[Transitional care from hospital to home: how to target the right population?] / Soins de transition entre l'hôpital et le domicile: pour quels patient-es ?

When patients are discharged from the hospital and return home, they are at risk of adverse events if the continuity of care is broken. So far, the evidence for transitional care models to reduce readmission rates has focused mainly on patients with a single condition. Based on this observation, we identified the population that may benefit the most from the development of a new transitional care model, as part of the INSTEAD project, by consensus between patients and professionals in hospitals and the community. To ensure continuity of care, it is necessary to consider the patients' perception, their understanding of the care plan and changes impacting the home care plan. Interprofessional collaboration is essential to achieve this.

Lorsqu'un-e patient-e retourne à domicile suite à une hospitalisation il-elle est souvent confronté-e à des événements indésirables si la continuité de ses soins n'est pas assurée. Jusqu'à ce jour, les modèles de soins de transition qui ont montré une diminution du taux de réadmission concernaient des patient-es ne souffrant que d'une seule pathologie. Partant de ce constat, nous avons identifié la population qui pourrait le plus bénéficier de soins de transition, dans le cadre du projet INSTEAD, par un consensus incluant d'une part des patient-es et, d'autre part, des professionnel-les hospitaliers et communautaires. Pour assurer la continuité des soins, il s'avère nécessaire de prendre en compte la perception de la personne, sa compréhension ainsi que les changements influençant son plan de soins à domicile. Pour ce faire, une collaboration interprofessionnelle est indispensable.

Older patients referred for geriatric consultation in the emergency department: characteristics and healthcare utilization.

BACKGROUND: Comprehensive geriatric assessment (CGA) is difficult to perform in the emergency department (ED) environment and performance of screening tools in identifying vulnerable older ED patients who are best candidates for a geriatric consultation remain questionable. AIM: To determine the characteristics of older patients referred for a geriatric consultation by ED staff and to investigate these patients' subsequent healthcare utilization. METHODS: Secondary analysis of data previously collected for a prospective observational study of patients aged 75 + years visiting the ED of an academic hospital in Switzerland over four months (Michalski-Monnerat et al., J Am Geriatr Soc 68(12):2914-20, 2020). Socio-demographic, health, functional (basic activities of daily living; BADL), cognitive, and affective status data were collected at admission by a research nurse using a standardized brief geriatric assessment. Information on geriatric consultations, hospitalization, discharge destination, and 30-day readmission were retrieved from hospital database. Bivariable and multivariable analyses were performed using this data set collected previously. RESULTS: Thirty-two (15.8%) of the 202 enrolled patients were referred for a geriatric consultation. Compared to the others, they were older (84.9 ± 5.4 vs 82.9 ± 5.4 years, p = .03), more impaired in BADL (4.8 ± 1.6 vs 5.5 ± 1.0, p = .01), with more comorbid conditions (5.3 ± 1.5 vs 4.5 ± 1.9, p = .03), more frequently admitted after a fall (43.7% vs 19.4%, p = .01), and hospitalized over the previous 6-month period (53.1% vs 30.6%, p = .02). Multivariable analyses that adjusted for variables significantly associated with outcomes in bivariable analysis found that being admitted after a fall (AdjOR 4.0, 95%CI 1.7-9.4, p < .01) and previously hospitalized (AdjOR 2.7, 95% CI 1.2-6.2, p = .02) remained associated with increased odds of consultation, whereas the inverse association with BADL performance remained (AdjOR 0.7, 95%CI 0.5-0.9, p = .01). Patients referred for geriatric consultation had higher odds of hospitalization (84.4% vs 49.4%; AdjOR 5.9, 95%CI 2.1-16.8, p < .01), but similar odds of home discharge when admitted, and of 30-day readmission. CONCLUSION: About one in six older ED patients were referred for a geriatric consultation who appeared to be those most vulnerable, as suggested by their increased hospitalization rate. Alternative strategies are needed to enhance access to geriatric consultation in the ED.

Development of a Predictive Model for Hospital-Acquired Pressure Injuries.

