SMILE ProgramMaintaining and/or Improving functional ability of elderly patients by SMILE Program

Alidina, Karimah; Kohlberger, Kim; Merchant, Anna-Marie & Stoskopf, MaureenHalton Healthcare Services

Rationale

Purpose

SMILE

The purpose of this project is to maintain and/or improve the functional ability in at least 75%

of our eligible admitted elderly patients age 70+ in our Community Hospitals by introducing

the ‘SMILE’ Program (i.e. Stimulate, Move the Body, Improve Hydration, Limit Caffeine,

Enjoy Better Hearing and Vision).

Conclusions

Outcome Measures Findings

Metrics: Number of volunteers recruited and trained;

Number of staff trained;

Number of patients who were screened and participated in SMILE

program

Functional ability of the eligible patients who had participated in the

SMILE program as measured by the Modified Barthel Scale administered

upon admission and discharge

Patients and/or family satisfaction rate

Staff and volunteer satisfaction rate

Delirium and functional decline are serious, common and preventable

complications of hospitalization

This project used simple tools to empower patients and caregivers to take

an active role in the prevention of both

Further highlights include enhancement of team dynamics and improved

work satisfaction among the project and frontline clinical staff

Embedding the principles of prevention in routine healthcare practice will

support the long term sustainability of this project

References

1. Nigam, Y., Knight, J., Jones, A. Effects of bed rest 3: musculoskeletal and immune systems, skin and

self-perception. Nursing Times, 2009; 105 (23), 18-22

2. Inouye, S.K. Delirium in older persons. New England Journal of Medicine, 2006; 354:1157-65

3. Jiricka, M.K. (2008) Activity tolerance and fatigue pathophysiology: concepts of altered health states.

In: Porth, C. M. (ed) Essentials of Pathophysiology: Concepts of Altered Health States. Philadelphia,

PA: Lippincott Williams and Wilkins

4. Winkelman, C. (2009). Bed rest in health and critical illness: A body system approach. Advanced

Critical Care, I20(3), p. 254-266.

5. Dittmer, D.K. And Teasell, R. Complications of immobilization and bed rest. Canadian Family

Physician, 1993; 39: 1428-1437.

Methods The project was implemented as part of a Senior Friendly Hospital Initiative

Volunteers were recruited and trained to implement the SMILE program

SMILE program was implemented on Medical/Surgical and Complex Care units

Education was provided to frontline staff and volunteers

The volunteers educated patients and families via a brochure

Inclusion criteria: Inpatient elderly patients on Med /Surg. and CCC units who are at

risk for functional decline and immobility, such as: patients > 70 years of age with 1or

more risk factors for functional / cognitive decline or delirium (Risk Factors:

decreased mobility, pre-existing cognitive impairment, dementia, history of delirium,

sensory impairment (vision, hearing), inadequate caloric intake or dehydration, sleep

deprivation)

Exclusion criteria: Outpatient units; too medically unstable, unresponsive, death is

imminent, severe dementia, psychosis, or behavioural problems unsafe for volunteer

interaction; aphasia; patient or family refusal for participation; patient in isolation

49 volunteers were recruited and trained for the SMILE program

67 staff members were trained for the SMILE program

82 patients were enrolled in the program over a 3 month period

82% of patients and caregivers reported that this program had helped

them and had improved their hospital stay

100% of volunteers reported increased role satisfaction with the

implementation of this program

100% of the staff reported that volunteers interacted well with patients

100% of staff reported that this program had benefited patients’ overall

hospital stay

90% of the staff also reported improved work satisfaction

The initial results obtained from Modified Barthel Index Scale indicate

that the functional abilities of patients participating in SMILE program

on a Medical/Surgical unit remained the same at admission to discharge.

However, there was a slight improvement in the functional abilities of

the patients participating in SMILE program on a Complex Care unit

upon discharge

.

Functional Decline Is a lack of activity which leads to the loss of muscle strength and endurance, bone

weakening, altered skin integrity, immune suppression, fatigue and loss of motivation1

Functional decline is identified as the leading complication of hospitalization for the

elderly

Reported rates are between 35-50%2

During hospitalization, the elderly patient often experiences reduced mobility and

activity levels leading to accelerated bone loss, dehydration, malnutrition, delirium,

sensory deprivation, isolation, sheering forces on the skin, and incontinence.

The larger the muscle, the faster the loss of strength, particularly those muscles which

resist gravity in the upright position3

Deconditioning and functional decline from baseline have been found to occur by day

two of hospitalization in older patients4

Following 3-5 weeks of bed rest, almost half the normal strength of a muscle is lost5

Discussion

The implementation of SMILE program can positively impact patients’

by maintaining and/or improving the functional ability in the elder

patients

The implementation of SMILE program can also positively impact

patients/family/volunteers/staff job and role satisfaction

Lower Risk

Communication Devices

Mental Exercise

Physical Activity

Natural Sleep

Nutrition/Hydration

Education Materials

Keep Your Mind and Body Active in Hospital

A Patient and Caregiver Guide to Preventing Delirium and

Functional Decline

S Stimulate your mind

M Move your body

I Increase your hydration

L Limit caffeine

E Enjoy better hearing and vision

FallsPressure Ulcers

Reactive Behaviours

Length of Stay

Healthcare Dollars