Another important resource for NICHE sites is a listserv, through which participating sites can share information on protocols, technologies, materials, assessment instruments, and staff development tools. The Hartford Institute also provides NICHE sites with tools for evaluating the effectiveness of the nursing care models and clinical practice protocols. NICHE sites also have access to a free on-line review course to prepare nurses for the American Nurses Credentialing Center Gerontological Nursing Examination.
Studies conducted by individual NICHE hospitals have demonstrated measurable results from NICHE implementation, including reduction in use of physical restraints, reduction in catheter use and the associated urinary tract infections, decreases in injuries from falls, and declines in delirium. These patient outcomes have been correlated with administrative cost savings. One hospital reported a significantly lower length of stay and numbers of patients readmitted within one month of discharge.
Overall, hospitals that have implemented NICHE report enhanced nursing knowledge and skills regarding treatment of common geriatric syndromes, greater patient satisfaction, decreased length of stay for elderly patients, reduced readmission rates, increases in the length of time between re-admissions, and reductions in costs associated with hospital care for the elderly.10 Being a NICHE site has the added benefits of assisting health care facilities with their accreditation reviews and in obtaining status as a Magnet hospital. The Magnet Recognition Program was developed by the American Nurses Credentialing Center (ANCC), a division of the American Nurses Association, to recognize health care organizations that provide nursing excellence.
In 2003, Rochester General Hospital wanted to explore its options completely before making the commitment. So Ms. Nickoley led the development of a pilot program on two medical units of the hospital, using the NICHE resources and materials that are available free of charge on the Hartford Institute Web site. Ms. Nickoley began by administering the Geriatric Institutional Assessment Profile, both at the beginning and two years later.
"Even though we were a nonpaying institution, I was able to informally consult by phone with the people at the Hartford Institute and they willingly shared knowledge and resources that allowed us to proceed with improving care to our older patients," says Ms. Nickoley.
As part of the pilot study, the team created a walking program for older patients, an evening nutritional snack program, and a program to manage high-risk medications. Ms. Nickoley also performed geriatric risk screening rounds and the team worked with medical colleagues to get geriatrics embedded in the standardized medical orders, including bed rest, urinary catheters, prevention of blood clots, and immunization items. "During this pilot phase, we were learning and growing, but we were also using this experience to build a case for becoming a NICHE hospital and investing more resources in geriatrics," says Ms. Nickoley.
By February 2005, the administration at Rochester General Hospital agreed that becoming a NICHE site was warranted, expanding the pilot projects across the entire hospital. A core geriatric class was offered with 70 classes attended by over 1,300 staff. In addition, Ms. Nickoley created a Web page called "Age Matters" to communicate the many geriatric resources available for bedside staff, including NICHE content and a link to the Hartford Institute Web site.
Two years after implementation, the institutional survey was readministered, showing statistically significant improvements. Staff perceived improved education on geriatrics and greater satisfaction with staff knowledge on how age affects response to treatment and the extent to which geriatric care issues are addressed.