1. Care of Older Adults at JMH October 9th, 2012 Facilitator: Patrick Watson, Interim Sr. VP of Care Coordination and Integration

2. John Muir Health – proprietary and confidential 2 Agenda Care of Hospitalized Older Adults CHF * Chest Pain * Cardiac Rehab Break Diabetes Education, Inpatient and Outpatient Discharge Process Lunch Afternoon at JMH Physician Network Disease Management/ Medical Home Home Health Senior Services Women’s Health Center * Community Health

3. About Us Our Mission We are dedicated to improving the health of the communities we serve with quality and compassion. Our Vision We will exceed our patients' expectations for seamless, consistently positive experiences with all aspects of John Muir Health.

4. John Muir Health – proprietary and confidential 4 Programs and Services Cancer Institute Cardiac Rehabilitation Cardiovascular Institute Certified Stroke Center CHF Clinic Chest Pain Program Continence Program Diabetes Center Health & Wellness Health Education Classes Medical Home Neuroscience Institute Occupational Health Palliative Care Pulmonary Rehabilitation Rehabilitation Services Senior Services Transforming Chronic Care Case Management Women’s Health Center Wound Care Center http://www.johnmuirhealth.com/index.php/services.html

5. John Muir Health – proprietary and confidential 5 Awards Ranked one of the nation’s top hospitals by U.S. News & World Report for the fourth consecutive year Named one of nation’s top 51 health systems for clinical quality and safety by Thomson Reuters Both of our hospitals, Walnut Creek and Concord have earned Magnet status. We are two of four hospitals in N. CA earning this distinction. The Magnet Recognition Program® recognizes health care organizations that demonstrate excellence and adherence to national standards for the delivery of nursing services HealthGrades study denotes both our hospitals for the “Distinguished Hospital Award for Clinical Excellence.” We were two of three hospitals in the Bay Area.

6. John Muir Health – proprietary and confidential 6 Definition of an Elder Friendly Health System  Responsive to developmental needs of older adults  Holistic focus combining a gerontological developmental approach with a diagnostic approach to care  Care is patient and family centered

7. John Muir Health – proprietary and confidential 7 Four Dimensions of an Elder Friendly Health System 1.Physical Design / Environment 2.Social Behavioral Climate 3.Policies and Procedures 4.Services, Care Systems and Processes

8. John Muir Health – proprietary and confidential 8 Elder-Friendly Care in the Hospital Why focus on older adults? Population growth of those >65 yrs old Improving quality care to geriatric patients identified as health system strategic initiative Gain community recognition as an elder-friendly health system

9. Elder-Friendly Care in the Hospital Why focus on older adults? Complexity of care Geriatric Syndromes Fast paced Health Care Environment Educational needs of nursing and medical staff

10. John Muir Health – proprietary and confidential 10 Elder-Friendly Care in the Hospital For the Patient Each patient is a unique individual and should be evaluated as such: –Assessment process –Outside of acute care setting –Patient’s baseline function

11. John Muir Health – proprietary and confidential 11 Elder-Friendly Care in the Hospital For the Staff Nurses demonstrate clinical competence in geriatric nursing Nurses Improving Care for Health System Elders (NICHE) Geriatric Resources Nurse (GRN) Acute Care of the Elderly unit (ACE) Certification in Geriatric Nursing is encouraged and supported

12. John Muir Health – proprietary and confidential 12 Elder-Friendly Care in the Hospital For the Staff SPICES Sleep Problems with eating or feeding Incontinence Confusion Evidence of Falls Skin

13. Elder-Friendly Care in the Hospital For the Staff Excellent communication that is tailored to meet the needs of the geriatric patient: Age sensitivity training Keeping the patient and family informed Case Management role Interdisciplinary contribution

14. John Muir Health – proprietary and confidential 14 Elder-Friendly Care in the Hospital For the Staff The organization provides resources that support best practice in geriatric nursing care Geriatric Clinical Nurse Specialist (CNS) Geriatric Resource Team Palliative Care Volunteer Program Music and Pet Therapy

15. John Muir Health – proprietary and confidential 15 Elder-Friendly Care in the Hospital For the Environment The physical environment supports the needs of the geriatric patient and family and staff –Hearing Enhancers –White Boards –Clocks –Chairs with arms –Bed and chair alarms –Walkers, commodes

16. John Muir Health – proprietary and confidential 16 Elder-Friendly Care in the Hospital The elder-friendly environment is embraced hospital-wide: Older adults identified as one of the communities we serve The Geriatric Resource Team (GRT) provides input to senior leadership regarding care of geriatric patients Goal is for education regarding the needs of the older patient be provided to all staff

17. John Muir Health – proprietary and confidential 17 Stroke Program at JMH Joint Commission: Disease Specific Certification Concord and Walnut Creek awarded certification – 2005 On-site Review every 2 years Follows National Patient Safety Goals Stroke Program Awards

18. John Muir Health – proprietary and confidential 18 Admission Protocols Stroke/TIA Admission Orders ICH Admission Orders Neurosurgical Orders ( WC campus only) Stroke units at both campuses Nurses required to have 8 hours Stroke Education/Year Critical Care post tPA: minimum 24 hours Rehabilitation initiated Patient Care standardized to prevent complications Discharge Planning

19. John Muir Health – proprietary and confidential 19 Multi-Disciplinary Stroke Rounds Neurologist Stroke Unit Nursing Rehabilitation Services: PT, OT, Speech Acute Rehab Referral Case Management Dietician

20. John Muir Health – proprietary and confidential 20 Stroke Education Teach Signs and Symptoms of Stroke Call 911 if stroke symptoms return, not their MD Review risk factors of stroke; recommend lifestyle changes Review medications and why important to continue Smoking cessation, if indicated Follow-up Appointments: –Physicians –Rehabilitative services –Lab or Diagnostic Testing

21. John Muir Health – proprietary and confidential 21 In-Patient Acute Stroke New onset of Neurological Symptoms: Last Known Normal is < 6 hours Call: Rapid Response Team

22. John Muir Health – proprietary and confidential 22 An elder friendly health system is.....