Journal of Gerontological Nursing

Feature Article Supplemental Data

Enhancing the ADMIT Me Tool for Care Transitions for Individuals With Alzheimer's Disease

Janet R. Moore, PhD, RN; Meghan M. Sullivan, BS, RN

Abstract

One of the goals of the National Plan to Address Alzheimer's Disease is to ensure safe care transitions. To facilitate safe and effective transitions from home to hospital, the ADMIT (Alzheimer's, Dementia, Memory Impaired Transitions) Me tool was developed and three focus groups were conducted with caregivers (n = 6), emergency department nurses (n = 6), and first responders (n = 14) to determine its usefulness and applicability to practice. Feedback was used to enhance the tool to reflect their needs. Each group expressed that the tool would help promote safety in care transitions. Using ADMIT Me, nurses can practice with clear communication and collaboration in care transitions, and provide patient-centered care based on the behaviors and unique needs of the individual with dementia. [Journal of Gerontological Nursing, 43(5), 32–38.]

Abstract

One of the goals of the National Plan to Address Alzheimer's Disease is to ensure safe care transitions. To facilitate safe and effective transitions from home to hospital, the ADMIT (Alzheimer's, Dementia, Memory Impaired Transitions) Me tool was developed and three focus groups were conducted with caregivers (n = 6), emergency department nurses (n = 6), and first responders (n = 14) to determine its usefulness and applicability to practice. Feedback was used to enhance the tool to reflect their needs. Each group expressed that the tool would help promote safety in care transitions. Using ADMIT Me, nurses can practice with clear communication and collaboration in care transitions, and provide patient-centered care based on the behaviors and unique needs of the individual with dementia. [Journal of Gerontological Nursing, 43(5), 32–38.]

Paramedics transport a man with dementia to the emergency department (ED) via ambulance. They report to the primary nurse that the patient became increasingly combative in the ambulance and continually shouted for someone named Mary. He was home alone and no information could be found regarding his next-of-kin or pertinent medical information. “Good luck,” they warn the nurse as they leave.

In the ED, the patient continues to exhibit aggressive behavior, refuses to stay in bed, and continues to repeatedly call for Mary. The patient care technician reports to the nurse, “We have a confused, crazy old man in bed 315. We need a sitter and we need one now.”

The nurse is able to assign a sitter. However, after 2 hours with the man, the sitter frantically exits the room, saying, “I need a new assignment or this patient needs something to calm him down. I don't know how much more of this I can take.” The nurse calls the physician and describes the behavior of the patient. Ativan® is prescribed.

This vignette illustrates what can happen during a transition of care from home to hospital. The purpose of the current article is to describe the results from focus group meetings aimed at enhancing a tool for care transitions for individuals with dementia and determining the need for such a tool.

Transitions of care are defined by the National Transitions of Care Coalition (NTOCC) (NTOCC Work Group, 2008) as “the movement of patients between health care locations, providers, or different levels of care within the same location” (p. 1). Similarly, the Joint Commission (2012) defines transitions of care as “the movement of patients between healthcare practitioners, settings, and home as their condition and care needs change” (p. 3). The Joint Commission (2013) specifically includes admission, in addition to discharge from a facility, as a key transition of care.

Patients with Alzheimer's disease or other dementias exhibit memory loss as a defining characteristic of the disease (American Psychiatric Association, 2013). They may lose the ability to communicate and provide their medical history as the disease progresses. Early in the disease, patients may begin to have word-finding difficulties; complete aphasia may be apparent in the later stages. Caregivers, whether paid or unpaid, ultimately become responsible for patient information and the facilitation of transitions from one setting to another.

The NTOCC (2010) reports that individuals living with chronic conditions may visit up to 16 physicians in 1 year. Individuals with dementia may have even more transitions. The National Institute on Aging (NIA; n.d.) asserts that individuals with dementia have “almost twice as many transitions as people free of dementia” (para. 2). This number reflects that those with dementia do not receive care in a single location for 1 year; rather, they often move from home to hospital to skilled nursing facility (or any combination of these three places).

