Fourteen-Year Trends in the Use of Psychotropic Medications, Opioids, and Other Sedatives Among Institutionalized Older People in Helsinki, Finland
This study aimed to investigate trends in the prevalence of psychotropics, opioids, and sedative load in a LTC setting over a 14-year period. We also explored the interaction of psychotropic and opioid use according to residents ’ dementia status in nursing home (NH) and assisted living facility (ALF) settings. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2019 Category: Health Management Authors: Hanna-Maria Roitto, Hannu Kautiainen, Ulla L. Aalto, Hannareeta Öhman, Jouko Laurila, Kaisu H. Pitkälä Tags: Original Study Source Type: research

Is There an Opioid Crisis in Nursing Homes?
In this issue of JAMDA, several articles appear that discuss opioid use in nursing homes. The first, by Roitto et  al, found that the prevalence of opioid use in Helsinki nursing homes nearly tripled to 30.2% in 2017. In addition, the concomitant use of psychotropics was common.1 This is consistent with findings from US nursing homes in which nearly one-third of long-stay residents in 2012 received an opioid i n a 120-day follow-up period.2 The second study in this issue is by Torchia et al. These study authors examined the new use of opioids after a fragility fracture of the hip, humerus, and radius in US elders...
Source: Journal of the American Medical Directors Association - February 27, 2019 Category: Health Management Authors: Jennifer Pruskowski, Joseph T. Hanlon Tags: Editorial Source Type: research

A Case of Barium Enema –Induced Anal Fistula in a Long-term Care Resident: An Imperative to Avoid Barium Enema as a Screening and Diagnostic Tool in the Elderly
The use of barium enema study has decreased as lower GI endoscopy becomes more prevalent. However, it is still used in several clinical settings given benefits of sedation avoidance, less invasiveness and low cost. Even though barium enema is a relatively safe study, complications may result in rare cases. Colonic perforation is the most frequent serious complication, occurring in 0.02 to 0.04% of patients. Extra peritoneal perforation is usually less catastrophic than intra peritoneal perforation, but may result in pain, abscess, rectal stricture or fistula. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2019 Category: Health Management Authors: So Yeon Chung, S.Y. Chung, K. Sharma Tags: Case Report Source Type: research

A Case of the Uncontrollable Tears
Pseudobulbar affect is a common cause of “emotional lability” in patients with neurodegenerative disorders and can significantly affect a patient's quality of life. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2019 Category: Health Management Authors: Xin Zhang, X. Zhang, B. Verdoorn Tags: Case Report Source Type: research

Actinomyces Odontolyticus Bacteremia in an Immunosuppressed Patient
Mr. X is an 81-year-old male with history of atrial fibrillation, meningioma, and recent pacemaker placement 1 month prior reporting to the hospital after being called by the ER for positive blood cultures. Apparently, he was in ER 4 days prior with fever, chills, malaise, and shortness of breath, and blood culture and urine cultures were done. He was discharged with a diagnosis of bronchitis and given azithromycin and steroids. He had regular dental cleaning 3 weeks prior without any antibiotics prophylaxis. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2019 Category: Health Management Authors: Srividya Koduru, S. Koduru Tags: Case Report Source Type: research

Bilateral Eyelid Edema – a Subtle Presentation of Superior Vena Cava Syndrome
We present a rare case of a Caucasian female who was repeatedly evaluated for bilateral upper eyelid edema, with an eventual diagnosis with SVCS secondary to lung adenocarcinoma. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2019 Category: Health Management Authors: Ali Ahmad, A. Ahmad, S. Hussain, H. Kusz Tags: Case Report Source Type: research

Cardiac Limited Ultrasound Exam (CLUE) Protocol for CHF Management in a Skilled Nursing Facility Setting
We present a case to illustrate the role of portable ultrasound in CHF management to reduce the risk of hospital readmission for patients in SNF settings. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2019 Category: Health Management Authors: Dae Hyoun Jeong, D.H. Jeong, J. Albers, S. Saeed, A. Mohammad Tags: Case Report Source Type: research

