Our folks are working on an important new project. It derives from a number of adverse events, cases in which elderly patients fell and were injured. Our review process often indicated that the staff had done just the right things with regard to fall prevention and supervision of patients. Using the "5 Why" process of Lean, they kept digging into the cause of these falls. A hypothesis emerged: Perhaps we were contributing to the likelihood of falls by over-medicating geriatric patients or missing important parts of their supervision and therefore causing them or allowing them to be disoriented.
Our group began to construct a new "geriatric bundle" of care. (You have seen this be tremendously effective in other arenas, like avoiding Ventilator Associated Pneumonia.) But what should it look like, and what should it include? Well, we have just started rolling it out on an experimental basis, and we will report the results as things progress. Here's a summary from the staff:
The Geriatric Bundle now has a new name - GRACE (Global Risk Assessment and Careplan for Elders). This program is designed to improve the care of all hospitalized elders admitted to the BIDMC, with the hope that we will reduce the risk of delirium, falls, pressure ulcers, functional decline, etc.
There are three main components of the initiative:
- Provider Order Entry (POE) enhancements
- Improved Pharmacy/Medication safety
- Bedside care protocol
The bedside care component is a major piece and through the diligent work of many is well on its way to implementation. A tool is a GRACE bedside flow sheet that will be used for all patients 80 and older each day. You can see it and the other elements at this link to Slideshare, where you can read the entire presentation that was shared with our clinical staff on several floors.