Hospital-acquired pressure injuries are a challenge for healthcare systems, and the nurse's role is essential in their prevention. The first step is risk assessment. The development of advanced data-driven methods based on machine learning techniques can improve risk assessment through the use of routinely collected data. We studied 24 227 records from 15 937 distinct patients admitted to medical and surgical units between April 1, 2019, and March 31, 2020. Two predictive models were developed: random forest and long short-term memory neural network. Model performance was then evaluated and compared with the Braden score. The areas under the receiver operating characteristic curve, the specificity, and the accuracy of the long short-term memory neural network model (0.87, 0.82, and 0.82, respectively) were higher than those of the random forest model (0.80, 0.72, and 0.72, respectively) and the Braden score (0.72, 0.61, and 0.61, respectively). The sensitivity of the Braden score (0.88) was higher than that of long short-term memory neural network model (0.74) and the random forest model (0.73). The long short-term memory neural network model has the potential to support nurses in clinical decision-making. Implementation of this model in the electronic health record could improve assessment and allow nurses to focus on higher-priority interventions.

Feedback on clinical team performance: how does it work, in what contexts, for whom, and for what changes? A critical realist qualitative multiple case study.

BACKGROUND: Feedback on clinical performance aims to provide teams in health care settings with structured results about their performance in order to improve these results. Two systematic reviews that included 147 randomized studies showed unresolved variability in professional compliance with desired clinical practices. Conventional recommendations for improving feedback on clinical team performance generally appear decontextualized and, in this regard, idealized. Feedback involves a complex and varied arrangement of human and non-human entities and interrelationships. To explore this complexity and improve feedback, we sought to explain how feedback on clinical team performance works, for whom, in what contexts, and for what changes. Our goal in this research was to present a realistic and contextualized explanation of feedback and its outcomes for clinical teams in health care settings. METHODS: This critical realist qualitative multiple case study included three heterogeneous cases and 98 professionals from a university-affiliated tertiary care hospital. Five data collection methods were used: participant observation, document retrieval, focus groups, semi-structured interviews, and questionnaires. Intra- and inter-case analysis performed during data collection involved thematic analysis, analytical questioning, and systemic modeling. These approaches were supported by critical reflexive dialogue among the research team, collaborators, and an expert panel. RESULTS: Despite the use of a single implementation model throughout the institution, results differed on contextual decision-making structures, responses to controversy, feedback loop practices, and use of varied technical or hybrid intermediaries. Structures and actions maintain or transform interrelationships and generate changes that are in line with expectations or the emergence of original solutions. Changes are related to the implementation of institutional and local projects or indicator results. However, they do not necessarily reflect a change in clinical practice or patient outcomes. CONCLUSIONS: This critical realist qualitative multiple case study offers an in-depth explanation of feedback on clinical team performance as a complex and open-ended sociotechnical system in constant transformation. In doing so, it identifies reflexive questions that are levers for the improvement of team feedback.

Evaluation of a theory-informed implementation of a nursing discharge teaching intervention for older adults.

AIMS: To evaluate the implementation process of a multi-site trial of a novel discharge teaching intervention. DESIGN: Hybrid type 3 trial. METHODS: A discharge teaching intervention for older adults was implemented in medical units from August 2020 to August 2021 with 30 nurse participants. The implementation process was guided by behaviour change frameworks. Outcome data comprised determinants of nurses' behaviours related to teaching and the acceptability, appropriateness, feasibility of the intervention and frequency of teaching activities received by the participants. This study adheres to StaRI and TIDieR reporting guidelines. RESULTS: Twelve of 18 determinants of nurses' behaviour domains improved post-implementation. Being trained reinforced nurses' knowledge and skills in patient teaching. Practicing the intervention increased their awareness on the gaps between evidence-based teaching principles and their actual practice. The intervention was considered acceptable and moderately appropriate and feasible. CONCLUSION: A theoretically informed implementation process can influence nurses' perceptions and behaviours related to discharge teaching by targeting specific behaviour domains. Practice change to improve discharge teaching will require organizational support from nursing management. NO PATIENT OR PUBLIC CONTRIBUTION: Although the conceptual foundations of the intervention tested in this study were informed by the priorities and experience of patients, this population was not directly involved in the design and conduct of the study. TRIAL REGISTRATION: ClinicalTrials.gov: NCT04253665.

Conceptualization and content validation of the MEDication literacy assessment of geriatric patients and informal caregivers (MED-fLAG).