Individuals with dementia may experience more complicated end-of-life transitions and are often unable to advocate for their wishes. Gozalo et al. (2011) found that one in five nursing home residents with advanced dementia underwent burdensome transitions in the last 90 days of their lives. Such transitions were inefficient and ineffective, and only increased the stress and frustration of patients and family members, as the individuals with dementia were removed from a familiar environment. This statistic is particularly troubling because the final days of an individual's life, which should be a peaceful time, may be marred by anxiety and exasperation.

These ineffective transitions affect individuals with dementia and their caregivers, as well as members of the health care team. The movement between locales means more individuals must be re-oriented to the unique needs of patients, including their other diagnoses, medications, nutritional considerations, and behaviors secondary to dementia.

Nurses are not the only ones facing barriers in care transitions. Physicians are also struggling with care transitions, as noted in a white paper on care transitions for individuals with dementia (Burke et al., 2016), which identifies a number of barriers, including the inability to know the patient's baseline mental status. Shamji, Baier, Gravenstein, and Gardner (2014) state that “clinicians in all settings express frustration when they receive a patient and do not have the clinical information that they need to assume the responsibility for the patient's care” (p. 323). Harm could potentially come to the patient if accurate information is not readily available to the clinician (Goldsmith et al., 2010).

According to the NTOCC (2010),

poor communication during transitions from one care setting to another can lead to confusion about the patient's condition and appropriate care, duplicative tests, inconsistent patient monitoring, medication errors, delays in diagnosis and lack of follow through on referrals. (p. 1)

Reconciliation of medications (Callinan & Brandt, 2015) and a current list of problems (Lim, Foust, & Van Cleave, 2012) are crucial to a successful transition. In patients with dementia, overmedication and medication errors can sometimes occur. The NTOCC (2010) asserts that “an estimated 66 percent of medication errors occur during transitions: upon admission, transfer or discharge of a patient” (p. 7). Cognitive impairment complicates the transition process and can add to the use of medications. Sometimes over-medication of patients with dementia is due to their behaviors, especially if they are unruly or aggressive. However, knowledge of specific nonpharmacological interventions can be just as effective and may prevent the use of medications.

Behaviors such as confusion, aggression, and wandering place individuals with dementia at risk for various hazards, including falls and/or harming themselves or others. By recognizing that these behaviors are often due to a reaction to a trigger within the environment, pain, or emotional cause (e.g., feeling lost or abandoned), the health care team can react appropriately, which prevents the escalation of the situation and hopefully safeguards against harm. Increasing health care providers' understanding of the expected behaviors of the individual with dementia and calming techniques unique to him/her may prevent the unnecessary use of medications.

Background

One of the goals of the National Plan to Address Alzheimer's Disease (U.S. Department of Health and Human Services, 2013) is to ensure safe transitions. Three former nursing students were concerned that patients with memory loss had a lack of care coordination. Quandaries they experienced included identifying baseline behaviors of the memory-impaired patient, preventing use of restraints when a patient with dementia became combative, and developing rapport with the patient with dementia. They realized that all of these situations impacted the safety of patients and health care providers, and resulted in poor care transitions.

To facilitate safe and effective care transitions, the students and faculty advisor (J.R.M.) designed a tool, A.D.M.I.T. (Alzheimer's, Dementia, Memory Impaired Transitions) ME. Behavioral problems that may be exhibited by individuals with dementia, along with calming techniques to manage them, were incorporated into the tool as suggested by Epstein-Lubow and Fulton (2012). Although other tools exist for care transitions (i.e., File of Life [access http://www.folife.org] and INTERACT [access http://interact2.net/tools.html]), they are either not specific for individuals with dementia or not intended for use by everyone involved in care transitions (i.e., patients and families).

The tool was presented by the faculty advisor to several content experts, including those on the Med/Sci Liaison Committee of the Massachusetts/New Hampshire Alzheimer's Association, a consultant to the Alzheimer's Association on Habilitation Therapy, and members of an interdisciplinary group with an interest in gerontology. Represented individuals included psychologists, nurse practitioners, nurse faculty, physical therapists, and social workers. Several suggestions were incorporated into the tool, including adding “hallucinations/delusions” to the behavior category and “triggers to behaviors” as a separate category. The content expert from the Alzheimer's Association suggested placing “emergency information” in red at the heading and having a physician's signature included to “give it more credibility.” This was subsequently changed to a health care provider's signature, affirming it had been reviewed.

