IPEC 561: Interprofessional Virtual Geriatrics Case

GENERAL COURSE INFORMATION

Academic Year: 2018-19 Type: Standard Letter Grade
Semester: Fall/Spring Prerequisites: None
Credit Hours: 2.0

BULLETIN DESCRIPTION
Using a web-based interface, health professional students from multiple disciplines will collaborate to identify
health care needs and plan care for an older adult patient. Contemporary theoretical concepts and
evidence-based recommendations are integrated within a complex, unfolding case that crosses all settings and
services of care: ambulatory, inpatient, post-acute, community-based care, and palliative/end-of-life care.
Patient and family-centered care concepts are also emphasized throughout each module. Students who
participate in this preceptor-supervised virtual case will make decisions based on their discipline-specific
geriatric-gerontological competencies, reinforce understandings about the scope of practice for other health
professions, and expand working capacity for interprofessionalism and team-based care.

INSTRUCTIONAL FRAMEWORK
Working as a member of a small interprofessional team (typically 5-6 students), participants will collaborate with
students from other healthcare disciplines to complete a case-based exercise comprised of 4 units of study
(ambulatory care, inpatient management, post-acute and community-based care, and palliative/end-of-life
care). After an initial orientation unit, students will engage via an online platform to analyze patient and
family-specific information, enter discipline-specific data and information into a virtual medical record, and
respond to case-specific, competency-based questions. After discipline-specific consideration of the content,
students will then have the opportunity to collaborate with members of their assigned team to answer the same
questions and develop an interprofessional plan of care for the patient and family. Collaboration is facilitated by
an embedded online message board within the case system. At the conclusion of each unit, students will
complete peer evaluations. Question responses, collaborative activities, and peer evaluation scores will be used
by faculty-preceptors to evaluate each student’s individual participation and outcomes.

