POGOe - Portal of Geriatrics Online Education - University of Colorado School of Medicine

Intended learner audience:

3 MM: Document a patient’s medication list

Geriatric Competencies:

25 HOSP: Communicate a discharge plan

Learning resource types:

Standardized Patient

Estimated time to complete:

45 minutes

POGOe Id:

20892

Date posted:

Wed, 12/21/2011

Date Submitted or Reviewed/Updated for Clinical Accuracy:

Wed, 12/21/2011

No CME credits available

Not peer reviewed

Discharge Planning Standardized Patient Facilitator instructions.docx
- 14.52 KB

OSCE Transfer note final.doc
- 25 KB

James Leslie case outline final.doc
- 52 KB

James-Jane Leslie checklist final1.doc
- 45 KB

Posting status:

Posted

Previous Taxonomy Authors: Dr. Susan Bray-Hall, Dr. Eva Aagaard

Conflict of Interest Disclosure:

No, I (we) have nothing to disclose.

Editor's notes:

1/11/12 Author does not want to be notified of each request. Just release the material - cg

Author(s):

Susan Bray-Hall, MS

Eva Aagaard, MS

Contact Person/Corresponding Author:

POGO E

Contact Person Email:

Caring for the Older Adult

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Competency-Based Test of Inpatient Geriatric Management Skills

ecumbler — Sun, 11 Oct 2009 21:41:07 +0000

University of Colorado School of Medicine

Abstract:

Competency-based test of inpatient geriatric management skills grading admission orders for a standardized case.

Assessment of a student or resident's clinical skills in the care of the hospitalized elderly patient requires evaluation of applied knowledge measured in discrete competencies. This assessment grades the student on admission orders based on history, physical, and laboratory assessment of a standardized patient. It is designed to evaluate actual clinical behavior in the inpatient setting. The test assesses selected competencies from the Minimum Geriatric Competencies for Internal Medicine and Family Medicine Residents. Management of geriatric syndromes in the hospital setting occurs in the milieu of inter-current medical illness, co-morbid conditions, and need to prevent iatrogenic complications. As such, this assessment also incorporates competencies of hospital medicine from The Core Competencies in Hospital Medicine.

Educational objectives:

The patient is an elderly woman with multiple predisposing factors for falls that began to have increased falls and functional limitation after toe amputation and new initiation of amitriptyline. These elements contributed to gait impairment and increase in falls over the prior month. The acute trigger for this hospitalization was increased weakness induced by systemic infection (MRSA abscess/cellulitis) beginning approximately 3 days prior to admission. This infection triggered decreased p.o. intake, dehydration, and acute on chronic renal failure. Impaired clearance of digoxin from worsening renal function led to accumulation and digoxin toxicity manifesting as nausea and visual changes. The final event which caused her to seek medical attention was a fall with inability to get back up. As with many admissions the problem is multifactoral with both chronic and acute elements.

The test taker is expected to recognize that this patient is ill, merits empiric antibiotics with coverage against MRSA (given the high and rising prevalence of caMRSA and patients history of recent hospital exposure) with renal adjustment, and requires discontinuation of medications which are causing side effects. House officers need to anticipate and mitigate hazards of hospitalization such as delirium, falls, iatrogenic urinary tract infections, hyper/hypoglycemia, venous thromboembolism and deconditioning.

Additional information/Special implementation requirements or guidelines:

Paper based exam in which the learner is graded based on their written admission orders for a standardized patient case.

The standardized case was developed to have face validity and piloted on a cohort of 10 third year medical students, 10 interns, and 8 third year residents who had completed an inpatient geriatric rotation. To evaluate external validity, the standardized case was then reviewed by 20 expert educators in geriatrics and hospital medicine at 6 academic medical centers nationally (eight geriatricians, eight hospitalists, and four geriatric-hospitalists). The scoring system was developed using a relative weight for each competency using average judgment of the 20 experts and multiplying the importance of the competency by the importance of acting on this competency for the patient in the standardized case.

Test performance in the pilot cohort was:

Third year medical student average score 49.4 (range 11-80)
First year resident average score 61.7% (range 36-91)
Third year resident average score 85.5% (range 78-100%)

Content Categories:

Intended learner audience:

Case-Based Instruction/Learning

Learning resource types:

Learner Assessment

Discipline/specialty:

Pharmacology/Toxicology

Estimated time to complete:

30 minutes

POGOe Id:

20596

Date posted:

Wed, 12/09/2009

Date Submitted or Reviewed/Updated for Clinical Accuracy:

Wed, 07/11/2012

No CME credits available

Not peer reviewed

None Selected

Posting status:

Posted

Previous Taxonomy Authors: Ethan Cumbler, MD, Jeannette Guerrasio, MD

Editor's notes:

