TEACH© (Transitioning Elders Across the Continuum of Healthcare) was developed at Penn State Hershey Medical Center to provide caregivers with knowledge and skills in geriatric care.
The need to improve hospital care for elders at PSHMC created the impetus for this nurse led program. This practice innovation was directed at identifying elders at risk and preventing functional decline through evidence based practices.
TEACH©, lead by a Gerontological Clinical Nurse Specialist, uses content based on the John A. Hartford Foundation Institute for Geriatric Nursing. TEACH© provides essential geriatric training using the Geriatric Resource Nurse (GRN) Model. A multidisciplinary team was created to include advanced practice nurses, staff nurses, social workers, physicians, pastoral care, clinical nutrition, physical and occupational therapists, pharmacists, and a psychiatric liaison. Team expertise is used to deliver TEACH© content. In addition, they meet monthly to provide a forum for evidence-based care for hospitalized elders and families, and are available for patient consultations. In order to identify elders at risk, the electronic charting system was used to generate automatic referrals to the APN when two or more geriatric syndromes are documented.
TEACH© has provided over 50 GRNs and team members with enhanced problem solving skills in geriatric care. A significant accomplishment has been increased identification of vulnerable elders at admission and improved consultation with the APN.
Outcomes and Implications:
- TEACH© as an innovative practice has raised awareness of PSHMC’s commitment to geriatric care.
- Multidisciplinary leadership provides a mechanism for continuing best, evidence-based practices to hospitalized elders and their families. Multidisciplinary rounds provide the best possible collaborative and evidence-based care to hospitalized elders and their families. Client outcomes include improved recognition of geriatric vulnerabilities and symptom management (pain, depression, weakness, etc.) Patient and family members have verbalized increased satisfaction as a result of better patient education and the client and family members’ direct participation in multidisciplinary rounds.
- TEACH© has produced a team of 35 Geriatric Resource Nurses from inpatient and outpatient units across the campus that are trained in special geriatric needs and vulnerabilities.
- A Geriatric Nursing website has been established. The website provides staff nurses with ready access to evidence-based geriatric tools such as the JAHF Try This and with other direct links to policies and websites supplying elder expertise.
- Minimum competency requirements for nurses caring for older adults were developed in conjunction with the Hospital Education Council.
- Council members represent geriatric interests across the campus at other councils and forums.
- Geriatric educational opportunities have been extended across the disciplines to nursing staff at every opportunity including surgical updates, trauma updates, women’s health updates, critical care updates, and so on. Physical therapists, housekeeping, and central transport staff have also received geriatric training. The first geriatric case studies were presented to the Penn State College of Medicine’s 3rd year medical students as part of the Medicine Clerkship. The outcome of these educational activities has been increased access to the knowledge and skills necessary in providing care to a specialized elder population.
- Another outcome of TEACH© includes the use of an evidence-based practice model to examine hospital readmissions in the older adults and identify gaps in discharge planning. Data will be collected to measure improvement in discharge planning with the implementation of a new discharge tool.
- Monthly meetings are held by the 15 member TEACH© Council to synergistically address geriatric needs across the campus. The council has contributed to process improvements for scheduling follow-up appointments. Pneumonia was recognized as the most frequent diagnosis for our elder hospitalized population, and a new interdisciplinary education record was developed by the CNS and implemented by the hospital’s education and practice councils. The TEACH© team was consulted when the sitter policy and confusion assessment algorithm were reviewed and modified. The electronic charting system was modified and a tool was developed to identify vulnerable elders who developed two or more geriatric syndromes, and to trigger a consult to the CNS.
- The entire TEACH© team was awarded HMC’s MAGNET Collaborative Practice Award in May.
Ongoing TEACH© projects include the updating of our falls protocol, and a program is being developed to allow elders to wear their hearing and visual aids to the operating room. Pre-operative case management with particular interest in geriatric vulnerabilities is being developed for our elder joint replacement patients. It is hoped that this program will yield data related to decreased LOS and morbidity and increased patient satisfaction.
