a journey to learning… organization structure niche –the leading nurse-driven program designed...

1

{

Nurses Improving Care for Health System Elders

NICHE and the

Long Term Care Community

2014-2015

Phase I

A journey to learning…

Formation of Geriatric Collaborative Care Services (GCCS), LLC

Instructors APRN-CNS, Board Certification in Gerontological

Nursing RN, Board Certified in Hospice/Palliative Care Nursing

and Gerontological Nursing Directors’ of Nursing from both NHs, Director of

Nutrition, Nutrition Consultant and both Managers’ofTherapy

Critical Thinking/Leadership Course with author’s permission

(Educator at Oklahoma State University MedicalCenter)

Organization structure

nicheprogram.org • 2016 Annual NICHE Conference • Care Across the Continuum

2

NICHE – the leading nurse-driven program designed to help health care systems, such as Long Term Care: Provide a Geriatric Education Program

Improve the care of older adults

Provide principles and tools

Stimulate a change in the culture to embrace Evidence Based Practice (EBP)

Achieve patient/family centered care for older adults

NICHE Portfolio, 2013

Purpose of the project

Eldercare Workforce Alliance (2015)

Geriatrics education and training remains inadequate

Geriatric principles insufficiently represented in schools of nursing curricula

Clinical experiences lack strength

Direct care staff –CNAs-low confidence and ineffectively trained and provide 70-80% of “hands-on” care in LTC.

Why did we need to do this project?

Institute of Medicine (IOM) REPORT 2001 AND 2008 Major challenge for 21st century healthcare Prepare the healthcare workforce with skills and

new models to improve quality of care NICHE PROGRAM, Fulmer, 1991

Addressing prevalent problems experienced by older adults – Understand Geriatric Syndromes

Ability to anticipate/recognize avoidable problems -Implement preventive/therapeutic interventions -Understand Geriatric Syndromes

Staff needs an in-depth knowledge of subtle geriatric presentations

Why did we need to do this project?

3

“The NICHE Program deepens geriatric knowledge and caregiving skills of the CNA, LPN, and RN working in long term care addressing basic gerontological tenets such as access and quality of care, especially for vulnerable populations.” (Boltz, et al, 2012)

The NICHE core curriculum

Improve communication and collaboration between care team members

Proactive/preventive focus

Increased recognition of risk factors

Improve early recognition of geriatric syndromes and chronic disease changes in the frail older adult

Addressing these changes through:

Admission process

Interdisciplinary/intraprofessional rounding

Care plans

Handoff report

NICHE core curriculum - Goals

Ultimately extends to and directly affects the nursing home/household resident

The Certified Nurse Aide (largest % of direct care givers)

The Certified Medication Aide

The Licensed Practical Nurse

The Registered Nurse

Executive Nurse Leaders

Population this project will serve

4

“Our intention was/is to complement the Oklahoma State Department of Health Certified Nurse Aide Course with the NICHE GPCA Program.”

Education and Training: Meeting the needs of the older adult

How Many Facilities Participated? Oklahoma Methodist Manor

Member of the Eden Alternative Philosophy of Care

82 Elders (max)

CCRC

4 LTC Households

2 Skilled Households

Tulsa Jewish Retirement and Healthcare Center 56 Elders (Max)

CCRC

3 LTC/SNF Units

Scope of the project

Additional funding

Conferences/meetings-

Eden Alternative Philosophy of Care

NGNA & NICHE Conferences

Governor’s Healthy Aging Summit

Discussions with Saint Francis Hospital, designated NICHE Hospital

“Dementia Beyond Drugs” Conference

Oklahoma Foundation for Medical Quality (OFMQ) Culture Change meetings

Other occurrences that influenced the project

5

On-line State Surveyor Reports

Discussion with Director, State Surveyors

Leading Age reports at OFMQ

Advancing Excellence reports at OFMQ & NGNA

NICHE Leaders

Oklahoma Board of Nursing

Other occurences that influenced the project

ITEM OUTCOME

NICHE CORE CURRICULUM

Completed at both NHs (Jan 6 – Jul 31, 2015)

Summation of Phase I Completed (Aug 3 – Aug 28, 2015) & hand delivered

90 staff (students) completed the Core Curriculum

OMM – 33 CNA/CMA21 LPN’s & 11 RN’s

TJRHCC – 15 CNA/CMA10 LPN’s

90%, or more, of all NH staff will complete the NICHE Core Curriculum

OMM – CNA/CMA33 Completed course (100%)2 Terminated after course2 Left to return to school

EXPECTED OUTCOMES

ITEM OUTCOME

OMM – LPNs21 Completed course (100%)

1 Terminated after courseOMM – RNs11 Completed course (100%)11 continue to practice at OMM

TJRHCC – CNA/CMA17 Total students began

2 Terminated before completing15 Completed the course (88%)

3 Completed course, wereterminated after the course

12 Completed and continue topractice at TJRHCC

TJRHCC – LPNs10 Completed the course (100%)10 Completed and continue to

practice at TJRHCC

EXPECTED OUTCOMES

6

Integration of evidenced-based practice

Incorporate NICHE education into daily practice

Example: hand-off reports, team approach to

care

Incorporate shared governance concepts into PIP

teams to improve processes and care associated

geriatric syndromes and other outcome measures

NICHE Coordinators

Incorporate NICHE training in orientation for new

employees

Host “train the trainer” classes for other SNF/LTC’s

EXPECTED OUTCOMES

Dream big..........can you imagine a world in which LTC means EXCELLENCE in nursing care???!!!

