Abstract
BackgroundFrail older patients are at risk of experiencing a decline in physical and cognitive function unrelated to the reason for admission. The Elder-Friendly Care (EFC) program was designed to improve the care, experiences, and outcomes of frail older adults. The project supported 8 Early Adoption Sites (EAS) in a large Canadian healthcare organization by providing multiple strategies, educational opportunities, and resources. The purpose of this study was to assess the usefulness of EFC educational materials and resources, staff practice changes and perceptions in pilot sites, and readiness for scale and spread.MethodsThe study was conducted from May 2017 to June 2018 using a mixed-methods approach incorporating the Kirkpatrick Model of Training/Evaluation. A total of 76 Direct Care Staff participated in the staff survey, which assessed their awareness of, satisfaction with, and utilization of EFC principles, resources, and practices. Additionally, 12 interviews were conducted with staff who were directly involved in site implementation of EFC.ResultsMost survey participants were aware (86%, n = 63) of the EFC program, and 85% (n = 41) indicated they or their site/unit had implemented EFC. Out of these 41 participants, the most common practice changes identified were: incorporating alternatives to restraint (81%, n = 33), decreased use of pharmacological restraint (78%, n = 32), and patient and family care planning (76%, n = 31). Participants that attended all 3 EFC Learning Workshops (LWs) were significantly more likely to recommend the EFC Toolkit to others (87% versus 40%; χ2 = 8.82, p < 0.01) compared to participants attending less than 3 EFC LWs. Interview participants indicated that the program was well structured and flexible as sites/units could adopt changes that suited their individual sites, needs, contexts, and challenges.ConclusionsThe educational materials and resources used for the EFC project are useful and appreciated by the Direct Care Staff. Further, participants perceive the EFC intervention as effective in creating positive practice change and useful in reducing hospital-related complications for older patients. Future implementation will investigate the impact of EFC on system-level outcomes in acute care.
Highlights
Frail older patients are at risk of experiencing a decline in physical and cognitive function unrelated to the reason for admission
Older adults are at risk of experiencing declines in physical and cognitive function unrelated to the reason for admission leading to extended stays, higher care needs at discharge, and emergency department visits and re-admissions after discharge [6]
Direct care staff survey A variety of health care practitioners participated in the Elder-Friendly Care (EFC) Direct Care survey; majority were Registered Nurse (RN) (25%, n = 19), Licensed Practiced Nurse (LPN) (24%, n = 18), Management Staff (12%, n = 9), Healthcare Aide or Nursing Assistant (HCA) (8%, n = 6), Unit Clerks (7%, n = 5), others (20%, n = 15) and data missing for 5% (n = 4)
Summary
Frail older patients are at risk of experiencing a decline in physical and cognitive function unrelated to the reason for admission. In 2017, the total health expenditure for older adults was $242 billion, representing 11.5% of Canada’s Gross Domestic Product (GDP) [4] With this combination of population aging and increased demand for healthcare services leading to higher healthcare spending-to-GDP ratios [5], new principles and practices of care need to be explored and adopted. Older adults are at risk of experiencing declines in physical and cognitive function unrelated to the reason for admission leading to extended stays, higher care needs at discharge, and emergency department visits and re-admissions after discharge [6]. The level of patient and family engagement in care planning for older patients is unclear, especially when patients have cognitive impairment from delirium or early dementia Routine practices such as the use of indwelling catheters and washable under-pads may lead to hospital-acquired wounds and infections [11]
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