POGOe - Portal of Geriatrics Online Education - Wake Forest University School of Medicine

Patient Safety

Care Settings & Models

Intended learner audience:

Practicing Physician/CME

25 HOSP: Communicate a discharge plan

Social Worker

Therapist

Geriatric Competencies:

HOSPITAL CARE FOR ELDERS

Learning resource types:

Demonstration

Other Resource Type

Discipline/specialty:

Pharmacology/Toxicology

Physical Medicine and Rehabilitation

Surgery

Estimated time to complete:

15 minutes

POGOe Id:

21943

Date posted:

Mon, 10/17/2016

Date Submitted or Reviewed/Updated for Clinical Accuracy:

Mon, 10/17/2016

No CME credits available

Not peer reviewed

Sample event planning timeline
- 204.02 KB

Sample event agenda
- 202.71 KB

Pitches by department
- 215.33 KB

Sample inhouse event publicity
- 199.82 KB

Sample judging criteria
- 268.86 KB

Resident Level Competencies:

Transitions of Care

Posting status:

Posted

Conflict of Interest Disclosure:

No, I (we) have nothing to disclose.

Author(s):

Hal Atkinson, MD, MS

Contact Person/Corresponding Author:

Hal Atkinson, MD, MS

Contact Person Email:

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Geriatricized H&P with Function and Delirium Risk Assessments

jlawlor — Thu, 10 Sep 2015 17:16:28 +0000

Wake Forest University School of Medicine

Abstract:

One important goal of the Wake Forest Geriatrics Principles for Specialists program is to train faculty, chief residents and fellows in the use of quality improvement techniques to enhance care for older adult patients that they serve. As a product of this effort, chief residents and their faculty mentors in General Internal Medicine developed functional assessment and delirium risk assessment tools that have been incorporated into the history and physical template of the electronic medical record (EMR) to identify pre-hospital functional and cognitive limitations that affect admitted patients age 65 or older. At present these tools are found in the note template of the following services: four general medicine teaching services, two cardiology services, the renal service, the hematology oncology service, the leukemia service, the Acute Care for the Elderly service, the cardiac critical care service, and the medical intensive care service.

The functional assessment, implemented in July 2014, includes four questions to help determine a patient’s baseline functional status, including ability to complete activities of daily living and independent activities of daily living, ambulation status, and pre-hospital residence. Analysis involving chart reviews pre-and post- functional assessment tool implementation showed increased documentation of functional history data in the EMR.

The delirium risk assessment, implemented in July 2015, includes four items to help identify a patient’s cognitive status, including age greater than 80, a reverse spelling task, orientation to location, and illness severity. Analysis of delirium incidence of hospitalized patients pre- and post- delirium risk tool implementation is planned for fall 2015. Our hypothesis is that delirium incidence will rise as awareness and watchfulness by providers increases with use of the tool.

While the results of implementing these physical and cognitive assessment tools are preliminary or still in process, anecdotal feedback received from case managers and other stakeholders in the discharge planning process indicate that they find such information incorporated in the H&P by admitting physicians to be valuable. Further study is needed to determine whether such documentation expedites discharge planning, improves use of therapy services, or improves readmission rates or morbidity outcomes. Next steps planned beyond testing of the delirium assessment tool include implementing a delirium prevention order set to standardize measures taken to decrease delirium among inpatients, followed by further evaluation of changes in delirium incidence, and eventual implementation of a delirium management order set. The success of these measures within Internal Medicine could encourage roll-out of these tools institution-wide.

An additional benefit of this effort has been the educational value of supporting the training of residents in informatics so that they can contribute to developing solutions for improving patient safety and quality of care.

Educational objectives:

To train residents and faculty in quality improvement techniques for the purpose of enhancing quality of care and patient safety for older adult patients.
To involve residents in developing EMR tools that emphasize the importance of physical and cognitive assessments when admitting older adult patients to the hospital.
To provide training opportunities in EMR informatics for residents and junior faculty.

