NICHE Handouts - Palmetto Health

Welcome to the Palmetto Health Acute Care of the Elderly Unit
P
almetto Health is proud to announce that 6 West, a general medical unit, is now an
Acute Care of the Elderly (ACE) unit. The ACE unit is part of a larger initiative called
Nurses Improving Care for Healthsystem Elders (NICHE), which recognizes that older
adult patients have specialized needs and that patient- and family-centered care is imperative to creating a positive experience for older adult patients. Palmetto Health has the
only two NICHE designated hospitals in South Carolina.
Our specially trained team members focus on keeping your mind and body working as
well as they were before you came to the hospital. Generally, patients on our unit are over
70 years old and able to walk and take care of themselves with minimal assistance.
Sleep: A good night’s rest is one of the most important parts of healing. That’s why we try
to let you sleep as much as possible at night.
Team Rounds: During your hospital stay, you’ll be visited by a team daily between 1011 a.m. daily to discuss the care you are receiving (called bedside rounds). The team may
include a geriatrician (a physician who specializes in the care of elderly patients), your
attending physician, a social worker, a nurse case manager, your assigned nurse, a physical
rehabilitation team member, a pharmacist, the charge nurse, the nurse manager and the
NICHE coordinator. Not all of these team members will be present every day, and other
specialties such as chaplaincy or wound care may be invited.
Bedside rounds are meant to be brief, usually only two to five minutes. If you have a question that arises during rounds, please ask someone from the team to stay after rounds or
write your questions on the “Family Notes/Questions” sheet in this folder. We will be able
to spend more time with you after rounds are completed.
If you prefer that we not wake you for these rounds or that we not come to your room to
discuss your care, please let us know. We hope that by including you in the rounds, you
will be able to better understand your care. Also, our team can help you get better faster if
we are able to see how you are doing each day.
Walking: Another way we care for you is to help you get out of the bed and walk around
as much as possible. To keep you safe, please call us for help or ask a family member,
friend or volunteer to walk with you. Likewise, it is important to sit in a chair during
meals, too.
If you have any questions or suggestions, please share them with your nurse or write
comments about your care on the “Family Notes/Questions” sheet in this folder. We want
to take care of you just like we would care for our family members and friends. We want to
make sure your care is excellent and your experience with us is extraordinary. Welcome to
the ACE Unit!
SM
MSS-5955
MSS-5955 ACE Unit Welcome Letter.indd 1
PalmettoHealth.org 803-296-CARE (2273)
12/26/13 3:18 PM
Acute Care for the Elderly
(ACE) unit
SM
PalmettoHealth.org 803-296-CARE (2273)
PATIENTS ARE ADMITTED TO THIS FACILITY AND ARE RENDERED SERVICES WITHOUT DISTINCTION DUE TO RACE, COLOR,
NATIONAL ORIGIN, HANDICAPPING CONDITION OR AGE.
PRODUCED BY MARKETING AND COMMUNICATIONS ©2014 PALMETTO HEALTH
AVAILABLE FOR REPRINT AT XEROX DIGIPATH 11/13 | MSS-5923 ACE UNIT PATIENT/FAMILY BROCHURE
MSS-5923 ACE Unit Patient/Family Brochure.indd 1-3
PalmettoHealth.org 803-296-CARE (2273)
12/26/13 3:28 PM
We care about you.
Our goal is to minimize the functional decline
in our elderly patients by:
•Keeping the use of physical/chemical restraints
to the absolute minimum (aim for restraint-free
environment)
•Preventing delirium that could adversely affect
patient outcomes and health care costs or
identifying its early onset
A
cute Care for the Elderly (ACE) units help
meet the needs of hospitalized older adults.
ACE units are part of a larger initiative
called Nurses Improving Care for Healthsystem
Elders (NICHE), which recognizes that older
adult patients have specialized needs and that
patient- and family-centered care is imperative
to creating a positive experience for older adult
patients. Palmetto Health has the only two NICHE
designated hospitals in South Carolina.