BACKGROUND: The assessment of patients' medication literacy skills (i.e., abilities to access, comprehend and interact with medication-related information) is an important step in assisting clinicians to plan for appropriate care. Despite several attempts by researchers to develop measures of medication literacy, an instrument tailored to the specific needs of older adults remains a significant shortfall. Therefore, an interprofessional team that included a citizen co-researcher conceptualized a new standardised measure of medication literacy-the MEDedication Literacy Assessment of Geriatric patients and informal caregivers (MED-fLAG). MED-fLAG was designed as a three-dimensional self-reported measure of functional, interactive and critical skills. This study describes the conceptualization process and provides the results of an evaluation of MED-fLAG's content validity, acceptability, and feasibility during a hospital stay. METHODS: MED-fLAG was developed in accordance with the guidance on scale development and standards for good content validity, by using the following steps: (I) conceptualization of a provisional version of MED-fLAG; (II) iterative qualitative evaluation of its content validity by older adults, informal caregivers and healthcare professionals. RESULTS: The qualitative assessment of the initial 54-item MED-fLAG was conducted in 36 participants, namely 13 home-dwelling older adults and/or informal caregivers and 23 healthcare professionals. Six rounds of revisions were performed to achieve content validity and to propose a 56-item revised MED-fLAG. Participants reported benefits of using a standardized assessment of medication literacy during a hospital stay but warned about certain limitations and prerequisites. The extent to which MED-fLAG could be integrated into discharge planning needs to be further investigated. CONCLUSIONS: MED-fLAG is the first medication literacy measure tailored to the specific needs of older patients and informal caregivers. A unique feature of this measure is that it includes prescribed and non-prescribed medications, irrespective of the galenic form. Additional studies are required to evaluate the other measurement properties of MED-fLAG, and to reduce the number of items before considering its clinical application.

On the basis of what has been written about medication literacy and the experiences of experts, we developed a new questionnaire to measure medication literacy (MED-fLAG) in older adults and/or informal caregivers. MED-fLAG was then submitted to older adults, informal caregivers and healthcare professionals to retrieve their feedback concerning the relevance, comprehensibility and exhaustiveness of the proposed items. In future, MED-fLAG will allow health professionals to evaluate medication literacy skills in older patients during hospitalization and/or in their informal caregivers when they are responsible for preparing or administering the medications, and then propose individualised support.

How does nursing-sensitive indicator feedback with nursing or interprofessional teams work and shape nursing performance improvement systems? A rapid realist review.

BACKGROUND: Care quality varies between organizations and even units within an organization. Inadequate care can have harmful financial and social consequences, e.g. nosocomial infection, lengthened hospital stays or death. Experts recommend the implementation of nursing performance improvement systems to assess team performance and monitor patient outcomes as well as service efficiency. In practice, these systems provide nursing or interprofessional teams with nursing-sensitive indicator feedback. Feedback is essential since it commits teams to improve their practice, although it appears somewhat haphazard and, at times, overlooked. Research findings suggest that contextual dynamics, initial system performance and feedback modes interact in unknown ways. This rapid review aims to produce a theorization to explain what works in which contexts, and how feedback to nursing or interprofessional teams shape nursing performance improvement systems. METHODS: Based on theory-driven realist methodology, with reference to an innovative combination of Actor-Network Theory and Critical Realist philosophy principles, this realist rapid review entailed an iterative procedure: 8766 documents in French and English, published between 2010 and 2018, were identified via 5 databases, and 23 were selected and analysed. Two expert panels (scientific and clinical) were consulted to improve the synthesis and systemic modelling of an original feedback theorization. RESULTS: We identified three hypotheses, subdivided into twelve generative configurations to explain how feedback mobilizes nursing or interprofessional teams. Empirically founded and actionable, these propositions are supported by expert panels. Each configuration specifies contextualized mechanisms that explain feedback and team outcomes. Socially mediated mechanisms are particularly generative of action and agency. CONCLUSIONS: This rapid realist review provides an informative theoretical proposition to embrace the complexity of nursing-sensitive indicator feedback with nursing or interdisciplinary teams. Building on general explanations previously observed, this review provides insight into a deep explanation of feedback mechanisms. SYSTEMATIC REVIEW REGISTRATION: Prospero CRD42018110128 .

