The Portal of Geriatrics Online Education

Patient Safety

IMPROVE Polypharmacy Clinic Resource Site

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Other Learning Resource Type: 
Product Information
Estimated time to complete: 
3
Abstract: 

Polypharmacy and inappropriate prescribing are common among older adults. Polypharmacy is associated with a variety of adverse outcomes in older adults including falls, adverse drug events, hospitalization, mortality, and measures of function and cognition. The Initiative to Minimize Pharmaceutical Risk in Older Veterans (IMPROVE) is an interprofessional polypharmacy clinic within an academic patient-aligned care team at the VA Connecticut Center of Excellence in Primary Care Education. The clinic consists of a pre-clinic conference, shared medical appointment, individual visit, and team precepting. The team consist of a pharmacist, geriatrician, primary care provider, and health psychologist and involves medicine residents, nurse practitioner residents, pharmacy residents, and psychology residents. This website describes the clinic design and provides the resources and links helpful for starting an IMPROVE Polypharmacy Clinic including forms, short topic discussions in polypharmacy, and various other resources helpful for deprescribing.

Educational objectives: 

This website:

1.  Describes the IMPROVE Polypharmacy Clinic design

2.  Provides resources needed to implement an IMPROVE Polypharmacy Clinic

3.  Provides handouts for short topic discussions on various polypharmacy-related topics and deprescribing

Date posted: 
Thu, 10/13/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Thu, 10/13/2016
Contact Person/Corresponding Author:



Suggested Citation:
IMPROVE Polypharmacy Clinic Resource Site. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/1089

Interprofessional Geriatric Education and Training in Texas: Elder Mistreatment

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Product Information
Estimated time to complete: 
1
Abstract: 

Although estimates vary, it is generally believed that 11% of the elderly are abused. According to the National Incidence Study on Elder Abuse, approximately 450,000 elderly experienced abuse each year. If self-neglect is included, the number increases to 551,000. Elder mistreatment is too large of a problem for any one person or one discipline to resolve. Incorporating the expertise of all the members of the interprofessional healthcare team is critical to determine the facts in the situation and the motives of the people involved. Healthcare providers can only see what is presented in the clinical setting. There is so much of the story that may not be manifested in a routine exam and encounter. Having all team members knowledgeable about the sometimes subtle signs of elder mistreatment is helpful for eliciting information and devising a holistic intervention plan.

The University of North Texas Health Science Center (UNTSHC) Reynolds Interprofessional Geriatric Education and Training in Texas (IGET-IT) Program has developed an Elder Mistreatment module as part of the Interprofessional Communication Improvement Modules (ICIM) Elder Safety series. The ICIM Elder Safety modules were created in collaboration with the National Board of Osteopathic Medical Examiners (NBOME) and are supported, in part, by a grant from the Donald W. Reynolds Foundation. The goal of the Elder Safety ICIMs is to provide innovative and sustainable programs to improve the ability of physicians to work with other health disciplines in teams to provide better care for geriatric patients. The care of older adults can be very complex and studies have shown that a team approach can be most effective in leading to quality outcomes.

 

Educational objectives: 

Upon completion of this activity, participants will be able to:

  • Define “elder mistreatment”
  • Describe the prevalence of elder mistreatment in the US
  • Define the multiple forms of elder mistreatment
  • Identify risk factors for elder mistreatment
  • List indicators of elder mistreatment
  • Prioritize the steps of elder mistreatment assessment
  • Determine the approach for including an elder mistreatment assessment in an IP team model of geriatric assessment
Publications from, presentations from, and/or citations to this product: 

Marquez Hall, S. (2016, May). Assessment Tool for Elder Safety on the Topics of Falls Risk and Elder Mistreatment. Presented at American Geriatrics Society Annual Scientific Meeting Education Product Showcase, Long Beach, CA.

Date posted: 
Wed, 10/05/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Wed, 10/05/2016
Product Viewing Instructions: 
Select your activities and add them to your cart. In the cart, click Proceed to Checkout. You will be prompted to create a new account or log in to your existing one. Once your account is created, you will be directed back to complete your registration.
Contact Person/Corresponding Author:



Suggested Citation:
Interprofessional Geriatric Education and Training in Texas: Elder Mistreatment. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/1089

Interdisciplinary Experience on ACE Unit

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Product Information
Abstract: 

During a 2- or 4-week elective geriatric rotation for medical students and month-long required rotation for Family Medicine residents, learners spend time as part of the ACE Unit Interdisciplinary Safety Team. One to two half days are spent working alongside patient care aides, physical therapy, occupational therapy or nursing to be exposed to a typical day for each team member. The experience allows learners to see the unqiue ways each discipline addresses the safety and works to maintain function of vulnerable, hospitalized older adults. Learners also participate in interdisciplinary rounds with their designated team members. 

