The Portal of Geriatrics Online Education

Wake Forest University School of Medicine

Is this a Reynold's grantee: 
Yes

Hacking Geriatrics: The World 2 Challenge

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Product Information
Estimated time to complete: 
0
Abstract: 

The World 2 Challenge is an innovative quality improvement competition designed by our Reynolds Next Steps team, based on the concept of a healthcare hackathon.  We partnered with institutional leadership in our health system, graduate medical education leadership, nursing, physical therapy, pharmacy, and other interprofessional representatives to design a platform to promote friendly competition led by specialty faculty, fellows, and residents to improve the quality of care for older adults. In the process, they learn key principles of geriatrics and how to apply them at a broader level across the institution. Our first competition in April 2016 focused on improving communication at transitions of care for older patients.  At a retreat, 9 QI project "pitches" were delivered to a broad interprofessional audience, 5 were chosen by a voting process and developed their ideas further through interprofessional team collaboration. Ultimately, 2 project ideas were selected to go forward, and the ultimate winner of the QI competition will be the project with the most successful implementation and the broadest impact for the care of older patients institution-wide. This has been an energizing initial effort, and we look forward to its continuing for years to come because of several unique aspects that promote its success. The most important are the interprofessional focus, teamwork, contextual learning, and alignment with institutional priorities to make actual change in the way that patients are cared for at our institution.  We provide a timeline that illustrates the key inputs and steps to promote such a QI competition to enhance geriatric education and care.  We also provide the event agenda, pitch template, judging template, list of pitch topics, and follow-up inhouse publicity from our institution to give our geriatrics colleagues at other institutions sample materials which could be adapted to their specific needs.

Educational objectives: 
  1. To demonstrate how geriatrics can lead and facilitate improvements in care across the broader institution through interprofessional focus, teamwork, contextual learning, and alignment with institutional priorities, grounded in geriatrics principles.
Date posted: 
Mon, 10/17/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Mon, 10/17/2016
Contact Person/Corresponding Author:



Suggested Citation:
Hacking Geriatrics: The World 2 Challenge. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/1246

Geriatricized H&P with Function and Delirium Risk Assessments

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Other Learning Resource Type: 
Product Information
Estimated time to complete: 
0
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: 
  1. To train residents and faculty in quality improvement techniques for the purpose of enhancing quality of care and patient safety for older adult patients.
  2. To involve residents in developing EMR tools that emphasize the importance of physical and cognitive assessments when admitting older adult patients to the hospital.
  3. To provide training opportunities in EMR informatics for residents and junior faculty.
Publications from, presentations from, and/or citations to this product: 

M. Wesley Milks, Farra Wilson, Ajay Dharod and Kirsten Feiereisel.  Abstract 347:  Identification of Functional Limitations on Admission by Internal Medicine Resident Physicians.  Circulation: Cardiovascular Quality and Outcomes. 2015;8:A347.

Contact Person/Corresponding Author:



Suggested Citation:
Geriatricized H&P with Function and Delirium Risk Assessments. POGOe - Portal of Geriatrics Online Education; 2015 Available from: https://pogoe.org/taxonomy/term/1246

Wake GPS Quality Improvement Project Handbook

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Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Other Intended Learner Audiences: 
Other Learning Resource Type: 
Product Information
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:

  1. The model for improvement framework for selecting an improvement target to develop into an actionable project.
  2. The audit and feedback and technique for obtaining data and jump starting system change.
  3. Process mapping the steps to a given outcome.
  4. Assembling a care team to review the project plan.
  5. Planning a test of change using the concept of the PDSA cycle.
  6. Measuring outcomes.
Date posted: 
Wed, 10/01/2014
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Wed, 10/01/2014
Product Viewing Instructions: 
To download the eBook version of the Wake GPS Quality Improvement Handbook, please go to the Wake Geriatrics website.
Contact Person/Corresponding Author:



Suggested Citation:
Wake GPS Quality Improvement Project Handbook. POGOe - Portal of Geriatrics Online Education; 2014 Available from: https://pogoe.org/taxonomy/term/1246

Meals-on-Wheels Falls Risk Assessment Program

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Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Product Information
Estimated time to complete: 
999
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: 
Publications from, presentations from, and/or citations to this product: 

Atkinson HH et al.  Teaching Medical Student Geriatrics Competencies in 1 Week: An Efficient Model to Teach and Document Selected Competencies Using Clinical and Community Resources.   J Am Geriatr Soc 61:1182–1187, 2013.

Date posted: 
Fri, 10/11/2013
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Fri, 10/11/2013
Contact Person/Corresponding Author:



Suggested Citation:
Meals-on-Wheels Falls Risk Assessment Program. POGOe - Portal of Geriatrics Online Education; 2013 Available from: https://pogoe.org/taxonomy/term/1246

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

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Other Learning Resource Type: 
Product Information
Estimated time to complete: 
999
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
Date posted: 
Wed, 12/08/2010
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Wed, 12/08/2010
Contact Person/Corresponding Author:



Suggested Citation:
and . SMILE: Senior Mentor Independent Living Education Program with Meals-on-Wheels. POGOe - Portal of Geriatrics Online Education; 2010 Available from: https://pogoe.org/taxonomy/term/1246

SmartPrescribe: Principles of Rational Prescribing

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Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Other Learning Resource Type: 
Product Information
Estimated time to complete: 
0
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: 
  1. Define polypharmacy and the scope of problems related to drug prescribing in the elderly.
  2. List strategies to avoid drug interactions and adverse drug events in older persons.
  3. List classes of drugs and specific drugs to avoid in older adults.
Date posted: 
Fri, 10/30/2009
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Mon, 01/28/2013
Contact Person/Corresponding Author:



Suggested Citation:
and . SmartPrescribe: Principles of Rational Prescribing. POGOe - Portal of Geriatrics Online Education; 2009 Available from: https://pogoe.org/taxonomy/term/1246
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