Cerebral Amyloid Angiopathy Limits Treatment of Stroke
Cerebral amyloid angiopathy (CAA) is a predominantly sporadic degenerative vasculopathy characterized by beta-amyloid deposition in the cerebral microvasculature, which may lead to lobar intracerebral and sulcal hemorrhage in older adults. Although relatively common after the 7th decade of life (>50% of persons), CAA rarely impacts the management of stroke in those living with CAA disease. In cases of severe CAA, reconsideration of traditional thrombolytic and antiplatelet therapies is warranted to reduce risk of CAA-related hemorrhage. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2019 Category: Health Management Authors: Monica Gavaller, M. Gavaller, H. Oh Tags: Case Report Source Type: research

Co-Residents in a Long-Term Facility-Can They Affect Mortality and Quality of Life?
Frontotemporal dementia (FTD) is a group of neurodegenerative disorders where there is atrophy of the frontal/temporal areas of the brain responsible for executive function and language. Primary progressive aphasia is a subtype of frontotemporal dementia, primarily affecting language. Language and communication skills typically decline gradually and subsequently, impacting interactions with others. There is literature that looks at the relationship and communication between residents, families and nursing home staff. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2019 Category: Health Management Authors: Urmi Das, U. Das, N. Sattar, M. Bednarczyk Tags: Case Report Source Type: research

Cryptogenic Cirrhosis: Nonalcoholic Steatohepatitis Despite the Absence of Risk Factors?
We report an unusual case of cryptogenic cirrhosis due to nonalcoholic fatty liver disease (NAFLD) in a patient with no known risk factors for nonalcoholic steatohepatitis (NASH). (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2019 Category: Health Management Authors: Sara Sharif, S. Sharif, H. Oh Tags: Case Report Source Type: research

Hospital Discharge of Tuberculosis into a Skilled Nursing Facility: A Case Report
Skilled nursing facilities are familiar with mandatory requirements for screening for tuberculosis for patients and health care workers. However, they may not be as familiar with guidelines for admission and isolation of patients with active tuberculosis (TB) who need placement in a skilled nursing facility. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2019 Category: Health Management Authors: Kevin Parks, K. Parks, A. Chandra Tags: Case Report Source Type: research

Human Immunodeficiency Virus in Octogenarians, Lessons for Long Term Care Providers
Relatively recent advancements have transformed Human Immunodeficiency Virus (HIV) from a rapidly progressive disease to a chronic health condition. The impact on the increasing number of these patients will continue to be seen in PA/LTC settings. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2019 Category: Health Management Authors: Kevin Parks, K. Parks, P. Takahashi Tags: Case Report Source Type: research

It's the Antibiotic, Not the Infection: An Unusual Case of Delirium
Delirium is a common cause of hospital admission from nursing homes. This case discusses a nursing home resident admitted to the hospital for acute mental status changes (AMS) secondary to ertapenem-induced delirium. Increased awareness of this rarely seen antibiotic side effect and consideration of all medications as possible etiologies for delirium is important as nursing home providers are tasked with caring for increasingly multi-morbid and acutely ill patients. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2019 Category: Health Management Authors: Idona Brewer, I. Brewer, D. Antimisiaris, B. Setters Tags: Case Report Source Type: research

Misdiagnosis of Rapidly Progressing Necrotizing Fasciitis —A Close Call
Interdisciplinary discussions are tremendously important, especially during possible end-of-life cases. Prior to initiating potentially deadly end-of-life medications, a patient's general clinical picture should be taken into account. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2019 Category: Health Management Authors: Erika Hutz, E. Hutz, P. Merai Tags: Case Report Source Type: research