ACE units are designed with attention to physical
environment, collaborative team building
(physician, social worker, nurses, physical
rehabilitation team member, pharmacist and the
NICHE coordinator) and special care plans to
enhance patient function. Our specially trained
team members focus on keeping your mind and
body working as well as they were before you came
to the hospital. Generally, patients on our unit are
over 70 years old and able to walk and take care of
themselves with minimal assistance.
MSS-5923 ACE Unit Patient/Family Brochure.indd 4-6
•Reducing falls and the negative impact of
injuries from falls that could affect the length of
hospitalization
NICHE helps hospitals implement proven strategies
and methods to address issues specific to older
patients, improve patient outcomes; and raise
patient and family satisfaction levels.
Features of our NICHE-designated ACE unit
include:
•Environmental modifications (large number
clocks, large print reading materials, menus, etc.)
•Interdisciplinary team approach to care, delivery
and coordination of services
•Medical director and dedicated nursing staff
•Ancillary services that include nutrition,
pharmacy, social services, pastoral care, HELP
volunteers who are trained to assist older adults,
and physical, occupational, music, speech and
recreational therapies such as pet diversion
activities
•Reducing the number of infections and
pressure ulcers
•Maintaining or improving functional ability by
encouraging early mobility, being out of bed for
meals, etc.
We want to provide an extraordinary
experience for our patients and their families
through coordination of care and daily multidisciplinary team rounds, including:
•Identifying patients who need a change in living
situation within 48 hours of arrival, to prevent
discharge delays
•Reducing unavoidable discharge delays
•Making referrals to appropriate disciplines within
four hours of arrival and performing initial
evaluations within one work day
12/26/13 3:28 PM
Information taken from: University of Utah Health Sciences Center
Substitute Word List
Since health writing usually uses technical terms, it is helpful to the reader to use shorter words
whenever possible. Here is a list of words that are commonly found in health literature. Using the
substitute word instead of the technical word will help lower the readability level of your material. This
list was adapted from:
Hilts, L. & Krilyk B. J. (1991). Write readable information to educate. Hamilton, Ontario: ChedokeMcMaster Hospitals and Hamilton Civic Hospitals.
University of Wisconsin Hospital and Clinics. (1996). Developing Health Facts for You: An author’s
guide. Madison, WI: Author.
ability - skill
accomplish - carry out
alternative - choice
ambulate – walk
annually – yearly
apply - put on, use
approximately – about
assist – help
attempt- try
available – ready
bacteria – germs
cell culture - tissue study
cerebral hemorrhage – stroke
cessation - stop, pause
chorionic villi – tissue
cognizant – aware
communicate – talk
compassion – pity
competent – able
completion - end, finish
conclusive – final
contact – call
contraceptive - birth control
contusion – bruise
conversion – change
coronary thrombosis - heart attack
correspond – agree
decrease - make less, reduce, lower
deficit – shortage
delete - strike out
demonstrate – show
detect – find
detrimental – harmful
develop - arise, occur
diagnosis - problem, condition
diminish - get less, slow down
discoloration - change in color
disconnect - undo
discontinue - stop
dressing - bandage
due to the fact that - because
dyspepsia - indigestion
elevate - raise
eliminate - get rid of
embolism - lump of blood, clot
encourage - urge
endeavor - try
difficulties - problems, trouble
excessive - too much
experience - feel
facilitate - help, ease
feasible - can be done
frequently - often
fundamental - basic
generate - produce
guarantee - backing, promise
hazardous - risky
humid - damp
humorous - funny
identical - same
illustration - picture
impair - harm
inadvertent - careless
inadvisable - unwise
incision - cut
incorrect - wrong
independent - free
indication - sign
ineffectual - useless
inform - tell
1
Substitute Word List
inhibit - check, hinder
initial - first
initiate - begin, start
injection - shot
innovation - change
instrument - tool
institute - set up
intention - aim
interrupt - stop
laceration - cut, tear
lenient - mild
locality - place
manifest - clear, plain
minimal - smallest
modification - change
nebulous - hazy, vague
notification - notice
numerate - count
nutrient - food
obligation - duty
observation - remark
observe - note
obvious - plain
occurrence - event
opportunity - chance
option - choice
palatable - pleasing
penetrate - pierce
perforation - hole
permission - consent
physician - doctor
present - give
principal - main, chief
project - plan
qualified - suited
recognize - know, accept
recuperate - get well
rehabilitate - restore
saturate - soak
scarlatina - scarlet fever
segment - part
sensation - feeling
several - many
severity - how bad
similar to - like
similarity - likeness
similarity - likeness
similar - like
situated - placed
status - state
stimulate - excite
sufficient - enough
sustenance - support
sutures - stitches
tear of ligament - sprain
technicality - detail
termination - end
therapy - treatment
ultimate - last, final
uncommonly- rarely
understand - know
unequivocal - clear
unfounded - groundless
unnecessary - needless
until such time - until
utilize - use
varicella - chicken pox
visualize - picture
voluminous - bulky
2
Lavender Oil
Suggestions for use
Suggestions for use:
When preparing a patient for sleep:
•Place one or two drops of
•Place one or two drops of lavender oil on a cotton ball or tissue, and tuck in pillow case or in patient’ss gown pocket.
