A Gold Standard in Geriatric Care

Student pharmacist Lauren Conway conducts a patient call to review a list of medications and relevant issues under Teresa DeLellis’ supervision and assistance.

A Manchester University pharmacist elevates community and emergency senior care.

By Linda Homewood

Dr. Teresa DeLellis, assistant professor of pharmacy practice at Manchester University, helped develop and implement new policies and protocols for senior emergency care, including data tracking and quality improvement programs. In addition to her faculty role, she also holds an appointment as a clinical pharmacy specialist in geriatrics and transitions of care at Dupont Hospital. She has been “going for the gold” since she led a compliance initiative in 2018 that earned Dupont Hospital a Bronze Level 3 Geriatric Emergency Department Accreditation. After a rigorous process, interrupted by COVID-19, her goal was realized in August when the hospital advanced to the highest standard: a Gold Level 1 accreditation in geriatric care. “As a clinician and educator, it has been rewarding to help implement geriatric-based health education for the emergency department staff who worked hard to achieve this level of care,” DeLellis said. She has a clinical practice at the Fort Wayne hospital, which is the 11th in the country to achieve the Gold status.

The American College of Emergency Physicians, with support from the Gary and Mary West Health Institute and John A. Hartford Foundation, launched the accreditation program in 2018 to recognize those emergency departments that provide excellent care for older adults. For Dupont Hospital CEO Dr. Lorenzo Suter, the Level 1 transition validates the skills of Dupont’s nurses, physicians, pharmacists and technicians in treating seniors.

"Our facility is dedicated to our mature population,” said Suter. “To care for those who once cared for us is one of the highest honors.” Identified as the most vulnerable population affected by the pandemic, seniors’ healthcare quickly rose to the forefront last spring. With board certifications in geriatric pharmacy and as a pharmacotherapy specialist, DeLellis was prepared for the challenges ahead.

Working with a new national initiative in the geriatric department process has been huge in fueling my goal of furthering quality senior care. We’ve become one of the leaders in that program and it’s rewarding to help other hospitals to develop policies in creating their programs.

Dr. Teresa DeLellis

Calling on Students to Help Seniors

In March, DeLellis began providing telehealth prescription management services to discharged hospital patients to maximize the safety and efficacy of their medications. Working closely with a physician, she calls patients to review and fine-tune their prescribed medicines. Her training in polypharmacy and deprescribing helps her identify patients who have an excessive number of prescriptions that need to be reduced.

DeLellis oversees about 18 student pharmacists each year who serve in clinical rotations at Dupont, the only hospital in the area health system with senior-specific guidelines. She tasked the students with helping to research policy and guidelines for the Gold standard achievement goals such as data tracking and clinical care objectives.

Student pharmacists also provide a medication therapy management role by helping patients understand their medications, educating them on drug safety and offering improvements as needed. The students engage in a truly multi-professional advocacy role, DeLellis noted. After reviewing medications, they confer with the physicians to discuss any issues they may find. They also help nurses with patient histories and documenting patient charts as well as educating patients about medications.

To better serve senior patients in the community, DeLellis joined a COVID-19 Senior Response Team to determine and respond to the highest needs as the pandemic encroached. The local health department and an agency on aging knew that more resources would be required for extending health services to older adults who were isolating at home. “Social isolation is a known health risk for seniors,” said DeLellis. “We provided needs priorities for getting services such as medication delivery and social connections to seniors advised to stay at home.”

First, she researched and provided a list of services to a local volunteer center that matches organizations with volunteers. Next, she recruited students (without major risk factors) who remained in the community during the COVID-19 outbreak. DeLellis knew her pharmacy students were prepared to help having learned about patient safety and geriatric pharmacotherapy, including a transitions of care topic within her courses. She connected a dozen student pharmacists to the volunteer center, creating a perfect match for health services outreach. With their studies disrupted, students were eager to provide meaningful service in the community, practicing what they had been taught.

“They did the majority of the work—giving flu shots and making phone calls to break the isolation of so many older adults staying in place. The students did everything from delivering medications to helping the seniors use a laptop or tablet to communicate with family,” DeLellis said. As a clinician and co-coordinator of Dupont’s geriatric program, DeLellis said being among the first hospitals to achieve the Gold accreditation positions her to help transform the health and wellness of seniors in other states. The achievement has led her to communicate and engage with hospitals in Arkansas, Pennsylvania, North Carolina and Florida as well as others across Indiana.

Her ultimate goal is to improve the care and quality of life for as many older adults and their families as possible. “Working with a new national initiative in the geriatric department process has been huge in fueling my goal of furthering quality senior care. We’ve become one of the leaders in that program and it’s rewarding to help other hospitals to develop policies in creating their programs.”

Linda Homewood, former news director at UF College of Pharmacy,
is a freelance health science writer.