Preparing the Next Generation of Leaders in Gerontological Nursing: Over the past decade, GAPNA’s influence has increased on endorsing standard of care practices and health care policy that improves healthcare for older adults. The work of GAPNA has been sustained, in large part, through members who have assumed leadership roles and opportunities within the organization. GAPNA’s growth and influence will continue to grow, as more clinicians are caring for the nation’s rapidly-expanding older adult population. It is critically important to identify and support members who are interested in developing, reinforcing, and broadening leadership skills to better prepare them for leadership roles within the organization. The GAPNA Leadership Institute is a 1-year-long leadership program that includes both online synchronous and face-to-face components. An experienced and nationally recognized nurse leader facilitates the curriculum. All fellows work one-on-one with mentors, all of whom have held leadership positions within GAPNA.

Preparing the Next Generation of Leaders in Gerontological Nursing: Over the past decade, GAPNA’s influence has increased on endorsing standard of care practices and health care policy that improves healthcare for older adults. The work of GAPNA has been sustained, in large part, through members who have assumed leadership roles and opportunities within the organization. GAPNA’s growth and influence will continue to grow, as more clinicians are caring for the nation’s rapidly-expanding older adult population. It is critically important to identify and support members who are interested in developing, reinforcing, and broadening leadership skills to better prepare them for leadership roles within the organization. The GAPNA Leadership Institute is a 1-year-long leadership program that includes both online synchronous and face-to-face components. An experienced and nationally recognized nurse leader facilitates the curriculum. All fellows work one-on-one with mentors, all of whom have held leadership positions within GAPNA.

Preparing the Next Generation of Leaders in Gerontological Nursing: Over the past decade, GAPNA’s influence has increased on endorsing standard of care practices and health care policy that improves healthcare for older adults. The work of GAPNA has been sustained, in large part, through members who have assumed leadership roles and opportunities within the organization. GAPNA’s growth and influence will continue to grow, as more clinicians are caring for the nation’s rapidly-expanding older adult population. It is critically important to identify and support members who are interested in developing, reinforcing, and broadening leadership skills to better prepare them for leadership roles within the organization. The GAPNA Leadership Institute is a 1-year-long leadership program that includes both online synchronous and face-to-face components. An experienced and nationally recognized nurse leader facilitates the curriculum. All fellows work one-on-one with mentors, all of whom have held leadership positions within GAPNA.

Preparing the Next Generation of Leaders in Gerontological Nursing: Over the past decade, GAPNA’s influence has increased on endorsing standard of care practices and health care policy that improves healthcare for older adults. The work of GAPNA has been sustained, in large part, through members who have assumed leadership roles and opportunities within the organization. GAPNA’s growth and influence will continue to grow, as more clinicians are caring for the nation’s rapidly-expanding older adult population. It is critically important to identify and support members who are interested in developing, reinforcing, and broadening leadership skills to better prepare them for leadership roles within the organization. The GAPNA Leadership Institute is a 1-year-long leadership program that includes both online synchronous and face-to-face components. An experienced and nationally recognized nurse leader facilitates the curriculum. All fellows work one-on-one with mentors, all of whom have held leadership positions within GAPNA.

Purpose: To present findings from panel discussions with healthcare professionals who participated in virtual interviews regarding the diagnosis and treatment of tardive dyskinesia (TD) in real-world clinical settings.

Rationale: TD is a persistent and potentially disabling movement disorder associated with prolonged exposure to antipsychotics and other dopamine receptor blocking agents (DRBAs). Despite the availability of approved TD medications (e.g., valbenazine), diagnosis of this disorder remains complex and appropriate treatment remains important.

Methods: In July 2020, 12 experts (6 neurologists, 3 psychiatrists, 3 psychiatric nurse practitioners) participated in individual semi-structured qualitative interviews about how TD is diagnosed and treated in the clinical practice setting. Topics included education, TD screening, diagnosis, assessment, and treatment; opportunities for improving TD diagnosis and treatment outcomes; barriers to treatment; and patient/caregiver perspectives. In November 2020, separate group discussions with the psychiatrists and neurologists were conducted to discuss the implementation of telehealth in diagnosing and treating TD. No quantitative or statistical methods were applied. The key findings presented at this meeting are intended to be narrative in nature.

Results: The panel generally agreed that any history of DRBA use raises suspicion of potential TD, and that all DRBA-treated patients should be monitored accordingly. More education is needed, particularly with regards to differential diagnosis; this may require more consistency in terminology across medical specialties. Telehealth with video can be an effective tool for TD diagnosis and monitoring, but the complexity of the TD patient population may present challenges. First-line treatment with an approved TD medication (e.g., valbenazine) is recommended; anticholinergics are not appropriate for treating TD. Barriers to treatment include clinicians’ misconceptions (e.g., TD as symptom of underlying disease), patients’ lack of awareness, lack of approved treatments until recently, and patients’ unwillingness to be treated.

