Care Protocols for the Injured Older Adult

Original Date: 8/2024 | Location: MH Katy | Go Live: 7/1/25

Identification of Vulnerable Geriatric Patients

  • Frailty syndrome screening and assessment
      • Use Clinical Frailty Scale (CFS)
      • Add to problem list if frailty diagnosed (Frailty R54).
        cfs
  • Frailty syndrome management
    • Focus on optimization of comorbid medical conditions
    • Delirium Prevention Bundle (see below)
    • Nutrition consult and evaluation
    • Social Worker evaluation of social support network
    • Physical/Occupational Therapy consult and evaluation

Identification of patients who will benefit from the input of a health care provider with geriatric experience

  • Geriatric trauma patients (≥65 years) with isolated injuries who would benefit from medical optimization may be admitted to a Hospitalist with a surgical consult.

Prevention, identification, and management of dementia, depression, and delirium

  • Delirium Prevention Bundle EPIC Order Set
  • Recurrent nursing education – B-CAM, sleep hygiene, pain management strategies
  • Trauma and Depression Screening (PTSD5) completed by nursing on admission, weekly, and at time of discharge

Process to Capture and document what matters to patients, including preferences and goals of care, code status, advanced directives, and identification of a proxy decision maker

  • Social worker addresses MPOA and the presence of advanced directives
  • When discussing goals of care, code status, and advanced directives with patient or proxy, document conversation and time spent in a progress note (ACP [Advanced Care Planning] template).

Medication reconciliation and avoidance of inappropriate medications

  • Delirium Prevention (Non-ICU) EPIC Order set
  • Geriatric Multimodal Acute Pain Management EPIC Order set
  • Pharmacist consult for medication reconciliation form and review for potentially inappropriate medications
  • Minimization of nighttime awakening for medication administration

Screening for mobility limitations and assurance of early, frequent, and safe mobility

  • Physical/Occupational therapy consult are automatic for geriatric patients (included in Trauma admission order set and Delirium Prevention Bundle)

Implementation of safe transitions to home or other healthcare facility

  • Social worker and case manager evaluation are automatic for geriatric patients (included in Trauma admission order set)