Clinical Guidelines for Frail Seniors in Emergency Departments and Hospitals

Action Plan Commitment: Establish clinical guidelines by June 2012 for frail seniors in emergency and hospitals to improve care outcomes and establish follow up care and supports for a successful return home.

What does this mean for me?

Clinical guidelines are documents that explain to hospital staff what the best care is for patients, based on the latest medical evidence. The Ministry of Health, in collaboration with health authorities, has developed new clinical guidelines for seniors in hospital, to make sure they get the best care to support their recovery. The guidelines explain best practices for six areas of care: cognitive functioning, pain management, mobility, nutrition & hydration, medication management, and bowel & bladder management. When these areas are well looked after while a person is in hospital, it helps patients maintain independence and functional mobility, and get home sooner. The guidelines are fully implemented in Vancouver Island Health Authority, and all other health authorities are working on implementation now. Ministry policy requires all health authorities to have the guidelines implemented for all older adults (70+) at all acute care hospitals by the end of March 2014.

Definitions

Cognitive Functioning - Refers to the mental processes including memory, thinking, judgment, calculation, and visual spatial skills. Attention must be paid to the possibility of dementia, delirium and mild cognitive impairment.

Pain Management - Refers to the use of medications and other interventions (such as massage, exercise, or physiotherapy) to prevent, reduce, or stop acute or chronic pain.

Nutrition & Hydration Management - Working with each person in hospital to ensure adequate amount and type(s) of food and liquid consumed, assessing for any swallowing difficulties and/or food allergies, and supplementing intake where necessary. Malnutrition is the inadequate intake of nutrients and dehydration is the inadequate intake of fluids.

Medication Management - This refers to reviewing each person's medication list, dosages (dose and dose interval), potential medication interactions and balancing the benefits versus the risks of medications.

Bowel & Bladder Management - Bowel and bladder management refers to working with the patient to maintain their usual bowel and bladder function, intervening where necessary with additional interventions.

Functional Mobility - A person’s ability to stand, walk, and transfer from bed to a chair. Bed rest inhibits a person’s capability to perform these functions as it contributes to muscle atrophy (wasting or loss of muscle tissue), reduced endurance.

Individualized Care Plans will be established for each senior patient addressing these six related areas of health. Care Plans are an essential part of improving hospital care. They document the care goals of the senior and the interventions that will be used to maintain and/or return the senior to pre-hospital or best possible functioning in each of these areas of health while they are in hospital.

The clinical guidelines have been developed and are currently being implemented throughout the Vancouver Island Health Authority (VIHA). The lessons learned from implementing the guidelines in VIHA will be used to implement them in the other health authorities in the coming year.