On-site posters are located in the portico across from registration.
NCPD Posters: 0.5 contact hours may be earned for poster viewing of nursing continuing professional development posters listed as P01 through P17.
Non-NCPD Posters: No contact hours are awarded for viewing posters GLI1, GLI2, GLI3, GLI4, non-NCPD01, non-NCPD02, and non-NCPD03.
Assisted living facility (ALF) residents are greater risk of declining health and death from the COVID-19 pandemic due to advanced age, frailty, and underlying chronic conditions. ALF residents can suffer from the consequences of the methods employed to reduce disease transmission in these facilities, including mandatory room quarantine. Room quarantine can lead to loneliness, decline in appetite, less feeding assistance, and potentially harmful changes in weight. During the quarantine period, our clinic received greater than usual reports of unintentional weight loss, in some cases up to 10%, in our patients living in multiple assisted living facilities (ALFs). A weight loss of 5% of body weight in one month or 10% over a period of six months is considered problematic in older adults.
We proposed a quality improvement project to reduce the risk of weight changes during quarantine. We conducted a retrospective chart review of 53 house call patients from 18 area assisted living facilities over a 6-month period and found that greater than 44% of the 53 residents in the study had 5% or more weight loss 5 to 6 months after quarantine began and 19% lost 10% or more.
Besides descriptive statistics, a paired sample T-test comparing before and after COVID-19 quarantine weights was significant at
The World Health Organization has identified medication without harm as an international global patient safety challenge (WHO, 2022). Healthcare professional education and training related to safe medication prescribing is a fundamental aspect of this initiative. Polypharmacy is common among older adults in long-term care settings and contributes to patient falls, risks of drug interactions, adverse side effects, functional impairment, and risk of hospitalizations (Wastesson, Morin, Tan, Johnell 2018). Therefore, employing tools designed for careful and systematic evaluation of prescribed medication is of critical importance for APRN’s treating geriatric patients. Pharmacogenomics (PGX) is the scientific study of gene/drug relationships and the resulting impact on individual drug response (Dere, Suto, 2009). PGX could be a useful medication safety tool deployed in long-term care settings. The purpose of this project was to evaluate the therapeutic impact of PGX testing in long term care. Specifically, PGX testing for patients using the following drug categories were included: antipsychotics, mood stabilizers, anxiolytics, hypnotics, antidepressants, stimulants, and non-stimulants. Buccal swabs containing genetic material were collected for 46 patients and PGX panel was completed for each patient. Of the 46 patients, 27% were male and 63% were female. The age range of patients was 53 to 96 years, with an average age of 75.3 years. Results are categorized as either a normal metabolizer, intermediate metabolizer, rapid metabolizer, or poor metabolizer. Of the drug categories tested, 42% of patients had a current medication fall into a category that required medication review, medication dose adjustment, or a medication substitution. An interprofessional team of APRNs, psychiatry, physicians, pharmacy, and nurses reviewed patient medication profiles and PGX results to determine best medication adjustments. Family and patients were educated regarding results and recommended changes to medication regimen. PGX data can be a valuable tool to assist healthcare providers in providing safe medications to geriatric populations. Understanding the science of PGX data and its role in preventing medication harm is essential for APRNs providing care to geriatric patients.
According to the US Census Bureau (2019), there were approximately 5.1 million elderly people (age 65 plus) living in the United States. During the peak of the COVID-19 epidemic, prior to vaccines becoming available, elderly people were advised to limit their in-person socialization with people who were unvaccinated or those whose vaccine status was unknown. With continued limits on socialization, even now with fear of the Delta variant and vaccine immunity waning, COVID-19 continues to cause social isolation and loneliness amongst this age group. A poll by the Kaiser Family Foundation (KFF) (2020) found that the coronavirus pandemic, coupled with the economic downturn, has created a backwash with one in four adults reporting increased anxiety and/or depression.
From May 2020 through July 2020, the number of adults (age 18+) who reported unfavorable mental health with symptoms of anguish and apprehension increased by 22%. Feelings of communal isolation, loneliness, deprivation, and sorrow, related to the COVID-19 pandemic (Koma, True, Biniek, Cubanski, Orgera and Garfield, 2020) in the elderly is important to investigate when studying the overall impact of the pandemic in this vulnerable group. Within this group, females, Hispanics, individuals with lower income, individuals with compromised health, individuals recently unemployed, and/or individuals living alone reported experiencing the most impact to their mental health.
The National Academies of Science, Engineering and Medicine (2020), and US Surgeon General Vivek Murthy, (NIH, 2021) have chronicled the connection between loneliness and increased risk of premature death, dementia, stroke, depression, anxiety, and suicide, which are all factors influencing the social determinants of health (SDOH). These relationships are important, as healthcare focuses on improving healthcare quality and improved outcomes for vulnerable populations, such as the elderly.
