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NICHENICHENurses Improving Care for Healthsystem Elders

An Introduction to NICHE

An Introduction to NICHEAn Introduction to NICHE

© 2015 NICHE All Rights Reserved

NICHE - Nurses Improving Care for Healthsystem Elders• NICHE is the PREMIERE international geriatric nursing program

that addresses the needs of hospitalized older adults• Currently there are NICHE Designated hospitals and healthcare

facilities in the U.S., Canada, Bermuda and Singapore. Over 100 hospitals are joining NICHE every year!

• NICHE collaborates with over 20,000 healthcare providers in the NICHE network on important geriatric issues

Older Adults Are Hospitals’ CORE Consumers

• By 2050, the older adult population will number nearly 89 million, more than double the current population in 2010

• Reason for the increasing population:–People living longer–Baby Boom population becoming 65 and older

• Every day until 2031; 10,000 Baby Boomers turn 65• By 2030 healthcare expenditure will increase by 25% for older adults• Medicare spending will go from $555 billion yearly

to $903 billion by 2020

http://www.cdc.gov/aging/help/dph-aging/state-aging-health.html

The Quality Imperative: Improve Clinical and Fiscal Outcomes!Older adults comprise 13% of the US population , Your local datahere:

• But comprise 37% of hospital discharges and 43% of hospital days• Have longer lengths of stay (7.8 days vs. 5.4 days)• Higher rates of 30 day hospital re-admissions• Higher rates of functional decline and medical errors

Reference: U.S. Dept. of Health and Human Services, Centers for Disease Control. Trends in Health and Aging. Retrieved October 31, 2008 fromhttp://www.cdc.gov/nchs/hdi.htm

Hall, M.J., DeFrances, C.J., Williams, S.N., Golosinskiy, A., & Schwartzman A. (2010). National Hospital Discharge Survey: 2007 summary. National health statistics reports; no 29. Hyattsville, MD: National Center for Health Statistics. 2010

Older Adults Are Your hospital name here CORE Consumers

This slide should have your statistics by unit, include a graph to show a few months data if you can.

Improving Care for Hospitalized Older Adults Is Good Business

• Optimal care requires appropriate skills

– Aging demographics– Geriatric skill gap– High cost of inaction

• Older adult patients are everywhere

– Need for flexibility– Ongoing training and

coaching roles– Cost effective “train the trainer”

virtual services

Improving Care for Hospitalized Older Adults Is Good Business• Proactive & skilled nursing care avoids costly problems

– “Never” events– Complications that increase LOS and costs

• Patient and family satisfaction– Better functional status at discharge– Smoother transitions

• Improved nurse satisfaction & efficiency, less turnover• Creating an interdisciplinary team environment• Improved MD satisfaction and improved efficiency

NICHE Program

– Achieve systemic nursing change that will benefit hospitalized older adults

– Provide geriatric sensitive and exemplary care to all hospitalized adults 65 years and over

– Import principles and tools to stimulate change in the culture of healthcare facilities and achieve patient-centered care for older adults

Goal

Vision

Mission

What Is the Focus of NICHE?

…focuses on programs and protocols that are predominately within the scope of nursing practice.

1. Improve patient outcomes2. Improve the patient experience3. Promote staff effectiveness and satisfaction4. Establish leadership as a provider of care to older adults5. Provide fiscally responsible care6. Increase collegial networks

NICHE Program Goals

Geriatric Resource Nurse (GRN) ModelThe online curriculum contains the latest evidence-based practice content, and is designed for easy access and navigation. The GRN is based on the book Evidence-Based Geriatric Nursing Protocols for Best Practice.

•Why Geriatric Nursing?•Age-Related Changes in Health•Depression, Delirium, Dementia•Falls•Family Caregiving•Function•Healthcare Decision Making

• Medications• Nutrition, Hydration, and Oral Health• Pain• Pressure Ulcers and Skin Tears• Restraints• Sleep• Urinary Incontinence

Rewards of the GRN Model

• Clinical ladder• Novice expert growth• Respect within the role• Deeper geriatric expertise

Outcomes described by NICHE sites

• Improved clinical outcomes• Increased staff skill• Increased satisfaction, both staff and patient

NICHE Program for “Members Only”

•Training and Education Programs

– Core Curricula: for Nurses, Patient Care Techs (CNAs), other disciplines and general staff

– Webinars and in-service materials– Contact hours – Educational resources for patients and families – Conferences

•National Community– NICHE Discussion Boards resource, topic and special interest based

NICHE Program for “Members Only”

• Measurement– Geriatric Institutional Assessment Profile (GIAP) – Clinical outcomes– Program self-evaluation

• Clinical Management Tools – Organizational Strategies & Clinical Improvement Models

© 2015 NICHE All rights reserved. The information contained in this module is provided for informational purposes only. The content has been developed by NICHE participants and the NICHE staff at New York University’s College of Nursing and is protected by copyright under the laws of the United States and foreign laws. Under no circumstances may these materials be reproduced for sale or profit. Any use of content not expressly permitted may violate copyright, trademark, and other laws.