HELP Project Planning Tool

In this section think about…. What will the screening process at your site

look like? How strict to the original inclusion and

exclusion criteria will you be? What will you include in your baseline

assessment ? Which units will you choose to start HELP

on?

Where To Start…Every patient aged 70 years and older admitted to

the HELP unit(s) is screened for enrollment into the program. The purpose of screening is threefold.

1)First, screening helps to verify that the patient has at least one risk factor for cognitive or functional decline that will allow him/her to benefit from the program.

2)Second, screening verifies that the patient does not have exclusion criteria that make interventions difficult or inappropriate.

3)Third, the risk factors that are identified during screening trigger specific intervention protocols by the HELP team.

Important to note…

Each patient should be screened and enrolled within 24-48 hours

of admission or transfer to a HELP unit.

ENROLLMENT CRITERIA FOR HOSPITAL ELDER LIFE PROGRAM PATIENTS

• Age 70 years and older and on HELP unit• At least one risk factor for cognitive or functional

decline.

Risk factors include:• Cognitive impairment – MMSE <24/30 (or equivalent ratio)• Any mobility or ADL impairment• Vision impairment: <20/70 best corrected vision• Hearing impairment: < 3 of 6 whispers in each ear on Whisper test• Dehydration: Urea x10/Cr >0.7 • Able to communicate verbally or in writing. Nonverbal patients who can communicate in writing are included.

Exclusion Criteria• Coma• Mechanical ventilation• Aphasia (expressive and/or receptive) if

communication ability severely impaired• Terminal condition with comfort care only, death

imminent• Combative or dangerous behavior• Severe psychotic disorder that prevents patient from

understanding/participating in interventions• Severe dementia (e.g., unable to communicate; MMSE

= 0). For patients with severe impairment (MMSE <10), decision to enroll will be made on a case-by-case basis depending on their ability to participate in interventions.

Exclusion Criteria cont’d

• Airborne precautions (e.g., tuberculosis). • Neutropenic precautions• Discharge firmly anticipated within 48

hours of admission• Refusal by patient, family member (if

patient is incompetent), or Physician

Exceptions to the RulesPalliativeALC Delirious on admissionAdmitted for over 48 hoursUnder age 70 Language barrier

Case Scenario #184-year old lady, living in a retirement home (RH) for past 8

years following a stroke. She has Type II Diabetes and hypertension

Active in her RH, using her walker, a little more forgetful and repetitive, and this has been getting slowly worse over the past year or so. She wears bilateral hearing aids, and bifocals.

Came into ER after being found on the floor in her RH. Unable to get up and complaining of chest and abdominal pain

In the ER, she is disoriented to time and place, and repeating herself often. Staff need to speak slowly and repeat instructions often. She is consistently alert and coherent. Family state that this is how she is at home.

Case Scenario #283-year old lady living alonePMHx – CHF, Htn, Glaucoma, MCIPatient was getting up in the middle of the night, forgot to use her walker, and fell.On the floor for over 12 hours – daughter found her the next morning incontinent of foul-smelling urine.Taken to ER – xray shows fractured right femur, bladder

catheter inserted, made NPO for surgery – no time scheduled yet – morphine, gravol, ativan ordered.

Report from ER states that patient has been disoriented to time/person/place – pulled out IV 3x, patient had trouble focusing and was inconsistent with following commands.

Case Scenario #2 cont’d

Very restless, attempting to climb out of bed. 30 minutes later, patient is sleeping but does arouse with verbal stimulus

Urine tested positive for e-coli, relevant labs include: elevated WBC, elevated urea and creatinine

Report from family – patient was managing well at home – independent with BADLs and family assisting with IADLs

Family state that patient is saying strange things (i.e. “why is it so busy in this mall?”). At times she does not make sense, and rambles in conversation.

SCREENING PROCEDURE

1. ELS Reviews patient list on HELP units

2. Chart Review

3. HELP Program Description and Patient Consent

4. Baseline Assessment

Sample Assignment Sheet

Allocation of Patients Started on medical ward at McMaster

Receptivity to improving geriatric care Supportive manager Champion for HELP familiar with the unit HELP research was done in medical population

Expansion to Juravinski hospital to orthopedic surgery ward High rate of delirium

Expansion to orthopedics at McMasterTransitioned McMaster resources to two medical

units at Hamilton General