June 22, 2018
by Sandra Gordon for ASA
Paula Duncan, a registered nurse at Park Nicollet's Methodist Hospital in St. Louis Park, Minnesota, was only vaguely familiar with delirium when she got a phone call from her sister-in-law. “I don’t know what’s happening with dad,” her sister-in-law said. “Something is very wrong. He is being mean, using language with the staff and doing all sorts of things that are out of character.”
While traveling in Colorado, Duncan’s father-in-law, Leroy, had been hospitalized with pneumonia. The former coal miner was 79; he had only one remaining lung and he was in an unfamiliar place. After being hospitalized for a short time, Leroy was discharged to a rehabilitation facility, where he died three weeks later. “He never recovered from his delirium,” Duncan says. “He received antibiotics to treat his pneumonia but his confused state was something they couldn’t change. That’s what gave me the drive to say, ‘Okay, I couldn’t help Leroy, but there must be something I could do to help others,’” Duncan says.
Passion with a Purpose
Duncan, an Elder Life specialist, is the coordinator of Methodist Hospital’s Hospital Elder Life Program (HELP), which was developed by Sharon Inouye, M.D., M.P.H., director of the Aging Brain Center at the Institute for Aging Research, Hebrew SeniorLife in Boston. HELP is a comprehensive patient-care program staffed by volunteers any hospital can implement that helps prevent delirium and loss of functioning for older adults in the hospital.
After her father-in-law’s experience with delirium, Duncan implemented the HELP program at Methodist Hospital in April 2010, starting with one inpatient unit and 12 volunteers. “We didn’t have all of the resources that Inouye outlined in her plan, so we put together a program based on what we had,” Duncan says.
Within two years, the program grew. It’s now a massive undertaking, designed to staff up to 12 volunteers per day—four volunteers each in the morning, afternoon and evening, accommodating 1,100 patients per year, most of whom are age 70 and older.
Strategic Visits
At Methodist Hospital, there are two specific types of HELP visits patients receive, which average 15 minutes in length each:
“This visit isn’t a battery of questions, such as: ‘How are you today? How are you sleeping? What did you eat?’ It’s more conversation,” Duncan says. “It allows the patient and family to relax and talk with us about how are things going so volunteers can best meet the patients’ needs.”
Patients typically receive two HELP visits per day, but those with a UTI, pneumonia or hip fracture, automatically get three daily HELP visits. “We want to really get in front of those people who are most at risk for delirium,” Duncan says.
Measuring Success
When the hospital’s HELP program began in 2010, the delirium rate was 17 percent. “In that first year, we reduced it to 6 percent, which gave us the impetus for moving forward,” Duncan says. It has continued to decline, thanks to the HELP program and other strategies physicians and the nursing staff use to prevent delirium.
But perhaps the most satisfying measure of success is the feedback Duncan receives from the family members of patients who’ve received HELP visits. “I’m always getting stories from people,” Duncan says. For example, one patient’s daughter wrote:
The gentleman who visited with my mother was so good with her. He was able to engage her in some of her interests. She’s an avid bird watcher and I witnessed her having an animated discussion with him about it. This has made me appreciate how valuable the HELP program is. My mom was perhaps seen as a disoriented and somewhat irritable person by nursing staff. The HELP program helped validate her as more than just that. It also aided in her recovery by helping her stay in the present.
Another patient’s son wrote:
The volunteer who visited with my dad explained he was fairly new to the program. However, you could not tell in the way he interacted with my dad. Although he answered a few questions from my mother and I, you could tell his focus was on speaking with my dad. My father, who can be a bit cantankerous and cranky, complained he hadn’t read a newspaper in a couple of days. Steven told him he could fix that and went right out and brought in a paper. He talked with my dad about going to school, about my Dad’s military history and his age, etc. Steven was a great conversationalist and was very respectful and kind to my father.
It’s success data and stories like these that keep Duncan and her extensive volunteer team going. Still, “the HELP team can’t take all the credit. When we look at delirium reduction, it takes everybody’s efforts to make it happen,” Duncan says, including hospital leadership, physicians and nursing staff.
Read on for tips on how to implement a HELP program
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