Date of Graduation

Summer 8-9-2024

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)

College/School

School of Nursing and Health Professions

Program

Kaiser cohort MSN capstone

First Advisor

Liesel Buchner

Second Advisor

David Ainsworth

Abstract

Abstract

Background: This project's microsystem was a 32-bed medical-surgical telemetry unit at a small community hospital in Marin County. The unit needed a framework that focused on the unique needs of the geriatric population and daily activities that enhanced physical and cognitive activities to mitigate risks for any issues that created a prolonged Length of Stay (LOS).

Problem: The microsystem is a medical-surgical telemetry unit where the average length of stay (LOS) is five days, surpassing the organization's goal of four days. Reducing LOS can enhance patient satisfaction and meet organizational targets.

Context: This project aims to reduce the extended length of stay (ELOS) by one day for patients aged 75 and older in a medical/surgical/telemetry unit by July 30, 2024.

Interventions: The goal of incorporating interventions to maximize cognitive and physical activities to promote shorter hospitalizations included music therapy, art therapy, and physical exercises. A C.A.L.M. (Cluster Care, Assess Alarms, Lights Off, and Medications Given) initiative improved sleep hygiene and aimed at preventing delirium. The 5 Ms tool (Mobility, Medications, Mentation, Multi-complexity, and Matters Most) ensured a comprehensive view of patient needs.

Measures: The goal was to reduce the ELOS from five to four days for patients aged 75 and older in a medical/surgical/telemetry unit by July 30, 2024. The aim was for 75% of patients to have a discharge order by day three, with a plan to leave by 1:00 p.m. on day four.

Results: Over a three-month PDSA cycle, interventions significantly improved re-admissions and LOS, with the NICHE certification plan showing initial success and promise. To date, 43.75% of the nursing staff and 93% of the PCTs on the pilot floor are GRN and GPCT certified. The C.A.L.M. project provided a reproducible and maintainable framework for improving patient outcomes, although the 5 Ms tool struggled throughout the PDSA cycles.

Conclusions: Implementing a multi-pronged approach to minimizing LOS and mitigating the risk of cognitive decline during a prolonged hospitalization proved challenging. Aligning a practice that highlights the unique needs of the geriatric population serves the greater good as there is recognition of a significant need. Reducing LOS is achievable with the support of a well-versed team, family involvement, and ongoing education to support the ever-changing needs of the geriatric population.

Keywords: cognitive-improvement activities, geriatrics in acute care, patients aged 65 years and older, physical exercise recommendations, and multi-disciplinary care plan.

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