Proton Pump Inhibitors and Hypomagnesemia
Patient is a 73-year-old female with chronic kidney disease 3 who presented to the hospital with abnormal lab results through a primary care doctor's office. Magnesium level was 0.6 mg/dL and calcium 6.6 mg/dL despite being on chronic oral magnesium, calcium supplements and one time outpatient mg infusion. Patient had a chronic mild hypomagnesemia [magnesium range between 1.4-1.6 mg/dl] and hypocalcemia [calcium range 7.5-8.1 mg/dl] for the past 1.5 years despite being on oral supplements. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2019 Category: Health Management Authors: Srividya Koduru, S. Koduru, L. Bandi Tags: Case Report Source Type: research

Recurrent Shingles in a Frail Nonagenarian
Herpes Zoster (HZ) is a neurocutaneous disease caused by reactivation of latent Varicella Zoster Virus (VZV). Although up to 20% of people develop shingles during their lifetime, it predominantly affects older individuals. The lifetime recurrent rate of HZ in the general population is approximately 1-6%, and it is increased in people with advanced age, disease, and compromised immune system. It may progress to post-herpetic neuralgia (PHN), leading to significant dysfunction, debility, and morbidity. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2019 Category: Health Management Authors: Shujing Lin, S. Lin, A. Ahmad, H. Kusz Tags: Case Report Source Type: research

Transitioning from Insulin to DDP-4 Inhibitors for Type 2 Diabetes
Dipeptidyl-peptidase 4 (DPP-4) inhibitors are a relatively new treatment regimen for Type II Diabetes Mellitus (T2DM) and are associated with less hypoglycemia than insulin. There are no published data regarding the effects of these drugs on insulin therapy. This case series presents findings from a cohort of older adults on insulin who received DPP-4 treatment with the intention of discontinuing insulin, if possible. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2019 Category: Health Management Authors: Irene Hamrick, I. Hamrick, M. Goblirsch, W.-J. Tuan Tags: Case Report Source Type: research

Unique Acupuncture Headache Protocol for Chronic Daily Headache
Pain is a very common problem in U.S. adults, especially in adults more than 65 years old. 40-80% of nursing home. Headache is one of the most frequent complaints in older people. Chronic headache is defined as having a headache on at least half the days for 3 months or more; it affects 3-4% of the general population, and there is no data regarding nursing home residents. Chronic daily headache is challenging to manage, especially in older, frail nursing home residents. Current headache management is medication based. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2019 Category: Health Management Authors: Xiangrong Shao, X. Shao, S. Khan Tags: Case Report Source Type: research

Wound Care Consultation in PA/LTC: Characteristics and Practice Challenges
Wound care is an important topic in PA/LTC in terms of  quality measurement, risk management, reimbursement, and cost. Despite its importance, characteristics of residents with wounds and prevalence of wound types have not been well studied. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2019 Category: Health Management Authors: Santhini Namagiri, J.M. Levine, R. Menezes, S. Namagiri, R. Spinner, G. Brandeis Tags: Case Report Source Type: research

Early Implementation of Dedicated Geriatric Training for Internal Medicine Resident Physicians
The practice of geriatric medicine is an integral component of residency training in internal medicine. In fact, the Accreditation Council for Graduate Medical Education (ACGME) in Internal Medicine specifies that training programs should have a dedicated geriatric education coordinator, and residents should have an assignment in geriatrics with sufficient clinical exposure. Such an assignment exposes residents to clinical experience in both outpatient geriatric clinics and assisted nursing facilities. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2019 Category: Health Management Authors: Ali Ahmad, A. Ahmad, H. Kusz, V. Kollu Tags: Education Source Type: research

ECHO Care of the Elderly – Using Technology to Build Capacity of Primary Care Providers in Long-term Care
Project ECHO (Extension for Community Healthcare Outcomes) is an educational program that uses videoconferencing technology to link primary care providers in local communities with expert interprofessional teams at an academic hub in order to build capacity of primary care providers and promote a learning and support community. Each ECHO session includes a short presentation by specialists on specific topics of interest followed by cases presented by the learning partners (spokes). Feedback and recommendations on cases are provided by both the Hub and spokes. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2019 Category: Health Management Authors: Sid Feldman, L. Sokoloff, S. Feldman, A. Moser, D. Conn Tags: Education Source Type: research

