IPEC 561: Interprofessional Virtual Geriatrics Case Syllabus

General Course Information

Academic Year: 2019-20 | Type: Standard Letter Grade | Semester: Fall | Prerequisites: None | Credit Hours: 2.0 

Bulletin Description 
Using a web-based interface, health professional learners from multiple disciplines will collaborate to identify health care needs and plan care for an older adult patient. Contemporary theoretical concepts and evidence-based recommendations are integrated within a complex, unfolding case that crosses all settings and services of care: ambulatory, inpatient, post-acute, community-based care, and palliative/end-of-life care. Patient and family-centered care concepts are also emphasized throughout each module. Learners who participate in this preceptor-supervised virtual case will make decisions based on their discipline-specific geriatric-gerontological competencies, reinforce understandings about the scope of practice for other health professions, and expand working capacity for interprofessionalism and team-based care.

Instructional Framework
Working as a member of a small interprofessional team (typically 4-5 learners), participants will collaborate with learners from other healthcare disciplines to complete a case-based exercise comprised of 5 units of study (orientation, ambulatory care, inpatient management, post-acute and community-based care, and palliative/end-of-life care). After an initial orientation unit, learners will engage via an online platform to analyze patient and family-specific information, enter discipline-specific data and information into a virtual health record, and respond to case-specific, competency-based questions. After discipline-specific consideration of the content, learners will then have the opportunity to collaborate with members of their assigned team to answer the same questions and develop an interprofessional plan of care for the patient and family. Collaboration is facilitated by an embedded online messaging system within the case platform. At the conclusion of each unit, learners will complete peer evaluations. Collaborative activities will be used by faculty preceptors to evaluate each learner’s individual participation and outcomes. 

