在示范二甲医院中确立老年人临床护理专家的角色

IF 6 2区 医学 Q1 GERIATRICS & GERONTOLOGY Age and ageing Pub Date : 2024-09-30 DOI:10.1093/ageing/afae178.209
Cliona Woulfe, Patricia Moloney, Emma Jennings
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引用次数: 0

摘要

背景 我们的模范二型医院平均有 87.5%的住院病人年龄在 65 岁或以上。同样,57.5%的住院病人需要中度至高度依赖护理。为了满足这部分患者的需求,我们于 2023 年 9 月设立了一个新职位 "老年临床护理专家 (CNS)"。方法 使用在线转介系统,转介标准包括 i) 新发意识模糊或谵妄;ii) 临床虚弱评分(CFS)达到或超过 6 分;iii) 已知帕金森病;iv) 护理或医疗团队临床判断。所有接受复查的患者均接受了全面的老年医学评估,评估采用老年医学 5M 框架(行动能力、药物治疗、多重复杂性、心理和最重要事项),确保对患者护理的各个方面进行评估,并促进多学科团队(物理治疗、营养师、言语和语言治疗、职业治疗和药房)的及时投入。结果 在 207 天的时间里,新成立的 CNS 服务共收到 317 份转诊申请。其中三分之二(206 人,占 65%)接受了 CNS 复查,三分之一(111 人,占 35%)未接受复查;45 人(占 14%)接受了老年病学顾问的治疗,为避免重复,未接受复查;66 人(占 21%)在复查前已出院。结论 自设立 CNS 职位以来所收到的转诊数量表明,我们医院的住院病人非常需要这项服务。该职位的设立确保了三分之二的转诊患者能够获得由 CNS 领导的 CGA。此次试点的结果表明,有必要进一步发展和扩大这项服务,将目标对准五分之一错过复查的患者,并进一步扩大转诊标准。
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Establishing The Role Of The Clinical Nurse Specialist For The Older Adult In A Model 2 Hospital
Background On average 87.5% of inpatients in our Model-2 Hospital are aged sixty-five years or above. Equally 57.5% of inpatients have medium to maximum dependency care needs. In order to meet the needs of this cohort of patients a new post “Clinical Nurse Specialist (CNS) For The Older Adult” was established in September 2023. Methods Using an online referral system, criteria for referral included i) new onset confusion or delirium, ii) clinical frailty score (CFS) of six or greater, iii) known Parkinson’s disease and iv) nursing or medical team clinical judgement. All reviewed patients received a comprehensive geriatric assessment using the Geriatric 5M framework (Mobility, Medications, Multi-Complexities, Mind and Matters Most) ensuring all aspects of patient care were assessed and promoting timely input from our multi-disciplinary team (Physiotherapy, Dietitian, Speech and Language Therapy, Occupational Therapy and Pharmacy). Results Over a period of 207 days the newly established CNS service received a total of 317 referrals. Two thirds (n=206, 65%) received CNS review, one third (n=111, 35%) did not; 45 (14%) were under the care of a consultant Geriatrician and not reviewed to avoid duplication and 66 (21%) were discharged before review could occur. Conclusion Referral numbers received since the established of the CNS post emphasises the need for the service in our hospital inpatient population. Development of the post has ensured that two-in-three referred patients receive a CNS lead CGA. Results from this pilot highlights the need to further develop and expand the service to target the one-in-five who missed review and further extension of the referral criteria.
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来源期刊
Age and ageing
Age and ageing 医学-老年医学
CiteScore
9.20
自引率
6.00%
发文量
796
审稿时长
4-8 weeks
期刊介绍: Age and Ageing is an international journal publishing refereed original articles and commissioned reviews on geriatric medicine and gerontology. Its range includes research on ageing and clinical, epidemiological, and psychological aspects of later life.
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