Content Categories:

Patient Safety

Care Settings & Models

Intended learner audience:

Practicing Physician/CME

Tools for function & delirium assessments of geriatrics patients on admission
- 22.66 KB

Learning resource types:

Other Resource Type

Other Learning Resource Type:

EMR modification

Discipline/specialty:

Family Medicine

Internal Medicine

Estimated time to complete:

15 minutes

POGOe Id:

21864

No CME credits available

Not peer reviewed

Resident Level Competencies:

Cognitive, Affective, and Behavioral Health

Posting status:

Posted

Conflict of Interest Disclosure:

No, I (we) have nothing to disclose.

Contact Person Email:

Wake GPS Quality Improvement Project Handbook

jlawlor — Mon, 08 Sep 2014 16:05:46 +0000

Wake Forest University School of Medicine

Abstract:

This handbook was developed for the Geriatrics Principles for Specialists (GPS) Program of Wake Forest School of Medicine. In order to facilitate improvements in clinical care of older adult patients, it provides an overview of key steps for the development, implementation, and evaluation of quality improvement (QI) projects by graduate medical learners (i.e., residents and fellows) and faculty members. For each given step, the handbook reviews the associated purpose, content, and deliverables, and provides links or citations to additional learning resources. The handbook is available in both PDF and ePub versions.

Educational objectives:

The educational objectives of the handbook are to inform learners about:

The model for improvement framework for selecting an improvement target to develop into an actionable project.
The audit and feedback and technique for obtaining data and jump starting system change.
Process mapping the steps to a given outcome.
Assembling a care team to review the project plan.
Planning a test of change using the concept of the PDSA cycle.
Measuring outcomes.

Content Categories:

Care Settings & Models

Intended learner audience:

Fellow

Independent/Self-Directed Learning

Other Intended Learner Audiences:

medical faculty

Learning resource types:

Other Learning Resource Type:

Handbook/Manual

POGOe Id:

21773

Date posted:

Wed, 10/01/2014

Date Submitted or Reviewed/Updated for Clinical Accuracy:

Wed, 10/01/2014

No CME credits available

Not peer reviewed

Wake GPS Quality Improvement Handbook
- 1.51 MB

Wake GPS Quality Improvement eBook

Assigned Editor:

chowe

Posting status:

Posted

Conflict of Interest Disclosure:

No, I (we) have nothing to disclose.

Author(s):

Kathryn Callahan, MD, MS

Contact Person/Corresponding Author:

Kathryn Callahan, MD, MS

Contact Person Email:

2 MM: Identify medications that should be avoided

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Meals-on-Wheels Falls Risk Assessment Program

jlawlor — Mon, 30 Sep 2013 18:57:36 +0000

Wake Forest University School of Medicine

Abstract:

Falls in older adults have significant outcomes including injury, isolation due to the fear of falling, and an increase in morbidity and mortality. In this mandatory experience for third-year medical students rotating through Geriatrics, the student accompanies an assessor for the local Meals-on-Wheels (MOW) program to evaluate homebound seniors for their fall risk. The student obtains subjective and objective information including the number of falls, medications, visual acuity (using Snellen vision chart), cognition (using the Mini-Cog assessment instrument), and physical function. The student then determines the client's risk of falls as indicated by assigned readings and resources on falls prevention guidelines and the Beers List. The information obtained by the student is discussed and turned in at the wrap-up meeting with a faculty member at the end of the weeklong Geriatrics rotation.

Educational objectives:

1. To perform a falls risk assessment of a community-based older adult

2. To practice clinical skills in the geriatric competencies of medication management, cognitive and behavioral disorders, self care capacity, and falls/balance/gait disorders

3. To integrate knowledge and data from a variety of sources into a comprehensive assessment

4. To provide an effective educational intervention for clinical students in Geriatrics in the face of limited faculty time

Additional information/Special implementation requirements or guidelines:

Requires use of a Snellen card for the vision testing. Also requires students to read two journal articles:

1) Panel on Prevention of Falls in Older Persons, American Geriatrics Society and British Geriatrics Society (2011), Summary of the Updated American Geriatrics Society/British Geriatrics Society Clinical Practice Guideline for Prevention of Falls in Older Persons. Journal of the American Geriatrics Society, 59(1):148–157.

2) The American Geriatrics Society 2012 Beers Criteria Update Expert Panel (2012), American Geriatrics Society Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. Journal of the American Geriatrics Society, 60(4): 616–631.

