Christine Waszynski DNP, APRN, GNP-BC, FAAN …...EPIC • Nurse - Nurse handoff • Nurse - PCA handoff 3 Do • Review CAM/CAM -ICU & RASS/mRASS Scores • Daily cognitive assessment

Christine Waszynski DNP, APRN, GNP-BC, FAANHartford Hospital February 6, 2020

Hospital Inpatient

Consults & Programs

PPN SNFs/SNF programs

Home

Outpatient Geri Consults Primary Care

Geriatric oncology Co-management

APRN Home Visits/REACH

Hartford HealthCare Geriatric Continuum of Care

9 sites

8 sites

1 of 7hospitals

Serve 13 towns

Integration of AFHS into Hartford HealthCare

Core Values• Caring-individualized care;

dignity• Safety –promoting safe

mobilization• Excellence-evidence based

practice • Integrity-trust

4 M’s• What Matters• Medications• Mobility• Mentation

HHC Mission: To improve the health and healing of the people and communities we serve

Goal: To provide an integrated, seamless, comprehensive care system linking seniors and their families to the services required and requested to maintain and restore health in alignment with expressed patient goals/wishes.

Hartford HospitalHartford CT

Inpatient Geriatric Team Players

February 7, 2020Confidential and Proprietary Information 5

2 geriatricians1 geriatric nurse practitioner

2 masters prepared nurses with geriatric certification

GRN ChampsGRNs

GPCAsKeeping In Touch

Activity CartMeal Mates

MobilitySafety

VOLUNTEERS

Geriatric Education

Nursing StaffNurses• General Nursing Orientation• Nurse Residency• Annual Competency• Geriatric Resource Nurse Program• GRN Champ Program• Fellowships/rotationNursing Assistants• General orientation• Annual Competency• Geriatric PCA

Other Staff Providers• New hire orientation• Grand rounds• Geriatric consults• Geriatric rotationRehab• Inservices• Mobility volunteer rotationsAll hospital staff• Annual competency

ADAPT- Making Delirium Awareness a Priority

•Began in 2012•Supported by hospital administration•Inter-professional Team (representation across departments and disciplines n=42)

•Plan for structure (delirium care pathway)Build supports in EHR to guide documentation and gather dataEducation (classroom/CESI/bedside)Adjunct Support (volunteer programs; therapeutic activities)Quality / research/ feedback

ADAPT

Actions to enhance Delirium Assessment Prevention and Treatment

Screening all patients (improve recognition)Preventative measures for high risk patients (40% cases are

preventable)Quick response by health care team to a positive delirium screen

(cause; safety; preservation of function) decreases severity and duration of deliriumEvidence based interventions to improve outcomes

Application of Universal Evidence-Based Best Practice Strategies

•Information in Patient Handbook –patient and family to report S/S of delirium promptly. Family encouraged to participate in care

•Delirium assessment integrated into rounds and handoffs

•Early mobilization/noise reduction/ sleep enhancement efforts

•Personalized care “Hartford HealthCare Cares About Me” poster

Application of Universal Evidence-Based Best Practice Strategies

•Creation of a sensory modulation room for patients and families (Therapeutic HUB)

•Volunteer programs that focus efforts towards patient experiencing or at high risk for delirium–Keeping in Touch Volunteer Visiting Program; Meal Mates; Activity Cart; Safety Volunteers; Mobility Volunteers

• Activated EHR alerts on medications that may cause delirium

• Standardized provider order sets• Provide data driven feedback to change practice

NO

• Document course and cause of Delirium if known

• Degree of resolution

• Discontinue unnecessary psychotropics

• Follow up for Delirium if not resolved

• Document on W10/After Visit Summary

7 Discharge

• CAM or CAM-ICU every 8 hours + prn• Comfort/calm/consistent• Toileting• Feed/hydrate• Mobilize to maximum• Maintain normal sleep/wake cycle• Touch/backrub• Assess response to medications• Family & volunteer involvement• Alternative therapies (Reiki, Pet, Art,

Music)• Document progress

5 Daily Care

• Physical exam• Med review• Determine potential

causes*• Differential diagnosis• Document acute

encephalopathy• Activate Delirium order set

in EPIC

• Diagnostics• Drugs for hyperactive

pts (RASS/mRASS ≥ +2)

