This post is part of a series about how quality standards can be used to support quality improvement together with others who are working on adopting the quality standards. The introductory post can be found here.
From years of experience in the field, we know that the typical geriatric pathway for inpatient populations available in most organizations is not detailed and focused enough; for years it has been usually unclear who is doing what and when.
Any admitted geriatric patients are complex and/or have multiple conditions and much of the clinical care activity begins once they become ALC (Alternate Level of Care), which can be a considerable amount of time after admission. Once ALC status is designated there is a flurry of activity such as doing assessments, managing behaviours, prescribing, planning discharge, coordinating with CCACs.
At Niagara Health we struggled with these issues: we felt we needed a change. We needed to be more effective in care provision as well as in transitions and we wanted to improve our overall health outcomes.
We were also aware of our limitations: we did not have specialized inpatient units specific to the geriatric population nor an electronic health record in place.
Around the time we started discussing all this, we learned that HQO had released the Behavioural Symptoms of Dementia (BSD) Quality Standard. At that point, we set up a working group with staff who had an interest in geriatrics and eldercare.
We also engaged BSO and other geriatric program resources. We met 11 times in three months. We wanted to have a product that would help us to deal with our clinical challenges and so we decided to develop a geriatric mental health pathway.
This direction was in line with other treatment pathways developed within the last two years. We included four pathways in one because this pathway can be used for patients with:
3) Mood, Anxiety, Suicide Prevention; and
4) Schizophrenia or Psychosis
In the specific case of the Dementia sub-pathway, we used HQO’s BSD Quality Standard as a reference and to identify our gaps.
Anyone over 60 who is admitted goes through this pathway and our expectation is that this pathway will provide a good clinical picture of the patient’s need and their specific goals.
The use of the pathway is complemented with the designation of a Nurse Practitioner (navigator) to oversee the case management of each patient across our inpatient service. This navigator follows all geriatric patients within the Mental Health and Addictions inpatient program and provides consultation to the interprofessional care team related to the care pathway.
We started piloting this pathway on June 1st in acute care and our plan is to test it with ten patients and then reassess it based on feedback from staff who are using it.
We are very optimistic because preliminary results show significant improvements in the health outcomes of the first patients who used this pathway.
In the future, we hope this pathway will inform, and be used, in the transition of patients from our institution to other Long Term Care and/or community organizations.
One of our key learnings throughout the whole process (pathway development, utilization, testing and adjustment) is that a multi-disciplinary approach and the commitment of our inter-professional team is critical. We look forward to hearing from other experiences and happy to continue the conversation on elderly care!
Those interested can access our pathway here.