Implementation of an Evidence-Based Geriatric Guideline on a Military Trauma ICU

Purpose: To implement an evidence-based comprehensive geriatric assessment (CGA) guideline on a trauma-focused military Intensive Care Unit (ICU) to improve geriatric care and eliminate adverse geriatric patient safety events. The recent two-fold increase in geriatric Veteran and retiree admissions, coinciding with a decrease in combat trauma admissions, has resulted in several “never events” in this population including a patient fall and several reportable hospital-acquired pressure ulcers. It is clear that the nursing staff is not proficient in assessing the geriatric patient and in implementing age-appropriate interventions. Patient safety events are the primary problem triggers for this Iowa-model-based project, and drive the need for this intervention. The need for geriatric nursing knowledge to implement the CGA is knowledge trigger.

Specific Aims:  The specific aims for this project include: 1) Evaluate and implement an evidence-based CGA guideline to promote safe and expert patient care 2) Develop an evidence-based CGA training plan with identified pre- and post-intervention outcome measures 3) Evaluate implementation effect on patient safety as evidenced by risk management outcome measures 4) Develop an intervention that is sustainable and generalizable throughout Department of Defense military treatment facilities. 

Project design: An educational initiative to implement a CGA to guide the assessment of a geriatric patient and the application of evidence-based guideline recommendations. The initiative will consist of two segments, didactic instruction to create a geriatric knowledge base and teach the components of the CGA and simulation training sessions to practice using the CGA with a range of simulated geriatric patients.  The outcome measures consist of pre- and post- intervention falls numbers, skin integrity data and knowledge assessment. This implementation of this project will impact the care given to over 100 older Veterans, retirees and dependents on the LRMC ICU per year. The CGA has the potential to be implemented in military treatment facilities across the globe. This initiative is forward-thinking and anticipates the projected substantial increase in the geriatric population.

Trauma-trained military ICU nurses are being tasked to provide competent, safe and evidence-based care for the increasing number of older Veterans and retirees entrusted to their care. This implementation project provides the guideline and knowledge necessary to expand geriatric nursing capabilities and practice across military treatment facilities.

Final report is available on NTRL: https://ntrl.ntis.gov/NTRL/dashboard/searchResults/titleDetail/PB2017102...