Deirdre Lang Director of Nursing NCPOP

1. NATIONAL CLINICAL PROGRAMME FOR
OLDER PEOPLE
Current Developments &
Future Direction
Deirdre Lang Director of Nursing NCPOP

2. Strategic Vision
Educational
Framework
National Frailty
Education
Programme
National Nursing
Transfer Letter
Delirium
NCPOP
Discussion Points: NCPOP Current
Work streams & Developments

3. RESEARCH QUESTION
 To determine the knowledge, skills & competence
required to produce a nursing workforce that can
provide quality person centered care to older
people where-ever they access healthcare
 In doing so to develop an educational framework to
enable nurses to acquire and maintain the
necessary knowledge, skills and competence at the
appropriate level to deliver quality person-centered
care to older people throughout the Irish health
service

4. RESEARCH
 Literature Review (National & International,
Completed by UCC)
 5 National Focus Groups (World Café
Methodology)
 Vision articulated for three separate
domains
Home/Community
Residential Care
Hospital Care

5. ROLE DEVELOPMENT
• Skills & CompetencesGeneralist
• Specially focused knowledge and
skills
• Recognised post-registration
education
Specialist
• Nurses practising at an advanced level
incorporate professional leadership,
education and research into their
clinically based practice
Advanced

6. Strategic Vision
Educational
Framework
National Frailty
Education
Programme
National Nursing
Transfer Letter
Delirium
NCPOP
Discussion Points: NCPOP Current
Work streams & Developments

7. FRAILTY: WHAT WE KNOW
Almost 22% of all hospital emergency
department attendees are aged 65 and over
This age group accounts for 40% of all acute
emergency medical admissions and 47.3%
of total hospital bed days
(NCPOP 2012, ED Task Force Report, 2015).

8. 8
Positive correlation between age and admission rate from ED (75yr olds x 2
and 94 yr olds x 3)
A stay of 4-8 hours increases inpatient length of stay by 1.3 days, while a
stay of more than 12 hours increases length of stay by 2.35 days.
48% of people over 85 die within one year of hospital admission
There is a strong correlation between excessively long PETs and in patient
AVLOS
If Admitted to Hospital –
More Likely to Move
Wards
More Likely to Experience
a Longer Stay
More Likely to Experience
a Delayed Discharge
More Likely to Suffer an
Adverse Outcome
Every bed move adds two to length of stay
10 days in hospital is equivalent of 10 years loss of muscle mass

9. FRAILTY: WHAT WE KNOW
 The recognition of frailty is important and should
form part of any interaction between an older person
and a healthcare professional.
 An individual’s degree of frailty is not static. It may
be made better or worse, depending on the care
received when an individual presents to a health
professional.
 While nurses are first responders they have a limited
understanding of frailty.

10. FRAILTY: WHAT WE KNOW
By increasing the understanding of frailty,
we can improve the detection,
prevention, management and therefore
outcomes for these older adults.

11. THE NATIONAL CLINICAL PROGRAMME FOR
OLDER PEOPLE
PARTNERING
ONMSD
• Office Nursing & Midwifery Services Director
NEMP
• National Emergency Medicine
Programme
NAMP
• National Acute Medicine Programme

12. FRAILTY EDUCATION METHODOLOGY
National Facilitators
Undertake Education
Programme with TILDA
Deliver Education
Sessions Locally
Maintain
Database Locally
of Educated Staff
Participate in
Local Governance
Group

13. INTER-PROFESSIONAL EDUCATION
The WHO promote inter-professional
collaboration as a strategy to strengthen
and optimise health care systems and
improve patient outcomes.
Health professionals have traditionally been
educated in professional silos.
To achieve positive outcomes, inter-
professional education must be integrated
into health education curriculum

14. Strategic Vision
Educational
Framework
National Frailty
Education
Programme
National Nursing
Transfer Letter
Delirium
NCPOP
Discussion Points: NCPOP Current
Work streams & Developments

15. THE NATIONAL CLINICAL PROGRAMME FOR
OLDER PEOPLE
PARTNERING
SVUH
• St Vincent’s University Hospital
SMH
• St Michael’s Hospital
NHI
• Nursing Homes Ireland
Nursing
Homes Ireland
• St Patricks Hospital Waterford

16. WHY?
No single standardised nursing transfer
letter is available nationally in Ireland.

17. AUDIT & FOCUS GROUPS
 Too little V Too much
Issues with communications into
hospital, within hospital and from
hospital out
Safety issues
Quality issues
Time issues
Relationship issues

18. Strategic Vision
Educational
Framework
National Frailty
Education
Programme
National Nursing
Transfer Letter
Delirium
NCPOP
Discussion Points: NCPOP Current
Work streams & Developments

19. STATS
 Delirium affects 1 in 8 acute hospital inpatients
30% acute geriatrics patients; 50% ICU and post hip
fracture surgery)
 Delirium is distressing for patients and families
 Delirium is linked with 2-fold increased length of hospital
stay;
 2-fold risk of falls; 3-fold higher mortality: 1 in 5 are dead
in one month
 About 40% of delirium is preventable
 Delirium is often not detected; but detection improves
care & outcomes
 Established delirium (present for a few days) is harder to
treat

20. NCPOP WORKSTREAMS
Delirium as
part of the
NFEP
Delirium in
ED/AMU
Delirium in
Acute
Medical/
Surgical
bed
Delirium in
Residential
Facility

21. Strategic Vision
Educational
Framework
National Frailty
Education
Programme
National Nursing
Transfer Letter
Delirium
NCPOP
Discussion Points: NCPOP Current
Work streams & Developments