Adapting the Geriatric Institutional Assessment Profile for different countries and languages: A multi-language translation and content validation study.

BACKGROUND: Hospitalization can be hazardous for older people, but most hospitals in Europe are not prepared to meet the unique needs of older adult inpatients. Adaptations of the physical environment, care processes, and staff knowledge and skills in geriatric care are essential to improve the quality of care for older people. An assessment of baseline organizational approaches to older adult care is an important first step toward recognizing the challenges organizations face when delivering acute care services to older adults and attempting to improve them. The Geriatric Institutional Assessment Profile could be a promising tool for this endeavor. OBJECTIVES: To describe a systematic process implemented across seven countries and languages that sought to develop valid and culturally-appropriate translations of the Geriatric Institutional Assessment Profile. DESIGN: Cross-cultural instrument translation and content validation study. SETTING AND PARTICIPANTS: Expert review panels comprised of 68 practicing nurses from seven European or EU associated countries (Austria (German), Belgium (Dutch), Denmark (Danish), Israel (Hebrew), Poland (Polish), Switzerland (German, French), and Turkey (Turkish)) evaluated cross-cultural relevance, including translation, of the Geriatric Institutional Assessment Profile. METHOD: A systematic approach to translating and validating a cross-cultural survey instrument, including back-to-back translation, adaptation, and evaluation of content validity using content validity indexing (CVI) techniques for each country and language, assessing translation and relevance content validity separately. The item, subscale and domain content validity index scores were calculated and adjusted for chance agreement among raters for all parts of the Geriatric Institutional Assessment Profile: the four subscales of geriatric care environment, the general knowledge about older adults subscale, and the clinical geriatric knowledge subscale. Consensus discussions among the raters then finalized translations. RESULTS: CVI scores for relevance and translation were all in the "good" to "excellent" range. The geriatric care environment scale's CVI scores were 0.84 to 0.94 for relevance and 0.82 to 0.98 for translation. The clinical geriatric knowledge subscale's CVI scores were 0.83 to 0.97 for relevance and 0.94 to 0.98 for translation. The general knowledge about older adults subscale received high translation agreement (0.93 to 0.99) but slightly lower scores for relevance, ranging from 0.46 to 0.94. CONCLUSION: Study results provided preliminary evidence of the applicability and validity of a multi-factor measure of age-friendly care in diverse health care systems, in German, Dutch, Danish, Hebrew, Polish, French, and Turkish languages.

Prevalence and clinical significance of point of care elevated lactate at emergency admission in older patients: a prospective study.

OBJECTIVE: Patients who are over 65 years old represent up to 24% of emergency department (ED) admissions. They are at increased risk of under-triage due to impaired physiological responses. The primary objective of this study was to assess the prevalence of elevated lactate by point of care testing (POCT) in this population. The secondary objective was to assess the additional value of lactate level in predicting an early poor outcome, as compared to and combined with common clinical scores and triage scales. METHODS: This monocentric prospective study recruited ED patients who were over 65 years old between July 19th 2019 and June 17th 2020. Patients consulting for seizures or needing immediate assessment were excluded. POCT lactates were considered elevated if ≥ 2.5 mmol/L. A poor outcome was defined based on certain complications or therapeutic decisions. RESULTS: In total, 602 patients were included; 163 (27.1%) had elevated lactate and 44 (7.3%) had a poor outcome. There was no association between poor outcome and lactate level. Modified Early Warning Score (MEWS) was significantly associated with poor outcome, alongside National Early Warning Score (NEWS). Logistic regression also associated lactate level combined with MEWS and poor outcome. CONCLUSION: The prevalence of elevated lactate was 27.1%. Lactate level alone or combined with different triage scales or clinical scores such as MEWS, NEWS and qSOFA was not associated with prediction of a poor outcome. MEWS alone performed best in predicting poor outcome. The usefulness of POCT lactate measurement at triage is questionable in the population of 65 and above.

[Patient-oriented discharge summary : a tool for patients to prepare their hospital discharge]. / Le résumé de sortie de l'hôpital : un outil en main des patients.

