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JAMDA
March 1, 2016

The purpose of contact precaution is to prevent dissemination of the pathogen. In recent years, the standard protocols of imposing contact precaution were researched and practiced in nursing homes. The previous researches were mostly focused on when to initiate and discontinue the contact precautions in a hospital setting. The discontinuation protocol of contact precaution is not outlined clearly in many cases. The benefits of contact precaution are balanced with negative ramifications. Patients are often dissatisfied as they feel neglected due to restricted visits from house staff such as...

JAMDA
March 1, 2016

Diabetes mellitus is a major health problem in the United States. Patients with diabetes have significantly higher rates of mortality, morbidity, and higher health care costs. Among the common practices in long term care which has been targeted as an area of concern is the use of sliding scale insulin (SSI). SSI is associated with a high fingerstick burden and poorer glycemic control. Because of this and other data, SSI has been added to the Beers Criteria. Our geriatric practice - Austin Geriatric Specialists - currently provides medical direction and practitioner services at 14...

JAMDA
March 1, 2016

Residents living and dying in long-term care (LTC) homes represent one of society's most frail and marginalized populations of older adults. The average length of stay within LTC has decreased significantly in recent years making LTC a major location of death for frail older adults internationally. Yet, comprehensive palliative approaches to care that include early discussions about care goals, and timely end-of-life care planning is still rare.

JAMDA
March 1, 2016

Medication reconciliation commonly known as “med rec,” is identified by the Joint Commission as a process of “accurately and completely reconciling medications across the continuum of care.” The Joint Commission established National Patient Safety Goal (NPSG) 03.06.01, which is the need to maintain and communicate accurate patient medication information. The need for medication reconciliation is evident during the time of a patient transition, because medication error occurs most often when a patient transitions from one setting to another.

JAMDA
March 1, 2016

Fall is any event that leads to an unplanned, unexpected contact with a supporting surface. Between half and three-quarters of NH residents fall each year and about 10% to 20% of NH falls cause serious injuries; and 2% to 6% of those cause fractures. There are several extrinsic and intrinsic risk factors responsible for falls in nursing home. Muscle weakness and walking or gait problems are the most common causes of falls among nursing home residents.

JAMDA
March 1, 2016

FOF is a common condition that contributes to falls and loss of independence. It affects over 50% of the institutionalized elderly. Among the main contributing factors that cause FOF are comorbidities such as hypertension, cognitive impairment and osteoarthritis; also, the use of multiple medications and the history of previous falls. The measurement of weight in the functionally impaired is a challenge that requires instrumental adaptations. Such improvements, like the use of an electronic floor weighing scale, are costly going over $1400 USD.

JAMDA
March 1, 2016

Emergency Room (ER) transfers of patients from nursing homes for inappropriate reasons are expensive, worsens patient outcomes, hastens functional decline and decreases the quality of life. In reviewing call center calls for our group it was noted that many patients from nursing homes were being sent to the ER for inappropriate reasons. A QI project started in May 2010 currently ongoing with zero ER transfers for inappropriate reasons. *Inappropriate defined as patients with change in condition who can be treated either at the nursing home or be directly admitted to the acute care of the...

JAMDA
March 1, 2016

There has been the recent phenomenon of specialists seeing patients onsite in our institutions. With the increase in specialized units for dementia patients with behaviors, there has been an increase in the onsite visitation of psychiatrists. At one of our facilities, the psychiatrist no longer was able to provide in-house service. The primary care clinicians then took over the role of assessments and treatments for psychiatric care in the facility. We reviewed the CASPER data before and after this change at one skilled nursing facility.

JAMDA
March 1, 2016

Preventative interventions for pressure ulcer begin with identification of high-risk individuals. The Program of All-Inclusive Care of the Elderly (PACE) is a comprehensive care model for older adults with multiple chronic conditions. Centra, a non-for-profit regional health system head quartered in Lynchburg Virginia has two PACE sites. PACE organizations are regulated by the State and Federal government and are required to complete routine comprehensive assessment of each enrolled patient using screening tools that have been validated.

JAMDA
March 1, 2016

The Transitional Care (TC) Quality Improvement and Innovation Project was launched to ensure a safe and comprehensive transfer of elderly patients as they navigate levels of care. It aims to improve overall outcome and as such reduce the 30 day post-discharge, unplanned hospital readmission rate. In order to achieve these objectives, PRASS: Patient Risk Assessment and Stratification Screening tool (PRASS) was developed to provide a multidimensional and multiaxial approach to classifying patient's clinical status.