Despite the prevalence and significant morbidity and mortality for older adults related to CV disease, only one-half of the elderly with diagnosed PAD are symptomatic. The elderly have complex comorbidities, physical or cognitive disabilities, and frailty, which negatively impact assessing the common symptoms associated with PAD adequately. The advancement of critical limb ischemia, including tissue loss, is often the initial presentation related to higher rates of limb loss and CV events.
The poor prognosis of critical limb ischemia demands early and rapid clinical assessment, initiation of wound care when appropriate, and referral for the possibility for surgical revascularization to decrease the incidence of a CV event or major amputation. The treatment of the elderly with PAD is multidisciplinary in its approach. Therefore, it is vital to equip the advanced practice nurse caring for these patients with the knowledge and skills needed to recognize and diagnose PAD and understand the management for the patient and when to refer the patient for a vascular evaluation.
Gerontological advance practice nurses in acute, primary, and long-term care manage the complex needs of the geriatric population. Symptom presentation is fundamental to building the differential diagnosis. However, older adults often present atypically, for example, with only functional changes, rather than with characteristic symptoms.
A significant illness in the older adult can manifest itself without traditional elements seen in younger patients. The clinician should be aware of challenges of diagnosis due to vague or non-specific presentations, under-reporting of symptoms. or atypical presentations of disease states. Non-specific presentations, such as falls, weakness, decline in function, dizziness, or alterations in mentation may be sign of an imminent acute illness in an older adult. Under-reporting occurs when a symptom is thought to be a normal part of the aging process. Atypical presentation requires the clinician to look beyond the typical sign and symptom clusters to reveal the correct diagnosis.
This presentation intends to provide the participant with unfolding case discussions of older adults with atypical presentations of illnesses. Interactive imbedded questions will enhance the learning experiences. In order to identify potentially life-threatening illness in this group, it is necessary to understand the appearance of symptoms, exam alterations, and the physiological age changes that underly them. By applying knowledge of these unique variations, gerontological advanced practice nurses can help decrease mortality and morbidity in our older adult population.
Patients over the age of 65 account for 55% of all operative procedures performed in the US, and nearly 50% of Americans will have a surgical procedure after the age of 65 years. Some decline in function will occur in 35%, and over 20 % of them may not be able to return to live independently. Up to 50% of older adults experience some kind of complication related to hospitalization.
Advanced age does not preclude surgical interventions that can improve function or quality of life. A decrease in physiological reserves, the presence of multiple chronic conditions, and functional impairments have all been associated with increased risk for adverse surgical complications. Even patients without apparent deficits may have little functional reserve so that an acute illness or insult (such as a surgical procedure) can lead to disability and dependence.
The American Geriatric Society and American College of Surgeons provide a consensus guideline that address the perioperative care of the older adult. The American Society of Anesthesiologists follow a physical status classification system for the patient in their care. The American College of Cardiology and the American Heart Association provide a stepwise approach using multivariate risk indices to the preoperative assessment for patients undergoing non-cardiac surgery.
This presentation will provide the gerontological advanced practice nurse with tools to safely guide the cardiovascular risk assessment in the older adult in an ambulatory care or long-term setting. Application of a comprehensive geriatric assessment can enhance the decision-making for the potential surgical team and judiciously guide risk and benefit discussions in a shared decision-making context.
Purpose: As an adult-gerontological primary care nurse practitioner (AGPCNP) student develops their knowledge, consideration is needed with working with older adults, including patients with dementia. Because dementia is a general term, symptoms and experiences can vary including sensory and cognitive impairments. Encountering a patient with dementia in the clinic setting can influence how AGPCNPs will provide care.
The purpose of this simulation was to give AGPCNP students the opportunity to experience firsthand the struggles a person with dementia might be facing, familiarize themselves with dementia's manifestations from the patient's viewpoint in a classroom environment, and develop empathy for the patients in their care.
Description: AGPCNP students experience an in-class interactive dementia simulation. Students are asked to put on dark sunglasses to dim clear sight and peripheral vision and thick gloves and shoe inserts simulating decreased tactile and visual senses. Students entered a dark room prepared by instructors with a loud audio overload, including traffic sounds, music, and visual effects of flashing lights.
Students were performing a series of tasks, placing pills in pill boxes, and drawing face of clock numbers and time.
Evaluation/outcome: Once the simulation was over for all students, they were asked to give feedback. Comments from students included, “It was so much fun and allowed us to really put ourselves in the patient’s shoes.” “This was a great activity for perception! And an overall fun activity to break up the monotony of lecture! Should be a staple in the course.” The student feedback was positive, desiring that this simulation be repeated future courses.
Conclusion: Meeting the required AGPCNP competencies for student education and providing multiple learning experiences for AGPCNP students can be challenging at times. The activity took only a few minutes of class time, but it was a great learning experience.