COURSE GOALS AND OBJECTIVES

● Medication Management
○ Explain impact of age-related changes on drug selection and dose based on knowledge of
age-related changes in renal and hepatic function, body composition, and Central Nervous
System sensitivity.
○ Identify medications, including anticholinergic, psychoactive, anticoagulant, analgesic,
hypoglycemic, and cardiovascular drugs that should be avoided or used with caution in older
adults and explain the potential problems associated with each.
○ Document a patient’s complete medication list, including prescribed, herbal and
over-the-counter medications, and for each medication provide the dose, frequency, indication,
benefit, side effects, and an assessment of adherence.
● Cognitive and Behavioral Disorders
○ Compare and contrast among the clinical presentations of delirium, dementia, and depression.
Formulate a differential diagnosis and implement initial evaluation in a patient who exhibits
delirium, dementia, or depression.
○ In an older patient with delirium, urgently initiate a diagnostic work-up to determine the root
cause (etiology).
○ Perform and interpret a cognitive assessment in older patients for whom there are concerns
regarding memory or function.
○ Develop an evaluation and non-pharmacologic management plan for agitated demented or
delirious patients.
○ Develop verbal and nonverbal communication strategies to overcome potential sensory,
language, and cognitive limitations in older adults.
○ Assess barriers for older adults in receiving, understanding, and giving of information.
● Self-Care Capacity
○ Assess and describe baseline and current functional abilities in an older patient by collecting
historical data from multiple sources, making sure to include instrumental activities of daily
living and activities of daily living, and performing a confirmatory hearing and vision
examination.
○ Develop a preliminary management plan for patients presenting with functional deficits,
including adaptive interventions and involvement of interdisciplinary team members from
appropriate disciplines, such as social work, nursing, rehabilitation, nutrition, and pharmacy.
○ Identify and assess safety risks in the home environment, and make recommendations to
mitigate these.
○ Incorporate professional attitudes, values, and expectations about physical and mental aging in
the provision of patient-centered care for older adults and their families.
○ Assess the living environment as it relates to functional, physical, cognitive, psychological, and
social needs of older adults.
○ Utilize resources/programs to promote functional, physical, and mental wellness in older adults.
○ Identify actual or potential mistreatment (physical, mental or financial abuse, and/or
self-neglect) in older adults, and refer appropriately.
○ Facilitate ethical, non-coercive decision making by older adults and/or families/caregivers for
maintaining everyday living, receiving treatment, initiating advance directives, and
implementing end-of-life care.
● Falls, Balance, Gait Disorders
○ Ask all patients > 65 y.o., or their caregivers, about falls in the last year, watch the patient rise
from a chair and walk (or transfer), then record and interpret the findings.
○ In a patient who has fallen, construct a differential diagnosis and evaluation plan that addresses
the multiple etiologies identified by history, physical examination and functional assessment.
○ Implement and monitor strategies to prevent risk and promote quality and safety (e.g., falls,
medication mismanagement, pressure ulcers) in the nursing care of older adults with physical
and cognitive needs.
● Healthcare Planning and Promotion
○ Define and differentiate among types of code status, health care proxies, and advance directives
in the state where one is training.
○ Accurately identify clinical situations where life expectancy, functional status, patient preference
or goals of care should override standard recommendations for screening tests in older adults.
○ Accurately identify clinical situations where life expectancy, functional status, patient preference
or goals of care should override standard recommendations for treatment in older adults.
 ○ Recognize the need for continuity of treatment and communication across the spectrum of
services and during transitions between care settings, utilizing information technology where
appropriate and available.
○ Assist caregivers to identify, access, and utilize specialized products, professional services, and
support groups that can assist with caregiving responsibilities and reduce caregiver burden.
○ Know how to access, and share with older adults and their caregivers, information about the
healthcare benefits of programs such as Medicare, Medicaid, Veterans’ Services, Social Security,
and other public programs.
○ Provide information to older adults and their caregivers about the continuum of long-term care
services and supports – such as community resources, home care, assisted living facilities,
hospitals, nursing facilities, sub‑acute care facilities, and hospice care.
○ Facilitate safe and effective transitions across levels of care, including acute, community-based,
and long-term care (e.g., home, assisted living, hospice, nursing homes) for older adults and
their families.
○ Compare models of care that promote safe, quality, physical and emotional health care for older
adults, such as PACE, NICHE, Guided Care, Culture Change, and Transitional Care Models.
● Health Promotion and the Older Adult
○ Identify and inform older adults and their caregivers about evidence-based approaches to
screening, immunizations, health promotion, and disease prevention.
○ Intervene to assist older adults and their support network to achieve personal goals, based on
the analysis of the living environment and availability of community resources.
○ Know how to access and explain the availability and effectiveness of resources for older adults
and caregivers that help them meet personal goals, maximize function, maintain independence,
and live in their preferred and/or least restrictive environment.
○ Integrate relevant theories and concepts included in a liberal education into the delivery of
patient-centered care for older adults.
● Atypical Presentation of Disease
○ Identify at least 3 physiologic changes of aging for each organ system and their impact on the
patient, including their contribution to homeostenosis (the age-related narrowing of
homeostatic reserve mechanisms).
○ Generate a differential diagnosis based on recognition of the unique presentations of common
conditions in older adults, including acute coronary syndrome, dehydration, urinary tract
infection, acute abdomen, and pneumonia.
○ Recognize the complex interaction of acute and chronic co-morbid physical and mental
conditions and associated treatments common to older adults.
○ Use valid and reliable assessment tools to guide nursing practice for older adults.
○ Implement and use online guidelines to prevent and/or identify and manage geriatrics
syndromes.
○ Recognize and respect the variations of care, the increased complexity, and the increased use of
healthcare resources inherent in caring for older adults.
● Palliative Care
○ Assess and provide initial management of pain and key non-pain symptoms based on patient’s
goals of care.
○ Identify the psychological, social, and spiritual needs of patients with advanced illness and their
family members, and link these identified needs with the appropriate interdisciplinary team
members.
○ Present palliative care (including hospice) as a positive, active treatment option for a patient
with advanced disease.
○ Advocate for timely and appropriate palliative and hospice care for older adults with physical
and cognitive impairments.
 ● Hospital Care for Elders
○ Identify potential hazards of hospitalization for all older adult patients (including immobility,
delirium, medication side effects, malnutrition, pressure ulcers, procedures, peri and
post-operative periods, transient urinary incontinence, and hospital acquired infections) and
identify potential prevention strategies.
○ Explain the risks, indications, alternatives, and contraindications for indwelling (Foley) catheter
use in the older adult patient.
○ Explain the risks, indications, alternatives, and contraindications for physical and
pharmacological restraint use.
○ Communicate the key components of a safe discharge plan (e.g., accurate medication list, plan
for follow-up), including comparing/contrasting potential sites for discharge.
○ Conduct a surveillance examination of areas of the skin at high risk for pressure ulcers and
describe existing ulcers.
○ Promote adherence to the evidence-based practice of providing restraint-free care (both
physical and chemical restraints).
● Interprofessional Evaluation and Assessment
○ Define the purpose and components of an interdisciplinary, comprehensive geriatric assessment
and the roles individual disciplines play in conducting and interpreting a comprehensive geriatric
assessment.
○ Distinguish among, refer to, and/or consult with any of the multiple healthcare professionals
who work with older adults, to achieve positive outcomes.
○ Communicate and collaborate with older adults, their caregivers, healthcare professionals, and
direct-care workers to incorporate discipline-specific information into overall team care
planning and implementation.
● Interprofessional Evaluation and Assessment
○ Define the purpose and components of an interdisciplinary, comprehensive geriatric assessment
and the roles individual disciplines play in conducting and interpreting a comprehensive geriatric
assessment.
○ Distinguish among, refer to, and/or consult with any of the multiple healthcare professionals
who work with older adults, to achieve positive outcomes.
○ Communicate and collaborate with older adults, their caregivers, healthcare professionals, and
direct-care workers to incorporate discipline-specific information into overall team care
planning and implementation.
○ Integrate leadership and communication techniques that foster discussion and reflection on the
extent to which diversity (among nurses, nurse assistive personnel, therapists, physicians, and
patients) has the potential to impact the care of older adults.
○ Plan patient-centered care with consideration for the mental and physical health and well-being
of informal and formal caregivers of older adults.