Afterward, learners complete a written, personal reflection on the experience. Reflective ability is an important skill for practicing physicians but is rarely taught or encouraged through medical school or residency training. Furthermore, reflection is an important step in cementing new learning. 

Attached is a sample of the 2-week curriculum, a list of resources used with learners and overall description of the ACE rotation. Samples of these reflections are also included. Please contact me if you would like more information on the overall structure of these rotations. 

 

 

Educational objectives: 

1. Describe and participate in roles filled by physical therapy, occupational therapy, nursing and patient care aides as part of an interdisciplinary safety team caring for vulnerable, hospitalized older adults. 

2. Reflect on the experience to apply to future practice as a clinician. 

Date posted: 
Fri, 10/21/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Fri, 10/21/2016
Contact Person/Corresponding Author:



Suggested Citation:
Interdisciplinary Experience on ACE Unit. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/1089

Geriatric Interprofessional Teaching Clinic (GITC)

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Other Learning Resource Type: 
Product Information
Estimated time to complete: 
1
Abstract: 
•Collaborative interprofessional practice and care are essential to the complex healthcare needs of a rapidly growing older adult population.
•Interprofessional collaboration (IPC) occurs when various health care practitioners, clients and/or caregivers work together to improve a client’s overall health.
•Teaching an IPC model continues to be a major gap in every health professionals’ education.
•To address this gap, the Geriatrics Interprofessional Teaching Clinic (GITC) at the University of Kansas Medical Center's Landon Center on Aging was created. It incorporates six professions: Students and faculty from  Physical Therapy, Medicine, Pharmacy, Social Welfare, Dietitics/Nutrition and Occupational Therapy.
•It is scheduled one half day a week with four patients scheduled on a "rolling" basis allowing for interprofessional teams of three to see patients in a staggered fashion. On average, each visit takes approximately 60-90 minutes.
•Logistically, students from 3 professions review the medical record together, discuss what they want to accomplish in the room, and how they will approach the patient encounter as a team. The students then see the patient and report back to the attending physician and other health professions faculty as a team. The assessment and plan for the patient is developed by the team.
•Team members are asked to define their roles by what the patient needs at that particular visit, starting with their own professional training and scope of practice, but then encouraged to allow themselves to participate in new ways. The interprofessional clinic faculty assist the learners by facilitating reflection on their clinical performance as individuals and as a team at the time of the clinic visit, incorporating their reflections into their next clinical encounter and through debriefing.
•To quantify interprofessional collaboration, evaluation tools are being piloted to assess for team dynamics, and surveys are sent out to each individual learner to assess for behavior and attitude changes. These are both done at the "beginning" and "end" of their GITC experience.
 
 
Educational objectives: 
•Create an interprofessional (IP) clinic involving multiple learners, emphasizing the national interprofessional competencies (values/ethics, roles/responsibilities, interprofessional communication and teams/teamwork).
•Train students in IP teams to evaluate their communication with the patient and with other team members following a patient encounter in GITC using a validated rubric. 
•Monitor changes in IP team behavior through individual learner evaluations.
Date posted: 
Mon, 10/10/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Mon, 10/10/2016
Contact Person/Corresponding Author:



Suggested Citation:
Geriatric Interprofessional Teaching Clinic (GITC). POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/1089

Elder Care A Resource for Interprofessional Providers: Animal-Assisted Interventions for Older Adults

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Product Information
Estimated time to complete: 
1
Abstract: 

 Animal-Assisted Interventions for Older Adults is one of a continuing series of practical, evidence based, Provider Fact Sheets which summarize key geriatric topics and provide clinically useful assessments and interventions. Initially developed for remote, rural clinical sites, they are useful for students and health care professionals from many fields and across a very broad range of health care settings.

Educational objectives: 
  1. Identify the different types of animal-assisted interventions
  2. Identify benefits of animal-assisted interventions for patients with dementia
  3. Identify  benefits of animal-assisted interventions for patients with cardiovascular disease
Additional information/Special implementation requirements or guidelines: 

Subscribers to POGOe are free to reprint Elder Care on their own stationery or in other publications without obtaining specific permission, so long as:

  1. Content is not changed,
  2. No one is charged a fee to use or read the publication,
  3. Authors and their affiliated institutions are noted without change, and
  4. The reprint includes the following statement: “Reprinted courtesy of the Arizona Reynolds Program of Applied Geriatrics and the Arizona Geriatrics Workforce Enhancement Program”. 
Publications from, presentations from, and/or citations to this product: 

The Elder Care provider sheets are occasionally published in the Arizona Geriatrics Society Journal, which is published twice yearly.

Nelson, D. and Medina-Walpole, A. (2010, December), Elder care provider fact sheets. Journal of the American Geriatrics Society, 58(12), 2414-2415. Also available online.         

