Four New Jersey facilities received grants this past fall to prevent and treat geriatric patients with hospital-acquired delirium. Newark Beth Israel Medical Center was given funding to initiate an HAD program and The University Hospital in Newark, Morristown Medical Center and Overlook Medical Center in Summit received funding to expand or enhance their existing programs.
The Healthcare Foundation of New Jersey, an independent, endowed, grant-making organization dedicated to reducing disparities in healthcare delivery and improving access to quality healthcare for vulnerable populations, has committed almost $500,000 to this initiative. Through screening and early detection, the goal of the HAD program is to prevent delirium from occurring while patients are in the hospital or to limit its advancement to improve recovery time.
Creation and coordinationOn the med/surg and oncology unit at Overlook Medical Center, Kirsten Scheper, RN, nursing coordinator, and Kathy Leifeste, RN, nurse educator, were presented with commendations by Mark Holtz, COO, to honor their significant contributions to leadership in Overlook’s delirium program.
Once NBIMC received the grant, Russell Ramlal, RA, CTRS, geriatric activity therapist, was transferred to the geriatrics unit to assess and implement structured therapeutic activities with patients, either in groups or one-on-one.
“I use a variety of sensory orientation activities, such as the stress ball, music, relaxation or deep-breathing techniques, current events and sensory stimulation, depending on the patients’ needs,” Ramlal said. “Sometimes just sitting and speaking with a patient helps to decrease the confusion.”
Ramlal said he uses an activity therapy assessment tool he developed to determine each patient’s limitations, illnesses and recreational or leisure interests before working with him or her.
Nurses and physicians have been trained in the use of the confusion assessment method developed by Sharon Inouye, MD, and implement appropriate interventions based on it.
“In our assessment, we are alerted to the patients’ physical conditions or medications they are taking that might trigger HAD,” said Lori Pineda, RN-BC, MSN, CCM, behavioral health nurse educator at NBIMC. “We also use nonpharmacologic measures, such as clocks, calendars and family pictures in patients’ rooms, and we maintain a schedule of daily activities to keep our patients engaged and oriented.”
Staff members are in the process of making physical changes to the patient rooms and the family room.
Families can participate in support groups led by social workers and case managers three days a week in the unit’s large family room. “Our patient satisfaction has improved significantly because family members are learning and involved, and they are pleased that their loved ones are engaged and safe while they are hospitalized,” said Colleen English, RN, MA, director of geriatrics, med/surg and orthopedic units at NBIMC.
At the same time the hospital received the grant, it opened a geriatric ED and was designated a NICHE hospital. “Many times the patients who are admitted to our geriatric ED come to our unit. We can coordinate care for the elderly because our services fit together so well,” said Hester Tynes, RN-BC, MS, geriatric nurse educator. An advanced practice nurse also serves the elderly in the NBIMC outpatient services and educates the public in community churches, schools and senior groups.
“Now that we have a collaborative approach, we’re expecting to see decreased lengths of stay, decreased falls and a decreased need for restraints in our elderly population,” said MaryEllen Wiggins, RN, MSN, ACRN, NE-BC, assistant vice president of patient care services at NBIMC.
The foundation hired a researcher from Columbia to perform cross-site evaluation of the projects at the four facilities. “We recognized that addressing this preventable, treatable problem is very important and believe it will only become more critical in future years,” said Marsha Atkind, executive director of The Healthcare Foundation of New Jersey. “It is our hope that the data collected will show significant benefits to patients and a cost savings to hospitals so facilities will continue these programs.”