Adapting the HELP Model for Use in an Oncology Unit

Adapting the HELP Model for Use in an Oncology Unit

Adapting the HELP Model for Use in an Oncology Unit

D. Cooke, E. Siegler, M. Kramps, Department of Geriatric Medicine Box 39, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, 525 East 68th Street, New York, NY 10021,

After we instituted Inouye’s Hospital Elder Life Program (HELP) on a 17-bed Acute Care for Elders (ACE) unit at New YorkPresbyterianHospital, we decided to extend the service to the neighboring Oncology unit because geriatric service patients overflowed to that unit and the majority of oncology patients were over the age of seventy. Of the first six oncology patients who were enrolled, 3 expired and 3 went home, 1 with hospice and 2 with routine services. We encountered a number of barriers: long lengths of stay, poor adherence to volunteer interventions due either to clinical deterioration or patient/family refusal, high mortality rate, and staff resistance, despite inservicing. Although volunteers said that their time and energy were well spent, we briefly suspended enrollment of oncology patients to address these barriers. We discussed targeting issues with nursing leadership, recruited a senior staff nurse to adopt HELP and act as a champion, and reinstated the program with a corps of volunteers who work exclusively with the oncology patients and focus more on nutritional and functional impairments associated with chemotherapy and prolonged hospital stays. Most of the patients HELP assists on this unit are lonely, depressed, and/or have little family involvement. Expansion of HELP to subspecialty units is possible but requires ongoing assessment of disease-specific needs.
Supported by the Fan Fox and Leslie R. Samuels Foundation

Background

After successfully instituting the Hospital Elder Life Program (HELP) model on a 17-bed Acute Care for Elders (ACE) unit, we extended HELP services to work with the neighboring Oncology unit and their Geriatric patients.

InouyeSK et al. A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med. 1999; 340:669-76.

InouyeSK et al. The Hospital Elder Life Program: A model of care to prevent cognitive and functional decline in older hospitalized patients. J Amer Geriatr Soc. 2000; 48:1697-1706.

InouyeSK et al. The role of adherence on the effectiveness of nonpharmacologic interventions. Arch Intern Med. 2003; 163:958-64.

Why an Oncology unit?

  • Geriatric service patients overflowed to that unit;
  • Majority of oncology patients were over the age of 70 years;
  • Its proximity to the ACE Unit made it the logical place to start expansion of the HELP program.

Initial Pilot of HELP on Oncology Unit

Enrollment: 6 patients

  • AgeRange: 78—85 years
  • Gender: 3 Male, 3 Female
  • Average Length of Stay: 27 days
  • Underlying Diagnoses: Leukemia, Solid Tumor

Intervention Adherence: relatively poor when compared to our ACE unit (see Chart1).

Discharge Destination: see Chart 2

Barriers to Initial Expansion

We soon realized the Oncology population differed markedly from the ACE unit patients, and standard HELP interventions were insufficient and at times inappropriate. We identified the following barriers:

  • Long lengths of stay
  • High mortality rate
  • Staff resistance, despite inservicing
  • Poor adherence to volunteer interventions (see table) due to:
  • Clinical deterioration
  • Patient/family refusal
Barrier Resolutions

Once we identified the barriers, we suspended enrollment in an effort to properly address these barriers and ensure we were working with a population who would benefit from HELP interventions. We addressed the problem by:

  1. Conducting a support group with volunteers to help them with their coping of our high mortality rate. Volunteers expressed that their time and energy were well spent on the unit.
  2. Discussing all these issues with nursing leadership.
  3. Recruiting a senior staff nurse to adopt HELP and act as a champion.
  4. Reinstating the program with a corps of volunteers who work exclusively with the oncology patients.
  5. Focusing more on nutritional and functional impairments associated with chemotherapy and prolonged hospital stays.
  6. Refining enrollment criteria for patients to focus on those who are lonely, depressed, and/or have little family involvement.

Where Are We Today?

We reinstated HELP on the Oncology unit in March 2005 and have found greater success with our HELP champion and 20 volunteers.

Enrollment: 176 patients (see DiagramA)

Intervention Adherence: continues to improve as volunteers become more comfortable introducing interventions and learning proper documentation skills. (See Chart 3)

Discharge Destination: see Chart 4

Diagram A:

Patient Enrollment

10Central/South: Oncology units

Start up date: March 1, 2005

Data current to: October 31, 2005

Full InterventionBecame

(all interventions) Delirious

Screened In

Patients ReviewedPartial Intervention

(feeding only,

friendly visits)

Screened Out

(nonresponsive)

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