or in patient
gown pocket.
•Place one or two drops in a basin of warm water at the bedside to release the calming
bedside to release the calming aroma.
A small bottle of lavender oil is kept in the med‐room.
Lavender oil is used
Lavender oil is used extensively in aromatherapy and is described as therapeutic for insomnia, headaches,
for insomnia, headaches, migraines, anxiety, nervousness, and melancholy. Lavender has been used as a sleep aid
been used as a sleep aid and can be a useful nonpharmacological alternative to traditionally prescribed medications for
prescribed medications for insomnia, which are strong risk factors for falls in elderly adults. Because lavender is thought to have
lavender is thought to have soothing properties, it is logical to assume it may also affect the anxiety and agitation which lead to
agitation which lead to sleeplessness.
J Am Geriatric Soc. 2012;60(6):1005-1011.
Palmetto
Health Baptist
Channel 60
he C.A.R.E. Channel
provides ambient television programming for
you and your family
during your time with
us as a restful alternative to commercial television.
The C.A.R.E. Channel has been
developed to create an environment that is supportive of recovery and to improve comfort and
rest. Our staff is committed to the
highest standard of care which
includes responding to both your
medical and non-medical needs.
Available on a 24-hour basis,
The C.A.R.E. Channel provides
beautiful nature images and
instrumental music that has
been composed and produced
specifically to support healing
environments. The programming
is designed to be in pace with
the day/night cycle, with latenight programming from 10pm
to 6am providing both soothing
music and a soft, subdued
midnight starfield.
We invite you to support the
artists who have offered
their music for The C.A.R.E.
Channel:
Marcus Allen, Randy Armstrong,
Jim Bajor, Bruce Becvar, Haydn
Bertelson, Teja Bell, Charles
Michael Brotman, Christine
Brown, Dirk Damonte, Dwight
Dixon, Dave Eggar, Craig Evans,
Jon Galfano, Joanne Grauer,
Mark Handler, Sally Harmon,
Michael Allen Harrison, Max
Highstein, Susan Hoadley, Bob
Kindler, Steve Kindler, Ben Tavera
King, Kitaro, Maria Kostelas, Gary
Lamb, Dan Luevano, Greg
Maroney, Susan Mazer, Jeffrey
Michael, Scott Moulton, Kate &
Richard Mucci, John Nilsen,
Stevan Pasero, Christopher Paul,
Christian Paulin, Sambodhi Prem,
Rojo, Tadamitsu Saito, Roy Scoutz,
Michelle Sell, Shardad, Shinji,
John Shockey, Richard Shulman,
Dallas Smith, Mike Strickland,
Danny Tudor, Ger-Matthias
Wegner, Brad White, Rob
Whitesides-Woo, Allison Zopel.
For information about
The C.A.R.E. Channel please
contact:
Healing HealthCare Systems
We are committed to providing
an environment that supports
healing, health and care.
700 Smithridge Drive, Ste. A102
Reno, NV 89502
Toll Free (in the U.S.)
800.348.0799
info@healinghealth.com
www.healinghealth.com
pflyerCC/11/10
Daily visitor program
What can a HELP volunteer do for our patients over 65?
Companionship
Re‐orientation to time, place, season, etc.
