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National Clinical Programme for Older People - Current Developments & Future Direction

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Deirdre Lang Director of Nursing NCPOP

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National Clinical Programme for Older People - Current Developments & Future Direction

  1. 1. NATIONAL CLINICAL PROGRAMME FOR OLDER PEOPLE Current Developments & Future Direction Deirdre Lang Director of Nursing NCPOP
  2. 2. Strategic Vision Educational Framework National Frailty Education Programme National Nursing Transfer Letter Delirium NCPOP Discussion Points: NCPOP Current Work streams & Developments
  3. 3. 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
  4. 4. 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
  5. 5. 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
  6. 6. Strategic Vision Educational Framework National Frailty Education Programme National Nursing Transfer Letter Delirium NCPOP Discussion Points: NCPOP Current Work streams & Developments
  7. 7. 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. 8. 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
  9. 9. 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.
  10. 10. FRAILTY: WHAT WE KNOW By increasing the understanding of frailty, we can improve the detection, prevention, management and therefore outcomes for these older adults.
  11. 11. THE NATIONAL CLINICAL PROGRAMME FOR OLDER PEOPLE PARTNERING ONMSD • Office Nursing & Midwifery Services Director NEMP • National Emergency Medicine Programme NAMP • National Acute Medicine Programme
  12. 12. 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
  13. 13. 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
  14. 14. Strategic Vision Educational Framework National Frailty Education Programme National Nursing Transfer Letter Delirium NCPOP Discussion Points: NCPOP Current Work streams & Developments
  15. 15. 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
  16. 16. WHY? No single standardised nursing transfer letter is available nationally in Ireland.
  17. 17. 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
  18. 18. Strategic Vision Educational Framework National Frailty Education Programme National Nursing Transfer Letter Delirium NCPOP Discussion Points: NCPOP Current Work streams & Developments
  19. 19. 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
  20. 20. NCPOP WORKSTREAMS Delirium as part of the NFEP Delirium in ED/AMU Delirium in Acute Medical/ Surgical bed Delirium in Residential Facility
  21. 21. Strategic Vision Educational Framework National Frailty Education Programme National Nursing Transfer Letter Delirium NCPOP Discussion Points: NCPOP Current Work streams & Developments

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