Integrating the Online Core Curriculum on Medical Direction in PA/LTC in an Academic Family Medicine Residency Nursing Home Experience
Introducing residents of family medicine programs to a standardized nursing home curriculum is key to not only providing educational opportunities but ultimately providing quality, compassionate care to residents of nursing homes. Many graduates of family medicine programs will have opportunities to practice in the nursing home setting, and as such, having early exposure to the Society for Post-Acute and Long-Term Care Medicine organization is vital. Having previously been in assisted living facilities and family care homes, the Duke Family Medicine residency program was poised to create a unique learning experience integr...
Source: Journal of the American Medical Directors Association - February 27, 2019 Category: Health Management Authors: Teah Bayless, T. Bayless Tags: Education Source Type: research

Nutrition Pathway for Clostridium Difficle Infection (CDI) Colitis in Long-Term Care
A Center for Disease Control National Healthcare Safety Network (NHSN) study involving 38 long-term care facilities (LTC) in South Carolina (SC) identified gaps in educational and care tools addressing clostridium difficile infections (CDI), particularly with respect to the nutritional care needs and prevention of CDI through nutritional interventions. As the NHSN study results were collected, we found the CDI incidence in SC LTC settings was low, with more residents admitted to LTC with the CDI diagnosis and on treatment rather than contracting CDI during the LTC stay. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2019 Category: Health Management Authors: Sarah Smith, M.W. Mohr, S. Smith Tags: Education Source Type: research

Role of the Advanced Practitioner in the Delivery of Quality Care in the Post-Acute Care Setting
Though the cost of health care is rising, and our aging population is becoming more medically complex, hospital length of stays are shorter and the utilization of skilled nursing facilities (SNFs) has increased. A large proportion of patients admitted into a SNF are readmitted into the hospital within 30 days. Many hospital transfers from SNFs are potentially avoidable. Our objectives are 4-fold: 1) to identify the benefit of having Advanced Practitioners (APs) embedded in a SNF; 2) to explain various strategies that we employ to reduce hospital readmissions and prevent ED visits of SNF patients; 3) to provide insight into...
Source: Journal of the American Medical Directors Association - February 27, 2019 Category: Health Management Authors: Kevin Robatin, M.L. Robatin, K. Robatin, S. Reed Tags: Education Source Type: research

Using Respiratory Care Practitioners to Reduce Readmissions by Managing Cardiopulmonary Patients in a Skilled Nursing Facility
Patients with complex cardiopulmonary disorders pose unique challenges to acute and post-acute care teams. They present with multiple comorbidities, are at high risk for hospital readmission, and struggle with adherence to their treatment regimens. Despite their medical challenges, however, they are typically discharged from acute care with no respiratory support. When seen in the skilled nursing facility (SNF), they require a higher level of care than most SNFs can successfully provide. The goal of this pilot was to determine if the addition of a respiratory care practitioner (RCP) to the interdisciplinary care team at a ...
Source: Journal of the American Medical Directors Association - February 27, 2019 Category: Health Management Authors: Janene Harper, V.J. Mandal, V. Florentine, J.e Harper Tags: Education Source Type: research

A Quality Improvement Project Using Fall Management Clinical Algorithms in a Long-Term Care Unit
Falls have been an ongoing and reportable problem in long-term care (LTC) facilities. Moreover, falls can lead to serious physical, psychological and financial consequences for residents, their families and the staff. Each resident has individual risk factors for falling. Multifactorial interventions, or strategies that target multiple risk factors for falls, have been shown to reduce the number of falls and are recommended for fall prevention and management. The initial step in fall prevention and management includes identifying each resident's risk factors upon admission into the facility and after each fall. (Source: Jo...
Source: Journal of the American Medical Directors Association - February 27, 2019 Category: Health Management Authors: Bianca Lopez, B. Lopez, F. Naqvi, T. Majid, B. Windemuth Tags: Quality Improvement Source Type: research

