Older Adult Group Project

Improving Care Transition

🙠 🙢
Hannah Adame, Harry Loida, Jessica McClure, Saloni Singh, Kathryn Williams
11/16

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Case Study Overview: Sue Flynn

🙡 70 y/o white, catholic, transgender female

o Recently divorced after coming out
🙡 Admit for nonspecific CP and dyspnea
o R/O MI, Negative for initial troponin, NSR
with no ST elevation on initial EKG
o Highly anxious
o ASQ score on admission: Non-Acute Positive
o Mini Mental Status Exam: 30/30
🙡 Arrives with someone else’s nitroglycerin SL and lorazepam
🙡 PMHx: HTN, CAD, depression, anxiety, GERD
🙡 Prescribed: Labetalol, Prozac, Buspar, Simvastatin, Nexium
(OTC)
🙡 Plans to discharge home in the AM if negative nuclear stress
test
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What is Concerning about Case

🙡 Plans to discharge after negative nuclear stress

test
o No mention of further suicide safety
assessment (ASQ Screening Tool, n.d.)
🙡 Severe lack of social support or structure
o Reports anxiety around being discharged home
🙡 Prescription medications not prescribed to patient
in potentially suicidal patient’s possession
🙡 Buspar prescribed along with Prozac

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Boost Model 8P’s
Problems w Meds
🙡 Problems include clutching
pill bottles that are not hers
and taking prozac with
buspar can worsen
psychological symptoms
🙡 Interventions
o Discuss importance of
only taking your
medications
o Review compatibility
with the doctor
Psychological
🙡 Problems include being
anxious, tearful, and having a
history of anxiety and
depression. The patient is
recently divorced and has
friends turning against her.
🙡 Interventions
o Teach breathing exercises
o Discuss moving somewhere
with more support.
o Introduce NAMI and mental
health services they provide.
(NAMI, 2022) 4
Boost Model 8P’s
Principal DX Physical Limitations
🙡 The patient has non 🙡 The patient is experiencing
specific chest pain and chest pain and shortness of
the doctors are ruling out breath. She is also on the
a MI.
2nd floor of her apartment
🙡 Interventions
complex
o Monitor cardiac
enzymes to rule out 🙡 Interventions
MI o Teach breathing
o Educate patient on techniques
what to do in case of
a MI o Go over pain medications
o Use integrative needed for chest pain
principles to decrease o Teach proper body
pain mechanics when using
stairs
(Johnson & Ghassemzadeh, 2022) 5
 Boost Model 8P’s
Poor Health Literacy Patient Support

🙡 Inability to do Teach 🙡 Lack of Support-reports

Back-patient in clear living alone, recent
panic/anxiety attack divorce, friends “less than
supportive”
🙡 Interventions
🙡 Interventions
o Lead breathing
o Follow up appointment
exercise
within 7 days of dc
o Provide discharge
o Involve home health if
education with
appropriate language appropriate
o Link to community o Link to community
resources-SAGA resources-First
Christian Church 6
(Coffey et al., 2013)
Boost Model 8P’s
Prior Hospitalization Palliative Care

🙡 Unplanned in last 6 🙡 Would you be surprised

month-current if pt died in next year?
hospitalization, sudden Does the pt have an
onset SOB, CP advanced/progressive
serious disease?
🙡 Interventions
o Review reason for 🙡 Interventions
hospitalization o Assess concerning
o Connect to provider reports (ASQ Score)
w/ follow-up o Connect to available
appointment within 7 services-SAGA
days
(Coffey et al., 2013)
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What P’s were Concerning or Overlooked?

🙡 Psychological: Think safety

🙡 Problem with medications: Prozac + Buspar

🙡 Rationale:
o ASQ score
o Drug interactions contributing to psychological
components
o Drug interactions contributing to other related
factors (confusion)

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Reflection on Prior Rotations

Microsystems at St. Joseph’s Neuro ICU

🙡Patient focus
○Need certified translators
○Use certified translators

🙡Interdependence
○Discharge process too long
○Disciplines not communicating

(Institute for Healthcare Improvement, n.d.) 9

References

🙡 Coffey, C., Greenwald, J., Budnitz, T., & Williams, M.V. (2013).

Project boost implementation guide (2nd ed.). Society of Hospital

Medicine. https://www.hospitalmedicine.org/globalassets/professional

-development/professional-dev-pdf/boost-guide-second-edition.pdf

🙡 GenderGP. (2022, February 28). Transitioning in older age. GenderGP Transgender

Services. Retrieved November 14, 2022, from https://www.gendergp.com/transitioning-

in-older-age/

🙡 Healthdirect Australia. (n.d.). Mini-mental State Examination (MMSE). healthdirect.

Retrieved November 14, 2022, from https://www.healthdirect.gov.au/mini-mental-state-

examination-mmse
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References

🙡Institute for Healthcare Improvement (n.d.). Clinical microsystem assessment tool.

https://www.ihi.org/resources/Pages/Tools/ClinicalMicrosystemAssessmentTool.aspx

🙡Johnson, K., & Ghassemzadeh, S. (2022, July 12). Home - books - NCBI. National Center for

Biotechnology Information. Retrieved from https://www.ncbi.nlm.nih.gov/books

🙡Nami: National Alliance on Mental Illness. NAMI. (2022). Retrieved from https://nami.org/Home

🙡U.S. Department of Health and Human Services. (n.d.). ASQ Screening Tool. National Institute

of Mental Health. Retrieved November 12, 2022, from

https://www.nimh.nih.gov/research/research-conducted-at-nimh/asq-toolkit-materials/asq-tool/

asq-screening-tool

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