Although the tool evolved with the suggestions from content experts, it was determined that it would be important to know if (a) ED nurses and first responders would find the tool useful and (b) caregivers would be able to easily complete it with their priorities represented. Therefore, the goal of the current study was to conduct three separate focus group interviews to enhance the usefulness of the ADMIT Me tool, help determine additions or deletions to the tool, and determine how best to disseminate it.

Method

Focus group interviews were the chosen data-gathering method. It was determined to use focus group interviews rather than individual interviews to elicit collective views. As Marshall and Rossman (2006) and Webb and Doman (2008) noted, individuals often have an opinion after listening to others, further stimulating discussion.

Three separate focus group meetings were conducted: one with caregivers at a support group meeting, one with ED nurses known to the researchers, and one with first responders also known to the researchers. The facilitator of the support group granted permission to attend the meeting and conduct the research. The Institutional Review Board of Elms College approved the study.

At each focus group meeting, the recruitment statement was given to each participant and the informed consent form was read aloud prior to asking participants to sign it. Participants were informed that a tape recorder would be recording the focus group meetings and that if there was an objection to the tape recorder, it would not be used. Members were assured that confidentiality would be maintained and that the only individuals listening to the tapes were three student research assistants. There were no objections to using the tape recorder. Responses were handwritten by the research assistants on an interview protocol form (Table A, available in the online version of this article) that was created by the faculty advisor (J.R.M.), as suggested by Creswell (2013). This form also created an audit trail to ensure rigor. Participants were asked to complete demographic data; no other personal data were collected.


            Interview Protocol

Table A:

Interview Protocol

A semi-structured interview process was used. Participants were asked to look at the ADMIT Me tool and verbally respond to the questions in the interview protocol. They were asked if the tool would be useful for them in their work (first responders and nurses) or as a caregiver of an individual with Alzheimer's disease or other memory impairment. They were also asked for additions, deletions, or changes to be made to the tool. The ADMIT Me tool was not collected. Caregivers were not asked to provide personal information.

The first focus group meeting was conducted with caregivers at their support group dinner meeting. They were asked the interview protocol questions, if they experienced barriers or facilitators to care transitions, and if the tool would ease their role.

The second focus group meeting was conducted with ED nurses at the college. The ADMIT Me tool had been e-mailed to them prior to the meeting to help facilitate the meeting. The ED nurses were also given the tool at the meeting and asked to comment on it in addition to being asked the interview protocol questions. Refreshments were provided, as suggested by McLafferty (2004). Although Webb and Kevern (2001) suggested it is best to conduct group meetings as opposed to one-on-one meetings, two nurses could not attend but met individually with the faculty principal investigator (J.R.M.), and another e-mailed her comments. Their suggestions were useful and incorporated into the tool.

The third focus group meeting was conducted with first responders off-site at a restaurant. Prior to the meeting, they were provided with a copy of the ADMIT Me tool to review and were also asked if it would ease their role in care transitions. Again, the interview protocol was used and refreshments were provided.

There was consensus among all participants at each focus group regarding all suggestions proposed. Member check-in was not used after each focus group meeting, but participants were given a copy of the final version of the tool to show them how their suggestions were incorporated.

All three interviews were recorded. Audiotapes were listened to and key phrases were transcribed by the research assistants. Transcriptions were compared with notes taken at each of the focus group meetings.

Results

Caregivers

The researchers met with six caregivers and two social worker group leaders at a support group meeting. Two caregivers did not wish to participate in the study after being read the consent form; the remaining six agreed to participate. Participants were all White females (one age 40 to 49, two ages 50 to 59, two ages 60 to 69, and one 80 or older). One had a high school education, two had bachelor's degrees, and three had Master's degrees.

Caregivers suggested several additions for the tool: adding “nickname” to the name line and “favorite conversations enjoyed.” One comment was to add a contact person to obtain more copies.

