Page 122 - HA Convention 2016 [Full Version]

HOSPITAL AUTHORITY CONVENTION 2016 Service Enhancement Presentations

F1.3 Service Revamp 13:15 Room 421

Elder-friendly Nursing Care — a Paradigm Shift
Ho JKY, Ng FLM, Kng CPL
Department of Geriatrics, Ruttonjee and Tang Shiu Kin Hospitals, Hong Kong

Tuesday, 3 May Introduction

In planning a new acute medical ward, Department of Geriatrics of Ruttonjee and Tang Shiu Kin Hospitals was given the
opportunity to help design the ward with practical elder-friendly considerations. We believe elder-friendly care is far beyond
the enhancement of physical environment only. During the past year, we have been continuously re-engineering care
processes and cultivating positive emotional and behavioural atmosphere within the department.

Objectives

(1) To address the unique needs of elderly; (2) to promote health, dignity and participation of elderly on the care process; (3)
to train up a skilled workforce who can understand the physical and emotional needs of elderly patients, and (4) to provide
quality of care.

Methodology

Essential care processes were targeted, including care of delirium/dementia patients, end-of-life care, fall prevention,
appropriate use of physical restraints, team collaboration with physiotherapist, occupational therapist and dietitian, family
engagement programme, re-organisation of daily ward routine. Intensive training on dementia/delirium care was widely
conducted in the department. Moreover, all supporting staff attended five training workshops which covered 10 basic
gerontological care topics.

Results

(1) Care of delirium patients: Short Confusion Assessment Method (CAM) and care plan were developed and implemented
in all geriatric wards. 60% of in-patients in geriatric ward identified of high risk of delirium were managed proactively with
delirium care protocol. (2) End-of-life care: Terminally-ill in-patients (n=58) with documented advanced care plan (ACP) and/
or “DNA – CPR” form in place received compassionate care compliant with ACP. (3) Fall prevention: Geriatric specific “red
flag system” in addition to Morse score was developed and educational leaflet on hospital fall prevention was designed.
(4) Physical restraints: Physical restraint rate as low as 3%, with senior audit round by Department Operations Manager
and Geriatric Associate Consultant to verify appropriate use of restraints. (5) Team collaboration with physiotherapist and
occupational therapist to provide ward-based rehabilitation exercise which increased therapy time by at least 10 minutes
per patient due to transport time saved. (6) Team collaboration with dietitian to provide appealing food choices for frail
elderly with restrictive diets. (7) Family engagement programme to encourage relatives to participate actively in exercises
and practise caring skills for patients particularly during evening (5 patients/day), weekend and holidays (15 patients/day)
to increase functional activity time for elderly. (8) Re-engineering daily ward routine, e.g. flexible visiting hours, systematic
booking mechanism for patient progress enquiry, sit out round, toilet regime, hydration and supplement round etc. Patient
satisfaction survey and focus group interviews were conducted with highly positive feedback for these newly introduced
measures; relatives appreciated the professional and caring approach of frontline staff. 15 workshops on gerontological care
for supporting staff were conducted with 285 attendances. Evaluation showed significant improvement in knowledge level by
11% to 38% (p<0.05).

Conclusions

Developing elder-friendly nursing care processes in an acute hospital requires a paradigm shift in thinking towards safe,
compassionate and effective person-centred care. Beyond the physical environment, the critical success factors are staff
education, leadership influencing ward culture, harnessing the strength of the multidisciplinary team support and family
engagement.

120