When elderly patients are admitted to CHRISTUS Santa Rosa Hospital in San Antonio, they often notice their surroundings look different than a traditional hospital unit. Outfitted with special floors, lighting, furniture, and a nursing staff specially trained in the needs of the geriatric patient population, the Acute Care for the Elderly unit is a 10-bed area where patients over 65 receive specialized care.
In early 2009, CHRISTUS Santa Rosa began partnering with physicians from the division of geriatrics in the department of family medicine at the University of Texas Health Sciences Center at San Antonio, to plan for the first ACE unit in
Imelda Sanchez, MSN, RN, director med-surg service line-med/surg; ACE/ortho; senior behavioral and NICHE program director for the hospital, said the 16 nurses who serve on the unit (eight on the day shift, and eight on nights), are certified in geriatric care through Nurses for Improving Care for Healthsystem Elder. The certification involves more than 20 hours of training in subjects such as recognizing signs of delirium and functional decline.
We are also looking to expand to an ACE without walls concept by offering our med/surg staff specialized geriatric education and training, and by making some of the renovations to flooring and lighting on other units of our hospital, Sanchez said.
By rounding every hour, the ACE unit has done away with most Foley catheters, and instead works to keep patients clean and dry through toilet training and using the bedside commode every two hours, according to Sanchez.
Our nurses take a very proactive approach to caring for patients, said Angie Lambert, BSN, MBA, RN, CNO for the hospital.
When admitted to the ACE unit, each patient receives a complete geriatric assessment, including cognitive evaluation, medication review, activities of daily living and depression screening. In addition, daily interdisciplinary rounds feature a team of nurses, physicians, pharmacy and nutrition services staff, physical therapists and those representing the spiritual care and case management departments.
Our ACE unit also emphasizes family-centered care, and features a family room where patients can enjoy meals with their loved ones, Lambert said. Our patients really take ownership of the unit even though most are only here for three or four days. For example, they eat meals and socialize with other patients, and most feel comfortable and safe walking in the unit due to the handrails, special flooring and the enhanced lighting.
Lambert said the hospitals NICHE designation recognizes the hospitals upgraded care for older adult patients, improved staff competence in nursing care of the elderly, increased awareness of geriatric issues and supported implementation of hospital geriatric protocols.
Peek inside an ACE unit
The aging Baby Boomer generation is forcing hospitals across the country to look at how they are caring for elderly patients.
For CHRISTUS Santa Rosa, the design of the ACE unit was completed by hospital staff after a visit to a successful ACE unit at Aurora Health Care, Milwaukee, according to Lambert.
We saw how we could individualize care to the life and priorities of each patient and provide care in a homelike environment to vulnerable seniors, Lambert said.
The ACE unit, which opened in the summer of 2010, features special laminate, non-skid flooring designed to reduce falls, softer lights, beds that are closer to the floor, and other amenities including artwork and bedspreads that are meant to be both calming and practical for older patients, according to Imelda Sanchez, MSN, RN.
With the new design, the hospital has shown marked improvement in reduced falls, pressure ulcers, functional level and length of stay. We have reduced our fall rate from 10% to 3.2%, which is well below the national average, Sanchez said. In addition, our ACE unit has a comprehensive discharge planning process that minimizes problems associated with the transition of care when seniors are leaving the hospital.