CENTRE UNIVERSITAIRE DE SANTÉ MCGILL MCGILL UNIVERSITY HEALTH CENTRE
La proportion de patients qui sont considérés comme fragiles augmente avec l ’ âge . Ceux-ci représentent :
• 15 % des personnes âgées de 65 ans et plus
• 5 % des 65-75 ans
• 30 % des 85 ans et plus
The proportion of patients who are considered frail increases with age . Globally , these patients represent :
• 15 % of people aged 65 years and over
• 5 % of people aged 65-75 years old
• 30 % of people aged 85 years and over
The Specialized Approach to Senior Care
At the MUHC , a Coordination Committee with various members of the interdisciplinary team is working together to ensure seniors are getting the best care possible with the implementation of the Specialized Approach to Senior Care ( approche adaptée à la personne âgée ( AAPA ))— a ministerial directive that requires its implementation in all hospitals . This includes leaders and frontline staff from Nursing , Allied Health ( Physiotherapy , Occupational Therapy , Nutrition ), Medicine , Volunteers , Quality as well as Patient Representatives .
Sometimes hospitalization is seen as a risk for the elderly . This can be attributed to how bed rest , malnutrition , adverse effects of medication , delirium ( a state of acute confusion ) and an inadequate physical environment can cause complications and negative effects in the short and long term on their autonomy and quality of life . The AAPA , in conjunction to existing programs of fall and bed sore prevention , helps limit these risks .
Training for this approach focuses on six care dimensions that form the acronym AINÉES ( elderly ) in French : functional autonomy ( stay active and moving ); skin integrity ( maintaining healthy skin ); nutrition and hydration ( eat well and hydrate ); elimination ( ensure regularity ); cognitive status ( stay alert and attentive ); and sleep ( having a proper environment for sleep ).
“ This specialized approach using the six dimensions has to be taught to all staff caring for this population . The goal is that everyone who comes in contact with these patients understands and considers their needs during their hospitalization in order to ensure these patients do not experience any loss in their previous abilities to perform daily tasks ( walking , feeding , drinking , dressing , bathing ) that they were doing prior to hospitalization ,” explains Tina Kusaian , project manager in the MUHC Nursing Quality Improvement Office .
The method currently used at the MUHC to spread the information is through 15-minute weekly huddles on each unit . This method has also been successfully implemented for another Quality Improvement initiative , CSISS ( Controlling Specific Infections Successful Strategies ).
“ The progress must be monitored and measured regularly ,” adds Tina . “ Several targets have been established in consultation with leaders from the interdisciplinary team such as percentage of patients sitting up at mealtimes , and having fluid and mobility or sensory aids within reach , to name a few .”
During these weekly huddles , staff , patients and families gather around a whiteboard ( Quality Station ) where audit results are displayed . A member of the interdisciplinary team presents these results and the group discusses any strategies that may improve the results on the unit . At the end of the weekly huddle , the team determines a plan of action for the following week .
WINTER 2018 MONTRÉAL enSANTÉ 91