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Compare Products Compare Products. Price History Features. Hand washing remains the single most effective strategy to eliminate nosocomial infection. Visible reminders of the importance of infection control.
Active, continuous infection control surveillance, rather than passive voluntary reporting programs need to be encouraged as they are far more effective in decreasing hospital infection rates.
Delirium or acute confusional state: See Delirium protocol Deconditioning and Functional Decline Malnutrition and Dehydration See Nutrition and Hydration Pressure Ulcers See Pressure Ulcer Urinary Incontinence See Urinary Incontinence Depression See Depression Fecal Impaction and Incontinence It is critical that nurses recognize their important role in preventing these nosocomial complications which far too often can and do trigger a cascade of inevitable decline that could have been prevented if the initial iatrogenic event had not occurred.
Environmentally-induced Accidental Complications See Falls Background Provider Values, Beliefs and Attitudes Nursing Interventions It is important that nurses examine their belief systems and not unwittingly contribute to the patient's suffering and despair because of biases against older patients that can compromise objectivity.
Prolongs hospital stay and increases risk of nursing home placement and death. Contributing factors include: Lack of education and awareness by nursing, medical and hospital staff to the importance of functional impairment to patient outcomes and quality of life. Organizational structures and processes of care that can impede the staff from knowing the patient's baseline functioning. Nursing must recognize the older adult at greatest risk of deconditioning, and implement aggressive progressive mobilization and self care protocols and promote restraint-free care.
Malnutrition is the single strongest predictor of long term mortality in the geriatric patient, even if the patient receives nutritional interventions in the hospital. Malnutrition is associated with longer lengths of stay, and increased hospital and home health costs.
Dehydration can be a medical emergency in the older patient and present as delirium or Falls See Delirium and Falls Topics. Age-related diminished thirst sensation and inability to concentrate urine, medications, altered level of consciousness, and cognitive or functional impairment can contribute to dehydration and malnutrition.
Nurses must closely monitor intake and output or laboratory values, question or prevent prolonged NPO status, and avoid delays due to scheduling of diagnostic tests. Functional incontinence, in which patients are unable to meet their own elimination needs, is very common in acute care setting. One of the most common causes of nursing home placement. Contributes to development of pressure ulcers, social isolation and depression.
Nurses need to recognize transient incontinence and collaborate with physician to assist the patient to regain continence. Affects one third of hospitalized elders with higher rates seen in patients in long term care and those with chronic disabling conditions.
Common comorbid condition in patients with dementia and CVA. Cognitive impairment may be a either a presenting symptom or result of depression. Depression in older adults commonly presents atypically with increased complaints of physical and somatic complaints.
May coexist with anxiety. Associated with increased morbidity and mortality with highest suicide rates noted among older men. It is critical that nurses screen older patients for depressive symptoms, especially vague somatic complaints, and work with physicians to aggressively manage late life depression.
Fecal impaction is one of the primary causes of fecal incontinence and very common among patients in acute and long term care settings. Primary risk factors for fecal impaction include polypharmacy, especially with constipating medications e. Prevention of fecal impaction and assisting patients to manage constipation is critical to avoid unnecessary surgery and resultant pain and suffering.
Physical features of hospital environments can contribute to iatrogenic events, most notably injuries or deaths related to falls, restraints and equipment defects. Falls are a major public health problem among older adults and the consequences can be devastating. Falls occur at a rate of 1. Skilled nursing facility incidence is even higher. Older adults tend to be at greatest risk of falling in the hospital due to a variety of intrinsic and extrinsic factors.
Try This Issue 8 - Fall Risk Assessment Environmental hazards that need to be eliminated: Slickly waxed floors are a serious hazard to any patient, however the age-related changes in vision and conditions such as neuropathy significantly increase this risk. Inappropriate foot wear which can contribute to falls.
Unnecessary clutter and equipment at the bedside, therapeutic lines and devices that tether the patient. Defective or improperly used equipment. Restraints, including full hospital bed siderails, increase the risk of harmful and potentially fatal injuries.
See Physical Restraint protocol Hospital beds with full side rails have caused injuries and deaths in higher risk patients due to both bed entrapment and falls over the side rails. Older adults at risk for falls, delirium, with dementia or dementia-related behaviors are at greatest risk of being restrained See Dementia and Delirium protocols Management: Proactive approach to patient safety needs to be a priority including: See Falls protocol Every effort must be made to implement restraint free management programs and to closely monitor the high risk restrained patient.
Patients need to be encouraged to wear sturdy shoes or slippers with rubber soles whenever they get out of bed. Routinely check hospital slippers to ensure the skid surface on sole of foot remains when patient ambulates. Equipment acquisition and hospital design and remodel must consider the age-related sensory and functional changes of the burgeoning older population. Properly placed handrails and contrasting colors to clearly identify doorways and toilet seats can assist the visually-impaired patient to more safely function within the environment.
Seating needs to be of the appropriate height with arm rests that will facilitate safe transfers. Finally, hospitals must promote a culture of safety that includes: Removal from service of any malfunctioning equipment Enforce good safety behaviors at both the unit and organizational level Prompt and blame-free reporting Healthcare provider's values, beliefs, fears, prejudices and attitudes can be equally detrimental to patients.
A nurse's perception of older adults as chronically ill and frail may foster increasing dependence and functional decline when the patient is not provided the opportunity or assistance to routinely ambulate or engage in self-care skills.
A diagnosis of dementia may lead a prejudiced or uneducated clinician to expect less of a patient and to subsequently offer fewer treatment options. The assumption that the quality of life of the demented person is "poor" may contribute to the physician assuming that palliation or institutionalization is the most appropriate goal of care. Most physicians are poorly trained in geriatric healthcare, unaware of the importance of the core concepts of geriatric medicine that promote function, and an interdisciplinary approach with emphasis on early discharge planning.
The present system of hospital care not only perpetuates dependency and iatrogenesis among geriatric patients, but tends to "erode their self-esteem, identity and individuality. Be less assertive with the physician or less aggressive in seeking second opinions due to generational differences. Increasing awareness to the dangers of diagnostic and therapeutic interventions and implementing proactive interventions at the national, regional and local levels such as: JCAHO National Patient Safety Goals Patient and public safety awareness campaign Mandate increased geriatric education in the profession and allied health schools Healthcare Organizational priorities Expected Outcomes Patient Healthcare provider Institution Follow-up Monitoring Implement appropriate initial and ongoing training to all staff: Provide geriatric training to all medical, nursing and ancillary healthcare professionals and care providers well integrated into hospital orientation, unit-precepting and annual mandatory training programs.
Hospital staff needs to understand the increased vulnerability of the geriatric patient, to readily identify those at higher risk, and to proactively intervene to prevent patient harm. Emphasis on teamwork needs to be an integral component of all training programs. Standardize and simplify structure and processes of care and work routine: Computerized patient records to minimize the number of medication errors due to illegible handwriting.
Pre-programmed medication alerts to prevent adverse drug-drug interactions. Looking for a fast and stress-free way to study prep? A must-have exam nursing prep study guide Test Bank solution that supports both practicing and learning students every step of the way as they develop the knowledge they will need for success in their future careers.
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