller World ) Patient
Survey

• Organizational Support
• Additional questions

• Physical Environment
• Amenities

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Evaluation Strategies Building on Existing Tools
Process for Comparative Analysis using OHA
Patient Satisfaction Survey Cluster items that
are most senior sensitive Analysis Dr S.
Amos-RGP and Dr. A. Brown, University of
Toronto Expected Outcomes Senior Specific
Hospital Report Card Comparison of SFH
achievement across the region and provincial
hospitals
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Comparison of Hospital Patient Satisfaction
Survey with SFH Guidelines
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Comparison of Hospital Patient Satisfaction
Survey with SFH Guidelines
Senior Friendly Guidelines
Are staffs communications senior friendly?
Information Sharing/Listening
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NRC Results
Respect for Patients Preferences 54.2 Had
enough to say about their treatment 80.1
Treated with respect/dignity Emotional Support
62.5 All Dimensions combined 47 Nurse
discussed anxieties/fears 57.9 Ease of finding
someone to talk to Information Education 64.8
All Dimensions combined Continuity
Transition 58.2 When to resume normal
activities Involvement with Family 60.9 Amount
of information given to family 62.3 Family had
enough recovery information
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SFH Dimensions of Quality
Process of Care

• Access
• Continuity and Transition
• Coordination of Care

• Physical Comfort
• Overall Impressions
• Additional Items

• Emotional and Behavioural Environment
• Emotional support
• Information and education
• Respect for Patient Preferences
• Involvement of Family
• Overall Impressions

Ethics in Clinical Care and Research Item not
included in NRC(Picker/Smaller World ) Patient
Survey

• Organizational Support
• Additional questions

• Physical Environment
• Amenities

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Other Quality Initiatives/Measures

Process of Care

• Develop and implement Senior Sensitive
  Protocols Falls, Restraints, Delirium, etc
• Adverse Events ( Encon)
• Patient / Family Comment Cards,
  Complaints/Compliments
• Utilization readmission, discharge disposition
  etc.

• Ethics in Clinical Care and Research
• Audits for informed consents
• Proportion of seniors enrolled in Research
  projects

• Emotional and Behavioural Environment
• Comment Cards, Complaints/Compliments
• Focus Groups

• Organizational Support
• Audits of Policies and Procedures to ensure
  sensitivity to seniors needs

• Physical Environment
• Adherence to Senior Friendly Guidelines
• Accessibility Working groups
• Focus Groups
• Audits

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More Evaluation Building on Existing Tools
Use other data collection tools and stratify by
age Prevalence reports Falls, Restraints,
Pressure Incidence reports Adverse
Incidents, Patient/Family Comment Cards
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Other Quality Indicators-Skin
Pressure Ulcer Prevalence (PUP) 2002 83 of
patients are at risk Of these, 65 have a
deficit in nutrition 18 prevalence rate in
ulcers Seniors represent 77 of ulcer
population 37 of ulcers develop within first 7
days after admission Average LOS 31 days vs 21
days patients with intact skin
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Other Indicators-Falls and Restraints
Falls 2003/04 Of the 2200 falls, those gt 71
yrs. experienced 41 of all falls Those gt71 yrs.
had 64 of population with moderate degree of
injury Those gt71 yrs. had 74 of serious degree
of injury Use of Restraints 2002/2003 Those gt70
yrs. represent 39.4 of population using
restraints Those gt70 yrs. 26.4 with both
physical and chemical restraints
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Care Processes

First steps Expert Panel convened Oct
03 Possible foci for care processes collated,
debated, clustered, and priorized Each member
exploring topic e.g. 3Ds Possible next
steps Use Steering Committee as focus group
Find champion(s) and support them Vision a
checklist for best processes for senior friendly
hospital care
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Where to Go From Here?

• Continue work on Conceptual Framework Elements
• Physical Environment-Completed
• Emotional/Behavioural Environment Nov03
• Care Processes-June 04
• Organizational Support- tbd
• Ethics in Clinical Care and Research-tbd
• Continue Dialogue and Education
• OHA- Toronto Nov 03
• Publication of Guidelines

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Benefits of Being Senior Friendly
W.H.O. recommends senior friendly health-care
centers Patients receive targeted approaches and
best practice care Care providers note
increased job satisfaction and morale Impacts
on patient safety and functional level (quality
and risk) Decreases LOS and cost- in human and
financial terms
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The Pitch To Boards and Administration
Seniors are 1/3 of hospital admissions but 2/3 of
days ER Readmission rates are 42 in patients gt75
years Frail elderly experience further functional
decline not related to acute episode but to
hospital practices (even when adjusted for age/co
morbidity) Frailest elderly 3 of population use
30 of health-care resources Supports
Accreditation Process Seniors are the largest
group of foundation donors
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In Closing.
Best Practice depends upon an environment where
choices are guided by clinical expertise,
developed through education, based on research,
and incorporating the wishes of seniors Success
requires building on the strengths of our
communities, leaders, care receivers and
providers We are just beginning, and would
welcome other partners
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Other Initiatives
Vancouver Island Health Authority- Elder
Friendly Hospital adopted the gerontology
perspective for all programs/services System-wide
approach-all levels and types of
staff High-risk screen at admission on all
patients Objectives Predict and prevent adverse
consequences of hospitalization Preserve
functional ability Early discharge planning and
return to the community
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Other Initiatives
Edmonton-Senior Friendly Toolkit Sponsored
by the Alberta Council on Aging Targeted the
community (retail sector) to direct changes in
facilities services Guide book,
Workshops/seminars, Presenters Kit, Tee shirts,
Stickers Senior Friendly Checkup with manual,
checklist rating scale
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Senior Friendly HospitalMajor Elements
Process of Care

• Assessment and diagnosis with special emphasis
  on age related changes
• Planning emphasis on avoiding hazards of
  hospitalization
• Implementation-use of aids to compensate for
  sensory losses
• Evaluation - consider response to
  hospitalization, impact of treatment

• Emotional and Behavioural
• Environment
• Courtesy of staff
• Respect
• Information sharing and listening
• Individualized approach to each patient
• Culturally and gender sensitive

• Ethics in Clinical Care and Research
• Confirm patients understanding of informed
  consent
• Use of Advanced Directives
• Thoughtful discussion of treatment options and
  palliative care options

• Organizational Support
• Relevant policies and procedures
• Inclusion into program development
• Staff recruitment, orientation, ongoing
  education
• Membership and TOR for committees dealing with
  patient outcomes

• Physical Environment
• Visual aspects
• Physical space including external
  surfaces/crosswalks,speed bumps, sidewalks /
  grounds
• Sensory Comfort
• Furniture

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RememberA Senior Friendly Hospital

• maintains and/or improves functional abilities
• has a safe and comfortable physical and
  emotional environment
• provides respectful and responsive care and
  services
• has staff who ask questions and listen for
  responses without making assumptions
• encourages and supports patients and families
  having input into decisions

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