A Quality Improvement Project Using PAINAD to Improve Pain Management and Opioid Reduction in Persons with Dementia
Pain identification and management for patients with dementia can be a challenge given difficulties with communication and atypical presentations. Recent review of the CIHI data for this LTC site showed a trend towards an increase in the QI indicator “has pain” from 6.70% in Q1 of 2015 to 9.0 in the most recent assessment in the 4th quarter of 2017. The current pain assessment tool used across our sites, which includes a visual analogue scale, is not specific to patients with dementia. This tool can be time consuming and cumbersome with nume rous questions that pose a barrier for consistent use amongst staff. (...
Source: Journal of the American Medical Directors Association - February 27, 2019 Category: Health Management Authors: Itode Ewa, L. Bailey, I.V. Ewa, L.K. Gibson, J.J. Bailey, M.L. Celis Tags: Quality Improvement Source Type: research

Accurate CMS Documentation of ADL Self-performance and Support
Since 1997, Medicare has implemented a Prospective Payment System [PPS] for a covered Skilled Nursing Facility service using a prospective, case-mix adjusted per diem payment rate. This methodology has evolved to capture compensation for staff, utility costs, and product costs (pharmaceuticals, food, etc.) and has simplified resident care needs into relatively homogenous reimbursement groups. The present iteration, called the Resource Utilization Groups – Version IV [RUG-IV], has 8 distinct groups outlined, which are tiered by level of skilled service provided, need for extensive services, clinical complexity, and re...
Source: Journal of the American Medical Directors Association - February 27, 2019 Category: Health Management Authors: Guy Fogg, G. Fogg, C. Huhn Tags: Quality Improvement Source Type: research

Adaptive Behavior Assessment and Intervention Tool (ABAIT)
Behaviors and psychological symptoms of dementia (BPSD) are problematic to caregivers. The Adaptive Behavior Assessment and Intervention Tool (ABAIT) is a BPSD management algorithm and personalized intervention program on an electronic platform that learns and suggests what interventions have worked for a given older adult with dementia. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2019 Category: Health Management Authors: Irene Hamrick, I. Hamrick, S. Bottum-Jones Tags: Quality Improvement Source Type: research

An Educational Program for Post-Acute and Long-Term Care Staff Targeting Behavioral and Psychological Symptoms of Dementia
This study highlighted the need for staff to be able to identify and treat dementia and BPSD. The management in our facility had noted escalations in BPSD and identified a potential learning opportunity for staff on recognizing and addressing BPSD. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2019 Category: Health Management Authors: Monica Stout, M. Stout, N. Ramlal, K. Thompson, B. Dotson, L. Genao, G. Buhr Tags: Quality Improvement Source Type: research

Are Assisted Living Memory Care Residents Meeting Hydration and Nutritional Requirements? A Quality Improvement Project
The assisted living memory care (ALMC) population presents with specific needs and challenges. Recognition that inadequate hydration and nutrition intake is associated with numerous common quality indicators such as falls and re-hospitalization promoted this project. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2019 Category: Health Management Authors: Phyllis Gaspar, P. Gaspar, S. Finsaas, M. Holmes, K.T. Brugge Tags: Quality Improvement Source Type: research

Asymptomatic Bacteriuria Identification and Management in Long Term Care Facility
Antibiotic treatment for asymptomatic bacteriuria is one of the key contributors to antibiotic overuse in long-term care. The guidelines from the Infectious Diseases Society of America (IDSA) suggest that antibiotic treatment of asymptomatic bacteriuria can only bring harm to the patient. However, inappropriate antibiotic treatment for asymptomatic bacteriuria in long-term care remains common. A retrospective chart review on a 40-bed unit in a city-based long-term care facility found that 55% of the patients with no definitive diagnosis of urinary tract infection were placed on antibiotics without documented reason. (Sourc...
Source: Journal of the American Medical Directors Association - February 27, 2019 Category: Health Management Authors: Yan Liu, Y. Liu, B. Windemuth Tags: Quality Improvement Source Type: research

