SMILE Program Maintaining and/or Improving functional ability of elderly patients by SMILE Program Alidina, Karimah; Kohlberger, Kim; Merchant, Anna - Marie & Stoskopf, Maureen Halton Healthcare Services Rationale Purpose SMILE The purpose of this project is to maintain and/or improve the functional ability in at least 75% of our eligible admitted elderly patients age 70+ in our Community Hospitals by introducing the ‘SMILE’ Program (i.e. Stimulate, Move the Body, Improve Hydration, Limit Caffeine, Enjoy Better Hearing and Vision). Conclusions Outcome Measures Findings Metrics: Number of volunteers recruited and trained; Number of staff trained; Number of patients who were screened and participated in SMILE program Functional ability of the eligible patients who had participated in the SMILE program as measured by the Modified Barthel Scale administered upon admission and discharge Patients and/or family satisfaction rate Staff and volunteer satisfaction rate Delirium and functional decline are serious, common and preventable complications of hospitalization This project used simple tools to empower patients and caregivers to take an active role in the prevention of both Further highlights include enhancement of team dynamics and improved work satisfaction among the project and frontline clinical staff Embedding the principles of prevention in routine healthcare practice will support the long term sustainability of this project References 1. Nigam, Y., Knight, J., Jones, A. Effects of bed rest 3: musculoskeletal and immune systems, skin and self-perception. Nursing Times, 2009; 105 (23), 18-22 2. Inouye, S.K. Delirium in older persons. New England Journal of Medicine, 2006; 354:1157-65 3. Jiricka, M.K. (2008) Activity tolerance and fatigue pathophysiology: concepts of altered health states. In: Porth, C. M. (ed) Essentials of Pathophysiology: Concepts of Altered Health States. Philadelphia, PA: Lippincott Williams and Wilkins 4. Winkelman, C. (2009). Bed rest in health and critical illness: A body system approach. Advanced Critical Care, I20(3), p. 254-266. 5. Dittmer, D.K. And Teasell, R. Complications of immobilization and bed rest. Canadian Family Physician, 1993; 39: 1428-1437. Methods The project was implemented as part of a Senior Friendly Hospital Initiative Volunteers were recruited and trained to implement the SMILE program SMILE program was implemented on Medical/Surgical and Complex Care units Education was provided to frontline staff and volunteers The volunteers educated patients and families via a brochure Inclusion criteria: Inpatient elderly patients on Med /Surg. and CCC units who are at risk for functional decline and immobility, such as: patients > 70 years of age with 1or more risk factors for functional / cognitive decline or delirium (Risk Factors: decreased mobility, pre-existing cognitive impairment, dementia, history of delirium, sensory impairment (vision, hearing), inadequate caloric intake or dehydration, sleep deprivation) Exclusion criteria: Outpatient units; too medically unstable, unresponsive, death is imminent, severe dementia, psychosis, or behavioural problems unsafe for volunteer interaction; aphasia; patient or family refusal for participation; patient in isolation 49 volunteers were recruited and trained for the SMILE program 67 staff members were trained for the SMILE program 82 patients were enrolled in the program over a 3 month period 82% of patients and caregivers reported that this program had helped them and had improved their hospital stay 100% of volunteers reported increased role satisfaction with the implementation of this program 100% of the staff reported that volunteers interacted well with patients 100% of staff reported that this program had benefited patients’ overall hospital stay 90% of the staff also reported improved work satisfaction The initial results obtained from Modified Barthel Index Scale indicate that the functional abilities of patients participating in SMILE program on a Medical/Surgical unit remained the same at admission to discharge. However, there was a slight improvement in the functional abilities of the patients participating in SMILE program on a Complex Care unit upon discharge . Functional Decline Is a lack of activity which leads to the loss of muscle strength and endurance, bone weakening, altered skin integrity, immune suppression, fatigue and loss of motivation 1 Functional decline is identified as the leading complication of hospitalization for the elderly Reported rates are between 35-50% 2 During hospitalization, the elderly patient often experiences reduced mobility and activity levels leading to accelerated bone loss, dehydration, malnutrition, delirium, sensory deprivation, isolation, sheering forces on the skin, and incontinence. The larger the muscle, the faster the loss of strength, particularly those muscles which resist gravity in the upright position 3 Deconditioning and functional decline from baseline have been found to occur by day two of hospitalization in older patients 4 Following 3-5 weeks of bed rest, almost half the normal strength of a muscle is lost 5 Discussion The implementation of SMILE program can positively impact patients’ by maintaining and/or improving the functional ability in the elder patients The implementation of SMILE program can also positively impact patients/family/volunteers/staff job and role satisfaction Lower Risk Communication Devices Mental Exercise Physical Activity Natural Sleep Nutrition/Hydration Education Materials Keep Your Mind and Body Active in Hospital A Patient and Caregiver Guide to Preventing Delirium and Functional Decline S Stimulate your mind M Move your body I Increase your hydration L Limit caffeine E Enjoy better hearing and vision Falls Pressure Ulcers Reactive Behaviours Length of Stay Healthcare Dollars