NICHE Nurses Improving Care for Healthsystem Elders HARTFORD INSTITUTE FOR GERIATRIC NURSING NEW YORK UNIVERSITY COLLEGE OF NURSING NICHE Nurses Improving

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NICHE Nurses Improving Care for Healthsystem Elders HARTFORD INSTITUTE FOR GERIATRIC NURSING NEW YORK UNIVERSITY COLLEGE OF NURSING NICHE Nurses Improving Care for Healthsystem Elders HARTFORD INSTITUTE FOR GERIATRIC NURSING NEW YORK UNIVERSITY COLLEGE OF NURSING Slide 2 NICHE Nurses Improving Care for Healthsystem Elders HARTFORD INSTITUTE FOR GERIATRIC NURSING NEW YORK UNIVERSITY COLLEGE OF NURSING Our Objectives Discuss the implications of the aging population for our hospital Discuss the opportunities and resources offered by the NICHE program Slide 3 NICHE Nurses Improving Care for Healthsystem Elders HARTFORD INSTITUTE FOR GERIATRIC NURSING NEW YORK UNIVERSITY COLLEGE OF NURSING NICHE Nurses Improving Care for Healthsystem Elders NICHE is a program of the Hartford Institute at the New York University College of Nursing NICHE is the only national geriatric nursing program that addresses the needs of hospitalized older adults Currently there are approximately 300 hospitals in more than 40 states as well as Canada with NICHE designation and this number is expanding Slide 4 NICHE Nurses Improving Care for Healthsystem Elders HARTFORD INSTITUTE FOR GERIATRIC NURSING NEW YORK UNIVERSITY COLLEGE OF NURSING Why a program focused on older adults? Slide 5 NICHE Nurses Improving Care for Healthsystem Elders HARTFORD INSTITUTE FOR GERIATRIC NURSING NEW YORK UNIVERSITY COLLEGE OF NURSING Utilization of Healthcare Services While adults aged 65 years & older represent only 12% of the U.S. population, they account for: 26% of all physician office visits 35% of all hospital stays 34% of prescriptions 90% of nursing home use In 2003, $329 billion or 44% of national hospital bill Reference: Hing, E., Cherry, D.K., Woodwell, B.A. (2006). National Ambulatory Medical Care Survey: 2004 Summary. Advance data from vital and health statistics; no 374. Hyattsville, MD: National Center for Health Statistics. Merrill, C.T. & Elixhauser, A. (2005). Hospitalization in the U.S., 2002: HCUP fact book No. 6. Rockville, MD: AHRQ. Jones, A. (2002) The National Nursing Home Survey: 1999 Summary. Hysattsville, MD: National Center for Health Statistics. Families USA. (2000). Cost overdose: Growth in drug spending for the elderly, 1992-2010. Washington, DC: Families USA. Russo, C.A. & Elixhauser. (2006). Hospitalizations in the elderly population, 2003. Rockville, MD: Agency for Healthcare Research and Quality. HCUP Statistical Brief No. 6. Slide 6 NICHE Nurses Improving Care for Healthsystem Elders HARTFORD INSTITUTE FOR GERIATRIC NURSING NEW YORK UNIVERSITY COLLEGE OF NURSING Implications of an Aging Society Older adults utilize 48% of the nations total health care resources Number of Americans age 65 and older will reach 70 million by 2030 20% of the population Approximately 50% of hospitalized patients are age 65 and over Reference: DeFrances, C.J., Lucas,C.A., Buie, V.C., & Golosinskiy, A. (2008). 2006 National Hospital Discharge Survey. National Health Statistics Reports, 5, 1-20. Slide 7 NICHE Nurses Improving Care for Healthsystem Elders HARTFORD INSTITUTE FOR GERIATRIC NURSING NEW YORK UNIVERSITY COLLEGE OF NURSING _____% of_____________ (our hospital) inpatient admissions are 65 years and older Older Adults Are Hospitals CORE Consumers Slide 8 NICHE Nurses Improving Care for Healthsystem Elders HARTFORD INSTITUTE FOR GERIATRIC NURSING NEW YORK UNIVERSITY COLLEGE OF NURSING Acute Care Services All agesAges 65-74 yrs Ages 75 + yrs # of physician office visits per 100 persons329647768 # of injury-related visits per 100 persons376074 # of hospital outpatient visits per 100 persons314138 # of ED visits per 100 persons403760 # of days of hospital care per 100 persons55140259 Average hospital length of stay4.8 days5.3 days5.7 days Health Services Utilization by Age Group, 2005 Data is for non-institutionalized persons. Data for injury-related visits is for 2004. Reference: Adapted from Institute of Medicine. (2008). Retooling for an aging America: Building the health care workforce (p. 46). Washington, DC: The National Academies Press. Slide 9 NICHE Nurses Improving Care for Healthsystem Elders HARTFORD INSTITUTE FOR GERIATRIC NURSING NEW YORK UNIVERSITY COLLEGE OF NURSING Older Adults Are Hospitals CORE Consumers U.S. Census Bureau reports 1/4 of all inpatient hospital days were used by adults 75 years and older Fastest growing segment of the population is those 85 years and older In the next 30 years, those 85 years and older will double in number to 8.5 million Reference: U.S. Dept. of Health and Human Services, Centers for Disease Control. Trends in Health and Aging. Retrieved October 31, 2008, from http://www.cdc.gov/nchs/hdi.htm Slide 10 NICHE Nurses Improving Care for Healthsystem Elders HARTFORD INSTITUTE FOR GERIATRIC NURSING NEW YORK UNIVERSITY COLLEGE OF NURSING Older Adults Are Hospitals CORE Consumers ___% of_____________ (our hospital) inpatient admissions are 85 years and older Slide 11 NICHE Nurses Improving Care for Healthsystem Elders HARTFORD INSTITUTE FOR GERIATRIC NURSING NEW YORK UNIVERSITY COLLEGE OF NURSING Older adults have: Longer lengths of stay (7.8 days vs. 5.4 days) Higher rates of re-admission within 30 days Higher rates of functional decline and medical errors Reference: U.S. Dept. of Health and Human Services, Centers for Disease Control. Trends in Health and Aging. Retrieved October 31, 2008 from http://www.cdc.gov/nchs/hdi.htm The Quality Imperative: Improve Clinical and Fiscal Outcomes! Slide 12 NICHE Nurses Improving Care for Healthsystem Elders HARTFORD INSTITUTE FOR GERIATRIC NURSING NEW YORK UNIVERSITY COLLEGE OF NURSING Improving Care for Hospitalized Older Adults is Good Business Optimal care requires appropriate skills Aging demographics Geriatric skill gap High cost of inaction Older adult patients are everywhere Need for flexibility Ongoing training and coaching roles Cost effective train the trainer virtual services Slide 13 NICHE Nurses Improving Care for Healthsystem Elders HARTFORD INSTITUTE FOR GERIATRIC NURSING NEW YORK UNIVERSITY COLLEGE OF NURSING Improving Care for Hospitalized Older Adults is Good Business Proactive & skilled nursing care avoids costly problems Never events Complications that increase LOS and costs Patients and families satisfaction Better functional status at discharge Smoother transitions Improved nurse satisfaction & efficiency, less turnover Improved MD satisfaction and improved efficiency Slide 14 NICHE Nurses Improving Care for Healthsystem Elders HARTFORD INSTITUTE FOR GERIATRIC NURSING NEW YORK UNIVERSITY COLLEGE OF NURSING NICHE Program Goal Achieve systematic nursing change that will benefit hospitalized older adults Vision Provide geriatric sensitive and exemplary care to all hospitalized older adults 65 years and over Mission Import principles and tools to stimulate change in the culture of healthcare facilities to achieve patient-centered care for older adults Slide 15 NICHE Nurses Improving Care for Healthsystem Elders HARTFORD INSTITUTE FOR GERIATRIC NURSING NEW YORK UNIVERSITY COLLEGE OF NURSING What is the focus of NICHE? NICHE focuses on programs and protocols that are predominantly under the control of nursing practice. Slide 16 NICHE Nurses Improving Care for Healthsystem Elders HARTFORD INSTITUTE FOR GERIATRIC NURSING NEW YORK UNIVERSITY COLLEGE OF NURSING In other words areas where nursing interventions have a substantive and positive impact on patient care Slide 17 NICHE Nurses Improving Care for Healthsystem Elders HARTFORD INSTITUTE FOR GERIATRIC NURSING NEW YORK UNIVERSITY COLLEGE OF NURSING Nurses Positioned to Play a Central Role Nurses are the primary caregivers for older patients in hospitals Nurses are generally not fully prepared to care for older patients Nursing models can improve older patients care and decrease hospital costs Nursing can be the focal point for stimulating interdisciplinary care Slide 18 NICHE Nurses Improving Care for Healthsystem Elders HARTFORD INSTITUTE FOR GERIATRIC NURSING NEW YORK UNIVERSITY COLLEGE OF NURSING Hospitals participating in NICHE report Enhanced nursing knowledge and skills regarding treatment of common geriatric syndromes Greater patient satisfaction Decreased length of stay for older adult patients Reduction in costs associated with hospital care for the older adult Enhanced Magnet initiatives Improved compliance with regulations and industry standards Slide 19 NICHE Nurses Improving Care for Healthsystem Elders HARTFORD INSTITUTE FOR GERIATRIC NURSING NEW YORK UNIVERSITY COLLEGE OF NURSING What are the objectives of the NICHE program? Slide 20 NICHE Nurses Improving Care for Healthsystem Elders HARTFORD INSTITUTE FOR GERIATRIC NURSING NEW YORK UNIVERSITY COLLEGE OF NURSING NICHE Program Goal #1: Improve patient outcomes Decrease iatrogenic complications Facility acquired pressure ulcers Falls and fall related injuries Catheter associated urinary tract infections Medication errors Functional decline Decrease length of stay for older adults on general medical units Slide 21 NICHE Nurses Improving Care for Healthsystem Elders HARTFORD INSTITUTE FOR GERIATRIC NURSING NEW YORK UNIVERSITY COLLEGE OF NURSING NICHE Program Goal #2: Improve the patient experience Promote environmental design that enhances function and comfort Increase staff sensitivity to the needs of older adults Slide 22 NICHE Nurses Improving Care for Healthsystem Elders HARTFORD INSTITUTE FOR GERIATRIC NURSING NEW YORK UNIVERSITY COLLEGE OF NURSING NICHE Program Goal #3: Promote staff effectiveness and satisfaction Increase knowledge and competence around care of older adults Promote role development home grown experts Maximize retention of nurses and enrich job satisfaction Maximize interdisciplinary collaboration Slide 23 NICHE Nurses Improving Care for Healthsystem Elders HARTFORD INSTITUTE FOR GERIATRIC NURSING NEW YORK UNIVERSITY COLLEGE OF NURSING NICHE

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