When asked about barriers to quality care, one daughter described that shortly after her mother died (who had served as a primary caregiver to her father), she experienced difficulty with her father's admission to the hospital. The hospitalist was unable to contact her father's primary care provider about his medications, which made it a challenging care transition for the daughter. She expressed that her mother most likely would have had that information but it was not written.

Several caregivers had suggestions regarding what would help facilitate smoother care transitions. One caregiver stated, “The behaviors are great.” Another caregiver responded, “Something like this I think would be immensely helpful. If something like this existed, it would make stepping into the role as caregiver so much easier.” A third participant added, “ADMIT Me allows all health care professionals to be up-to-date with the patient.”

One caregiver explained that if she was admitted to the hospital, her husband with dementia would be unable to fully communicate her history and medical condition, and claimed, “I would fill this out for myself.”

Nurses

Six nurses were interviewed; all were White females (two were ages 20 to 29 and four were ages 40 to 49). Four nurses had bachelor's degrees and were enrolled in a Doctor of Nursing Practice program, and two had Master's degrees. They were ED nurses with 2 to 10 years of experience in an ED.

Suggestions from the nurses included adding “height and weight” (for medication administration or potential computed tomography scanning and need for intravenous dye), attaching the Medical Orders for Life Sustaining Treatment (MOLST) form with the code status information, and adding “home care provider” to the list of contacts. They also had additions (i.e., “fistula,” “implanted device,” and “restricted extremity”) and deletions (i.e., “malignant hypothermia”) to the medical profile.

The nurses were asked, “Do you ever have a poor care transition, especially someone with dementia?” One nurse responded, “Probably every day.”

The nurses described barriers to quality care as “not knowing their baseline mental status or their needs at the time.”

When asked about facilitators, one nurse said, “This would be huge for someone with no one” (e.g., family, support). Another nurse added, “The medical and behavioral pieces are the most helpful on the form.”

One nurse was particularly enthusiastic. When asked about dissemination of the tool, she stated, “This is a must. This should be in every physician's office, every health care office, it should be handed out at discharge.”

First Responders

There were 14 first responders (seven males and seven females, with 13 ages 20 to 29 and one age 30 to 39). Twelve were White individuals, one identified as Black and Hispanic, and one identified as Portuguese. Four first responders had high school diplomas, two had associates degrees, six had bachelor's degrees, and one wrote “in process” of college and another wrote “some college.” They were an experienced group, with 13 having 1 to 5 years of experience, of which 10 had 3 to 5 years of experience. The remaining first responder was a paramedic with 6 years of experience.

The first responders suggested that the days of the week for dialysis be added to the medical columns, as well as “left and right” next to restricted extremity. They also suggested adding “baseline mental status.” The nurses discussed the importance of this during the focus group, but did not make a specific suggestion regarding this concern.

When asked about dissemination of the tool, one first responder suggested using yellow paper for the tool and instructing users to hang it on the refrigerator. Although it would stand out, it was determined that it may be impractical to send the tool via e-mail and ask caregivers to print on yellow paper. However, the tool states it should be posted on the refrigerator.

When asked, “What is the biggest barrier to care transitions?”, the first responders discussed not knowing the patient. One first responder commented:

The nurse wasn't familiar with the patient at all. The med reconciliation wasn't right. Baseline [of the patient] was very combative. She [the patient] was screaming the entire time and [we] had no idea how to calm her down. If we had this, like where it says behaviors and what triggers them, we could have avoided this from happening.

When the first responders were asked what would help facilitate smoother care transitions, they noted that, on the scene, there may not be a good historian present, with one saying, “This form allows us to grab and go.”

They also suggested having the tool filled out as part of the annual physical and having the physician sign it. One first responder gave an example: “A patient might report ‘I don't have this problem,’ when really the medication is correcting the problem.”

Discussion

Family members often take on the role of case manager each time an individual with dementia visits a health care provider, updating the health care team within that specialty regarding progress and/or regression in other aspects of the client's health (e.g., new medications, worsening of dementia). It is important for the family member to have current, accurate information readily available.