More than providing information, teaching older patients during hospitalization is essential to ensure that they acquire the necessary knowledge and maintain the skills to self-manage their health. But did you know that more than half of patients forget the information discussed with professionals after hospital discharge ? Preparing hospital discharge is a difficult time to provide teaching: older patients are often overwhelmed with a lot of information and stressed about going home. This article presents an interprofessional tool to interact with patients in a concrete way and to engage them in their discharge preparation.

Plus que la transmission d'informations, l'enseignement aux patients âgés pendant l'hospitalisation est essentiel pour qu'ils acquièrent les connaissances et maintiennent les compétences nécessaires à l'autogestion de leur état de santé. Mais saviez-vous que plus de la moitié des patients oublient les informations discutées avec les professionnels après être sortis de l'hôpital ? La préparation au retour à domicile est un moment difficile pour dispenser de l'enseignement : les patients âgés sont souvent submergés par une quantité d'informations et stressés à l'idée de rentrer chez eux. Cet article présente un outil interprofessionnel permettant d'interagir de manière concrète avec les patients et de les engager dans leur préparation à la sortie.

Medication Literacy in Hospitalized Older Adults: Concept Development.

BACKGROUND: Medication literacy encompasses the cognitive and social skills necessary for individuals to obtain, comprehend, communicate, calculate, and process medication-related information necessary to make informed decisions. Personal and contextual factors are widely recognized to influence the way that individuals acquire and maintain medication literacy skills. Despite a growing number of studies on medication literacy, current definitions remain general, lacking consideration for the specificities of older adults and hospitalization. OBJECTIVE: The project was conducted to identify, compare, and summarize the attributes, antecedents, and consequences of medication literacy in hospitalized older adults and to propose a refined definition. METHODS: A three-phase hybrid model of concept development was performed that included a literature review and focus groups with hospital nurses. In the final analytic phase, findings from the literature and focus groups were compared, and a refined definition of the concept was elaborated. KEY RESULTS: From the synthesis of 24 publications and the narrative data of 14 hospital nurses, 19 themes were described: 4 related to attributes, 8 to antecedents, and 7 to consequences. Medication literacy of hospitalized older adults has been further defined as the degree to which older adults and/or their natural caregivers can develop and maintain multidimensional skills, namely functional, interactive, and critical medication literacy skills. Adjustment of these skills is characterized by a dynamic and potentially complex process. In practice, optimal medication literacy might be achieved through control of and involvement in the medication regimen and the decisions related to it, and/or by using practical means to facilitate medication self-management (e.g., using lists, notes, reminders). CONCLUSIONS: The proposed refined definition might enhance professionals' common understanding of the concept and its application in practice, policy, and research. Managing a medication regimen is a complex activity that requires a high level of integration and coordination of cognitive and social skills. [HLRP: Health Literacy Research and Practice. 2022;6(2):e70-e83.] Plain Language Summary: Based on the literature on medication literacy and the experiences of nurses working in hospitals, this article defines medication literacy in hospitalized older adults. This definition will help professionals to better understand challenges related to medication literacy in older patients and to propose adequate support (i.e., provide education, simplify medication prescriptions, propose practical aids such as a pillbox).

Workplace Well-Being and Intent to Stay by Health Care Workers Reassigned during the First COVID-19 Wave: Results of a Swiss Survey.

Our study aimed at investigating the way not having the choice to be reassigned was associated to a poorer experience of reassignment among health care workers (HCWs) during the first wave of the coronavirus disease 2019 (COVID-19), and indirectly to a lower workplace well-being and reduced intent to stay at the hospital. We also investigated the moderating role of the perceived hospital management responsiveness on these associations. A cross sectional survey was sent to all professionals from 11 hospitals and clinics in the French-speaking part of Switzerland, in July 2020. Out of 2811 professionals who completed the survey, 436 were HCWs reassigned to COVID-19 units during the first wave of the pandemic and constituted our analysis sample. Results indicated that hospital management responsiveness moderated the association between lack of choice and reassignment experience, indicating that the more HCWs perceived responsiveness, the less the lack of choice affected their experience of reassignment and thus their intent to stay and workplace well-being. Lack of choice during reassignments can reduce intent to stay and workplace well-being, in particular if hospital management is not perceived to be responsive during the crisis. Attempts by hospital management to find solutions, such as flexibility in working hours or extraordinary leaves, can alleviate the perceived constraints of reassignment and be considered signs of responsiveness from hospital management.

