Older Adult Group Project

Improving Care Transition

Eve Suda, Jaime Teves, Anna Iverson, Alexis
Jackson, Megan Montgomery
Case Study Overview
🙡 Sue Flynn - 70 year old transgender female presenting with chest pain and shortness of breath.
Arrived with medications not prescribed to her (nitroglycerin and lorazepam). NSR, negative
troponin. Non-acute positive ASQ screen.
🙡 Key Points
o Past medical history
• HTN, CAD, GERD, anxiety, depression
o Psychosocial history
• Recently divorced, lives alone
• Recently came out as transgender
• Loss of support from friends
o Plan: nuclear stress test in AM, discharge pending results
What is Concerning about Case

From the case study we have gathered that Ms. Flynn is a 70 year old transgender female
who is experiencing chest pain and trouble breathing. She arrived to the ED holding 2 pill
bottles that were not hers asking if she should take them. She recently came out as
transgender and has lost a lot of support from those around her leaving her anxious and
scared.

Concerns
1. Recently coming out as transgender (Velasco et al., 2023)

2. Having pill bottles that don’t belong to her (Andres et al., 2019)
Problem Medications & Psychological Risks

🙡 Problem Medications (ICSI, 2019)

MEDICATION CLASS/USE

Labetalol ● Adrenergic Blocker o None

● Used for HTN
o But
Prozac
(Fluoxetine)
●
●
Antidepressant
Used for MDD
what if?

Nexium ● Gastric acid secretion inhibitor

● Used for GERD
🙡 Psychological Risks (ICSI, 2019)
Buspar ● Anti-anxiety
(Buspirone) ● Used for anxiety

Simvastatin ● Antihyperlipidemic
o H/O depression dx
● Used for CAD
o Aftercare, Communication, Support,
o https://sagatucson.org/
Institute for Clinical Systems Improvement. (2019).BOOST: Better outcomes
for older adults through safe transitions [PDF]. Retrieved from
https://www.icsi.org/wp-content/uploads/2019/07/7l.Boost-PPT
.pdf
 Principal Diagnosis & Polypharmacy
🙡 Principal Dx: (ICSI, 2019)
🙡 Non-specific CP, R/O MI
o No risks here either
o But…what if?

🙡 Physical Limitations (ICSI, 2019)

🙡 Older adult- advancing age? Possible, not
confirmed
o BUT WHAT IF?
• Support systems, supportive children
Institute for Clinical Systems Improvement. (2019). BOOST: Better
outcomes for older adults through safe transitions
[PDF]. Retrieved from
https://www.icsi.org/wp-content/uploads/2019/07/7l.Bo
ost-PPT.pdf
 Poor Health Literacy-Patient Support

Poor health literacy Patient support

o Discharge teaching with teach-back
method
o Take only medications that are
prescribed for you
o Understandable handouts
o Follow-up phone calls and
appointments
o Support from children and church
o Transgender support group -
Southern Arizona Gender Alliance
https://sagatucson.org/community

(Coffey et al., 2013)

 Prior Hospitalization-Palliative Care
🙡 Prior hospitalization
o None noted
o Regularly seeing PCP
o Evaluate reasons for re-
hospitalizations
(Coffey et al., 2013)
🙡 Palliative care
o Seriousness of illness
dependent on results of
nuclear stress test
o Palliative care not indicated
at this time
o Comfort care, pain
management, chaplain
What P’s were Concerning or Overlooked?
Three P’s
o Psychological
o Patient Support
o Problems with medication
• Although Ms. Flynn does not have more than 10 or high risk
meds…
Important Case Remarks
o If stress test is negative, pt has anxiety induced chest pain
o Lacking patient education: Anxiety management and medication
regimen
🙡 (Coffey et al., 2013)
Reflection on Prior Rotations

How can the STICU at Banner UMC improve organizational support and
interdependence?

🙡 We feel the STICU at Banner Main needs to improve the microsystems of

organizational support and interdependence for the benefit of patient safety
due to our observations
o Lack of daily rounding with social workers and hospital management
o Irritability with nursing students
o Improvement with collaborating as a whole team to address all health
concerns
(Dartmouth-Hitchcock Medical Center, 2023)
 Resources
Andres, T.M., McGrane, T., McEvoy, M.D., & Allen, B.F., (2019). Geriatric pharmacology: an update. Anesthesiology, 37(3), 475-492.

Retrieved from Elsevier: https://www.sciencedirect.com/science/article/abs/pii/S1932227519300370

Coffey, C., Greenwald, J., Budnitz, T., Williams, M. (2013). Projection Boost Implementation Guide. Society of Hospital Medicine

Community Resources. Southern Arizona Gender Alliance, (2023), https://sagatucson.org/community

Dartmouth-Hitchcock Medical Center. (2023). Clinical microsystem assessment tool. Institute for Healthcare Improvement.

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

Institute for Clinical Systems Improvement. (2019). BOOST: Better outcomes for older adults through safe transitions [PDF]. Retrieved from

https://www.icsi.org/wp-content/uploads/2019/07/7l.Boost-PPT.pdf

Velasco, R.A., Blakeley, A., Rostovsky, J., Skeete, K.J., & Copeland, D., (2023). Conceptualizing transgender and gender-diverse older adults

as a vulnerable population: a systematic review. Geriatric Nursing, 43, 139-147. Retrieved from

Elsevier:https://www.sciencedirect.com/science/article/pii/S0197457222002762?via%3Dihub