■ Interdisciplinary Bed Team trialed and selected an adjustable height range bed to ease transfers and increase mobility, with an integrated, comfortable, low air loss, microclimate management and pressure ulcer prevention mattress for all beds on the ACE unit.

■ The Heart of Nursing Care: The Dayroom ■ Room layout and designed,

staff selected and trained and activities planned, i.e. pet therapy, sing-a-longs, BINGO, trivia games, vintage movies, standing exercises, chair exercises, hair shampooing, manicures, discussion of current events, talking books, etc.

■ Dayroom activities promote cognitive and physical function, socialization and encourages family participation in a home-like environment.

■ Dayroom RN also provides increased patient safety monitoring as well as health and disease management patient teaching to prepare patients/families for transition to home or next level of care.

■ Family conference room is used to conduct meetings using the Smart board and SKYPE so families near and far can participate in important discussions about loved ones. ■ Utilized for ACE interdisciplinary team rounds. ■ Location for staff education including webinars, in-services, and

orientation for new employees.■ Developed, built, and utilized prototype patient room to trial the

construction design and plans prior to proceeding with phased remodeling.■ Management and staff were supportive and flexible during construction.

During demolition days, rooms were closed, patients were relocated away from the noise, ear plugs were offered to patients and staff, scripting provided to explain inconvenience to patients and families, and managers rounded frequently on patients.

After

Our Makeover Results• OfficialopeningoftheACEUnitwasSeptember12,2013,celebratedbyaGala

event to showcase and thank donors, which included tours conducted by staff.

• LocalnewscoverageofACEUnitopeningincludedseveralmediastoriesandatelevision news spot.

• GRN,GPCAandmobilitypinsdistributedtoall ACE Nursing staff and accomplishments celebrated with cake and punch.

• HCAHPSOverallGlobalRatingIncrease

• OneunitacquiredstageIIpressureulcersinceJune2013.

• KATZscoresupondischargeimprovedwhencomparedwiththeadmissionKATZ.

• 404dischargephonecallscompletedsinceSeptember2013.402/404respondedpositively about their hospital experience and the follow up call. One respondent offered feedback for improvement on a particular aspect of their experience and 1respondentwasnotappreciativeofafollowupcall.

Our Future• ContinueACEUnitinterdisciplinaryteammeetings.

• ExpandvolunteerstoinitiateSupport for and Promotion Of Optimal Nutritional Status (SPOONS) meal assistance and companion program.

• Offeradditionalinterdisciplinaryin-services.

• Continuetocollectandmonitoroutcomemeasures:KATZ,falls,HCAHPS,and pressure ulcers, discharge phone calls.

• GRN/GPCAtrainingfornewACEUnitemployeesaswellasexpandthetraining of GRNs/GPCAs to additional representatives from each unit in the hospital.

References• Krall,E.,Close,J.,etal(2012)InnovationPilotStudy:AcuteCareforElderly(ACE)Unit–Promoting

Patient-Centric Care. HERD,5(3),90-97.• Meiner,S.,(2011)Gerontologic Nursing,FourthEdition,Chapter9,HealthCareDeliverySettingsand

OlderAdults,148-177.• BetrabetGulwadi,G.,&Calkins,M.(2008),The Impact of Healthcare Environmental Design on Falls,

ConcordCA:CenterforHealthcareDesign,1-33.

Our Vision• Sharedbyakeygroupofinterdisciplinaryleaders.

• RemodelamedicalunitintoanACEunittoaddressthespecializedneedsofagrowing number of patients 65 years and older, using NICHE best practices to improve and strengthen the geriatric model of care for the future at Beaumont Hospital.

Our Mission• Toprovideageriatricfriendlyandsafe,healingenvironmentdevotedtothe

care of our older adults patients. Our specially trained and skilled professionals use an interdisciplinary approach and innovative best practices to provide the highest quality of care. Partnering with our patient’s families, our emphasis is on promoting and maximizing our patient’s physical and mental abilities while preventing loss of function during their hospital stay.

