Implementation of geriatric acute care best practices: initial results of the NICHE SITE self-evaluation.

Nurses Improving Care of Healthsystem Elders (NICHE) provides hospitals with tools and resources to implement an initiative to improve health outcomes in older adults and their families. Beginning in 2011, members have engaged in a process of program self-evaluation, designed to evaluate internal progress toward developing, sustaining, and disseminating NICHE. This manuscript describes the NICHE Site Self-evaluation and reports the inaugural self-evaluation data in 180 North American hospitals. NICHE members evaluate their program utilizing the following dimensions of a geriatric acute care program: guiding principles, organizational structures, leadership, geriatric staff competence, interdisciplinary resources and processes, patient- and family-centered approaches, environment of care, and quality metrics. The majority of NICHE sites were at the progressive implementation level (n = 100, 55.6%), having implemented interdisciplinary geriatric education and the geriatric resource nurse (GRN) model on at least one unit; 29% have implemented the GRN model on multiple units, including specialty areas. Bed size, teaching status, and Magnet status were not associated with level of implementation, suggesting that NICHE implementation can be successful in a variety of settings and communities.

The initial examination of the efficacy of low-dose promethazine for the treatment of nausea and vomiting in the hospitalized elderly.

The purpose of this study was to assess efficacy and safety of 3 doses (6.25 mg, 12.5 mg, 25 mg) of intravenous (IV) promethazine in treatment of established nausea and vomiting (N/V) in hospitalized elderly patients. Study participants aged > or =65 years received at least 1 dose of IV promethazine for treatment of N/V. Outcomes were degree of efficacy and safety. Efficacy was measured by time to relief and whether relief occurred. Safety was measured by the incidence of adverse drug reactions (ADRs). The results showed no difference in the time to relief and proportion of patients who felt relief between the 6.25-mg and 12.5-mg groups. The median frequency of ADRs in the 6.25-mg group, based on total administrations, was significantly less than the 12.5-mg group (P = .048). This study suggests a starting dose of 6.25 mg IV promethazine is as effective as higher doses and has fewer ADRs.

Examining the feasibility of implementing specific nursing interventions to promote sleep in hospitalized elderly patients.

Sleep deprivation and subsequent effects on health restoration have been documented in the literature. The purpose of this experimental pilot study was to examine the feasibility of implementing specific nursing interventions to promote sleep in hospitalized older adults. The experimental group received a sleep protocol intervention while the control group received usual nighttime care. While no differences were noted in sleep quality and duration between groups, the experimental group experienced better sleep quality (P = .001), ability to remain asleep (P = .018) and used fewer sleep medications than the control group (P = .044). In addition, those taking sleep medications experienced more awakenings and fewer sleep hours. Experimental group patients identified preferences such as personal hygiene, awareness of normal bedtime, receiving a back rub, straightening bed linens, and receiving a bedtime snack. This pilot provides initial support for the feasibility and utility of implementing a sleep protocol in an acute care setting.