Date posted: 
Sun, 12/31/2017
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Tue, 03/06/2018
Contact Person/Corresponding Author:



Suggested Citation:
Elder Care A Resource for Interprofessional Providers: Animal-Assisted Interventions for Older Adults. POGOe - Portal of Geriatrics Online Education; 2017 Available from: https://pogoe.org/taxonomy/term/1089

Postoperative Delirium Curriculum For General Surgery Residents

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Product Information
Estimated time to complete: 
2
Abstract: 

According to estimates, 50% of older adults will have an operation after the age of 65 with postoperative delirium being the most common complication in this age group. Even though delirium is common, the diagnosis is often overlooked and improperly treated. The American Geriatric Society surveyed surgical specialists and found that delirium was the geriatric clinical issue having the largest knowledge gap. Most surgical training programs still have little geriatric care incorporated explicitly into the curricula, and little explicit assessment of skills in caring for older patients. There is still a significant gap in formalized delirium education in surgical training programs. Our goal is to address this gap with this postoperative delirium curriculum for general surgery residents. Our objective is that through this geriatric surgical curriculum with a foundation consisting of delirium prevention, assessment, and management will ultimately lead to improved surgical care outcomes for older adults. This is a case based guide to compliment an online module through the Surgical Council of Resident Education (SCORE) website. We designed an online module on the SCORE website on postoperative delirium and this is an interactive case based small group exercise along with pre-post test, mini-cex, pocket card, and consultant check sheet. The case will require learners to go through a real surgical case, identify and modify risk factors, do delirium risk assessment, use a validated delirium screening tool (4AT), and come up with prevention and treatment options.

Educational objectives: 

After completion of the curriculum, the surgical resident will be able to:

  1. Identify the pathophysiological causes of postoperative delirium.
  2. Identify risk factors for the development of postoperative delirium.
  3. Recognize interventions to prevent postoperative delirium.
  4. Describe the common presentation of delirium and be able to distinguish delirium from dementia and depression.
  5. Recognize evidence based assessment tools (e.g. 3D CAM, 4AT, etc.) as reliable ways to screen for postoperative delirium.
  6. Describe the major effects that delirium has on surgical and patient outcomes.
  7. Correctly employed a validated delirium assessment tool (e.g. 4AT) to screen postoperative delirium in non-ICU older confused surgical patient.
  8. Calculate the correct delirium risk assessment score for a case scenario.
  9. Propose strategies for mitigating preoperative, intraoperative, and postoperative risk factors for a common general surgery case scenario.
  10. Identify "best-practice" non-pharmacologic and pharmacologic treatment strategies to manage postoperative delirium given a case scenario   
  11. Demonstrate to their attending or geriatric consultant the correct use of a validated delirium assessment tool to screen for postoperative delirium in non-ICU older confused surgical patient. 
  12. Perform prevention measures and monitor delirium development via evidence based assessment method (e.g 4AT) prior to geriatric consult.   

As a result of the curriculum, surgical residents will rate as important that surgeons should know:

1. Treatment strategies for postoperative delirium.

2. How to screen for postoperative delirium using a validated assessment tool.       

3. Strategies to prevent postoperative delirium.      

 

Publications from, presentations from, and/or citations to this product: 

This was presented at the American Geriatricy Society Meeting and American Delirium Society Meeting.

Date posted: 
Wed, 02/13/2019
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Mon, 01/28/2019
Contact Person/Corresponding Author:



Suggested Citation:
Postoperative Delirium Curriculum For General Surgery Residents. POGOe - Portal of Geriatrics Online Education; 2019 Available from: https://pogoe.org/taxonomy/term/1089

Your Role in Delirium Detection and Treatment: An Interdisciplinary Approach

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Other Learning Resource Type: 
Other Intended Learner Audiences: 
Other Sponsors: 
Product Information
Estimated time to complete: 
1
Abstract: 

This 24 minute video defines delirium and clarifies the role of each member of the acute care interdisciplinary team in detecting delirium and communicating with team members in the SBAR format (Situation, Background, Assessment and Request/Recommendation.)  The Confusion Assessment Method (CAM) is highlighted as the tool to use for delirium detection.  The video includes some voiceover with PowerPoint slides and a TeamSTEPPS video depictng a hospital nurse SBAR report to a provider on a patient with possible delirium. 

Educational objectives: 

Upon completion of this material, you will be able to:

  • Define and understand delirium and its significance in patient care.
  • Learn how to administer and interpret the Confusion Assessment Method (CAM.)
  • Define your role on an interdisciplinary team in caring for hospitalized patients with delirium.
  • Learn how to communicate effectively about delirium using SBAR (Situation, Background, Assessment, Request/Recommendation).