Applicability to APN practice: Despite the availability of FDA-approved TD medications, differential diagnosis and misconception/misinformation about TD are key obstacles to adequate treatment and optimizing patient outcomes. These challenges could be addressed through healthcare professional education on the diagnosis/clinical presentation and treatment of TD, whether virtually or in-person. Telehealth with video could be used to diagnose TD and assess changes over time.

Background: The blind stick technique for obtaining intravascular (IV) access often renders multiple unsuccessful attempts by nurses which lead to delays in medication administration, unsatisfied patients, and physician intervention likely ending with unnecessary central venous lines (CVLs) for difficult access patients.

Problem statement: Registered nurses (RNs) are requesting a great number of comprehensive vascular access team (CVAT) consults, not only for IV access but for lab work, on patients that are not difficult to gain IV access, in turn, increasing the CVAT volume. Over-use or improper use of CVAT by RNs result in delays in medical treatment, increased expenses, and a decrease in patient satisfaction for those that are truly difficulty to gain access.

Methods: Simulation-based trainings were offered to emergency department (ED) RNs. The training session was led by two expert ultrasound-guided peripheral IV (USGPIV) advanced practice providers (APPs). A total of thirteen RNs volunteered and completed the training. RNs were refreshed with IV starting skills, taught basic ultrasound (US) functions, and then incorporated a combination of the two skills simultaneously.

Results: The goal was to decrease CVAT consults within a six- to eight-week time frame (June 1 to July 15, 2019) by 25%. Of the 430 USGPIVs that were placed by CVAT and the ED RNs within this time frame, 89 were successfully placed in the ED which is a total decrease of 21% in CVAT consults. P value was less than 0.001 after the statistical analysis was performed using Chi Square Test which indicates statistical significance. Control chart is common cause as there was not a significant change in volume from previous months prior to the intervention.

Conclusion/implications: Although the intervention yielded a 21% decrease in volume instead of 25%, the intervention was still statistically significant. After the completion of this project, the quality improvement (QI) team will disseminate the findings with plans to broaden this evidence-based practice to more populations throughout the hospital, in turn, advancing the bedside RN’s skill set, potentially decrease delays in IV medication therapy as well as the length of stay, and increase patient satisfaction.

Learning Outcome: After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.

The SARS-CoV-2 (COVID 19) pandemic has changed the landscape of how we care for our vulnerable elderly. Institutionalized elderly residents of nursing facilities bare a disproportionate burden with a higher number of deaths in the very old, greater than 80 years. In an attempt to offset the deleterious effects, our seniors in long-term care have been isolated from their families and peers. The purpose of this research is to understand the impact of social isolation as it pertains to advance care planning (ACP) and hospitalizations and evaluate any mitigating factors which may impact these measures.

Method: Observational qualitative study: using experiential data in the form of close ended and Likert scale survey questions with and open-ended question at the end giving the advance practice clinicians (APC) the opportunity to describe experiences/observations. Sample population included complex care management advance practice clinicians in the state of Florida practicing in long term care facilities. The survey was sent to 95 APC’s with 46 responding; 35 were accepted for study purposes. Surveys were excluded due to incongruence in answers or failure to complete Likert scale.

Results: Identified groups; group A - no changes to ACP; group B – changes to ACP related to social isolation; group C - changes to ACP not related to social isolation. Group A had more frequent touches with their reponsbile party and was more likely to have visualization by window or video chat as a mitigation intervention; group B had changes to APC which were initiated by the responsible party (RP) with less frequent RP interaction and was less likely to be offered a visualization strategy to mitigate isolation. Group C experienced changes to APC not related to isolation found that changes were initiated by their facility in an effort to keep COVID-19 from spreading in facility. Rescinding of do not hospitalize status was the most frequent change to ACP.

Conclusion: Social isolation played a role in changes to ACP and hospitalization. Mitigation stratagies have been identified which may reduce the effects of social isolation during a pandemic. Thereby, preserving advance care plans and reducing hospitalization burden. 

Learning Outcome: After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.