Hearing and vision aide assistance (magnifiers/amplifiers)
g
( g f / p f )
Comforting/ Listening
Daily activities – reading the menu, TV programming, Newspaper reading, etc.
Arranging flowers, cards, personal items – lotion, brush, plants, etc.
Referrals can be made by physicians and nursing staff!
Therapeutic activities program
Therapeutic activities
Delirium prevention – therapeutic activities
Reminiscing, prayer, diversional activities – games, word puzzles, music, etc.
Current events, trivia, guided relaxation, meditation, etc. Early mobilization walking program
Early mobilization –
Active Range of Motion
Transfers from bedÆchair or wheelchair
Wheelchair mobility/hallway movement
Amb lation in room and/or aro nd nit
Ambulation in room and/or around unit
Non‐pharmacologic sleep enhancement
Play soft music CD’s, Channel 60, etc.
Provide non‐caffeinated hot tea or warm milk
Massage back, shoulders, arms, hands
How do I make a referral to the HELP Volunteer program?
Call the Volunteer Office Richland: 434‐6242 Baptist: 296‐5572 *give the patient’s information:
name, room #, specific needs
name, room #, specific needs
Feeding and hydration assistance
Menu assistance, setting up tray, feeding, companionship, encourage fluids, etc.
Delirium Interventions
1) Contact Education on Demand/Geriatric Resource Nurse at 434-3700
o Assess patient safety
Bed alarm on
Bed low, brakes locked, and alarm connected
Call bell within reach
Move patient closer to nurse’s station
Provide a sitter if available, or encourage family/ friend to stay
o
Eliminate or minimize the risk factor
Monitor for risk of infection, signs/symptoms of dehydration, and electrolyte
imbalances
Perform adequate pain assessment
Maximize oxygen delivery
Use sensory aids as appropriate: Hearing aids, Dentures, Glasses
o Regulate bowel/bladder function: Place on a toileting schedule Q 2 hours
o Provide adequate nutrition
Ask patient what kinds of food they like to eat
Provide patient with foods that they find satisfying
Assist patient with meals if needed
Provide a therapeutic environment
o Foster orientation:
Maintain patient orientation to place and time
Frequently reassure and reorient patient (unless patient becomes agitated)
Utilize easily visible calendars, clocks, caregiver identification
o During Night-time-Facilitate sleep:
Provide uninterrupted sleep during nighttime (6 hours is preferred), limit naps
during the daytime, reschedule tasks and medications as appropriate
Provide appropriate bedtime routine, such as: Perform a back massage, provide
warm milk or herbal tea, lavender, relaxation music/sound program, and avoid
awakening the patient
o During daytime: Provide appropriate sensory stimulation and maximize mobility
Get patient bathed, dressed and get patient up and moving during the day
Provide natural light (keep curtains open)
Perform one task at a time
Avoid physical restraint use
Ambulate or provide active range of motion at least three times a day
o Foster familiarity:
Maintain consistency of caregivers if possible
Encourage family/friends to stay at bedside
Ask family members to bring familiar objects from home
Page 1 of 2
(Inpatient) Delirium Prevention
o
o
o
o
o
Provide comfort measures:
Adjust room temperature as patient desires
Reposition patient minimizing pressure areas
Provide comfortable, warm clothing and covers, blanket, quilt, etc.
Reduce noise volume
Provide stimulating activities, maximize and improve communication
Utilize the delirium kit as appropriate
Provide calendars, clocks, and caregiver identification
Provide a plan of care for the shift/daily schedule
Carefully explain all procedures and activities providing explanation as needed
Family education:
Reassure and educate the family
Provide family with education sheet/booklet
Documentation
Notify Nurse how what interventions were used and how patient tolerated the
activities.
Include delirium risk and current interventions in hand-off information.
Volunteer to volunteer, volunteer to nurse or nurse tech
Page 2of 2
“
”
www.nicheprogram.org.
Learn more about the NICHE Program at
© 2011 NICHE All rights reserved.
NICHE protocols, learning
resources, implementation
strategies and collaboration were
invaluable to us as we rolled out
our system-wide
geriatric care
program.