NICHE educations becomes the springboard for the launch of shared governance, professional development through clinical ladders, an employer of choice, and working with hospital partners to improve transitions in care!

EXPECTED OUTCOMES

Disparity between traditional nursing leadership models vs. a transformational leadership style and approach.

NICHE becomes the standard for geriatric-specific education to LTC staff

Clinical outcomes are improved

LTC’s become an attractive environment for professional nurses to work

People looked forward to living out their lives in a our LTC’s throughout the nations

Focus on Leadership

7

FALLS UTIs

UNNECESSARY/AVOIDABLE HOSPITALIZATIONS

PRESSURE ULCERS

DATA AND QUALITY GOALS

Oklahoma Methodist Manor

0

5

10

15

20

25

30

35

40

Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec

Falls

CNA/CMA class-Jan thru Apr 2015 LPN/RN class-July 2015


0

5

10

15

20

25

30


Pressure Ulcers


8


0

5

10

15

20


Hospitalizations



0

5

10

15

20


UTI's


Tulsa Jewish Retirement & Healthcare

Center

0

5

10

15

20


Falls

CNA/CMA class - Jan thru Apr 2015 LPN/RN class - June 2015

9


Center

0

2

4

6

8

10


Pressure Ulcers



Center

0

2

4

6

8


Hospitalizations



Center

0

2

4

6

8

10


UTI’s


10

“The nurse armed with information on the unique ways in which older adults present with subtle signs and symptoms may actually avert complications. Additionally, the nurse equipped with knowledge about and implementation of proactive assessment and interventions may actually prevent these complications in the first place.”

Boltz, Capezuti, Fulmer & Zwicker, (2012)

Niche - a nurse-driven program

Boltz, M., Capezuti, E., Fulmer, T., Zwicker, D. (2012). Evidence-Based Geriatric Nursing Protocols for Best Practice. Springer Publishing Company, LLC

Eldercare Workforce Alliance 2015 –www.eldercareworkforce.org

Fulmer, T. (2007). AJN October 2007, Vol. 107, No. 10

Inter/Intra Professional education/collaboration –www.utexas.edu www.aacn.nche.edu

IOM Reports 2000 and 2008 –www.acestar.uthscsa.edu

NICHE Portfolio (2013). www.nicheprogram.org NICHE Program – www.nicheprogram.org

References

http://www.eldercareworkforce.org/

http://www.utexas.edu/

http://www.aacn.nche.edu/

http://www.acestar.uthscsa.edu/

http://www.nicheprogram.org/

http://www.nicheprogram.org/

NURSES IMPROVING CARE FOR HEALTH SYSTEM ELDERS

AND THE LONG TERM CARE COMMUNITY

HOW DID WE BEGIN?

Spoke with Administrators of two LTC Residencies in Tulsa and requested their

support for the NICHE Program to be introduced to their staff.

Research Funding Proposal (RFP) from the Oklahoma State Department of

Health, Protective Services (OSDH) announcement.

Submission of application to OSDH.

Grant was awarded by CMS and OSDH and funded with Civil Money Penalties

(CMP).

Phase I was developed

o The program was discussed with all staff

o Administration gave consistent support

o Non-clinical staff – Introduction of Gerontology

o CNAs & CMAs – GPCA Course

Monday – Sunday, both LTC residences, each shift, 4 months

Two days each week – administrative work and continual class

preparation, scoring of tests and recording grades

o LPNs & RNs – GRN Course

Same schedule, two classes each day

o Each student received 2 hours of clinical that provided application of

classroom learning to the bedside

Inclusion of all staff members in Project Improvement Programs (PIPs)

Inclusion of “Huddles” at the beginning of each shift

Involving all staff in decision-making and accountability for outcomes

Graduation of 86 students at the NICHE Designated Hospital in Tulsa with

family, friends, NICHE staff, OSDH staff, Nursing VP of NICHE Hospital,

D.O.N.’s of both residencies, Ex. Directors and VP of Health and Wellness from

both residencies.

NEXT ON THE AGENDA:

Submission of application to ODSH for Phase II in 2016

Consistency of NICHE education and program building in both residencies

CMS has approved Phase II. We are awaiting OSDH approval to begin.

a journey to learning… organization structure niche –the leading nurse-driven program designed...

Documents