Course Goals and Objectives

  • Medication Management
    • Explain the impact of age-related changes on drug selection and dose based on knowledge of age-related changes in renal and hepatic function, body composition, and Central Nervous System sensitivity.
    • Identify medications, including anticholinergic, psychoactive, anticoagulant, analgesic, hypoglycemic, and cardiovascular drugs that should be avoided or used with caution in older adults and explain the potential problems associated with each.
    • Document a patient’s complete medication list, including prescribed, herbal and over-the-counter medications, and for each medication provide the dose, frequency, indication, benefit, side effects, and an assessment of adherence.
  • Cognitive and Behavioral Disorders
    • Compare and contrast among the clinical presentations of delirium, dementia, and depression.
      Formulate a differential diagnosis and implement initial evaluation in a patient who exhibits delirium, dementia, or depression.
    • In an older patient with delirium, urgently initiate a diagnostic work-up to determine the root cause (etiology).
    • Perform and interpret a cognitive assessment in older patients for whom there are concerns regarding memory or function.
    • Develop an evaluation and non-pharmacologic management plan for agitated demented or delirious patients.
    • Develop verbal and nonverbal communication strategies to overcome potential sensory, language, and cognitive limitations in older adults.
    • Assess barriers for older adults in receiving, understanding, and the giving of information
  • Self-Care Capacity
    • Assess and describe baseline and current functional abilities in an older patient by collecting historical data from multiple sources, making sure to include instrumental activities of daily living and activities of daily living, and performing a confirmatory hearing and vision examination.
    • Develop a preliminary management plan for patients presenting with functional deficits, including adaptive interventions and involvement of interdisciplinary team members from appropriate disciplines, such as social work, nursing, rehabilitation, nutrition, and pharmacy.
    • Identify and assess safety risks in the home environment, and make recommendations to mitigate these.
    • Incorporate professional attitudes, values, and expectations about physical and mental aging in the provision of patient-centered care for older adults and their families.
    • Assess the living environment as it relates to functional, physical, cognitive, psychological, and social needs of older adults.
    • Utilize resources/programs to promote functional, physical, and mental wellness in older adults.
    • Identify actual or potential mistreatment (physical, mental or financial abuse, and/or self-neglect) in older adults, and refer appropriately.
    • Facilitate ethical, non-coercive decision making by older adults and/or families/caregivers for maintaining everyday living, receiving treatment, initiating advance directives, and implementing end-of-life care.
  • Falls, Balance, Gait Disorders
    • Ask all patients > 65 y.o., or their caregivers, about falls in the last year, watch the patient rise from a chair and walk (or transfer), then record and interpret the findings.
    • In a patient who has fallen, construct a differential diagnosis and evaluation plan that addresses the multiple etiologies identified by history, physical examination and functional assessment.
    • Implement and monitor strategies to prevent risk and promote quality and safety (e.g., falls, medication mismanagement, pressure ulcers) in the nursing care of older adults with physical and cognitive needs.
  • Healthcare Planning and Promotion
    • Define and differentiate among types of code status, health care proxies, and advance directives in the state where one is training.
    • Accurately identify clinical situations where life expectancy, functional status, patient preference or goals of care should override standard recommendations for screening tests in older adults.
    • Accurately identify clinical situations where life expectancy, functional status, patient preference or goals of care should override standard recommendations for treatment in older adults.
    • Recognize the need for continuity of treatment and communication across the spectrum of services and during transitions between care settings, utilizing information technology where appropriate and available.
    • Assist caregivers to identify, access, and utilize specialized products, professional services, and support groups that can assist with caregiving responsibilities and reduce caregiver burden.
    • Know how to access, and share with older adults and their caregivers, information about the healthcare benefits of programs such as Medicare, Medicaid, Veterans’ Services, Social Security, and other public programs.
    • Provide information to older adults and their caregivers about the continuum of long-term care services and supports – such as community resources, home care, assisted living facilities, hospitals, nursing facilities, sub‑acute care facilities, and hospice care.
    • Facilitate safe and effective transitions across levels of care, including acute, community-based, and long-term care (e.g., home, assisted living, hospice, nursing homes) for older adults and their families.
    • Compare models of care that promote safe, quality, physical and emotional health care for older adults, such as PACE, NICHE, Guided Care, Culture Change, and Transitional Care Models.
  • Health Promotion and the Older Adult
      • Identify and inform older adults and their caregivers about evidence-based approaches to screening, immunizations, health promotion, and disease prevention.
      • Intervene to assist older adults and their support network to achieve personal goals, based on the analysis of the living environment and the availability of community resources.
      • Know how to access and explain the availability and effectiveness of resources for older adults and caregivers that help them meet personal goals, maximize function, maintain independence, and live in their preferred and/or least restrictive environment.
      • Integrate relevant theories and concepts included in a liberal education into the delivery of patient-centered care for older adults.
  • Atypical Presentation of Disease
      • Identify at least 3 physiologic changes of aging for each organ system and their impact on the patient, including their contribution to homeostenosis (the age-related narrowing of homeostatic reserve mechanisms).
      • Generate a differential diagnosis based on recognition of the unique presentations of common conditions in older adults, including acute coronary syndrome, dehydration, urinary tract infection, acute abdomen, and pneumonia.
      • Recognize the complex interaction of acute and chronic comorbid physical and mental conditions and associated treatments common to older adults.
      • Use valid and reliable assessment tools to guide nursing practice for older adults.
      • Implement and use online guidelines to prevent and/or identify and manage geriatrics syndromes.
      • Recognize and respect the variations of care, the increased complexity, and the increased use of healthcare resources inherent in caring for older adults.
  • Palliative Care
      • Assess and provide initial management of pain and key non-pain symptoms based on patient’s goals of care.
      • Identify the psychological, social, and spiritual needs of patients with advanced illness and their family members, and link these identified needs with the appropriate interdisciplinary team members.
      • Present palliative care (including hospice) as a positive, active treatment option for a patient with advanced disease.
      • Advocate for timely and appropriate palliative and hospice care for older adults with physical and cognitive impairments.
  • Hospital Care for Elders
      • Identify potential hazards of hospitalization for all older adult patients (including immobility, delirium, medication side effects, malnutrition, pressure ulcers, procedures, peri and post-operative periods, transient urinary incontinence, and hospital acquired infections) and identify potential prevention strategies.
      • Explain the risks, indications, alternatives, and contraindications for indwelling (Foley) catheter use in the older adult patient.
      • Explain the risks, indications, alternatives, and contraindications for physical and pharmacological restraint use.
      • Communicate the key components of a safe discharge plan (e.g., accurate medication list, plan for follow-up), including comparing/contrasting potential sites for discharge.
      • Conduct a surveillance examination of areas of the skin at high risk for pressure ulcers and describe existing ulcers.
      • Promote adherence to the evidence-based practice of providing restraint-free care (both physical and chemical restraints).
  • Interprofessional Evaluation and Assessment
    • Define the purpose and components of an interdisciplinary, comprehensive geriatric assessment and the roles individual disciplines play in conducting and interpreting a comprehensive geriatric assessment.
    • Distinguish among, refer to, and/or consult with any of the multiple healthcare professionals who work with older adults, to achieve positive outcomes.
    • Communicate and collaborate with older adults, their caregivers, healthcare professionals, and direct-care workers to incorporate discipline-specific information into overall team care planning and implementation.
  • Interprofessional Evaluation and Assessment
    • Define the purpose and components of an interdisciplinary, comprehensive geriatric assessment and the roles individual disciplines play in conducting and interpreting a comprehensive geriatric assessment.
    • Distinguish among, refer to, and/or consult with any of the multiple healthcare professionals who work with older adults, to achieve positive outcomes.
    • Communicate and collaborate with older adults, their caregivers, healthcare professionals, and direct-care workers to incorporate discipline-specific information into overall team care planning and implementation.
    • Integrate leadership and communication techniques that foster discussion and reflection on the extent to which diversity (among nurses, nurse assistive personnel, therapists, physicians, and patients) has the potential to impact the care of older adults.
    • Plan patient-centered care with consideration for the mental and physical health and well-being of informal and formal caregivers of older adults.