Content Categories:

Intended learner audience:

Medical Student Clinical

Geriatric Competencies:

3 MM: Document a patient’s medication list

7 CBD: Perform and interpret a cognitive assessment

9 SCC: Assess and describe functional abilities

11 SCC: Identify safety risks in home

12 FBG: Ask about falls and intrepret tests

Learning resource types:

Other Resource Type

Discipline/specialty:

Family Medicine

Internal Medicine

Estimated time to complete:

More than 3 hours

POGOe Id:

21695

Date posted:

Fri, 10/11/2013

Date Submitted or Reviewed/Updated for Clinical Accuracy:

Fri, 10/11/2013

No CME credits available

Not peer reviewed

MOW falls risk visit instructions
- 23.26 KB

MOW falls risk assessment form
- 29.61 KB

Posting status:

Posted

Previous Taxonomy Authors: Jamehl L. Demons; Brooke R. Davis; Jeff D. Williamson; Kathryn E. Callahan; Hal H. Atkinson

Conflict of Interest Disclosure:

No, I (we) have nothing to disclose.

Author(s):

Jamehl Demons, MD

Contact Person/Corresponding Author:

Janice S. Lawlor

Contact Person Email:

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SMILE: Senior Mentor Independent Living Education Program with Meals-on-Wheels

jlawlor — Fri, 15 Oct 2010 15:52:39 +0000

Wake Forest University School of Medicine

Abstract:

This is a one-morning community experience pairing a medical student with a volunteer driver (age 65+) for the local Meals-on-Wheels program. The student accompanies the driver on the delivery route and en route conducts a life history of the driver and delivers a prevention message on an aspect of healthy aging. Afterwards, the student writes a reflection paper on the experience with this high-functioning senior. Students evaluate the experience and are evaluated by the driver and a faculty member on professionalism and communications. Evaluation forms are included.

Educational objectives:

Successful aging
Self-care capacity
Professionalism
Communication
Interviewing skills
Prevention counseling
Attitudes toward older adults

Content Categories:

Medical Student Pre-Clerkship

Geriatric Syndromes

Intended learner audience:

Geriatric Competencies:

9 SCC: Assess and describe functional abilities

Learning resource types:

Curriculum/Syllabus

Other Learning Resource Type:

Program development guide

Discipline/specialty:

Intro to Clinical Medicine/Clinical Skills/Doctoring

Estimated time to complete:

More than 3 hours

POGOe Id:

20821

Date posted:

Wed, 12/08/2010

Date Submitted or Reviewed/Updated for Clinical Accuracy:

Wed, 12/08/2010

No CME credits available

Not peer reviewed

WFUSM Guide to Developing a Senior Mentor Program with Meals-on-Wheels
- 748.9 KB

Editable version - WFUSM Guide to Developing a Senior Mentor Program with Meals-...
- 155 KB

Posting status:

Posted

Previous Taxonomy Authors: Jamehl Demons, Brooke Davis

Conflict of Interest Disclosure:

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

Author(s):

Jamehl Demons, MPH

Brooke Davis, MPH

Contact Person/Corresponding Author:

Jamehl Demons

SmartPrescribe: Principles of Rational Prescribing

jlawlor — Sat, 10 Oct 2009 09:15:06 +0000

Wake Forest University School of Medicine

Abstract:

This is a web-based lesson on the principles of rational prescribing. It includes three cases and addresses polypharmacy, adverse drug events, and off-label prescribing. The principles apply to all patient populations, but this lesson focuses on older adults because they constitute a large and growing population at high risk of polypharmacy and unwanted side effects of medications. The lesson utilizes PowerPoint slides, audio, and interactive features including focus questions within the cases and a specially created drug interaction game. Printable resources available for download include the American Geriatrics Society's Beers Criteria Pocket Card and a sample medication grid for patient use. The lesson is free and requires about 15 minutes to complete.

Educational objectives:

Define polypharmacy and the scope of problems related to drug prescribing in the elderly.
List strategies to avoid drug interactions and adverse drug events in older persons.
List classes of drugs and specific drugs to avoid in older adults.

Content Categories:

Intended learner audience:

Fellow

Medical Student Clinical

Practicing Physician/CME