Moreño (2014) and Jeffs, Lyons, Merkley, and Bell (2013) noted that poor communication is evident in transitions from hospital to other health care facilities. To strengthen communication, many authors affirm that a standardized transfer tool will help improve the exchange of patient information (Boltz, Parke, Shuluk, Capezuti, & Galvin, 2013; Callinan & Brandt, 2015; Kessler, Williams, Moustoukas, & Pappas, 2013). Although transfer tools are found to enhance communication from nursing home to ED (Dalawari, Duggan, Vangimalla, Paniagua, & Armbrecht, 2011), they are not widely used and a caregiver may not be available to provide needed information about the patient's behaviors and calming techniques.

Toles, Abbott, Hirschman, and Naylor (2012) found that families wished for more involvement in transitions. Yet, the NTOCC (2010) asserts that caregivers are not always encouraged to take part in transitions of care, which was found by Toles et al. (2012). Families must be included in discussions to be sure their needs are met and anxiety is decreased.

Ethical Considerations

The information in ADMIT Me is protected by HIPPA and considered confidential. Considering the informal and formal commitments health care providers make to protect the privacy of patients, ADMIT Me should be considered a sensitive document to be handled with respect and consideration.

Limitations

One limitation of the current study was its small sample sizes for the focus groups. It would have been more robust to have had more caregivers participate. Although the sample was not diverse in ethnicity and geographic location, it was somewhat diverse in age and gender. Future research should include participants of varying backgrounds and from a variety of areas (e.g., rural, urban) so the tool can assist in the provision of culturally competent care and assist as many populations as possible. Despite the limited diversity of the sample, the tool reflects the unique contributions of each group from the focus group meetings.

The second limitation was that the researchers did not revisit the participants to ensure the tool reflected their suggestions. However, consensus was achieved at each of the focus group meetings. In addition, participants were provided with a final copy of the tool.

ADMIT Me has yet to be widely distributed and used in the community. However, through the researchers' various efforts, ADMIT Me has the potential to become a standard tool in ensuring safe and successful care transitions. The researchers plan to perform a follow-up study by piloting the tool with caregivers to enhance the validity of the tool.

Nursing Implications

Based on the feedback from the various focus groups, the use of the ADMIT Me tool has the potential to significantly impact communication and collaboration. The tool serves as the bridge between the various experiences and health care providers that have treated/interacted with the patient and family. Currently, certain components of the patient's care, such as behaviors secondary to dementia and triggers to behaviors, are typically learned through trial and error or not until a family member alerts the nurse of the concern. The ADMIT Me tool brings attention to behavioral concerns and addresses techniques that have been helpful in de-escalating behaviors. By knowing the patient's baseline behavior, triggers to behaviors, and calming techniques, it allows the nurse to create an individualized plan of care.

Members of the nurse and first responder focus groups affirmed that it can be challenging to determine the baseline mental status of an individual with dementia. Having baseline mental status on the ADMIT Me tool (Table B, available in the online version of this article) allows health care providers to quickly identify changes in condition. Having a baseline allows the nurse to better assess the patient's reactions to medications and treatments, and ultimately evaluate whether the patient's condition is improving or declining.


            Emergency Information: Admit me Alzheimer's, Dementia, and Memory Impaired Transitions
            Emergency Information: Admit me Alzheimer's, Dementia, and Memory Impaired Transitions

Table B:

Emergency Information: Admit me Alzheimer's, Dementia, and Memory Impaired Transitions

In addition, communication and collaboration is enhanced among the health care team. The various sections of the tool, including contact information for health care providers, medication table, and checklists for medical conditions and behaviors, help prevent crucial data from being missed in handoff reports. It also saves time that would be spent searching for this information. Through the regular updating of ADMIT Me, nurses and other health care team members can focus on implementing the patient's plan of care. ADMIT Me serves as the vehicle for continuity of care and prevents costly errors that can result from gaps in data, and allows health care providers to make the necessary adjustments to the patient's care plan as they work with one another in achieving a smooth care transition.