 

Date posted: 
Mon, 06/13/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Mon, 06/13/2016
Contact Person/Corresponding Author:



Suggested Citation:
Your Role in Delirium Detection and Treatment: An Interdisciplinary Approach. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/1089

Elder Care A Resource for Interprofessional Providers: Discussing Cognitive Aging with Patients and Families

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Product Information
Estimated time to complete: 
1
Abstract: 

Discussing Cognitive Aging with Patients and Families is one of a continuing series of practical, evidence based, Provider Fact Sheets which summarize key geriatric topics and provide clinically useful assessments and interventions. Initially developed for remote, rural clinical sites, they are useful for students and health care professionals from many fields and across a very broad range of health care settings.

Educational objectives: 
  1. Define cognitive aging
  2. Explain the difference between fluid intelligence and crystalized intelligence
  3. Identify a clinical test that can be used to assess speed of medical processing
Additional information/Special implementation requirements or guidelines: 

Subscribers to POGOe are free to reprint Elder Care on their own stationery or in other publications without obtaining specific permission, so long as:

  1. Content is not changed,
  2. No one is charged a fee to use or read the publication,
  3. Authors and their affiliated institutions are noted without change, and
  4. The reprint includes the following statement: “Reprinted courtesy of the Arizona Reynolds Program of Applied Geriatrics and the Arizona Geriatrics Workforce Enhancement Program”. 
Publications from, presentations from, and/or citations to this product: 

The Elder Care provider sheets are occasionally published in the Arizona Geriatrics Society Journal, which is published twice yearly.

Nelson, D. and Medina-Walpole, A. (2010, December), Elder care provider fact sheets. Journal of the American Geriatrics Society, 58(12), 2414-2415. Also available online.  

Date posted: 
Thu, 06/30/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Thu, 06/30/2016
Contact Person/Corresponding Author:



Suggested Citation:
Elder Care A Resource for Interprofessional Providers: Discussing Cognitive Aging with Patients and Families. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/1089

Ambulatory Geriatrics Curriculum for Internal Medicine Residents Module on BPSD: Agitation and Behavioral Problems in Dementia

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Product Information
Estimated time to complete: 
1
Abstract: 

In 2012, 5.4 million Americans are diagnosed with Alzheimer’s Disease.  Lifetime risk of experiencing BPSD (Behavioral and Psychological Symptoms of Dementia) is nearly 100%.  BPSD is associated with increased morbidity and nursing home placement and is potentially treatable.  The information in this curriculum has been created to help the general internal medicine residents have a structured approach to the evaluation and management of BPSD.  This is the 3rd topic covered in a four part ambulatory geriatric curriculum that was developed for internal medicine residents.  To learn more about the successful ambulatory curriculum developed, please  check out  manuscript by Chang C1, Callahan EH, Hung WW, Thomas DC, Leipzig RM, DeCherrie LV. A Model for Integrating the Assessment and Management of Geriatric Syndromes Into Internal Medicine Continuity Practice: 5-Year Report. Gerontol Geriatr Educ. 2015 Jul 9:1-15.

Educational objectives: 

At the conclusion of this module, learners will be able to:

  1. Define BPSD
  2. Evaluate BPSD
  3. Discuss the Guidelines for Management of BPSD
    • Nonpharmacologic Interventions
    • Pharmacologic Interventions
Publications from, presentations from, and/or citations to this product: 

Christine Changab*, Eileen H. Callahanab, William W. Hungc, David C. Thomasb, Rosanne M. Leipzigab & Linda V. DeCherrieab A Model for Integrating the Assessment and Management of Geriatric Syndromes Into Internal Medicine Continuity Practice: 5-Year Report Gerontology & Geriatrics Education. Published online: 09 Jul 2015. DOI:10.1080/02701960.2015.1031897.

Date posted: 
Mon, 09/12/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Mon, 09/12/2016
Contact Person/Corresponding Author:



Suggested Citation:
Ambulatory Geriatrics Curriculum for Internal Medicine Residents Module on BPSD: Agitation and Behavioral Problems in Dementia. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/1089

Nonpharmacologic Management of BPSD: Behavioral and Psychological Symptoms of Dementia

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Product Information
Estimated time to complete: 
1
Abstract: 

In 2012, 5.4 million Americans were diagnosed with Alzheimer’s Disease.  Lifetime risk of experiencing BPSD (Behavioral and Psychological Symptoms of Dementia) is nearly 100%.  BPSD is associated with increased morbidity and nursing home placement and is potentially treatable.  The information in this curriculum has been created to help the general internist have a structured approach to the evaluation and management of BPSD. 

Educational objectives: 

Participants will be able to:

  1. Define BPSD
  2. Evaluate BPSD
  3. Discuss the Guidelines for Management of BPSD
Date posted: 
Mon, 09/12/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Mon, 09/12/2016
Contact Person/Corresponding Author:



Suggested Citation:
Nonpharmacologic Management of BPSD: Behavioral and Psychological Symptoms of Dementia. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/1089

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