Choose a NICHE Designated Hospital
5 Richland Medical Park Dr.
ATTN: Donna Wolff,
NICHE Coordinator
Columbia, SC 29203
NICHE HARTFORD INSTITUTE FOR GERIATRIC NURSING
NEW YORK UNIVERSITY COLLEGE OF NURSING
Center of Excellence for Geriatric Care
The NICHE Program at
Palmetto Health
Nurses Improving Care for Healthsystem Elders
ASK YOUR NURSE OR
DOCTOR ABOUT THE
NICHE PROGRAM AT
PALMETTO HEALTH.
CARES ABOUT
THE OLDER
ADULT PATIENT
NICHE
For more information on the NICHE Program at
Palmetto Health, contact OUR NICHE Coordinator at
803-434-8004.
Ask your nurse or doctor for help accessing resources.
Patient/Family Resources
A number of resources are available through our affiliation with NICHE for geriatric
patients and caregivers to help with:
t Nurse/family partnering strategie
t Medication use
t Community care option
t %FNFOUJB
t 4FMGDBSF for family caregiver
t Work and care of older adult topics
t %JTDIBSHF QMBOOJOH
t And much more…
NICHE innovations implemented at Palmetto Health include…
t2VJFUBU/JHIUTMFFQFOIBODFNFOUCVOEMFUPQSPWJEFNPSFTBGFSFTUGVMOJHIUT
t(FSJBUSJD3FTPVSDF/VSTFBOE(FSJBUSJD4FOTJUJWJUZTUBõFEVDBUJPOBOEJNNFSTJPOQSPHSBNT
t(FSJBUSJD%FMJSJVN1SFWFOUJPOQSPHSBNJODMVEJOHEJWFSTJPOBMBDUJWJUJFTDBSUTPOJOQBUJFOUVOJUT
t Educational drug warnings and specialized geriatric patient order sets used in computerized
physician order entry system to alert to potentially inappropriate drug prescriptions for older
adult patients
t Provide improved patient/nurse interaction that helps allay older adult patient fears
and anxiety related to hospitalization
Some of the ways NICHE improves quality of care for older adult patients…
t Enhanced nursing knowledge and skills in the treatment of older adult patients
t Proven strategies and methods to address issues specific to older patients
t Improved clinical outcomes
t Greater patient and family satisfaction
NICHE provides Palmetto Health with the principles and tools to help us achieve patientcentered care for older adults.
Improving geriatric nursing competence is more critical than ever. Older adults are now the
core consumers of hospital care and nurses play a central role influencing care delivery.
The NICHE Program: Quality Care for Older Adult
Patients at Palmetto Health
All About Me – Elder Care Information
Help us care for your loved one by telling us about them.
Answer questions describing how your loved one was 1-2 weeks before coming to the hospital.
Thank you!
What name does he or she like to be called?______________
What was his or her job, career, or role as a younger person?________________________________
Favorites:
topics or things to talk about?_____________________________________________
things to do, activities, hobbies?___________________________________________
best time of day?__________________________________________________________
FOODS__________________________________________________________________
Drinks/liquids_____________________________________________________________
Needs help with- (please give helpful tips for your loved one as able):
Bathing__________________________________________________________________
Dressing_________________________________________________________________
Oral Care_________________________________________________________________
Walking___________________________________________________________________
Toileting__________________________________________________________________
Transferring from bed to chair and back again____________________________________
If married, name of wife or husband:_______________How many years married?________
How many children?_____Their names?______________________________________
________________________________________________________________
How many grandchildren?______Names or nicknames that might be helpful:___________
____________________________________________________________________
What is their bedtime routine? What helps them relax?______________________________
___________________________________________________________________
Favorite movies, TV shows, actors, actresses, books:___________________________
Circle if your loved one wears any of these:
Hearing aid
Glasses
Dentures
Any religious, spiritual, or church groups that are meaningful:_________________________
_____________________________________________________________ __________
Did they have a pet? Pet’s name(s)__________________________________________________
Where did your loved one grow up?_________________________________
Is there anything else you would like to share that would help improve our communication with your
family member/friend?:____________________________________________
______________________________________________________________________
_______________ _____________________________Phone number:____________
(Date)
(Name/Relationship of person(s) filling out this page)