• Haldol IV or Seroquel PO per delirium order set

• If contraindicated consult pharmacist

• Scheduled acetaminophen

3 Diagnosis / Do• Cognitive assessment

• F/U Diagnostics

• Review meds-adjust prn

5 Daily Visit• No harmful drugs*• Avoid abrupt

discontinuation* (Drugs, ETOH, nicotine)

• Avoid/limit Devices (catheters, lines, leads)

1 Deter

• Mobilize to maximum• Uninterrupted night-time rest

(noise, bundle care, eye shields, earplugs)

• Eyeglasses/hearing aids• Whiteboard up to date• Daily goals of care• Calendar/clock/familiar items• Assist with food/fluids• Comfort• “HHC Cares About Me” poster• Family as partners• Volunteers for social interaction

1 Deter• CAM every 8 hours

and prn• Determine baseline

mental status• Notify provider

immediately of firstpositive CAM or CAM-ICU and activate “Acute Confusion” CPG

2 Detection• Fall prevention• Discontinue/ Disguise devices• Family teaching - brochure• Provide Distractors (music,

flashball, animal)• T-A-D-A (Tolerate, Anticipate,

Don’t Agitate)1

• Reassurance• Individualize plan of care in

EPIC• Nurse - Nurse handoff• Nurse - PCA handoff

3 Do

• Review CAM/CAM-ICU & RASS/mRASS Scores

• Daily cognitive assessment

• Determine baseline mental status

2 Detection

• Document successful strategies

• Discuss ongoing needs• Discharge with one time

use Distracters (doll, animal)

• Discuss follow-up with family

• Document individualized care needs on W10/After Visit Summary

7 Discharge

CAM or CAM-ICU Positive

PROVIDE

R

PATIEN

T

NURSES

• Age > 65

• Dementia• Substance Dependency• Hx Delirium• ICU/SD• Impaired vision/hearing

Risk Factors• ED screen

of pts age >65

• Attention screen

• SQID?

• Provider + Nursing • +/- Pharmacist

• Huddle• Make Plan

4 Discuss

• Provider + Nursing • +/- Family

• Progression Rounds

• Is Patient Improving?

6 Daily Dialogue Age > 65:• Geriatric medicine consult

Age < 65 or major psychiatric Dx:

• Psychiatric consult• Family meeting

*see back of brochure for more information 1 Flaherty, 2011

NO

30 Day All Cause Readmission Rates Over Time

Outcome: Decreased Length of Stay In Patients with Delirium ADAPT DATA

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4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3

2012 2013 2014 2015 2016

Day

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CAM POS

February 7, 2020ADAPT Program - Hartford Hospital 13

Delirium Attributable DaysADAPT Data


0

5000

10000

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20000

25000

30000

35000

40000

45000

2013 2014 2015 2016 2017 2018

To

tol D

ays

Year

ROI Calculator Applied to ADAPT

2.26

2.50

2.06

2.33

2.56 2.53

1.932.06

2.40

2.10

2.33

2.06

2.602.50 2.50

2.97

2.66

2.90

2.302.40

2.60

2.27

1.90

2.102.00

1.90

0.260.36 0.40

0.23 0.17 0.20 0.10

0.30 0.300.23 0.26

0.36 0.40 0.30 0.260.40 0.40

0.300.43

0.530.37 0.37

0.230.40 0.36 0.30

0.00

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1.00

1.50

2.00

2.50

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3.50

Q3-

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2019

Average Quarterly Falls

Average Monthly # of Falls Per 1000 pt Days

Average Monthly # of Falls with Injury Per 1000 pt Days

Assisted falls data

Safe Mobilization


• Mobility volunteers since 2011 (PT or other health profession students) • 17,500 mobility episodes

• Implemented Gait belt and walker for all mobilization of high fall risk patients

Bed Exercises- increase patient engagement in care

2/7/2020Place Title Here in Header and Footer 20

Personalized activities for patients with cognitive impairment

• Observations were made on 74 agitated patients over a 6 month period.

Chart1

Positive Response

No Change

Response One Hour After Compared to Prior


47

27

Sheet1


Positive Response47

No Change27

To resize chart data range, drag lower right corner of range.