Implementation and preliminary testing of a theory-guided nursing discharge teaching intervention for adult inpatients aged 50 and over with multimorbidity: a pragmatic feasibility study protocol.

BACKGROUND: Discharge teaching by nurses during hospitalization is essential to provide multimorbid inpatients with the knowledge and skills to self-manage their health conditions. However, available disease-specific teaching guidelines do not address the cumulative complexity of multiple chronic diseases that occur with greater frequency in older adults. Therefore, there is a need for a discharge teaching intervention which uses concepts that specifically address the needs of these patients, such as considering their level of activation (i.e. knowledge, skills and confidence to self-manage their health) and the burden of multimorbid disease. The objectives of this pragmatic study will be to (1) test the feasibility of implementing a nursing discharge teaching intervention and (2) conduct a preliminary test of this novel discharge teaching intervention with adult inpatients age 50 or greater who have multiple comorbid conditions. METHODS: This study uses a two-group pre-posttest design. Participants are drawn from medical units in three hospitals in the French-speaking part of Switzerland. The implementation of the intervention will be facilitated by implementation strategies from the Theoretical Domains Framework and the Behavior Change Wheel and will target change in nurses' teaching behaviours. Implementation outcomes will include measures of feasibility of the implementation strategies and the intervention process. Participants in the intervention group will receive tailored discharge teaching by trained teaching nurses. Patient outcomes will inform the preliminary testing of the intervention and will be measured with validated questionnaires assessing patients' activation level, health confidence, perceived readiness for discharge, experience with the discharge process and rate of and time to readmission. DISCUSSION: The study takes a pragmatic approach to examining the feasibility of implementing the discharge teaching intervention to contribute to the knowledge development within the context of the real-world practice setting. Results will provide the foundation for clinical trials to build evidence for widespread adoption of this intervention. TRIAL REGISTRATION: The trial is registered at ClinicalTrials.gov (ID: NCT04253665 ) on the 30 of January 2020 and has been approved by the Cantonal Ethics Committee Vaud in Switzerland (2020-00141).

Instruments assessing medication literacy in adult recipients of care: A systematic review of measurement properties.

OBJECTIVES: The assessment of medication literacy in patients is an important step in assisting clinicians to plan for education, prescription simplification, assistance and/or medication aids. There have been several attempts to develop a standardised, objective measure of medication literacy. The objectives of this systematic review were to critically appraise, compare and summarise the measurement properties of existing instruments that assess medication literacy in adult recipients of care. DESIGN: A systematic review was performed. SEARCH METHODS: Structured searches were conducted in Embase, MEDLINE PubMed, CINAHL, APA PsycINFO and Web of Science Core Collection in March 2020. Additional searches were performed in ProQuest Dissertations and Theses, DART Europe, and Google Scholar, followed by citation tracking of included studies. REVIEW METHODS: Two researchers independently identified eligible studies. Two researchers then assessed the methodological quality of the studies and quality of measurement properties, using the Consensus-based Standards for selection of health Measurement Instruments (COSMIN) guidelines. A best-evidence synthesis for each instrument was performed. RESULTS: From the 5035 citations, 17 studies were included that concerned 13 instruments using different administration methods (i.e., performancebased or self-report), medication type (i.e., prescribed or nonprescribed) and context of use (i.e., clinical or community settings). Very low- to moderate-quality evidence supported satisfactory content validity regarding relevance and comprehensibility, while comprehensiveness remained inconsistent. Other measurement properties were less frequently examined and were supported by moderate-quality evidence (i.e., structural validity) to low- or very low-quality evidence (i.e., internal consistency, reliability, construct validity). The bestvalidated instrument is the unidimensional 14-item Medication Literacy in Spanish and English assessment tool (MedLitRxSE), based on direct testing of participant performance regarding four hypothetical scenarios on medication use. Nine instruments have the potential to be recommended but require additional research, while for others, their psychometric soundness is too limited and they require content revisions. CONCLUSION: This is the first systematic review to identify instruments for medication literacy. None of the identified instruments had all measurement properties properly assessed and none reported measurement invariance, measurement error and responsiveness of the instrument. Further research is necessary for a better theoretical understanding of medication literacy in order to assist health professionals in identifying patient needs for education, regimen simplification, assistance and/or medication aids. Such research will help conceptualise new instruments that not only cover relevant domains dedicated to specific populations (e.g., polymorbid and/or older individuals), but also exhibit satisfactory measurement properties.

