Wednesday, February 26, 2014
Senior Friendly Initiatives Helping Improve The Way - We Care For Our Older Patients
A noticeable shift in the way seniors are being cared for in hospital is taking place at the Pembroke Regional Hospital.
On the third floor Medical unit, the patients, mostly seniors, look forward to new exercise classes during which they have an opportunity to stretch their muscles, toss beanbags into baskets, and play catch with beach balls while reminiscing about their childhood and other games they enjoyed.
And while some are still of the mindset that if they are admitted to hospital they are put on bedrest, increased opportunities for mobility and cognitive activities are in fact, just what is being prescribed.
“Any additional activities and structure that we can provide for our patients only helps them achieve the goal of getting them well and out of hospital, and it results in a better quality of care,” said Medical Unit Manager Elaine Elliott, adding that, “There’s lots more that can be done, but this is a good beginning.”
With mandates now in place for hospitals to focus on senior friendly initiatives, gone are the days of not so long ago when routine care of our seniors in hospital always involved starting an intravenous (IV), providing them with a catheter, dressing them in a gown and putting them to bed.
“It has been proven that this traditional approach is so detrimental,” said Sabine Mersmann, Vice-President of Patient Services – Seniors and Community Care at Pembroke Regional Hospital.
“We have known aspects of this for a long time, but it was not addressed in a systematic approach,” she said.
That changed two years ago when the Ministry of Health and Long-Term Care engaged Dr. Samir Sinha as the provincial lead for a comprehensive study focusing on senior care in hospitals which resulted in the development of Ontario’s Seniors Strategy.
“Beyond accessibility, it was mandated that all aspects of care must meet the needs of seniors. The LHINs (Local Health Integration Networks) were directed to pay attention to this – to the point where it is now part of each hospital’s accountability agreement,” Mrs. Mersmann said.
Now, PRH is required to submit an annual action plan on its Senior Friendly Initiatives. And while many aspects of senior care can be addressed, the primary focus must be those initiatives designed to prevent delirium and functional decline. To assist with the development of this plan, PRH formed a committee in 2012/2013 which was championed by Dr. Joan Tyler and comprised of frontline staff.
To help prevent and detect the early onset of delirium which can have rapid onset and be intensified based on the level of dementia a patient may already have, an assessment program was launched which starts at admission and is repeated every 24 hours. This allows for early detection and treatment which could be as simple as making an adjustment in medication or dosage.
To prevent functional decline, the solution was obvious – mobilization.
“Particularly on the Medical Units, the challenge was finding ways to not only increase mobility, but also initiate a culture shift in the way our staff and our patients think about healing and wellness,” Mrs. Mersmann said.
She noted that the improvements which were brought about were gradual, such as bringing patients to the 2nd Medical dining room for meals and no longer serving food in bed. Patients were asked to bring in street clothes and indoor shoes, and on 3rd Medical, exercise classes were developed and green diamond-shaped mobility markers were posted throughout the corridors, 10 feet apart so that patients can track their distance and strive to meet prescribed mobility goals.
Other initiatives include the use of whiteboards in patient rooms, both as an additional means of two-way communication between patients and families and their healthcare providers, as well as being a place where mobility goals and patient ability can be posted for all to see.
Ms. Elliott said the families really enjoy the new whiteboards, finding them very professional and more standardized for communication purposes.
“Having the whiteboards has really improved communications – family members can write messages on the board for the healthcare team, patients can jot down questions for their physicians, and in turn we can provide the information they need in a location it can be easily found and accessed,” she said.
Physiotherapist Sarah Biggs highlighted new mobility pamphlets which are placed at the bedside for newly admitted patients and outline the importance of mobility as well as patient expectations.
“Mobility can be as simple as getting up to brush your own teeth, or doing exercises at your bedside, but more and more people are realizing the importance of doing this,” Ms. Biggs said. “Early mobilization is a complete change in mindset. It’s a whole culture change for us and for our patients but it’s one that I feel is going to help decrease a patient’s length of stay since they will be strong enough to go home when they are medically stable.”
Ms. Biggs said it also helps that the same message is being given to patients across the continuum of care and that both patients and their families are involved in the development of their individual mobilization plans.
Going forward, Mrs. Mersmann said that other initiatives are being looked at including a review of catheter use which greatly limits mobility.
“This is a work in progress and an ongoing shift in the way things are done,” she said. “It’s becoming the norm that, within any department, staying in bed is not an option. Mobilization is part of the daily treatment plan, just like taking medications.”
Carolyn Levesque is the Public Affairs and Communications Coordinator for the
Pembroke Regional Hospital.
|