Creating a Concierge Urgent Referral Process for Residents in the Post-Acute Setting by means of partnerships with Local Acute Care Systems
Given the growing older population, chronic disease management will continue to be a major focus of the government, health insurers and providers. Historically, the care system consisted of multiple silos with minimal integration, leading to overutilization without significant impact on quality of care. Not surprisingly, older adults have higher frequency of visits to emergency departments compared to their younger counterparts. Most importantly, they experience a higher incidence of poor outcomes due to prolonged ED stays and/or hospitalizations. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2019 Category: Health Management Authors: Yonette Davis, Y. Davis, J. Gabriel Tags: Quality Improvement Source Type: research

Decreasing Disruptive Behavior While Decreaseing Psychoactive Medications in Our Nurisng Facility
Many older adults would like to remain at home as they age. Many of these older adults have dementia and behavioral health challenges. Psychoactive medications such as antipsychotics and anxiolytics are prescribed to manage these behaviors and facilitate the provision of care by the family members. These medications often place the individual at risk for sedation, falls, elevated blood sugar, elevated lipids, and even sudden death. Additionally, some carry a “black box” warning if prescribed for management of behavior in patients with dementia. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2019 Category: Health Management Authors: Ritamarie Moscola, R. Moscola, J. Scheriff, C. Oliver, S. Whitcomb Tags: Quality Improvement Source Type: research

Developing a Culture of Antibiotic Stewardship in Post-Acute Care Setting
Antibiotics are among the most frequently prescribed medications in nursing homes, with up to 70% of residents receiving 1 or more courses of systemic antibiotics in a year. Forty to 75% of antibiotics prescribed in nursing homes may be unnecessary or inappropriate. Harm from antibiotic overuse is significant for the frail and older adults receiving care in nursing homes. As of November 2016, at the Coler Rehabilitation and Nursing Care Center (a 815-bed post-acute/long-term care facility affiliated with NYC Health and Hospitals, the largest public health care system in the United States), less than half of the residents t...
Source: Journal of the American Medical Directors Association - February 27, 2019 Category: Health Management Authors: Khoi Luong, K. Luong, S. Catullo Tags: Quality Improvement Source Type: research

Evaluating the Namaste Care Program to Improve Quality of Living and Dying for Residents with Advanced Dementia in Long-Term Care
Residents living and dying in long-term care (LTC) homes represent one of society ’s most frail and marginalized populations of older adults, particularly those residents with advanced dementia who are often excluded from activities that promote quality in their last months of life. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2019 Category: Health Management Authors: Sharon Kaasalainen, S. Kaasalainen Tags: Quality Improvement Source Type: research

Evaluating the Strengthening a Palliative Approach in Long-Term Care (SPA-LTC) Program in Canada
Palliative care in long-term care (LTC) homes is a global problem. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2019 Category: Health Management Authors: Sharon Kaasalainen, S. Kaasalainen Tags: Quality Improvement Source Type: research

Evaluation of the MaineHealth Skilled Nursing Facility Congestive Heart Failure Protocol
Acute exacerbation of congestive heart failure (CHF) is the most common reason for Medicare patients to be readmitted to the hospital within 30 days of discharge. Data about managing CHF in the skilled nursing facility (SNF) is sparse and what exists has been extrapolated from guidelines for community dwelling older adults. The MaineHealth SNF CHF protocol is a nursing-triggered, but provider-driven, standardized procedure for monitoring patients with CHF that is ordered upon admission to SNF. Once a patient is identified, providers follow a step-wise algorithm for the day-to-day adjustment of diuretics based on the target...
Source: Journal of the American Medical Directors Association - February 27, 2019 Category: Health Management Authors: Sarah Hallen, S. Hallen, M. Caminiti, R. Marino, E. Shao, A. Cannon, R. Veilleux, K. Dmytrasz, H. Wierman Tags: Quality Improvement Source Type: research

