April 4, 2008

New acute care unit geared to needs of elderly patients

Featured Image

Marilyn Dubree, M.S.N., R.N., left, Ralf Habermann, M.D., Donna Flowers-Capley, R.N., and others celebrate at Wednesday’s opening of the Acute Care Unit for the Elderly/Vanderbilt Senior and Special Care. (photo by Dana Johnson)

New acute care unit geared to needs of elderly patients

As the ranks of older Americans swell to record numbers, Vanderbilt has launched a new specialized patient care area to treat them.

The Acute Care Unit for the Elderly/Vanderbilt Senior and Special Care will treat high-acuity patients age 65 or older. Its 14 beds on the third floor of Medical Center North's Round Wing are staffed by nurses who've gone through extra training.

“The needs of the severely ill and the frail are very different from 25-year-olds who need to get their appendix taken out,” said Ralf Habermann, M.D., director of the Senior Care Service. “They need specialized treatment.”

Each patient admitted to the ACE Unit is screened by the Geriatric Interdisciplinary Team, which includes doctors, nurses, physical, occupational, speech and respiratory therapists, dietitians, pharmacists and wound care and safety specialists.

“Hospitalized seniors rarely have single problems,” said James Powers, M.D., director of the Senior Care Clinic. “It takes a team approach to address their needs.”

The patient's care plan is then custom-tailored for their diagnoses and age.

“The idea is for each patient to receive specialized, not cookie-cutter, treatment just because they happen to fall in the geriatric or special needs population,” said Donna Flowers-Capley, R.N., B.S.N., and clinical services manager for the unit.

Emphasis will be placed on issues such as preventing falls and pressure wounds, avoiding use of restraints and watching for medication side effects.

Other changes could include stress-reducers such as no blood draws at 3 a.m., or not checking vital signs as often if a patient is stable. Family members may be asked to bring pictures from home to help reorient a confused patient.

Such efforts come naturally to nurses with special geriatric training, Habermann said.

“The nurses have a lot of knowledge of these issues,” he said “We have tried to empower our team members from the beginning. It's inclusive, not as top-down. It's a unit now.”

With a consistent team caring for older patients, problems such as even small changes in mental status will be obvious more quickly, Habermann said.

“There aren't always traditional symptoms,” he said. “They can tell us , 'There's something wrong. You need to look at them a little bit earlier.' Because sometimes in an elderly, somewhat confused person who has an infection, the first sign might not be a fever or cough, it might be just less appetite or a small change in mental status.”

The staff also will get to know a patient's family, a key element of the unit's goal of caring for social issues as well as health concerns.

“The patient is paramount, of course, but as we're treating the patient with a hip fracture, at the same time we are looking at the family and the social environment,” Habermann explained.

The ACE Unit concept is still new, addressed by no national guidelines or standards of operation.

But few doubt the need for it, with the massive Baby Boomer population hitting retirement age.

“The tsunami of geriatric patients is here already,” Powers said.

“A geriatric patient-centered environment of care makes it easier for health professionals to do the right thing for seniors and their families.”

About 20 percent of patients seen at VUMC are age 65 and up, Habermann said, and they make up one-fourth of inpatient stays.

“What we are doing is not rocket science,” he said. “It's common-sense, good care of the elderly.”