Conclusion

Paramedics transport a man with dementia to the ED. They pass off the ADMIT Me tool to the primary ED nurse, who is able to contact the patient's daughter to inform her that her father is being admitted to the hospital. The patient care technician reports to the nurse that the patient repeatedly calls for his wife and is pacing in his room. The nurse reviews the ADMIT Me tool and finds that this is baseline behavior for the patient that can be relieved by singing his wedding song, “A Kiss to Build a Dream On.” The nurse and patient care technician are able to play this in the room as they settle the patient and conduct a thorough admission assessment.

This vignette illustrates the potential of the ADMIT Me tool. It is often tempting to treat a manifestation of a condition with a medication. However, ADMIT Me allows nurses and other health care professionals to practice holistically by identifying the least restrictive, calming interventions, and to foster stronger relationships built on trust with patients. In doing so, nurses and the health care team are able to practice quality patient-centered care.

Patients with Alzheimer's disease or other forms of dementia are often unable to communicate their needs and may not always have caregivers present who are familiar with their conditions. Not having a caregiver present becomes a safety concern when patients are in an unfamiliar environment and transitioning from one care setting to another.

With the number of those affected by dementia expected to grow as the aging population also increases (NIA, n.d.), health care providers, patients, and families all benefit from smooth care transitions from home to hospital. Nurses will be crucial in addressing the need for smoother care transitions for patients with dementia (World Health Organization, 2016).

Care transitions must be coordinated to decrease caregivers' stress and relieve the burden on the health care system by improving communication, collaboration, and patient-centeredness of care for individuals with dementia. The ADMIT Me tool addresses a critical gap that is evident in the current literature and conversations with nurses, caregivers, and first responders, as shown in the various focus groups. ADMIT Me has the potential to prevent frustration during hospitalization, promote holistic care, and enable nurses to have quality conversations with the patient's family and health care team regarding the patient's health conditions.

References

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Interview Protocol

Project: Pilot Study of Tool (ADMIT Me) to enhance care transitions for those individuals with memory loss/dementia
Date: Place:
Questions:
Have you ever experienced a care transition where you wished you had more information?
How would you describe care transitions presently for patients with dementia?
What is the biggest barrier to care transitions for patients with dementia?
What makes for smooth care transitions?
How would ADMIT Me ease your role in care transitions?
Would ADMIT Me help facilitate smooth care transitions?
What information do you find most helpful on ADMIT Me?
What information do you find least helpful on ADMIT Me?
Would you find this useful to use?
How would you suggest dissemination? Make it available? Hang on refrigerator like File of Life?
Is there any information you would add/subtract/change to ADMIT Me? Additional thoughts, comments, suggestions…
Thank you for coming. If you have any additional thoughts or concerns you can contact me at Elms
College. My information is on your consent form.

Emergency Information: Admit me Alzheimer's, Dementia, and Memory Impaired Transitions