Family Video Messaging


• Non pharmacological intervention to:

Provide comfort and connection to agitated patients with altered mental status

Engage families in care

Provide comfort to families

Offer a personalized intervention for staff

Example of Family Video Message


% of Participants Experiencing a Decrease in Agitation


0

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100

Pre- During Pre- Post Pre- 30 min post

% R

edu

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core

Time Points

Family

Nature

Usual

The Therapeutic HUB

HealingUnderstandingBelief in patient as person

The Therapeutic HUB multi-sensory stimulation environment



Patients may feel safer and more “normalized” in a controlled, multisensory environment compared

to a clinical, hospital room

Findings to date Jan 2018-2020Approximately 400 patients worked with a

nurse in the HUBMost have altered mentation

(dementia/delirium/both)

• Agitated patients become more calm• Withdrawn patient become more engaged• Improved eating• Improved mobilization• Improved mood

Families express increased satisfaction Opportunities for education

Staff implement bedside activitiesItems brought to bedside for those who can

not visit the HUB

• Qualitative data: “Feels like home”“ I feel more normal”

Pilot study suggests the HUB improves cognition and normalizes arousal levels.

Benefits of Therapeutic HUB

Voice over powerpoint with video: Therapeutic HUB

• https://vimeo.com/266874016/f693ff3a99

https://vimeo.com/266874016/f693ff3a99

Our 4 M Age Friendly Health System Focus


• Focused on 5 inpatient units 2 medical units 1 medical oncology unit 1 transplant medical unit 1 cardiac ICU

What You Can Do

What MattersNurse PCA

Discuss goals of care in rounds XPatient friendly goals on white board X XAsk pt what matters to them today X XMutuality/individualization in EPIC XHHC Cares About Me poster in room X XIdentify pts for Therapeutic HUB X XIdentify pts for Keeping in Touch X XMobilityMobilize level 5 ambulatory patients to maximum and document distance

X X

Give exercise sheet to patients and encourage them to do them X XMentationScreen CAM and RASS every 8 hours XNotify nurse of any changes in patient’s behavior XActivate Acute Confusion CPG for CAM + pts XMedication Identify new high risk meds and discuss with provider/pharmacist XTeach pts not to take OTC “PM” meds X

Unit based data collection tool


How are we doing addressing all 4 M’s with all older adults?

12% 14

%

14%

15%

12%

11%

18%

40% 4

3%

42% 4

5%

47%

42%

52%

38%

34% 37

%

33% 34

%

39%

25%

9% 8% 8% 8%

5%

8%

5%

0% 1%

0% 0% 1%

0% 0%

J ANUARY FEBRUARY MARCH APRIL MAY JUNE JULY

% OF NUMBER OF 4-M'S COMPLETED FOR ALL UNITS

4 Completed 3 Completed 2 Completed 1 Completed 0 Completed

How are we doing with each of the M’s with all older adults?

39%42% 40% 42% 41%

36%38%

85% 83%87% 87%

81%85%

88%

73% 74% 73% 74%77%

74%

83%

60%

67%63% 65%

66%

60%

73%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 Jul-19

Percentage of 4-M's by Month all Units combined

What Matters Medication Mobility Mentation

56%45%

67%

0%

100% 100%

0%

20%

40%

60%

80%

100%

120%

Mar-19 Apr-19 May-19 Jun-19 Jul-19 Aug-19

CollaboRATEB10I Percent of Perfect Scores

8.98.3

8.78.0

9 98.3 8.5

9.0 9.0 9 98.5

8.1

9.0

4.0

9 9

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

9.0

10.0


AVERAGE

SCORE

CollaboRATE B10I Average Scores

Question #1

Question #2

Question #3

Mentation

0%

20%

40%

60%

80%

100%

120%


Mentation Protocol Completionfor Unit B10I

CAM every 8Hrs.

RASS every 8Hrs.

Baseline Done on Admit

Do CAM+RASS = Notes

CAM Pos. Intervention

0%50%

100%150%

Percentage of Patients with Delirium Screening at least 3x in a 24 hr period for Unit B10I

0%20%40%60%80%

100%120%

Percentage of Patients with RASS done every 8Hrs. for

Unit B10I

0%20%40%60%80%

100%120%

Percentage of Patients withBaseline Mental Status done

on Admit for Unit B10I

0%50%

100%150%

Percentage of Patients where CAM+RASS = Notes for Unit

B10I

0%

20%

40%

60%

80%

100%

120%


Percentage of Patients with Positive CAM Intervention for Unit

B10I

75%

79% 79%

76%

82%

70%

83%

64%66%68%70%72%74%76%78%80%82%84%


Percentage of Patients withDelirium screening at Least 2x/24 hour

PeriodB10I

Mobility

0%

20%

40%

60%

80%

100%

120%

Mobility Protocol Completion Unit B10I

Exercise Sheet in Room

Doc. Of Exercises in EPIC

Amb. >150/24hrs.