Description of project: Evidence-based quality improvement practice program demonstrating that implementation of a transitional care management (TCM) program during the early post-hospital period and extending through the care phases and into the discharge process to home or community settings will lead to important improvements in resource utilization, patient satisfaction, and post-hospital outcomes including rehospitalization.
In system-to-system transitions, patient and caregiver education and empowerment facilitate high-quality discharge communication to ensure that the nursing home is ready to implement a post-hospital care plan. Often, high-quality discharge communication during system-to-system transitions does not occur.
The COMPASS program can fill this gap, supporting patients discharged to nursing homes and then the community (when appropriate) by incorporating patient and caregiver education empowerment while ensuring high quality, bi-directional system-to-system communication between the hospital and next care setting.
We developed a nurse practitioner led program at VA Pittsburgh Healthcare System (VAPHS) for complex veterans being discharged from our primary referral hospital to community living center (CLC, i.e., nursing home equivalent) and eventually to home. To accomplish this, we developed two distinct teams: The COMPASS admission team (CAT) and the COMPASS discharge team (CDT). The CAT assesses medically complex CLC-eligible veterans in the acute care facility, whereas the CDT manages veterans in the CLC and assists with their and placement in the community.
Method: Evidence-based quality improvement practice program.
Data analysis: Designed encrypted spreadsheet obtaining data measuring number of veterans seen, Medication reconciliation errors detected and hospital readmissions. Data obtained is unit-based metrics and workflow statistics standardize to improve care processes and ultimately patient outcomes.
Few outcome results
1. 10/2021: Number of COMPASS (hospital to CLC) veterans served cumulative: 173
2. 2/2022: Number of COMPASS (hospital to CLC) veterans served cumulative: 253
3. Demonstrated that a focus of transitional care coordination can have the potential to reduce the 30-day readmission rates.
4. 4. Medication reconciliation error 207: An advanced practice nurse practitioner-led model can demonstrate that system-to-system transitions of care can be integrated into a large complex healthcare system to produce organizational, operational, and veteran impact. More research is needed along with comparative data to show the precise value of this program.
Over the past couple of years, numerous natural disasters occurred, superimposed on a global pandemic. These events have had a disproportionate impact on our most vulnerable populations including our older patients who often have multiple health related concerns, limited income, lack transportation, or ready access to resources increasing their health disparity. Despite the best emergency planning efforts, every disaster presents its own unique set of challenges and opportunities to learn and improve the future response to similar situations. Depending on the significance of damage to the area’s infrastructure, resources can be scarce, and the rescue response delayed. To preserve the health and safety of the geriatric population and community during times of crisis or disaster, multiple federal, state, and local laws have been enacted. Yet, challenges still remain.
Healthcare delivery has undergone significant change as a result of these complex and unprecedented experiences. The National Academies of Medicine Future of Nursing 2020-2030 has recognized the increasing need to ensure that education of our nursing workforce must include a focus on addressing the social determinants of health and methods to improve health equity. The report also has identified the need to prepare nurses to be able to respond to disasters and public health emergencies. Studies have demonstrated that nurses worldwide do not feel adequately prepared for disasters (Fil et. al., 2021). Nurse practitioners (NP) provide care to a multitude of individuals across multiple care settings and play a vital role during times of disaster and emergencies.
It is imperative that the NP curriculum integrates emergency preparedness competencies to ensure that NP graduates are poised to address the challenges that present during times of crisis to reduce disparities in health for older adults.
Preparing our graduates to be healthcare leaders and providers for an unknown future by doing things the way we always have is no longer an option. This presentation will offer suggested content, assignments, and resources to educate our future nurse practitioner workforce to care for the geriatric population utilizing the National Organization of Nurse Practitioner faculties emergency preparedness competencies as published in 2007, the 2021 essentials, and NTF criteria.
Residents in long-term care settings have multiple chronic illnesses that contribute to an overall poor prognosis. Studies have shown that the median survival of a nursing home resident is 2.2 years. Despite this poor prognosis, the incidence of advance care planning and goals of care conversations remains low, leading to inappropriate and unwanted treatments and difficult last-minute decision-making for family members. Not only are advance care planning conversations difficult and time-consuming, but some clinicians have not had the necessary training. As a result, proactive and timely advance care planning and goals of care conversations are replaced by last-minute/crisis conversations, which lead to unnecessary, harmful, and unwanted treatments. Sometimes a healthcare provider is so focused on treating the acute changes in condition that he/she fails to see the big picture in terms of advanced or terminal illness and the resultant poor prognosis.
This interactive session will describe a distinct six-step advanced illness model which will serve as a guide for clinicians to have a meaningful goals of care conversation. The session will also help clinicians identify and prognosticate advanced serious illness. Facilitators will provide the talking points needed to navigate the complexity and nuances of these meaningful conversations. Potential barriers to an effective conversation will be discussed. Case studies utilizing role play will demonstrate the hands-on approach for the advanced illness conversations.