Virtual ACE Update
Demo ACE Tracker
Implementing Virtual ACE on Hospitalist
Units at UAB Hospital
also known as…..
How we are trying to make your life
better 
Major, Potentially Life-Threatening Geriatric Syndromes
That are Linked and Impact Care Transitions
Delirium
Care
Transition
Plan
Pain
Immobility/
Functional
Decline
Page 4
A Real Case: Mr. S:
Mobility, Pain, and Delirium are LINKED
Privileged Patient Safety Work Product Document
This information and any attachments are prepared and maintained for use in the quality improvement
process of the UAB Health System Patient Safety Organization, and University Hospitals and its’
clinics, considered privileged and confidential pursuant to the Code of Alabama, Sections 6-5-333, 2221-8, 34-24-58, and the Patient Safety and Quality Improvement Act of 2005.
Page 5
What is the Virtual ACE Intervention?
Unit-Based Care
Delivery Redesign that
trains all providers in:

The “Why”

Function/Safe Mobility

Pain Assessment and
Management

Delirium Prevention and
Management

Care Transitions
Delirium Prevention ToolboxPage 6
ORTHO UNITS OUTCOMES
Page 7
Variable
Pre-Training
(5M + OSCU)
N=53
Post-Training
(5M + OSCU)
N=138
Pvalue
Age, years
Mean
Range
73.9 ± 7.4
65-94
74.6 ± 7.4
65-94
NS
Female Gender, N(%)
37 (70%)
73 (53%)
P=.03
Service, N(%)
Ortho Service
Other Surgery Service
Medicine Service
Bedded ED
35 (66%)
1 (2%)
17 (32%)
94 (68%)
5 (4%)
38 (28%)
1 (1%)
Unit, N(%)
OSCU
5 Main
31 (59%)
22 (41%)
61 (44%)
77 (56%)
NS
History of Fall in last 3 months, N(%)
25 (47%)
51 (37%)
NS
Mean Baseline Katz Score
10.28 ± 3.5
10.00 ± 3.5
NS
Mean Current Katz at index visit
7.28 ± 4.7
8.18 ± 4.2
NS
8 (15%)
22 (16%)
NS
8.77 ± 4.0
9.64 ± 4.0
NS
Abnormal SIS
Mean # of sched meds at index visit
Data through 8-12-15
NS
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GERIATRIC CARE
PROCESS OUTCOMES
Page 9
Geriatric Processes of Care
All Patients, 5 Main and OSCU
Completion at Index Visit
100%
80%
91%94%
91%
71%
60%
P<.000
1
72%
P=.047
58%
60%
60%
42%
40%
20%
4%
0%
% Pts with % Pts with % Pts with
Baseline Current Katz
BOTH
Katz done
done
Baseline
and Current
Katz done
Pre
% Pts with
SIS done
% Pts with
NUDESC
done
Post
Data as of 8-12-15
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MOBILITY OUTCOMES
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Mobility in the Prior 24 Hours
All Patients, All Visits, 5 Main and OSCU
64%
70%
P<.01
60%
50%
40%
P=.01
36%
Pre
Post
31%
30%
18%
20%
10%
3%
3%
0%
Up to chair
Walk in hall
Pre: 65 encounters in 50 patients
Post: 115 encounters in 81 patients
Walk off unit
Data as of 8-12-15
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COGNITION OUTCOMES
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Delirium Documentation Status
All Patients, All Visits, 5 Main and OSCU
P=.02
20%
17%
15%
10%
5%
6%
Pre
Post
5%
0%
% Abn NUDESC by RA
% Abn NUDESC by
staff
Data as of 8-12-15
Pre: 44 patients, 60 NUDESCs by RA
Post: 61 patients, 84 NUDESCs by RA; 93 patients, 116 NUDESC by staff Page 14
Early ACE Unit Outcomes
Patient Descriptors: 4 Main through 7-7-15
Variable
4 Main PreTraining
(N=84)
4 Main During
Training
(N=34)
4 Main PostTraining
(N=106)
79.9 ± 8.6
65-97
79.5 ± 7.7