0%

20%

40%

60%

80%

100%

120%


Percentage of Patients withExercise Sheet in Room

Unit B10I

0%

20%

40%

60%

80%

100%

120%


Percentage of Patients withExercises Charted in EPIC

Unit B10I

0%

20%

40%

60%

80%

100%

120%


Percentage of Level 5 Patients withAmbulation >150/Day

Unit B10I

0 0 0 0 0 0 0 00

0.2

0.4

0.6

0.8

1

Number of Patients withAssisted Falls Without a Gait

BeltB10I

10.0%13.2% 14.9% 12.7%

23.4%

4.2%

34.3%

0.0%

10.0%

20.0%

30.0%

40.0%


Percentage of Patients withDocumented Mobility

Screening( Progressive mobility Level)

B10I

What Matters

0%

20%

40%

60%

80%

100%

120%


"What matters" Protocol Completionfor Unit B10I

HHC Cares Poster

Pt. Goals on W.B.

G.O.C. in EMR

Mutuality/EPIC

0%

20%

40%

60%

80%

100%

120%


Percentage of Patients with HHC Cares About Me Poster in

Room for Unit B10I

0%10%20%30%40%50%60%70%


Percentage of Patients with Advanced Directive/Goals of

Care in EMR for Unit B10I

0%

20%

40%

60%

80%

100%

120%


Percentage of Patients withPatient Friendly Goals on White

Board for Unit B10I

0%

20%

40%

60%

80%

100%

120%


Percentage of Patients with Mutuality/Individualization in

EPIC for Unit B10I

22.5%

31.6%

42.5%

31.6%

49.4%

38.0%

31.4%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%


Percentage of Patients withAdvanced Directive/Goals of Care in

EMRN = All Pts. 65 and Over

B10I

1.3%

0.0%

1.1%

2.5% 2.6%

4.2%

2.9%

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

3.0%

3.5%

4.0%

4.5%


Percentage of Patients withMutuality/Individualization in EMR

N = All Pts. 65 & OverB10I

0 0 0 0 0 0 00

0.10.20.30.40.50.60.70.80.9

1

Feb-19 Mar-19 Apr-19 May-19 Jun-19 Jul-19 Aug-19

# of Patients withVisits to Theraputic Hub

B10I

00

0.10.20.30.40.50.60.70.80.9

1

Aug-19

# of Patients withK.I.T. Visits

B10I

12% 14%

14%

15%

12%

11%

18%

40% 43

%

42% 45

% 47%

42%

52%

38%

34% 37%

33%

34% 3

9%

25%

9% 8% 8% 8%

5%

8%

5%

0% 1%

0% 0% 1%

0% 0%


% OF NUMBER OF 4-M'S COMPLETED FOR ALL UNITS


1% 1%

6%

1%

4% 6% 6%

19%

25%

32%

24%

32%

23%

31%

50%

47%

40%

49%

48% 5

2%

46%

30%

25%

21% 2

5%

13%

20%

14%

0% 1%

1% 0%

3%

0%

3%


% OF NUMBER OF 4-M'S COMPLETED FOR UNIT B10I


39% 42% 40% 42% 41% 36% 38%

85% 83% 87% 87% 81% 85%88%

73% 74% 73% 74%77% 74%

83%

60%67%

63% 65% 66% 60%

73%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


Percentage of 4-M's by Month all Units combined


24%

43% 44%33%

51%

38%31%

86%80% 84% 81%

71%

96%

80%

10% 13%15% 13%

23%

4%

34%

75% 79% 79% 76%82%

70%

83%

0%

20%

40%

60%

80%

100%

120%


Percentage of 4-M Completion for Unit B10I


Medications

0

10

20

30

40

50

60

70

80

90

May-19 Jun-19 Jul-19 Aug-19

Types of Prescriptions by MonthUnit B10I

Atypical Antipsychotics

Typical Antipsychotics

Benzodiazepines

Diphenhhdramine

Haldol

Muscle Relaxants

Sedative Hypnotics

Trycyclics

6 0

123

0 0 0 0 60

50100150

B10I Prescribed Medications

July 2019

AtypicalAntipsychotic

s

TypicalAntipsychotic

s

Benzodiazepines

Diphenhhdramine Haldol

MuscleRelaxants

SedativeHypnotics Trycyclics

CB2 132 18 1150 212 18 30 83 0CB3 157 7 670 123 12 22 105 33CB4 107 8 840 411 12 79 123 19CB5 281 23 1091 91 31 62 182 54B10I 6 0 123 0 0 0 0 6

