national clinical programme for older people - current developments & future direction
TRANSCRIPT
NATIONAL CLINICAL PROGRAMME FOR
OLDER PEOPLE
Current Developments & Future Direction
Deirdre Lang Director of Nursing NCPOP
Strategic Vision Educational Framework
National Frailty Education
Programme
National Nursing Transfer Letter
Delirium
NCPOP
Discussion Points: NCPOP Current
Work streams & Developments
RESEARCH QUESTION
To determine the knowledge, skills & competence
required to produce a nursing workforce that can
provide quality person centered care to older
people where-ever they access healthcare
In doing so to develop an educational framework to
enable nurses to acquire and maintain the
necessary knowledge, skills and competence at the
appropriate level to deliver quality person-centered
care to older people throughout the Irish health
service
RESEARCH
Literature Review (National & International,
Completed by UCC)
5 National Focus Groups (World Café
Methodology)
Vision articulated for three separate
domains
Home/Community
Residential Care
Hospital Care
ROLE DEVELOPMENT
• Skills & CompetencesGeneralist
• Specially focused knowledge and skills
• Recognised post-registration education
Specialist
• Nurses practising at an advanced level incorporate professional leadership, education and research into their clinically based practice
Advanced
Strategic Vision Educational Framework
National Frailty Education
Programme
National Nursing Transfer Letter
Delirium
NCPOP
Discussion Points: NCPOP Current
Work streams & Developments
FRAILTY: WHAT WE KNOW
Almost 22% of all hospital emergency
department attendees are aged 65 and over
This age group accounts for 40% of all acute
emergency medical admissions and 47.3%
of total hospital bed days (NCPOP 2012, ED Task Force Report, 2015).
8
Positive correlation between age and admission rate from ED (75yr olds x 2
and 94 yr olds x 3)
A stay of 4-8 hours increases inpatient length of stay by 1.3 days, while a
stay of more than 12 hours increases length of stay by 2.35 days.
48% of people over 85 die within one year of hospital admission
There is a strong correlation between excessively long PETs and in patient
AVLOS
If Admitted to Hospital –
More Likely to Move
Wards
More Likely to Experience
a Longer Stay
More Likely to Experience
a Delayed Discharge
More Likely to Suffer an Adverse Outcome
Every bed move adds two to length of stay
10 days in hospital is equivalent of 10 years loss of muscle mass
FRAILTY: WHAT WE KNOW
The recognition of frailty is important and should form part of any interaction between an older person and a healthcare professional.
An individual’s degree of frailty is not static. It may be made better or worse, depending on the care received when an individual presents to a health professional.
While nurses are first responders they have a limited understanding of frailty.
FRAILTY: WHAT WE KNOW
By increasing the understanding of frailty,
we can improve the detection,
prevention, management and therefore
outcomes for these older adults.
THE NATIONAL CLINICAL PROGRAMME FOR
OLDER PEOPLE
PARTNERING
ONMSD• Office Nursing & Midwifery Services Director
NEMP
• National Emergency Medicine Programme
NAMP• National Acute Medicine Programme
FRAILTY EDUCATION METHODOLOGY
National Facilitators
Undertake Education Programme with TILDA
Deliver Education Sessions Locally
Maintain Database Locally of Educated Staff
Participate in Local Governance
Group
INTER-PROFESSIONAL EDUCATION
The WHO promote inter-professional collaboration as a strategy to strengthen and optimise health care systems and improve patient outcomes.
Health professionals have traditionally been educated in professional silos.
To achieve positive outcomes, inter-professional education must be integrated into health education curriculum
Strategic Vision Educational Framework
National Frailty Education
Programme
National Nursing Transfer Letter
Delirium
NCPOP
Discussion Points: NCPOP Current
Work streams & Developments
THE NATIONAL CLINICAL PROGRAMME FOR
OLDER PEOPLE
PARTNERING
SVUH • St Vincent’s University Hospital
SMH• St Michael’s Hospital
NHI• Nursing Homes Ireland
Nursing Homes Ireland
• St Patricks Hospital Waterford
WHY?
No single standardised nursing transferletter is available nationally in Ireland.
AUDIT & FOCUS GROUPS
Too little V Too much
Issues with communications into
hospital, within hospital and from
hospital out
Safety issues
Quality issues
Time issues
Relationship issues
Strategic Vision Educational Framework
National Frailty Education
Programme
National Nursing Transfer Letter
Delirium
NCPOP
Discussion Points: NCPOP Current
Work streams & Developments
STATS
Delirium affects 1 in 8 acute hospital inpatients
30% acute geriatrics patients; 50% ICU and post hip
fracture surgery)
Delirium is distressing for patients and families
Delirium is linked with 2-fold increased length of hospital
stay;
2-fold risk of falls; 3-fold higher mortality: 1 in 5 are dead
in one month
About 40% of delirium is preventable
Delirium is often not detected; but detection improves
care & outcomes
Established delirium (present for a few days) is harder to
treat
NCPOP WORKSTREAMS
Delirium as
part of the
NFEP
Delirium in
ED/AMU
Delirium in
Acute
Medical/
Surgical
bed
Delirium in
Residential
Facility
Strategic Vision Educational Framework
National Frailty Education
Programme
National Nursing Transfer Letter
Delirium
NCPOP
Discussion Points: NCPOP Current
Work streams & Developments