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Care Plan for the Older Adult: Training. Faculty Scholars Program November 1, 2013 Kathleen T. Foley, PhD, OTR/L Associate Professor, Occupational Therapy College of Health Sciences Brenau University—North Atlanta Campus. Learning Objectives. - PowerPoint PPT Presentation
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Care Plan for the Older Adult: Training
Faculty Scholars ProgramNovember 1, 2013
Kathleen T. Foley, PhD, OTR/LAssociate Professor, Occupational Therapy
College of Health SciencesBrenau University—North Atlanta Campus
• Discuss the importance of care planning for the older adult.
• Identify differences between multi-, trans-, & interdisciplinary teams in health care.
• Describe the rationale for interprofessional care and interprofessional training given current healthcare trends.
• Describe a comprehensive education approach for teaching interprofessional care planning.
Learning Objectives
• Characteristics of their health care?
Older Adult Health Care
• What is the overarching goal?• What are the older adult’s issues & impact on health & quality
of life?• What are strengths & resources? Additional information
needed?• What is the plan of care?
– What needs to be done; – Who will do it; – When will it happen? – What is the priority of each issue?– What outcome(s) should be expected for each issue?
Vignette-Guiding Questions
• Optimal use of health workforce• Cost effectiveness• Efficient transition of care• Safety of patients (IOM, 2007)
– JCAHO reports nearly 70% of patient adverse events cite the lack of collaboration and communication between providers as a main cause of error.
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Concerns in Health Care
Sentinel event statistics. http://www.jointcommission.org/NR/rdonlyres?FA465646-5F5F-4543-AC8F-E8AF6571E372/0/root_cause_se_jpg
• Is developed from a complete assessment that evaluates the current and future medical, social, emotional, environmental, and financial needs of the older adult
• Includes issues/problems, interventions, and expected outcomes
• “Road map” for care; it should all aspects of care
• Traditional to nursing
Care Plan for the Older Adult
Care Plan for the Older Adult
• Caring for the complex older adult is important– Multiple diagnoses combined with normal aging
processes– Results a complex care requiring multiple services
• Care plan coordination should be:– Client-centered;– Supportive of family and informal caregivers– Focus on chronic care and health care transitions;– Bridge medical and social services;– Employ a comprehensive assessment; and– Implement and monitor a flexible care plan.
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• The integration of healthcare teams has lead to:– Stronger continuity of care,– Improved health outcomes, and– Lower costs. (Jencks et al, 2009; Hirth et al, 2009)
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Benefits of Teams
• Differing approaches and expectations toward client treatment
• Lack of knowledge of roles within team• Negative attitudes and stereotyping• Conflicts concerning accountability and
responsibility (Freeman et al, 2000; Garmen et al, 2006; Mickan & Rodger, 2000)
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Issues in Health Care Teams
Type of Health Care Teams-Review
• Multidisciplinary• Transdisciplinary • Interdisciplinary
Multidisciplinary– Discipline oriented goals– Each member responsible for work within their
discipline’s boundaries – Outcome is sum of each member’s efforts
Type of Team Review
Client
OT
PT RN
Psych
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Transdisciplinary– Based on patient needs, one member is team
leader– Leader delivers care – Other members contributing information &
recommendations
Type of Team Review
ClientOT
PT
RN
SLP Dietary
MD Respiratory
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Interdisciplinary– Members involved in problem-solving beyond
their discipline– Team identified goals– Works toward goals with respect to their
discipline– Collaboration replaces communication
Type of Team Review
ClientOT
PTRN Psych
SW
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MD
• Multidisciplinary teams• Transdisciplinary teams • Interdisciplinary teams
• Interprofessional teams?
