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Celebrating Ten Years of Improving Health Care for Older Adults
Making Best Geriatric Practice
Standard Practice

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Strategy No. 2: Promoting Work Environment Changes

Resources for NICHE

All of the comprehensive, evidence-based resources of the Hartford Institute are available for use by NICHE hospitals, including the procedures in the book "Geriatric Nursing Protocols for Best Practice" and the Try This series. NICHE sites are also provided with educational materials through the Partners for Dissemination Program to assist staff developers to assure nurse competency in geriatrics. Materials include a user's manual, curriculum guide, teaching slides, protocols, and evaluation packets. These materials address common age-related issues, such as falls, pressure sores, and functional loss.

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.

Investing Resources in Geriatrics: Rochester General Hospital

sue nickoley, ms, rn Sue Nickoley, MS, RN (second from right), Sue Montagliano, RN (left) and Judith Lawson, RN (right) discuss the after-surgery walking program. protocol with a patient at Rochester General Hospital in Rochester, New York. When Sue Nickoley, MS, RN, took a position at Rochester General Hospital as a clinical nurse specialist and care manager in acute rehabilitation, it was a departure from her previous position and lifelong interest in geriatrics. In 2003, when she learned that the hospital was interested in exploring ways to better serve its older patients, she decided to get involved by helping to initiate an interdisciplinary team using the NICHE model to identify and address the special needs of hospitalized elderly patients. Today, Ms. Nickoley holds the position of geriatric clinical nurse specialist, Rochester General Hospital is a formal NICHE site, and the hospital has been named a Nurse Magnet Hospital. Getting there took vision and persistence on the part of Ms. Nickoley, her nursing and team colleagues, as well as the support of the Hartford Institute for Geriatric Nursing.

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.

10- Swauger K, Tomlin C. "Best Care for the Elderly at Forsyth Medical Center." Geriatric Nursing. 2002. Vol. 23, Number 3, pp. 145-150.

Turner JT, Lee V, Fletcher K, Hudson K, Barton D. "Measuring Quality of Care with an Inpatient Elderly Population. The Geriatric Resource Nurse Model." Journal of Gerontological Nursing. 2001. Vol. 27, Number 3, pp. 8-18.

Pfaff J. "The Geriatric Resource Nurse Model: A Culture Change." Geriatric Nursing. 2002. Vol. 23, Number 3, pp. 140-144.

Guthrie PF, Schumacher S, Edinger, G. "A NICHE Delirium Prevention Project for Hospitalized Elders." In: Silverstein H, Maslow K, editors. Improving Hospital Care for Persons with Dementia. New York: Springer Publishing Co., 2005.
Visit the Hartford Institute for Geriatric Nursing Web site: www.hartfordign.org