[Medication literacy in older patients : skills needed for self-management of medications]. / Littératie en matière de médicaments des patients âgés : compétences nécessaires à l'autogestion des medicaments.

For a patient, the daily preparation and self-administration of medication require a wide range of cognitive and social skills : these skills fall under the concept of medication literacy. Individuals with insufficient skills have difficulties to understand instructions from professionals, to communicate their concerns and are at greater risk of inappropriate use of their medications. In this new area of research, standardised instruments have been developed but their conceptual basis lacks consensus and none have been designed for older patients and their specificities. This article proposes some benchmarks so that physicians, pharmacists and nurses can better understand this concept and identify patients with difficulties.

Pour un patient, la préparation quotidienne et l'autoadministration de médicaments nécessitent un large éventail de compétences cognitives et sociales : elles se réunissent sous le concept de littératie en matière de médicaments. Les personnes ayant des compétences insuffisantes ont des difficultés à comprendre les instructions que les professionnels leur donnent, à communiquer leurs inquiétudes et sont plus à risque d'une utilisation inadéquate de leurs médicaments. Dans ce nouveau domaine de recherche, des instruments standardisés ont été développés, mais leur base conceptuelle manque de consensus et aucun n'a été conçu pour les patients âgés et leurs spécificités. Cet article propose des repères pour que les médecins, pharmaciens et infirmiers puissent mieux comprendre ce concept, et identifier les patients ayant des difficultés.

Nursing discharge teaching for hospitalized older people: A rapid realist review.

AIM: To develop, refine and put forward a programme theory that describes configurations between context, hidden mechanisms and outcomes of nursing discharge teaching. DESIGN: Rapid realist review guided by Pawson's recommendations and using the Realist and Meta-narrative Evidence Syntheses: Evolving Standards. DATA SOURCES: We performed searches in MEDLINE, Embase, CINAHL Full text, Google Scholarand supplementary searches in Google. We included all study designs and grey literature published between 1998-2019. REVIEW METHODS: We followed Pawson's recommended steps: initial programme theory development; literature search; document selection and appraisal; data extraction; analysis and synthesis process; presentation and dissemination of the revised programme theory. RESULTS: We included nine studies and a book to contribute to the synthesis. We developed 10 context-mechanisms-outcome configurations which cumulatively refined the initial programme theory. These configurations between context, mechanisms and outcome are classified in four categories as follows: relevancy of teaching content; patients' readiness to engage in the teaching-learning process; nurses' teaching skills and healthcare team approach to discharge teaching delivery. We also found that some of the same contexts generated similar outcomes, but through different mechanisms, highlighting interdependencies between context-mechanisms-outcome configurations. CONCLUSION: This rapid realist review resulted in an explanatory synthesis of how discharge teaching works to improve patient-centred outcomes. The proposed programme theory has direct implications for clinical practice by giving meaning to the 'hidden' mechanisms used by nurses when they prepare patients to be discharged home and can inform curricula for nursing education. IMPACT: The essential components, process mechanisms, contexts and impacts of the nursing discharge teaching are not consistently or clearly described, explained or evaluated for effectiveness. This review uncovers underlying contexts and mechanisms in the teaching/learning process between patients and nurses. The resulting programme theory can guide nurse clinicians and managers towards improvements in conducting discharge teaching.

Assessing Older Patients' Vulnerability in the Emergency Department: A Study of InterRAI ED Screener Accuracy.