COURSE FACULTY
Role Name Email School
Course Director Peter Boling peter.boling@vcuhealth.org Medicine
Course Director Alan Dow alan.dow@vcuhealth.org Medicine
Course Director Darci Bowles dbowles@vcu.edu Nursing
Course Director Emily Peron epperon@vcu.edu Pharmacy
Coordinator Chuck Alexander charles.alexander@vcuhealth.org Center for Interprofessional
Education

REQUIRED AND OPTIONAL TEXTBOOK(S): ​None.

READINGS AND RESOURCES
A collection of online resources and other applicable course readings have been selected by faculty to support
student achievement of IPEC 561 objectives. Copies of a majority of listed references may be retrieved via active
electronic links or PDF files located within the virtual case system. Students are encouraged to access other
discipline-specific scholarly and evidence-based sources as needed.

GRADING STRUCTURE
Grades will be determined based on performance in four areas:
● Individual quiz scores
● Group quiz scores
● Proctor grades
● Completion of peer evaluations

For each unit, you will receive points in each of these categories. These points are evenly divided among the four
units.

Individual quiz scores​: Individual quiz scores will be worth 15% of the final grade. Because in this course you gain
points for selecting correct answers and lose points for selecting wrong answers, your final percentage correct
(answers selected if correct or not selected if incorrect) will be used to compute the contribution of the
individual quiz score. A typical student gets about 80% correct. Your percentage correct for each unit will be
displayed in the gradebook in eLearning (Blackboard) after each unit.

Group quiz scores​: Group quiz scores will be computed similar to the individual quiz scores and are worth 45% of
your final grade. These scores are almost always higher than individual quiz scores. They will also be displayed in
the gradebook in eLearning (Blackboard) after each unit.

Proctor grade:​ Proctor grades will range from 0-3 based on the posted rubric. The proctor score will be
converted to a percentage of points where: ‘0’ = 50%, ‘1’ = 70%, ‘2’ = 85%, and ‘3’ = 100%. Typical effort is
usually worth 2 points and achieving a ‘3’ is common with committed engagement. The proctor grade will be
worth 30% of the final grade. Proctor grades (0-3 scores) will be displayed within the virtual case system; their
equivalent percentage scores will be displayed in the gradebook in eLearning (Blackboard) after each unit.

Completion of peer evaluations:​ Completion of peer evaluations is worth 10% of the final grade. For each unit
where you complete your peer evaluation a score of 100% will be displayed in the gradebook in eLearning
(Blackboard).

Final grades will be assigned as followed:

A = 89.50-100 points
B = 79.50-89.49 points
C = 69.50-79.49 points
D = 59.50-69.49 points
F = below 59.49 points

COURSE POLICIES
Course Failure: A student earning a failing grade must repeat or remediate the course. The decision to remediate
or repeat the course will be made at the discretion of the Course Directors and in coordination with the
Academic Performance Committee or equivalent of the student’s program/school.

Grade Appeals: Grade appeals should be made through the Course Directors who will coordinate with the
Academic Performance Committee or equivalent of the student’s program/school.
ATTENDANCE
Students will complete the units of study asynchronously online.

COURSE SCHEDULE
Fall Semester Dates Unit Topic
1/15/2019 - 1/28/2019 Orientation

1/29/2019 - 2/11/2019 Unit 1: Ambulatory Care

2/12/2019 - 2/25/2019 Unit 2: Inpatient Management

2/26/2019 - 3/18/2019 Unit 3: Post-Acute and Community Based Care

(Extra week for spring break)

3/19/2019 - 4/1/2019 Unit 4: End-of-Life Care

UNIVERSITY POLICIES
Students should visit ​http://go.vcu.edu/syllabus​ and review all syllabus statement information. The full
university syllabus statement includes information on safety, registration, the VCU Honor Code, student
conduct, withdrawal and more.