Course Faculty 

Role Name Email School
Course Director Alan Dow alan.dow@vcuhealth.org Medicine
Preceptor Darci Bowles dbowles@vcu.edu Nursing
Preceptor Brittany Craven Brittany.Craven@vcuhealth.org Medicine
Preceptor Sarah Hobgood sarah.hobgood@vcuhealth.org Medicine
Preceptor Emily Peron epperon@vcu.edu Pharmacy
Preceptor Youssef Roman romany2@vcu.edu Pharmacy
Preceptor Laura Reitmeier laura.reitmeier@vcuhealth.org Nursing
Course Coordinator Chuck Alexander charles.alexander@vcuhealth.org Center for Interprofessional Education

 

Required and Optional Textbook(s)
None.

Readings and Resources
A collection of online resources and other applicable course readings have been selected by faculty to support learner achievement of IPEC 561 objectives. Copies of a majority of listed references may be retrieved via active electronic links or PDF files located within the virtual case system. Learners are encouraged to access other discipline-specific scholarly and evidence-based sources as needed.

Grading Structure
Each of the five units is weighted equally. Course grades are based on performance in four areas:

  • Individual quizzes- 3% per unit
  • Group quizzes – 9% per unit
  • Completion and submission of peer evaluations – 2% per unit
  • Preceptor evaluations based on contribution and collaboration as captured in the unit’s shared workspace – 6% per unit

Individual quizzes: Individual quiz scores are worth 3% per unit, totaling 15% of your final grade. Learners gain points for selecting correct answers and lose points for selecting incorrect answers.

Group quizzes: Group quiz scores are worth 9% per unit, totaling 45% of your final grade. The group quiz scores are calculated the same as individual quizzes. These scores almost always higher than individual quiz scores.

Completion and submission of peer evaluations: Completion and submission of peer evaluations are worth 2% per unit, totaling 10% of your final grade. If you do not complete or submit any peer evaluation at the , then zero points will be earned. Keep in mind that each of the unit’s peer evaluations take place outside of the case system and all learners are required to check their school email (eID@mymail.vcu.edu) often.

Preceptor evaluation scores: The preceptor evaluation score is worth 6% per unit, totaling 30% of your final grade. Your preceptor will evaluate your contribution to each unit as captured in each of the unit’s shared workspace. Preceptor scores are:

  • ‘0 – unsatisfactory’ = 50%; Student did not demonstrate evidence of sharing discipline-specific information with their teammates and participating in discussions about care plans.
  • ‘1 = needs improvement’ = 75%; Student shared incomplete, irrelevant, or inaccurate discipline-specific information with their teammates, or demonstrated minimal effort in discussions within the case platform.
  • ‘2 – satisfactory’ = 85%; Student shared complete, relevant, and accurate discipline-specific information with their teammates and actively participated in discussions within the case platform.
  • ‘3 – excellent’ = 100%; Student met criteria for ‘Satisfactory’ plus: demonstrated leadership by supporting and encouraging team interactions and articulated rationales for responses based on evidence-based outside resources.

Final grades will be assigned as follows:

A = 89.50-100 points
B = 79.50-89.49 points
C = 69.50-79.49 points
D = 59.50-69.49 points
F = below 59.49 points

Course Policies 
Course Failure: A learner earning a failing grade must repeat or remediate the course. The decision to remediate or repeat the course will be made at the discretion of the Course Directors and in coordination with the Academic Performance Committee or equivalent of the learner’s program/school.

Grade Appeals: Grade appeals should be made through the Course Directors who will coordinate with the Academic Performance Committee or equivalent of the learner’s program/school.

Attendance
Learners will complete the units of study asynchronously online.

Fall Semester Schedule* Unit Topic
9/10/2019 – 9/23/2019 Unit 1: Orientation 
9/24/2019 – 10/7/2019 Unit 2: Ambulatory Care
10/8/2019 – 10/21/2019 Unit 3: Inpatient Management
10/22/2019 – 11/4/2019 Unit 4: Post-Acute and Community Based Care
11/5/2019 – 11/18/2019 Unit 5: End-of-Life Care

*All units close at 11:59pm ET on their designated deadline date

University Policies

Learners should visit http://go.vcu.edu/syllabus and review all syllabus statement information. The full university syllabus statement includes information on safety, registration, the VCU Honor Code, learner conduct, withdrawal and more.