The first book I reached for in 2001 when I began my serious inquiry of best nursing practices for older adults was the initial edition of this very text. In fact, I had both a home version and an office version. It was never far from my reach, and I used it daily when developing a series of teaching plans to educate nurses on the care of hospitalized elders. Because each protocol was and remains research or evidence based, it represented the state of the science on care problems faced by staff nurses caring for older adults. So, you might imagine how thrilled I was to be asked to write the foreword for the fourth edition of Evidence-Based Geriatric Nursing Protocols for Best Practice. Initially only 15 chapters, the fourth edition now has 34 chapters—testimony to the growing body of geriatric nursing knowledge. New chapters include function-focused care, catheter-associated urinary tract infection prevention, mistreatment detection, acute care models, and transitional care. There is a heightened sense of urgency to deploy these protocols in practice and education because of recent reports and policy changes that are spotlighted by the debate and discussion surrounding the passage of the 2010 Affordable Care Act. Whereas the final outcome of the law remains to be seen, Americans agree that there is an urgent resolve for action. The public is waking up to the fact that “It’s tomorrow already,” as discussed in a recent AARP Bulletin—speaking to the multitude of complex national issues, not the least of which is health care reform (Toedtman, 2011). The message to nurses is that we must embrace this reality and work to fully use and promote these geriatric nursing protocols and motivate others to do the same. Proposed changes to the Centers for Medicare and Medicaid Services (CMS) measurements of quality and cost in health care delivery include the introduction of accountable care organizations (ACO) and value-based purchasing (VBP; CMS, 2011; Welton, 2010). Delivery model innovation mandates that health care must break away from traditional models and practices and move toward more efficient and safer care—a clinical transformation calling for the use of clinical protocols and improved coordination and collaboration (Health Care Advisory Board, 2010). Although the new language may seem daunting, geriatric nurses have used this paradigm for years. A recent Wall Street Journal report on health care summarized it best by saying, “Sometimes innovation means getting back to basics” (Landro, 2011). In truth, it is exactly why geriatric nursing protocols may be better received and, most importantly, implemented in the years ahead. These protocols address basic gerontological tenets: access and quality of care, especially for vulnerable populations; prevention of iatrogenic conditions; the institutionalization of best practices; and the application of innovative and interdisciplinary models of care. These are uncertain times in health care, with new payment systems and models of care being developed; however, the overriding theme is urgency and delivering results. Therefore, take these protocols and adopt them as your unit based standards. Talk to your patients and families about how nurses have developed methods to improve their care and reduce the risk of complications. Create teaching plans that supplement the protocols with actual patient situations, develop documentation templates to integrate xii Foreword the protocols into your charting system, and develop quality improvement initiatives to measure the degree to which you are currently using these protocols and set goals to improve their use. The 2011 Institute of Medicine (IOM) report, The Future of Nursing: Leading