The purpose of this case study was to develop a collaborative, multimodal, multidisciplinary treatment plan for peristomal pyoderma gangrenosum patients and to evaluate the efficacy of the plan. Level of efficacy was determined by decreased pain scores, increased pouch adherence and resolving PPG lesions in a sample population from an outpatient ostomy clinic in southeast Michigan. Pyoderma gangrenosum is a painful ulcerative inflammatory dermatosis presenting as full thickness dermal lesions. The diagnosis is often associated with inflammatory bowel diseases. Management of peristomal skin ulcers due to peristomal pyoderma gangrenosum (PPG) poses multiple challenges in diagnosis and management. To further complicate treatment, many patients with PPG are on a wide range of therapies, making management approaches problematic. The approach to develop a collaborative, multimodal, multidisciplinary plan for treatment of PPG wounds in this study began with assessment and diagnosis of PPG by an outpatient ostomy nurse practitioner. A treatment regimen was then prescribed using a multimodal approach of topical, intralesional, and oral therapies to manage the PPG wounds. A subsequent visit with a dermatologist was then conducted for multidisciplinary collaboration of the treatment regimen in an effort to provide the most effective wound healing. Two out of three patients in this study had complete resolution of their PPG ulcerations. The third patient continues to progress in wound healing at a slower rate. Each patient reported improved quality of life due to decreased pain and pouch leakage. Limited evidence is available for effective, organized treatment and maintenance modalities for patients with peristomal pyoderma gangrenosum. This small case study provides evidence that a collaborative, multimodal, multidisciplinary treatment plan can provide resolution of PPG ulcers and improved quality of life in ostomates. It is imperative that multidisciplinary clinicians collaborate and share treatment practices to establish future best practice guidelines for PPG wounds. 

Learning Outcome: After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.

Background: Heart disease is the leading cause of death in the United States; a person dies every 37 seconds from heart disease or 1 in every 4 deaths posing a population health risk for heart attack and stroke.

Local problem: According to clinical practice guidelines, adults should be screened for baseline cardiovascular disease (CVD) risk and every 4 to 6 years to guide decisions for primary preventive care interventions. A survey showed only 11% of participants reported CVD risk screening. This quality improvement initiative aimed to increase CVD screening and improve healthy lifestyle behaviors using a shared decision-making (SDM), client-centered approach for adults to 80% over 90 days.

Methods: This plan-do-study-act improvement process was implemented via an innovative virtual setting. Four, 2-week cycles included concurrent tests of change (TOC) related to risk screening, SDM, best practice care, and team engagement. Convenience sample demographics included an age range between 40 and 81 years old with a mean age of 58. Data were analyzed using run charts and aggregate data to assess the effect of interventions on outcomes.

Interventions: Clients were screened with the ASCVD risk calculator and the SDM process facilitated options for healthy lifestyle goals. Health indicators were tracked biweekly in a case management log to inform next cycle TOC and bimonthly surveys assessed team stress levels.

Results: The CVD screening rate was 97%. Only 17 (29%) clients had a risk score > 7.5% and the cohort mean risk score was 6.7% or borderline risk. The mean AIM score comprised risk screening and best practice care that finished at 88% and surpassed the goal of 80%. Team stress levels decreased to 24% by cycle four.

Conclusions: The ASCVD tool expanded access to preventive screening and showed an association with motivating clients to take action by choosing healthy lifestyle behaviors and meeting best practice care guidelines to mitigate CV risk factors. Learning involved the value of client partnerships. This project was approved by the Frontier Nursing University institutional review board. No outside funding was received for this project.

Learning Outcome: After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.

Background: Inappropriate polypharmacy is dangerous and disproportionately affects older adults, causing 1.3 million emergency departments within the United States every year. Formal medication reviews have been shown to reduce the prevalence and severity of this problem. An assisted living facility has no formal process to review residents’ medication lists for appropriateness. Each resident takes an average of 5.2 medications and qualitative interviews suggest some prescriptions are inappropriate.

Objective: The purpose of this quality improvement project was to improve providers prescribing behavior by formally reviewing assisted living residents’ medication lists for appropriateness.

Methods: This quality improvement project included 24 residents in a single assisted living setting. Two healthcare providers were exposed to training related to use of the screening tool of older persons’ prescriptions (STOPP). The medication appropriateness review tool and medication appropriateness review checklist were created from the STOPP criteria. These paper tools aided providers with their medication reviews and allowed for data collection. Outcomes included the proportion of assisted living residents who received a medication review and evidence of inappropriate prescriptions. A descriptive analysis was performed using Microsoft Excel.

Results: All 24 assisted living residents’ medications were formally reviewed using the STOPP criteria. Reviews required an average of 7.65 minutes to complete and providers did not feel that the process was overly burdensome. Eight potentially inappropriate medications (PIMs) were identified and all were continued. Five PIMs were continued because providers felt that the benefit greatly outweighed the risk and 3 were continued according to patient preference after discussions regarding risks. The reviews prompted the discontinuation of 1 medication that was not included in the STOPP criteria due to lack of efficacy.

Conclusions: All assisted living residents’ medications were reviewed using the STOPP criteria. The medication appropriateness review tool created from the STOPP criteria appears efficient and easy to use. Participating providers had a high level of geriatric expertise, which may explain the lack of improved appropriateness following implementation. Use of the STOPP criteria using the medication review checklist and medication appropriateness review tool need to be tested with a larger sample of providers and residents. 

Learning Outcome: After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.