Two nurses - a mentor/fellow team from Massachusetts General Hospital (MGH), Boston - created a systemwide geriatric program designed to advance the care of older adults. Geriatric Rounds to Evaluate, Assess and Teach, also referred to as GREAT, disseminates best practices for geriatric patients.

Deborah D'Avolio, PhD, APRN-BC, geriatric specialist for patient care services, is serving as a mentor to fellow Susan Gordon, APRN-BC, nursing director of a general medical unit. They developed the project based on evidence that common geriatric syndromes are often preventable and may signal a need for further assessment and intervention.

"From my perspective, older adults come in sicker and with more complications because of missed opportunities," D'Avolio added. "We have a unique opportunity here at MGH. We can get them home with out complications and prolonged lengths of stay."

Expanding the Project

MGH's nursing staff, like most RNs, does not have core geriatric assessment training. In November 2007, Gordon began examining ways to improve geriatric care on her unit. In March 2008, the twosome piloted GREAT on Gordon's general medical unit and plans to expand it throughout the hospital in the near future. In fact, several other units have volunteered to enroll in the project starting this month.

"We are the largest general medical unit with most of our patients over the age of 65," Gordon said. "It made logical sense to start here. We are a model for other units, and if it can be done here, it can be done anywhere. Our nurses are also enthusiastic and have a desire to improve care among older patients."

The project's outcomes are to develop an interdisciplinary team that will develop a rounding process to provide geriatric sensitive assessment, care and teaching. D'Avolio and Gordon say geriatric assessment is essential to the recognition, prevention and treatment of functional decline and complications associated with hospitalization among older adults. Risk factors include: injuries, acute illnesses, delirium, side effects of medication, pain, immobility, poor nutrition, changes in environment and the use of Foley catheters.

Positive Outcomes

Due to the GREAT project, Gordon's general medical unit is witnessing a reduction in the use of restraints and better outcomes for older patients, she said, crediting her nursing staff.

"There is a core group who has taken this project to heart," she explained. "For example, the GREAT project recommends an activity cart with diversion activities to reduce the number of restrained patients. Nurses took the leadership role on the project and purchased items such as checkers, Play-Doh and nail polish out-of-pocket. This shows how engaged the nurses are in the project."

One way the project reaches nurses - and motivates them - is through geriatric education. Lunch-and-learn sessions are presented by staff monthly, and nurses participate in educational seminars on nutrition, pain control and fall prevention, among others.

Geriatric Care Initiatives

In 2004, MGH became the first hospital in the state to become a designated John A. Hartford Foundation Nurses Improving Care for Health System Elders (NICHE) site. The hospital went on to create its MGH 65plus program, which is dedicated to improving systems of care for older adults. The GREAT project is being conducted in partnership with 65plus following successful pilots of geriatric care initiatives conducted on Gordon's patient care unit at the hospital.

The GREAT project is part of the 18-month Geriatric Nursing Leadership Academy offered by the Honor Society of Nursing, Sigma Theta Tau International. The academy - funded by the John A. Hartford Foundation and in partnership with the Hartford Foundation's Centers of Geriatric Nursing Excellence - was developed to prepare, position and recognize the ability of nurses to influence practice and patient outcomes in geriatric healthcare.

D'Avolio and Gordon are excited MGH embraced the concept early on and is committed to developing geriatric care.

"We have a unique opportunity in a system that wants to improve care," D'Avolio said. "As a mentor I can now share with [Gordon] what others gave to me while I was falling in love with geriatrics."

Emily Marchesani is a frequent contributor to ADVANCE.