Types of Teams
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• Similar to interdisciplinary; latest term• “When multiple health workers from
different professional backgrounds work with patients, families, caregivers, and communities to deliver the highest quality care”. (WHO, 2010)
• “Care delivered by intentionally created…small work groups in health care…having a collective identity and shared responsibility for a patient…” (IPEC, 2011, pg. 2)
The Interprofessional Team
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• Benefits of the Interprofessional team (IPT): – Client-centered care– Safer– Timelier– Improved efficiency– Improved effectiveness (Coleman, 2009)
– Equitable (IOM, 2001)
– Future of health care
Why Interprofessional Teams
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• Team members who:– Bring respective specialized knowledge and skills;– Recognize and appreciate contribution of each
member;– Take part in decision-making;– Assume responsibility for their own decisions and
team decisions;– Have good communication skills; and,
• Seamless team cooperation and coordination(Xyrichis & Lowton, 2008; Priegel & Kupperschmidt, 2009)
Effective IPT Characteristics
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• Interprofessional education (IPE) is recommended; defined as:– “When students from two or more professions
learn about, from and with each other to enable effective collaboration and improve health outcomes.”
(WHO, 2010)
• Goals:– Improve communication– Increase cooperation
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Educating Professionals
• Core Competencies for Interprofessional Collaborative Practice (Interprofessional Education Collaborative, 2011)
• Four Core Competencies:– Values/ethics for interprofessional practice– Roles/responsibilities– Interprofessional communication– Teams and teamwork
The Future Professional
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http://www.aota.org/Business/Partner/41738.aspx
• Goal is to experience what it is like to:– Participate on an interdisciplinary team– Develop a care plan in collaboration with other
health care professionals
• Sponsored by the UAB Center for Aging and Geriatric Education Center
• 9 disciplines totaling 300 trainees observe an interdisciplinary interview of an older adult
• Develop a care plan in smaller trainee groups
Interdisciplinary Team Training (IDT)
• Goal is to experience what it is like to:– Communicate with OAs to address problems from medical,
emotional, social, environmental and economic perspective– Work effectively in an IDT appreciating differences and
values of various disciplines
• Sponsored by the UAB Comprehensive Center for Healthy Aging & Geriatric Education Center
• Student trainees rotate weekly• Interview a resident as a group • Meet as a team to develop a care plan; facilitated by a
geriatrician
Interprofessional Clinical Experience (ICE)
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• Ford, CR, Foley, KT, Ritchie, CS, Sheppard, K, Sawyer, P, Swanson, M, Harada, CN, & Brown, CJ. (2013). Creation of an interprofessional clinical experience for healthcare professions trainees in a nursing home setting. Medical Teacher,35(7), 544-8. doi: 10.3109/0142159X.2013.787138. Epub2013April30.
Reference for ICE
• Interprofessional Collaboration Framework
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Integrating the IPT(Reeves et al, 2009)
• Education/training level:– Incorporate IPT training into orientation and/or annual
training; include didactic and practical components– Disseminate information on the various professions—OT ,
Nursing, PT, SW, Month
• Practice level:– Model behavior– Distribute reminders on the characteristics of a “good
team”
• Organizational level:– Policies and procedures for the IPT– Recognize “good” teamwork
What can you do?
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Interprofessional Team
“Build for your team a feeling of oneness, of dependence on one another, and of strength to be derived by unity.” –Vince Lombardi
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• The University of Alabama School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The University of Alabama School of Medicine designates this educational activity for a maximum of 1 AMA PRA Category 1 credit(s). Physicians should only claim credit commensurate with the extent of their participation in the activity. The University of Alabama School of Medicine is an equal opportunity/affirmative action institution.
• The University of Alabama School of Medicine (UAB) is committed to the provision o f CME that is balanced, objective, and evidence-based. The University of Alabama School of Medicine adheres to Accreditation Council for Continuing Medical Education (ACCME) Essentials and Standards. Accordingly, all parties involved in content development have disclosed any real or apparent conflicts of interest relating to the topics of this educational activity and the disclosure summary follows. The University of Alabama School of Medicine Division of CME has established mechanisms to resolve conflicts of interest should they arise. Participants in UAB CME programs are afforded the opportunity to provide feedback on the quality of individual programs at the conclusion of the activity. Comments can also be sent directly to the Division of CME at cme@uab.edu.
Notes…
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