0200400600800

100012001400

Axis Title

Prescribed MedicationsUnit Comparison

June 2018 - August 2019

CB2

CB3

CB4

CB5

B10I

The CESI mobile program


Post-Acute Care (PAC) experience

• 16-23% patients in sub-acute care enter with or develop delirium• Poor progress toward standard goals

– D/E impairs participation– SNF generally lack skills and strategy to rehabilitate and successfully

convalesce a delirious patient. No systematic studies to date. • Sparse programming/expertise for cognitive rehabilitation• Complicated by management ‘missteps’

– Medication choices that worsen confusion – Inappropriate goal setting– Avoidable complications: UTI, dehydration, falls, dysphagia,

behavioral incidents, readmissions.• Disposition dilemma

58

Overall Comparison

Baseline OrPre-educational intervention1

Educational Intervention1

Post-educational intervention1

Educational Intervention2

Pre-educational intervention2

Post-educational intervention2

3 to 6 monthsd1_pre d1_post d2_pre d2_post

KNOWLEDGE scores– compared across time points within individuals

x ̅ =71.1 + 24.7 (0-100)Median=75.0

x ̅ =91.8 + 11.1 (50-100)Median=100.0

N=75Neg Ranks=4Positive Ranks=45Ties=26Z= -5.5p (2 tailed)=0.000

d1_pre vs d1_post

x ̅ =97.1 + 8.1 (75-100)Median=100.0


d1_pre vs d2_post

x ̅ =81.3 + 20.8 (25-100)Median=75.0


d2_pre vs d2_post

Wilcoxon Signed rank test was used to evaluate differences in knowledge scores across time points. Results revealed that Knowledge scores significantly improved post-educational intervention 1. Median at time point 1 was 75 and at time point 2 was 100.

Results revealed that Knowledge scores significantly improved post-educational intervention 2. Median at time point 3 was 75 and at time point 4 was 100.

Results revealed that overall Knowledge scores significantly improved post-2 educational interventions.Median at time point 1 was 75 and at time point 4 was 100.

Confidence questions

How confident are you:1. Screening for delirium

2.Assessing for acute onset/fluctuating course of mental status different from baseline

3.Assessing for inattention

4.Assessing for altered level of consciousness

5.Assessing disorganized thinking

6.Notifying the provider of a positive CAM

Confidence scores– compared across time points within individuals

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

1 2 3 4 5 6

Aver

age

Con

fiden

ce L

evel

Question

The Effects of Training on Average Confidence

Brownstone- Annual Wellness

Population health project:• Underserved older adults (2x the rate of cognitive impairment than

surrounding community)• Operationalizes Annual wellness visit • integrates 4Ms• Universal cognitive screening using mini-Cog and CDR• Focused cognitive assessment using BrainCheck• Structured assessment of Modifiable Factors• Wellness intervention• Fitness Program, cognitive and physical

Brownstone Population seen


24 patients seen for focused cognitive assessment• - 17 non English speaking, 5 english, 1 korean, 1 chinese• - Mean age 75 (57-99)• - 18 female, 6 male• - 13 referred because of Annual Wellness Visit Screen fail; remainder referred because of

family concerns or observed compliance concerns (missed appointments, medications, other)

Cognitive Diagnoses:• 14 MNCD, 7 mild, 5 moderate, 2 severe• 14 no previous NCD dx• 11 no previous focused medical work up for treatable causes• 3 had core lab done in anticipation of the consultative visit• 2 MCI• 2 Clinical Deprression• 6 NO NeuroCognitive Disorder

Geriatric Oncology Program at HHC Cancer Institute

• Increased education for staffGRN and GPCA classes for in and outpt staffAnnual geriatric oncology conference

• Geriatric assessment for newly diagnosed pts• Geriatric case managementIntegrating the 4 Ms

Geriatric Oncology Program at HHC Cancer Institute

• Screen all older adults with a new cancer diagnosis using the G8 to determine cognitive and function fitness

