As health care providers, we are being met with a challenge to provide evidence-based quality care in the most efficient and cost-effective way possible. We are also being faced with a growing population of geriatric patients, as the baby boomers turn 65 at a rate we have never experienced before. Our elderly patients present to the hospital with complex needs that we must be prepared to address in order to continue to provide quality care that is not only efficient and cost-effective, but that also meets the needs of both the patients and their families.

Key leaders at the University of Alabama at Birmingham (UAB) Hospital identified that we needed to be proactive rather than reactive to our increasing number of geriatric patients coming to our hospital for care. UAB Hospital is a 1,157-bed Magnet facility that cares for more than 17,000 geriatric patients per year.

In 2008, UAB Hospital became Alabama’s first Nurses Improving Care for Healthsystem Elders (NICHE) hospital and began the journey of making our hospital a geriatric friendly institution. UAB Hospital also created Alabama’s first Acute Care for Elders (ACE) unit. The ACE unit focuses on delivering geriatric care through an interprofessional team approach. The ACE model has demonstrated a reduction in length of stay and costs of care.

In 2009, UAB’s Geriatric Scholar Program was created to educate nurses about how to provide evidence-based care to our geriatric patients and as a means to spread the ACE model concepts to the rest of the institution. The Geriatric Scholar Program was modeled off of NICHE’s Geriatric Resource Nurse Curriculum, which includes 14 evidence-based protocols that are developed for bedside nurses. UAB wanted to make sure that our scholars not only understood key geriatric concepts, but also could put them into their daily practice; therefore, we expanded our program so that our scholars received training for 2 years. The first year of training focuses on providing education through lectures, clinical rotations and simulations. In year two, the scholars are mentored through the development and implementation of a process improvement project that improves care that is delivered to geriatric patients.

The first two classes of Geriatric Scholars were only open to nurses. Due to the program’s success, it was opened to all professionals in 2011. We were very excited to make it an interprofessional program because it is essential to have an interprofessional team caring for our geriatric patients to make sure their needs are met. We have seen an added benefit from this change because the scholars are not only learning about geriatric concepts, but also about how to work together as a team to care for our geriatric patients. We currently have scholars from nursing, pharmacy and social work, as well as a polysomnographic technologist (which is a technologist that conducts sleep studies), physician assistants, and representatives from occupational, physical and speech therapy.

The Geriatric Scholar Program has impacted our institution greatly. The scholars have provided geriatric education to numerous peers. The process improvement projects that have been implemented by scholars have not only made changes in the units where they work, but also have been incorporated into hospital-wide quality initiatives. Examples of the impact that the process improvement projects have made include fall prevention and mobility protocols, implementation of evidence-based pressure ulcer prevention interventions, and improved functional and delirium assessments.

The fall prevention protocol implemented on a vascular surgery unit resulted in a decrease in the unit’s fall rate by 50 percent. The pressure ulcer prevention project focused on using written turning clocks as a reminder to turn patients. The post- implementation audits found that 70 percent of patients that met the criteria had a turning clock, and that 66 percent of the patients were turned in the correct position. The use of a posted written turning clock was added to the hospital’s pressure ulcer quality bundle after the project was completed.

Meanwhile, the outcomes from the Promoting Mobility Project included a decrease in the number of patients without an activity order from 21 percent to 6 percent, an increase in the number of patients that ambulated in last 24 hours from 52 percent to 81 percent, and an increase in staff knowledge scores related to mobility from 65.3 to 81.1. The Geriatric Scholars have presented their process improvement projects through oral and poster presentations at several national conferences.

As health care professionals, we must continue to find ways to better care for our aging population. In order to be successful in delivering quality patient and family centered care, we must make a commitment to be innovative in our care and learn from best practices that have been implemented by other institutions.

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Emily Simmons, MSN, RN-BC, CNL
UAB Hospital’s Center for Nursing Excellence
Advanced Nursing Coordinator
NICHE Coordinator