• Principlesguidingourchangingculture:

■ We are sensitive to the needs of our patients and their families.

■ The support and participation of family and loved ones is essential to recovery.

■ Movement is the best medicine.

■ A team approach to development of an individualized plan of care is essential.

Our Transition• FormedanACEUnitPlanning&ImplementationCommittee:

■ Representatives from Nursing (RNs, Nursing Assistants, Management, Administration), Geriatricians, PT, OT, SLP, Nutritional Support, Care Management, Social Work, Pharmacy, Informational Technology, Environmental Services, and Construction/Design.

• NursingProjectDirector:

■ Facilitated, guided and coordinated all aspects and 5 phases of the project.

■ Involvement included philanthropy, design, planning and implementation.

■ Provided vision, ongoing inspiration and motivation to committee members andunitstaffthroughoutthe2yearjourney.

• AttendedNationalNICHEconferencesin2011,2012and2013tofocusoninformational sessions/networking related to establishing an ACE unit.

• TeammembersmadevisitstoACEunitsinMichigan.

• SevenInterdisciplinaryWorkGroupsFormed:

■ Key Accomplishments by Workgroup

1. MissionStatement/GuidingPrinciples/Brochure/Web Site

2. GeriatricAssessmentTools

■ Geriatric Admission Assessment

■ Geriatric Depression Screen and Scale

■ KATZFunctionalAssessment (upon admission and at discharge)

■ Mini-Cog Mental Status Assessment

■ Confusion Assessment Method CAM(every12hours)

Opening an Acute Care for Elders (ACE) Unit – Transition or Extreme Makeover?

P11907_0214

JoanMunchiando,RN-BC,BSN,CRRN,CMSRN,NE-BC;LoisWebb,RN-BC,BSN,CMSRN;MaureenRaab,RN-BC,BSNBeaumont Hospital, Royal Oak, MI

3. BestPractice/EvidenceBasedProtocols/Order Sets■ Researched evidence based best

practices■ Developed/initiated ACE

admission order sets■ Developed and implemented

sleep protocol■ Implemented Mobility

Protocol ■ Revised Bowel Protocol ■ Revised Delirium

Medication order set■ Initiated Pharmacy

medication review to reduce/eliminate unnecessary medications

■ Individualized nutritional needs with room service

■ Continued skin bundle for pressure ulcer prevention

4. OperationalizeInterdisciplinaryRounds(SPICES)andCommunicationof Patient/Family Plan of Care■ Roundsconducted2–3timesperweekutilizingmodifiedSPICES

format.■ PlanofCareupdatedevery12hoursbyRN.■ Plan of Care utilized in Interdisciplinary rounds and shared with patient

and family.

5. Interdisciplinary Staff/Patient Education■ All RN’s and NA’s working on the ACE Unit have completed GRN/

GPCA training.■ Over250RNsandNursingAssistantshavebecomeGRNsand

GPCAs hospital wide.■ Interdisciplinary staff have also completed NICHE training.■ 15RNshaveattainednursingcertificationsandtheirpicturesareon

unit “Wall of Honor” display.

6. Transitional Care/Outpatient Resources/Discharge Planning■ Social Work and RN Care Managers initiated the Lawton

Instrumental Activities of Daily Living Scale to assist with discharge planning needs.

■ Dedicated Social Worker and Care Managers for ACE. ■ Evaluations by the Area Agency on Aging.■ Initiated/conducted follow-up discharge phone calls.

7. UnitDesign/Construction■ Researched best practices for safe, functional environment of care.■ Construction set up in phases to maintain the greatest bed occupancy

during renovation.■ Maintainedvideo-monitoring24/7foradditionalsupervisionand

safety.

Our Extreme MakeoverAnexisting66bedmedicalunitwasspeciallyredesignedtoallocate26bedsasadedicated,autonomousACEUnit.

Patient room & Bathroom Dayroom nursing station & hallway

Pre-ACE Unit 2012January 59.6

Post ACE 2013June 76.9July 76.5August 72.7September 71.4

Before During