Name:_______________________________ Nickname: _____________________________
Address: __________________________________________________________________________________________
Date of Birth: _____/_____/_____ Sex: M F Blood Type:__________________
Height__________Weight_________
CODE STATUS: ( )Full ( )DNR ( )CMO ( )Other__________
**Attach: Medical Orders for Life Sustaining Treatment (MOLST)
HEALTH PROVIDER SIGNATURE:__________________ DATE:_________
ALLERGIES/reactions (medication, food, etc.):
_______________________________________________________________________________________
_______________________________________________________________________________________
Hospital of Choice:_______________________________________________________________________
Power of Attorney or Healthcare Proxy? ( (if YES, attach and fill in below)
Name of Healthcare Proxy: ________________________________________________________________
Home Phone #:_______________________ Cell Phone #:_______________________
Alternate Name: _______________________ Phone #:_______________________
EMERGENCY CONTACTS (1st responders, use these contacts)
Name: _______________________ Home/Cell Phone #:_______________________
Relation: _______________________ Work Phone #:_______________________
Name: _____________ Home/Cell Phone #:_______________________
Relation: ____________ Work Phone #:_______________________
Primary Provider: ____________ Specialty Provider: ____________
Phone #:____________ Phone #:____________
Address/Practice: ____________ Address/Practice: ____________
Home Care Provider: ____________ Phone #:____________
MEDICAL INSURANCE
Med Ins Company: ________________________________________________________________________
Policy #:________________________________________________________________________
Other Med Ins Company: ____________________________________________________________
Policy #:________________________________________________________________________
ATTACH RECENT PHOTO. POST ON REFRIGERATOR.
Running head: FOCUS GROUP MEETINGS 24
MEDICAL DATA Last Updated:___/___/___
Surgeries & Dates:________________________________________________________________________
MEDICAL CONDITIONS (check all that apply)
Alzheimer's Disease Dementia Implanted Devices/Stents
Anemia Diabetes Leukemia/Lymphoma
Angina/M.I. Dialysis: Mon Tue Wed Th Fri Sat Memory Impaired
Asthma Eye Disease: Glaucoma/Macula Pacemaker
Bleeding Disorder Fistula Restricted Extremity: L R
Cardiac Dysrhythmia G.I Bleed Renal Failure
Clotting Disorder Heart Failure Seizure Disorder
COPD Heart Valve Prosthesis Stroke
Coronary Bypass Graft Hypertension Transplant
Other Medical Conditions:______________________________________________________
Medications (Use pencil to make changes)
Name of Medication Amount Time of Day
Name and phone # of Pharmacy: ______________________________________________________
DEVELOPMENT OF A TOOL FOR CARE TRANSITIONS 25
Baseline Mental Status: _________________________________________________________________________
COMMUNICATION (check all areas that apply)
( )Primary language:_____________________ ( )Non-Verbal ( )Uses Sign Language ( )Blind ( )Deaf ( )Hearing Impaired ( )Vision Impaired Other:___________________________
ASSISTIVE DEVICES (check all areas that apply)
( )Hearing aids ( )Dentures ( )Glasses ( )Walker ( )Cane ( )Wheelchair ( )Other:_________________
PERSONAL CARE (check the areas where help is needed)
( )Dressing and Undressing ( )Bathing or Showering ( )Grooming ( )Eating ( )Walking ( )Transferring (e.g.; bed to chair, etc.) ( )Toileting ( )Taking Medications
BEHAVIORS (check all that exist)
Biting Inappropriate sexual behavior Swearing
Calling out for loved one Multiple phone calls Spitting
Complaining Pacing up and down Suspicion
Following/Shadowing Repetitive questions Sleeplessness
Hallucinations Repetitive phrases Sundowning
Hiding and losing things Repetitive actions/movements Trying to leave building
Hitting Scratching Undressing in public
Hoarding Shouting or screaming Wandering
Intentional falling
TRIGGERS TO BEHAVIORS:___________________________________________________________________
CALMING TECHNIQUES (check all that apply)
( )Music – ( )Swing ( )Big Band ( )Rock n' Roll ( )Classical ( )Other:_________________ ( )Singing ( )Stuffed animals ( )Baby doll ( )Reminiscing ( )Exercise ( )Holding hands
( )Arts & Crafts ( )Housework (e.g. folding laundry) ( )Other____________________________________________________________________________________________
Favorite Conversations Enjoyed: ______________________________________________
Activities/Interests/Hobbies: ___________________________________________________________
Nutritional Preferences/Considerations/Difficulty Swallowing: _________________________________
Completed by: _____________________________ Relationship:_________________ Date:_______
ADMIT Me was designed by Elms College School of Nursing students and faculty in 2015. Delina DeVillier, Erica Dybas, Meghan Sullivan and Dr. Janet Moore were the original creators. Copyright pending. Address correspondence to: moorejanet@elms.edu.
Authors

Dr. Moore is Associate Professor, and Ms. Sullivan is Doctor of Nursing Practice Student, Elms College, Chicopee, Massachusetts.

The authors have disclosed no potential conflicts of interest, financial or otherwise.

The authors thank Delina DeVillier, BS, RN, and Erica Dybas, BS, RN, for their assistance in creating the ADMIT Me tool and facilitating focus group meetings.

Address correspondence to Janet R. Moore, PhD, RN, Associate Professor, Elms College, 291 Springfield Street, Chicopee, MA 01013; e-mail: moorejanet@elms.edu.

Received: August 08, 2016
Accepted: November 15, 2016
Posted Online: January 17, 2017

10.3928/00989134-20170112-01

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