nicheprogram.org

Our Objectives

• Discuss the implications of the aging population for our hospital

• Discuss the opportunities and resources offered by the NICHE program

NICHE Nurses Improving Care for Healthsystem Elders• NICHE is the premiere national geriatric nursing program that

addresses the needs of hospitalized older adults• Currently there are almost 500 hospitals in more than 45 states as

well as Canada and Bermuda with NICHE designation. Over 100 hospitals are joining NICHE every year!

• NICHE collaborates with over 20,000 healthcare providers in the NICHE network on important geriatric issues

Why a program focused on older adults?

Older Adults Are Hospitals’ CORE Consumers

• By 2050, the older adult population will number nearly 89 million, more than double the current population in 2010.

• Reason for the increasing population:–People living longer–Baby Boom population becoming 65 and older

• Every day until 2031; 10,000 Baby Boomers turn 65• By 2030 healthcare expenditure will increase by 25% for older adults• Medicare spending will go from $555 billion yearly

to $903 billion by 2020.

http://www.cdc.gov/aging/help/dph-aging/state-aging-health.html

Older Adults Are Hospitals’ CORE Consumers___% of_____________ (our hospital)

inpatient admissions are:• 65 years and older • 85 years and older

The Quality Imperative: Improve Clinical and Fiscal Outcomes!

Older adults 13% of the population:

• But comprise 37% of hospital discharges and 43% of hospital days• Have longer lengths of stay (7.8 days vs. 5.4 days)• Higher rates of 30 day hospital re-admissions• Higher rates of functional decline and medical errors

Reference: U.S. Dept. of Health and Human Services, Centers for Disease Control. Trends in Health and Aging. Retrieved October 31, 2008 fromhttp://www.cdc.gov/nchs/hdi.htm

Hall, M.J., DeFrances, C.J., Williams, S.N., Golosinskiy, A., & Schwartzman A. (2010). National Hospital Discharge Survey: 2007 summary. National health statistics reports; no 29. Hyattsville, MD: National Center for Health Statistics. 2010

Improving Care for Hospitalized Older Adults Is Good Business

• Optimal care requires appropriate skills

– Aging demographics– Geriatric skill gap– High cost of inaction

• Older adult patients are everywhere

– Need for flexibility– Ongoing training and

coaching roles– Cost effective “train the trainer”

virtual services

Improving Care for Hospitalized Older Adults Is Good Business• Proactive & skilled nursing care avoids costly problems

– “Never” events– Complications that increase LOS and costs

• Patient and family satisfaction– Better functional status at discharge– Smoother transitions

• Improved nurse satisfaction & efficiency, less turnover• Improved MD satisfaction and improved efficiency

NICHE Program

– Achieve systemic nursing change that will benefit hospitalized older adults

– Provide geriatric sensitive and exemplary care to all hospitalized adults 65 years and over

– Import principles and tools to stimulate change in the culture of healthcare facilities and achieve patient-centered care for older adults

Goal

Vision

Mission

What Is the Focus of NICHE?

focuses on programs and protocols that are predominately within the scope of nursing practice.

In Other Words…Nursing interventions have a substantive and positive impact on patient care outcomes

Hospitals Participating in NICHE Report…• Enhanced staff knowledge and skills• Greater patient satisfaction• Decreased length of stay for older adult patients• Reduction in costs associated with hospital care

for the older adult• Enhanced Magnet initiatives• Improved compliance with regulations and

industry standards

What Are the Objectives of the NICHE Program?

1. Improve patient outcomes2. Improve the patient experience3. Promote staff effectiveness and satisfaction4. Establish leadership as a provider of care to older adults5. Provide fiscally responsible care6. Increase collegial networks

NICHE Program Goals

Geriatric Resource Nurse (GRN) Model

• Began in Boston– Early 1980’s at Beth Israel

Unit based experts using existing resources Expanded at Yale New Haven Hospital

• Rationale - Those who voluntarily chose to participate in the effort would provide better care to older adults

• Central to the role - Geriatric education, competency evaluation, and mentoring

Rewards Related to the GRN Model

• Clinical ladder• Novice expert growth• Respect within the role• Deeper geriatric expertise • Parsimonious use of resources

Outcomes described by NICHE sites• Improved clinical outcomes• Increased staff skill• Increased satisfaction, both staff and patient

NICHE in Acute Care of the Elderly (ACE) Units

Key Elements

• Patient-centered care• Frequent medical review • Early rehabilitation• Early discharge planning • Prepared environment• Geriatric trained nurses (GRNs)• Interprofessional teams• Nursing evidence-based

protocols

Hospital outcomes

• Length of stay• Case mix• Cost per case• Readmission within

30 days

Improved patient outcomes

• Restraint use• Pain levels• Incontinence• Pressure ulcer prevention

or rates• Functional status, fall rates and

falls with injury• Urinary catheter use• Medication use

What Resources Does the NICHE Program Offer?

NICHE Program www.nicheprogram.orgThis website provides online access to:

•The NICHE journey, how to get started•Online Leadership Training Program information•Annual Conference information•NICHE Knowledge Center (online tools and resources)•Individual NICHE hospital websites•Patient and Family resources

NICHE Program for “Members Only”

•Start-up Tools–NICHE Planning & Implementation Guide –Leadership Training Program•Measurement–Geriatric Institutional Assessment Profile (GIAP) –Clinical Outcomes–Program Self-Evaluation•Clinical Management Tools –Organizational Strategies & Clinical Improvement Models

NICHE Program for “Members Only”•Training and Education Programs–Core Curricula: for Nurses, Patient Care Techs (CNAs), other disciplines and general staff–Webinars and in-service materials–Contact hours –Educational resources for patients and families –Conferences

•National Community–NICHE Listserv, discussion boards, resource, topic and special interest based

Getting Started

• Gather Stakeholders • Identify needs derived from:

– Staff development measures– Clinical outcomes– Financial outcomes– Budget considerations– Satisfaction surveys– Other strategic initiatives/plans– Passion of those who want to improve the

care of older adults

Attend Leadership Training Program (LTP)

• Who should attend the LTP? (minimum of 3 people responsible for initial steering of initiative)– Clinical Nurse Leader– Clinical Educator– Quality Manager or Administrator– Recommended additions to steer initiative: direct

care staff, other disciplines (physician, rehab, social work, pharmacy, etc.) and community partners

How to Become a NICHEDesignated Hospital

How to Become a NICHEDesignated Hospital

How is the LTP delivered? • 6 week online program delivery

– Participate in scheduled live webinars and phone conferences– Engage in online group activities

• Facilitated by NICHE faculty & experts from experienced NICHE sites

• Earn contact hours • Development of Action Plan upon program completion –

Reviewed & discussed with NICHE staff and faculty

© 2013 NICHE All rights reserved. The information contained in this module is provided for informational purposes only. The content has been developed by NICHE participants and the NICHE staff at New York University’s College of Nursing and is protected by copyright under the laws of the United States and foreign laws. Under no circumstances may these materials be reproduced for sale or profit. Any use of content not expressly permitted may violate copyright, trademark, and other laws.

Thank you!

For more information, please go to

www.nicheprogram.org