7/11/12 Author indicated product is up to date. Expiration waived for another three years. - cz

Author(s):

Jeannette Guerrasio, MD

Heidi Wald, MD

Jean Youngwerth, MD

Ethan Cumbler, MD

Sonja Rosen, MD

Judy Zerzan, MD

Contact Person/Corresponding Author:

Ethan Cumbler, MD

Contact Person Email:

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Transitions in Care Curriculum for Medical Students

Sat, 10 Oct 2009 09:19:08 +0000

University of Colorado School of Medicine

Abstract:

This curriculum was developed to educate medical students about how to improve hospital discharges. The curriculum is focused on peri-discharge communication with the patient and follow-up provider. Additionally, the student is expected to make a post discharge visit to the patient's home or care center to do medication reconciliation. The standardized Medication Discrepancy Tool by Eric Coleman is used as a tracking mechanism. A pre and post curriculum confidence survey helps the students and educators see what the student has learned. The students are tested on their ability to develop a discharge plan on their final exam.

Educational objectives:

Objectives:

Students will identify the critical components of care transitions and the common obstacles to quality of care in transitions from the inpatient setting.
Students will identify and describe the important role of healthcare providers in assuring quality of care during transitions of care from the inpatient setting.
Students will perform thorough medication reconciliation between hospital discharge and home/assisted living/skilled nursing facility.
Students will gain confidence and skills in inter-provider communication necessary for quality care in transitions from the inpatient setting.

Additional information/Special implementation requirements or guidelines:

The curriculum has been implemented within the Hospitalized Adult Care clerkship to give students the experience of discharging the patient and discovering how the patient functions at home.

Content Categories:

Intended learner audience:

11 SCC: Identify safety risks in home

Geriatric Competencies:

25 HOSP: Communicate a discharge plan

Discipline/specialty:

Family Medicine

Internal Medicine

POGOe Id:

20518

Date posted:

Fri, 08/07/2009

Date Submitted or Reviewed/Updated for Clinical Accuracy:

Mon, 07/02/2012

No CME credits available

Not peer reviewed

None Selected

Hospitalized Adult Care-Transitions
- 61.5 KB

Template for follow-up telephone and letter
- 34.5 KB

Medical student Pre-test assessment
- 35.5 KB

Discharge pocket card
- 51.34 KB

Transitions Exam short answer
- 39 KB

Posting status:

Posted

Previous Taxonomy Authors: Dr. Eva Aagaard, Dr. Susan Bray-Hall

Editor's notes:

7/2/12 Author indicated product is up to date. Expiration waived for another three years. - cz

Author(s):

Eva Aagaard, MD

Susan Bray-Hall, MD

Contact Person/Corresponding Author:

Dr. Susan Bray-Hall

Contact Person Email:

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Incontinence and Urinary Catheters for the Inpatient Physician

Sat, 10 Oct 2009 09:15:51 +0000

University of Colorado School of Medicine

Abstract:

A small group, preceptor-mediated, Power-Point guided workshop was designed on the evaluation and management of geriatric incontinence and urinary catheters for the inpatient physician. It is based on the philosophy that the hospital physician must be able to integrate the unique interaction between the physiology of the aging body and the inter-current illness in the context of the hospital system delivery of care. The module is designed to guide students through a practical process for evaluating and acting on risk factors for incontinence as a risk for placement of unnecessary urinary catheters or as a contributor to hazards of hospitalization, including falls and pressure ulcers in the elderly patient. A central emphasis of this module is that knowledge about the general topic of incontinence is insufficient if this is not interpreted in the context of the system of hospital care delivery including how the physician’s actions can increase or decrease the probability that a patient will have incontinence or a urinary catheter placed. The module explores barriers to continence in the hospital and exposes provider knowledge deficits about incontinence and institutional communication silos which contribute to unnecessary catheter use. The emphasis is on systems-based practice improvement rather than solely individual practitioner knowledge. It was developed for the Hospitalist Training Track internal medicine residents at the University of Colorado Hospital rotating on the Hospitalist Acute Care for the Elderly service, and is designed for small groups of 1-8 students. Content level is appropriate for 3rd and 4th year medical students and internal medicine/family practice housestaff. The entire module requires approximately 1 hour including a 5-10 minute follow-up review of the housestaff findings after the workshop.