Fall Reduction Program in a Skilled Nursing Facility: a Multidisciplinary Approach
Adults over the age of 65 are at high risk of mortality and morbidity from fall-related injuries. It is estimated that between 10-20% of falls in long-term care result in serious injury. It is imperative that strategies be developed to decrease the risk of falls in this setting. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2019 Category: Health Management Authors: Tiffany Rose, T. Rose, D. Flinchum, J. Proctor McCollum, J. Demons Tags: Quality Improvement Source Type: research

Focused Heart Failure SBAR Implementation in Home Health Care to Increase Interventions in the Home and Decrease Re-Hospitalizations Among HF Patients
This paper focuses on a quality improvement (QI) project implemented in a home health setting among a population of patients with heart failure (HF). It was discovered there was a lack of nurse-led recommendations and ineffective use of the situation, background, assessment, recommendations tool (SBAR) among home health nurse when communicating with providers about heart failure patients. Therefore, the QI project focused on creating and implementing a focused HF SBAR tool and a self-care patient checklist to be utilized by all home health nurses for all visits with heart failure patients. (Source: Journal of the American ...
Source: Journal of the American Medical Directors Association - February 27, 2019 Category: Health Management Authors: Christina Leonard, C. Leonard, M. Zomorodi Tags: Quality Improvement Source Type: research

Impact of Bed Alarm Removal and Implementation of Hourly Rounding to Reduce Falls
Audible pressure bed and chair alarms in the post-acute and long-term setting (PA/LTC) have proven to be an ineffective intervention for reducing falls and in fact have met criteria as a physical restraint according to the Centers for Medicare and Medicaid Services. A.G. Rhodes Health and Rehab facility (AGR) is a 150-bed non-profit nursing organization situated in Atlanta, Georgia, committed to fall prevention. As a 2-pronged approach, AGR eliminated all pressure alarms from its facility and implemented a patient-centered hourly rounding policy among nursing staff. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2019 Category: Health Management Authors: Monica Gavaller, M. Gavaller, H. Oh Tags: Quality Improvement Source Type: research

Impact of the EMediCal Application on the Efficacy of Clinical Communication Among Health Care Providers (HCP) and Nursing Home (NH) Staff
Clear and complete communication between health care providers (HCP ) is a prerequisite for the safe patient management and is a key component of the Joint Commission ’s 2008 National Patient Safety Goals for Long-Term Care (LTC). There is paucity of literature addressing communication challenges and related barriers in the nursing home (NH) setting, with even less data available regarding the use of smart phone apps. An ideal communication tool would be bidire ctional, rapid, secure, and capable of non-disruptive transmission with content-rich messages. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2019 Category: Health Management Authors: Shaista Ahmed, S. Ahmed, P. Magidson, F. Sheikh, M. Bellantoni Tags: Quality Improvement Source Type: research

Implementation of Function-Focused Care to Change Practice Behavior of Direct Care Workers in Assisted Living
Assisted living (AL) communities are home to over 830,000 adults, who are mostly 85 years and older. Older adults in AL spend the majority of their waking time sedentary and experience more decline in functional performance compared to nursing home residents. Decreased physical activity and functional impairment are strong predictors of adverse outcomes, institutionalization, and decreased quality of life. Routine care provided by direct care workers (DCWs) traditionally focuses on task completion, which limits residents ’ function and physical activity. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2019 Category: Health Management Authors: Jade Kim, J. Kim, B. Windemuth Tags: Quality Improvement Source Type: research

Implementation of Interdisciplinary Wound Care Rounds in a Skilled Nursing Facility
There is scant literature regarding interdisciplinary teams providing wound care in long-term care. Our long-term care facility did not have a consistent process for evaluation and treatment of wounds by nursing and physician teams. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2019 Category: Health Management Authors: Monica Stout, M. Stout, A. Ogunwale, N. Ramlal, K. Thompson, G. Buhr, L. Genao Tags: Quality Improvement Source Type: research

Improving Antibiotic Stewardship Program's Educational Materials in the Long-Term Care Setting
In November 2017, the Center for Medicare and Medicaid Services (CMS) mandated the implementation of Antibiotic Stewardship Programs (ASP) within Long-Term Care (LTC) facilities in the United States. A core element of this initiative is to provide multidisciplinary educational materials for practitioners, staff and residents and their families. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2019 Category: Health Management Authors: Andre Smyth, A. Smyth, S. Fridkin, S. Sefton, S. Saiyed, A. Bender Tags: Quality Improvement Source Type: research

Improving Deep Tissue Pressure Injury (DTPI) Outcomes: A 2.5 Year-long Quality Improvement Project
Long-term care facility (LTCF) residents with multiple co-morbidities, debility and cognitive loss are at higher risk of developing deep tissue pressure injury (DTPI). There is limited research supporting the treatment options for DTPIs, but offloading is recommended. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2019 Category: Health Management Authors: Autumn Henson, A. Henson Tags: Quality Improvement Source Type: research

Improving Experience of Sleep in the Community Living Center by Implementing Non-pharmacologic Interventions
Many older residents are prescribed psychoactive medications to improve sleep quality. These include antipsychotics, anxiolytics, and hypnotics. These medications are often prescribed in together and with narcotics. This practice places older adults at risk of falling, sudden death, and poor quality of life. The practice is seen in acute care and ambulatory settings. When residents are admitted to our unit, we attempt to follow CMS regulations and recommendations to provide quality care. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2019 Category: Health Management Authors: Ritamarie Moscola, R. Moscola, J. Scheriff, S. Whitcomb, C. Oliver Tags: Quality Improvement Source Type: research

Interprofessional Collaboration Improves Antibiotic Stewardship
The challenge to improve effective and safe use of antibiotics in PALTC settings is a national focus of great importance. Goals are to reduce the emergence of multi-drug –resistant organisms, AADE, and unnecessary cost. The Centers for Disease Control and Prevention (CDC) suggest AADE monitoring as one of several appropriate resident outcome measures for antibiotic stewardship programs, but AADE processes vary substantially among PALTC facilities. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2019 Category: Health Management Authors: Fatima Sheikh, B.J. Zarowitz, F. Sheikh, F.A. Naqvi, E. Heil, N. Brandt Tags: Quality Improvement Source Type: research

Music & Art in Medicine (MAM): the Effectiveness of MAM Events on the Interest and Perception of Geriatrics and Nursing Homes by Medical Students (MSs)
MAM is a MS interest group that provides community service  music and art performances. PALTC events are coordinated by the activities director. Music and Art QI projects have revealed a positive response in depression, pain, and cognition. A new QI collaboration was developed. MSs would be surveyed similar to research conducted by Janzen KM, et al., measu ring the effect of student-led educational events on geriatric patient and student participant perceptions and in research conducted by Couteur DG and Price DA reflecting MS attitudes toward older adults and careers in geriatric medicine. (Source: Journal of the Ame...
Source: Journal of the American Medical Directors Association - February 27, 2019 Category: Health Management Authors: Steven Diep, M.R. Finley, S. Diep, G. Castillo, M. Feng, J. Pious, C. Eby, A. Davila Tags: Quality Improvement Source Type: research

Palliative Care Services in a Nursing Home Setting-Influence on Care Preferences
We report results of palliative care (PC) progr am at our nursing facility. (Source: Journal of the American Medical Directors Association)
Source: Journal of the American Medical Directors Association - February 27, 2019 Category: Health Management Authors: Danuta Molenda, D. Molenda, K. Barnes, L. Riutta Tags: Quality Improvement Source Type: research