Tending to geriatric care with NICHE

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by Barbara Kancelbaum, MSJ

Editor's note:  On Thursday, Barbara discussed why two facilities chose the NICHE (Nurses Improving Care for Health-system Elders) program to improve the quality of geriatric care. Now she takes a look at the benefits it brought to both facilities...

Kathy Long, BSN, Acute Care for the Elderly (ACE) and palliative care manager at North Carolina Baptist Hospital (NCBH) in Winston-Salem, NC, and Jane Smeaton, RN, MSOLQ, manager of the medical floor at Waukesha Memorial Hospital in Milwaukee, WI, report their facilities are happy with the NICHE (Nurses Improving Care for Health-system Elders) results.

At NCBH, the Acute Care for the Elderly (ACE) unit is functioning well and the length of stay for patients (with an average age of 83) is below the hospital's budgeted 6.5 days. The fall rate on the ACE unit is 2.2 falls per 1,000 days and there have been only two hospital-acquired pressure ulcers in the past year. ACE patient satisfaction scores are routinely in the 90th percentile, among the highest in the hospital.

"The hospital administration is thrilled with the program," says Long, ACE and palliative care manager at NCBH, who adds that, when she presented the NICHE program to all the managers in the hospital, they were excited and supportive of this much-needed education.

Waukesha has also been successful in reducing fall rates, and reports zero ulcers in the first quarter of 2008. The hospital has seen an increase in patient satisfaction and Geriatric Resource Nurses (GRNs). Annual peer evaluations have shown that the GRNs are highly respected and appreciated by other nurses. One wrote on her evaluation, for example, that a GRN helped her understand that a patient's restlessness might reflect a need to use the bathroom.  

Long says that the GRNs tell her they are more confident about the care they give because they're able to problem-solve, adding that all of them use the Hartford Institute's geriatric-care Web site as a resource to answer many of their questions. "They tell us that, because of the NICHE training they've received, they were able to refrain from restraining a patient, were able to get a doctor to reduce a dose of sedating medication, and are decreasing the use of Foley catheters," says Long. 

Rewarding the GRNs

Waukesha and NCBH each offer a variety of incentives and rewards for participation in NICHE. Waukesha presents an annual Mathy Mezey award (in honor of the Hartford Institute co-founder), recognizing a GRN who has done an excellent job in helping improve care for older adults. NCBH provides its GRN graduates with certificates and gift bags labeled "Geriatric Resource Nurse," and recognizes them in an internal newsletter.

For both hospitals, the respect of NICHE nurses can be seen throughout. At Waukesha, NICHE nurses were invited to look at the design of a new wing, checking to see that the furniture and carpeting did not bear patterns that could make some older adults dizzy. At NCBH, the hospital's outpatient clinic requested to have a GRN on site, and another GRN works on the hospital's community hotline.  

 "I'm really proud that we're a NICHE hospital, and I talk about it frequently," says Smeaton. "It's so wonderful to be involved in a supportive, national group and to know that we have the same challenges. NICHE makes it so simple to get the resources we need."

She adds that the NICHE team uses material from the NICHE Web site and uploads it to the hospital's own computers, such as the "Try This" assessment series, which provides nurses with knowledge of best practices in the care of older adults. Also, when extra help is needed, the clinical nurse specialist uses the listserv to network with other NICHE hospitals through the Hartford Institute.  

Long, who now consults with other hospitals that are opening ACE units, echoes Smeaton's praise for the program.

 "NICHE hospitals share all kinds of resources. No matter what problem you have, there's someone who's willing to help," says Long. "It's also tremendously rewarding for the nurses to be recognized for their knowledge. And it's so important for them to know that there is evidence for best practice."

Editor's note: The annual NICHE Leadership Conference orients new hospitals to the program's principles and process of implementation. It will be held in Orlando, FL, in February 2009. To learn more about NICHE and the annual conference, visit