BACKGROUND: Identifying vulnerable older patients admitted to an emergency department (ED) who are at increased risk for adverse events and require a comprehensive geriatric assessment remains a major challenge. The interRAI Emergency Department Screener (EDS) was developed for this specific purpose, but data regarding its validity are scarce. OBJECTIVES: To determine (1) convergent validity of the EDS with results of a geriatrician's assessment in defining the need for prompt versus delayed/no further geriatric assessment and (2) predictive validity of the EDS for hospital admission, prolonged hospital length of stay (LOS), and 30-day readmission. DESIGN: Prospective observational study. SETTING: ED of an academic hospital in Switzerland. PARTICIPANTS: Older patients, aged 75 years or older (N = 202), who visited the ED over a 4-month period. Patients with life-threatening conditions were excluded. MEASUREMENTS: Data for EDS were collected by two clinical nurses. A brief geriatric assessment was performed separately and interpreted by a geriatrician blinded to the EDS results. Orientation after ED discharge, hospital LOS, and 30-day readmission were retrieved from the administrative database. RESULTS: Participants were aged 83.2 ± 5.4 years, 56.9% were female, and 43.6% lived alone. Frequent findings at geriatric assessment were impairment in gait/balance (69.3%), polypharmacy (64.9%), cognitive impairment/delirium (48.2%), risk of malnutrition (46.0%), and mood impairment (38.1%). The proportions of participants who required prompt, delayed, and no further geriatric assessment, according to the EDS, were 27.2%, 29.2%, and 43.6%, respectively. The EDS had low sensitivity in predicting hospital admission (28.8%), prolonged LOS (26.3%), and 30-day readmission (26.1%), with the Area Under the Receiver Operating Characteristics (AUROC) being 51.8%, 48.1%, and 49.4%, respectively. CONCLUSION: The EDS performed poorly in both convergent and predictive validity analyses, precluding its use as a screening tool in this ED environment. Further efforts should be undertaken to better target interventions to reduce adverse health trajectories in the older ED population.

Instruments for the identification of patients in need of palliative care: protocol for a systematic review of measurement properties.

OBJECTIVE: The objective of this review is to provide a comprehensive overview of the psychometric properties of available clinician-reported instruments developed to identify patients in need of general and specialized palliative care in acute care settings. INTRODUCTION: Identification of patients in need of palliative care has been recognized as an area where many health care professionals need guidance. Differentiating between patients who require general palliative care and patients with more complex conditions who need specialized palliative care is particularly challenging. To our knowledge, no dedicated instruments are available to date to assist health care professionals to make this identification. INCLUSION CRITERIA: Included studies will report on i) instruments aiming to identify patients in need of palliative care, ii) adult patients in need of palliative care in acute-care settings, iii) clinician-reported outcome measures, or iv) the development process or one or more of its measurement properties. Studies conducted in intensive care units, emergency departments, or nursing homes will be excluded. METHODS: We will search for studies published in English and French in a variety of sources, including Embase, Medline Ovid SP, PubMed, CINAHL EBSCO, Google Scholar, government websites, and hospice websites. All citations will be screened and selected by two independent reviewers. Data extraction, quality assessment, and syntheses of included studies will be performed according to the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) criteria. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42020150074.

Retrospective Analysis of Geriatric Major Trauma Patients Admitted in the Shock Room of a Swiss Academic Hospital: Characteristics and Prognosis.

Increased life expectancy exposes a great number of elderly people to serious accidents, thus increasing the amount of major geriatric trauma cases. The aim of our study was to determine the profile of elderly patients undergoing major trauma, and the contributing factors predicting mortality in this specific patient group, compared to the younger population. Retrospective analysis of 1051 patients with major trauma admitted over ten years in a Level-1 trauma center was performed. Data collected were: history, nature and type of trauma; age and sex; vital signs on admission; injury severity score; shock index; comorbidities; coagulation diathesis; injury patterns; emergency measures taken; main diagnosis; mortality; and length of hospital and intensive care unit (ICU) stay. Geriatric patients admitted for major trauma have a mortality rate almost four times greater (47%) than their younger counterparts (14%) with the same ISS. According to statistical regression analysis, anti-platelet therapy (OR 3.21), NACA (National Advisory Committee for Aeronautics) score (OR 2.23), GCS (OR 0.83), ISS (OR 1.07) and age (OR 1.06) are the main factors predicting mortality. Conclusion: Geriatric major trauma patients admitted to our trauma resuscitation area have a high mortality rate. Age, GCS, ISS and NACA scores as well as anti-platelet therapy are the main factors predicting mortality.