65-95
79.7 ± 8.4
65-96
Gender, N (%) Female
59 (70%)
22 (65%)
71 (67%)
Race, N(%)
White
Black
Other
48 (57%)
33 (39%)
3 (4%)
20 (59%)
13 (38%)
1 (3%)
65 (63%)
39 (38%)
0 (0%)
Cogn Impairment
documented in Problem List
in chart
15 (18%)
2 (6%)
23 (22%)
SIS performed on admit
77 (92%)
33 (97%)
97 (92%)
44%
48%
46%
10 (12%)
4 (12%)
88 (83%)
Age
Mean
Range
% Patients with abnormal
SIS score
NUDESC performed
Page 16
Virtual ACE Mobility Data: 4 Main Through 7-7-15
Characteristic
4 Main PreTraining
(N=84)
4 Main
During
Training
(N=34)
4 Main
PostTraining
(N=106)
N (%) Patients with Geri Screen
completed on admission
Baseline Katz
Current Katz
69 (82%)
68 (81%)
32 (94%)
29 (85%)
96 (91%)
95 (90%)
Hospital Day at time of first
mobility screen, days
Mean
Range
2.9 ± 2.9
1-18
4.0 ± 3.6
1-12
3.7 ± 6.5
1-59
Baseline Katz Score
Mean
Range
8.4 ± 4.5
0-12
9.3 ± 3.7
0-12
8.3 ± 4.3
0-12
Current Katz Score
Mean
Range
6.7 ± 4.9
0-12
6.9 ± 4.5
0-12
6.5 ± 4.4
0-12
28 (33%)
10 (29%)
48 (45%)
History of a fall in last 3 months,
N (%)
Page 17
Virtual ACE Mobility Data 4 Main Through 7-7-15:
All Patients Age ≥ 65
Pre-Training: 85 encounters in 64 patients
During Training: 25 encounters in 25 patients
Post-Training: 108 encounters in 89 patients
Page 18
Virtual ACE Mobility Data 4 Main Through 7-7-15:
All Patients Age ≥ 65 AND Current Katz Index Score ≥ 9
Pre-Training: 31 encounters in 23 patients
During Training: 8 encounters in 8 patients
Post-Training: 37 encounters in 33 patients
Page 19
4 Main: Promoting Safe Mobility and
Cognitive Stimulation
100%
90%
80%
70%
60%
Pre-Training
50%
During Training
40%
Post-Training
30%
20%
10%
0%
% Restrained % Lights On % Blinds Open
% OOB
% with Foley
Note this data is a convenience sample of random, one-time visits
and observations
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Virtual ACE Nurse-Driven Care Protocols
Pain Assessment and Management
Algorithm for Pain Management
Page 23
6 mins
Key to proper med frequencies
IV
Plasma Concentration
30
mins
SC / IM
Cmax
po / pr
60 mins
0
Half-life (t1/2)
Time
Page 24
Maintaining Mobility
Page 25
Safe Mobility Care Protocol
Page 26
Safe Mobility Care Protocol
Page 27
Delirium
Delirium may be
the only sign of
an acute
medical
emergency in
older adults
Page 28
What are the clinical criteria for delirium?
Every care
provider at UAB
Hospital MUST
commit to knowing
these criteria for
diagnosing
delirium
Ely et al, Crit Care Med 2001;29(7):1370-79; Pun, Ely. Chest 2007;132:624-36
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Nursing Delirium Screening Scale (NUDESC):
The Early Warning System for Delirium
Page 30
DELIRIUM PREVENTION TOOLBOX
Nurses are using these tools
in patients with ANY ONE of
the following risk factors for
delirium:
SIS ≥ 2
NUDESC ≥ 2
Katz score < 9
Vision impairment
Hearing impairment
BUN/Cr ratio ≥ 18
Anyone else you see as
frail, bored, or at risk
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EVERY patient deserves STOP DELIRIUM Care!
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If the NUDESC Score is ≥ 2, then….
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Demo Delirium Order Set
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