• Provide focused care by geriatric oncologist and geriatrician Determine patient wishes and goalsAssess risksIntervene for modifiable risksMake recommendations for treatment/care based upon patient

fitness and individualized goals

November 2018: mG8

Pilot

Resource Coordinators

Transitional Care Nurses

Dementia Specialists

Geriatric Care Management

2/26/2019 69

Center For Healthy Aging Services

Hartford HealthCare

TCN Identified:• 92% Medication discrepancies• 82% High risk for readmission/hospitalization• 16% Moderate risk for readmission/hospitalization• 91% Fall risk• 35% of patients were hospitalized within 12 months prior to seeing TCN• 43% of patients live aloneLink to Community Services• 57% referred to certified homecare services• 41% connected to provider• 23% linked to caregiver services• 71% required referral to social work/resource coordination• 24% connected to dementia specialists• 17% linked to behavioral health services• 7.4% required referral to elderly protective services

2/26/2019 70

Outcomes- Quality Data for TCNs

Hartford HealthCare

Caregiver education and support has delayed Skilled Nursing Facility (SNF) placement by approx. 1.5 years

•N=198•Annual CT SNF =$144,000/year•18 Months CT SNF= $216,000• Possible healthcare cost savings $42,768,000

Training for caregivers of people with dementia improves: • Caregiver confidence • Ability to manage daily care challenges• Supports caregivers in their role and relationship

*Mittleman, M.S., Haley, W.E., Clay, O.J., Roth, D.L. Neurology 2006;67:1592-1599 DOI: 10.1212/01.wnl.0000242727.81172.912/26/2019 71

Benefits of Dementia Education

Hartford HealthCare

Measurement ValueTotal patients referred to REACH 222Referred by HHCMG provider 200Referred by non-HHCMG provider 18Active REACH patients 170Index hospitalization rate 29.3%30 day readmission rate 5.9%Referrals from REACH to HHC 59.9%Referred to or utilizing home health 83.8%Referred to or utilizing HHC at Home 41.4%Referred to or utilizing hospice 32.9%Have an advance directive on file 24.8%Code status is DNR 32.9%ICP involved 63.5%Passed away 23.0%% on Hospice among pt's who passed away 83.0%Passed away at home 60%Passed away in hospital 40%

HHCMG Geriatrics

REACH Data

Questions and Comments


Slide Number 1Slide Number 2Integration of AFHS into Hartford HealthCareHartford Hospital�Hartford CTInpatient Geriatric Team Players Geriatric EducationADAPT- Making Delirium Awareness a PriorityADAPTApplication of Universal Evidence-Based Best Practice StrategiesApplication of Universal Evidence-Based Best Practice StrategiesSlide Number 1130 Day All Cause Readmission Rates Over TimeOutcome: Decreased Length of Stay In Patients with Delirium � ADAPT DATADelirium Attributable Days�ADAPT DataROI Calculator Applied to ADAPTSlide Number 16Assisted falls dataSafe MobilizationBed Exercises- increase patient engagement in careSlide Number 20Slide Number 21Personalized activities for patients with cognitive impairmentFamily Video MessagingExample of Family Video Message% of Participants Experiencing a Decrease in Agitation�� The Therapeutic HUBThe Therapeutic HUB multi-sensory stimulation environment�Patients may feel safer and more “normalized” in a controlled, multisensory environment compared �to a clinical, hospital roomFindings to date Jan 2018-2020Benefits of Therapeutic HUBVoice over powerpoint with video: Therapeutic HUBOur 4 M Age Friendly Health System FocusWhat You Can DoUnit based data collection toolHow are we doing addressing all 4 M’s with all older adults?How are we doing with each of the M’s with all older adults?Slide Number 37Slide Number 38Slide Number 39Slide Number 40Slide Number 41Slide Number 42Slide Number 43Slide Number 44Slide Number 45Slide Number 46Slide Number 47Slide Number 48Slide Number 49Slide Number 50Slide Number 51Slide Number 52Slide Number 53Slide Number 54Slide Number 55Slide Number 56The CESI mobile programPost-Acute Care (PAC) experience�Slide Number 59Confidence questionsConfidence scores– compared across time points within individuals �Brownstone- Annual WellnessBrownstone Population seenSlide Number 64Geriatric Oncology Program at HHC Cancer Institute Geriatric Oncology Program at HHC Cancer InstituteSlide Number 67Slide Number 68Center For Healthy Aging ServicesSlide Number 70Benefits of Dementia Education REACH DataQuestions and Comments

Documents

Christine Waszynski DNP, APRN, GNP-BC, FAAN …...EPIC • Nurse - Nurse handoff • Nurse - PCA handoff 3 Do • Review CAM/CAM -ICU & RASS/mRASS Scores • Daily cognitive assessment