Educational objectives:

1) To understand appropriate and inappropriate indications, risks and alternatives for indwelling urinary catheters 2) To understand the role of the physician and how this interacts with the role of nursing in the care of incontinence in the elderly hospitalized patient 3) To review the types and mechanisms of incontinence and how they relate to physiologic and functional changes with aging 4) To critically examine how hospital systems interact with the at-risk geriatric patient in regards to incontinence and indwelling catheters 5) To facilitate the learners exploration of how hospital systems could be redesigned to reduce the harms associated with incontinence and urinary catheters

Additional information/Special implementation requirements or guidelines:

Instructor Qualifications and Responsibilities The preceptor should be familiar with the hospital system and with the geriatric syndrome of incontinence. Familiarity with one of the many fine reviews of the subject is recommended. Two are suggested at the end of the manual. Small group facilitation skills are needed. Required Resources The preceptor should familiarize him/herself with the answer to three institution specific questions prior to facilitating this module. A hospital charge nurse can provide resources and answers to these questions in less than 15 minutes. 1) Where is assessment of incontinence recorded in the nursing portion of the medical record? 2) Where is the presence of an indwelling urinary catheter recorded in the nursing portion of the medical record? 3) What hospital protocols and triggers for implementation are in place for the patient who has incontinence during hospitalization. Do these occur automatically or do they require a physician order (i.e. scheduled toileting)? The module can be facilitated by a power-point projector and a board on which to write down the learners’ input. This is optional for the facilitator who is well versed in the material. Learners will need access to 6-10 elderly inpatients to assess use of indwelling urinary catheters and barriers to/problems with continence during hospitalization.

Content Categories:

Geriatric Syndromes

Intended learner audience:

Catheters Workshop
- 32 KB

Discipline/specialty:

Internal Medicine

POGOe Id:

20296

Date posted:

Tue, 12/09/2008

Date Submitted or Reviewed/Updated for Clinical Accuracy:

Tue, 09/18/2012

No CME credits available

Not peer reviewed

None Selected

Catheters Manual
- 48 KB

Catheters Evaluation
- 23.5 KB

Incontinence
- 227 KB

Posting status:

Posted

Previous Taxonomy Authors: Jeannette Guerrasio, MD, Heidi Wald, MD, Jean Youngwerth, MD, Ethan Cumbler, MD

Conflict of Interest Disclosure:

Yes, I (we) have conflict of interest to disclose.

Editor's notes:

1/17/13 Author indicated product is up to date. Expiration waived for another three years

Conflict Description:

In 2008, Dr. Wald received a one-time speaker’s fee from Medline Industries, a manufacturer of medical supplies.

Author(s):

Jeannette Guerrasio, MD

Heidi Wald, MD

Jean Youngwerth, MD

Ethan Cumbler, MD

Contact Person/Corresponding Author:

Jeannette Guerrasio, MD

Contact Person Email:

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Falls for the Inpatient Physician: Translating Knowledge Into Action

ecumbler — Sat, 10 Oct 2009 09:15:03 +0000

University of Colorado School of Medicine

Abstract:

A small group, preceptor-mediated, Power-Point guided workshop on evaluation and management of geriatric falls for the inpatient physician. It is based on the philosophy that the hospital physician must be able to integrate the unique interaction between the physiology of the aging body and the inter-current illness in the context of the hospital system of care delivery. It is designed to guide students through a practical process for evaluating and acting on risk factors for future falls in the elderly patient and to evaluate and mitigate the risk for falls during hospitalization. A central emphasis of this module is that knowledge about risk factors for falls is insufficient if this is not paired with concrete actions taken by the hospital physician. The module explores barriers to effective modification of contributors to the multi-factoral geriatric syndrome including “possibility paralysis” and institutional communication silos. The module trains the student to focus on a limited set of modifiable risk factors and to translate knowledge into definable orders to decrease the risk of falls. The emphasis is on systems-based practice improvement rather than solely individual practitioner knowledge. It was developed for the Hospitalist Training Track internal medicine residents at the University of Colorado Hospital rotating on the Hospitalist Acute Care for the Elderly service, and is designed for small groups of 1-8 students. Content level is appropriate for 3^rdand 4^thyear medical students and internal medicine/family practice housestaff. The entire module requires approximately 1 hour.

Educational objectives:

The learner will be able to:

Recognize the societal and personal adverse impact of the geriatric fall.
Recognize the barriers to taking effective action for a multi-factoral geriatric syndrome.
Understand risk factors for falls in the context of the interaction between the postural challenges of aging, medical co-morbidity/medications, and behavioral factors which, when combined with an environmental trigger and underlying physiologic frailty, combine to create a injurious fall.
Understand how physicians can improve their own fall risk assessment
Learn about the hospital system and how non-physician providers assess and attempt to reduce fall risk for hospitalized elderly patients. To critically examine how the physician operates within this hospital system and what actions on the level of the individual physician and system changes can be taken to reduce risk of in-patient falls.

Content Categories:

Geriatric Syndromes

Intended learner audience: