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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.

JAMDA
March 1, 2016

It was identified that nursing staff were inundating physicians with fax updates which caused frustration on the physician's part and time lost for the nurses in terms of preparing the faxes, monitoring for response, processing orders, and following up with physicians. Often times there was no “big picture” being presented to the MD, only small pieces of information at frequent intervals.

JAMDA
March 1, 2016

Nursing homes (NH) provide care to a unique subset of population that is medically, functionally, and cognitively impaired. There is evidence that the majority of residents are physically inactive. It is important to work with residents to achieve ADLs rather than provide care for, as residents in NH will experience functional decline, deconditioning, and disability if all care is provided for them. In order to alter this process, a strong mobility and restorative program is needed. Restorative care is already established in many nursing homes in the nation; however it is under-utilized...

JAMDA
March 1, 2016

Palliative sedation is defined by the AAPHM as “the intentional lowering of awareness towards, and including, unconsciousness for patients with severe and refractory symptoms”; this is generally performed after other methods to control these symptoms have failed. Refractory symptoms vary but generally include uncontrolled pain, dyspnea, or agitation.

JAMDA
March 1, 2016

Rates of healthcare- associated MDROs are increasing worldwide with US hospitals accounting for approximately 1.7 million infections and > 98,000 deaths each year. Healthcare- associated infections (HAI's) are also a major cause of hospitalization in long-term care with 1-3 million serious infections and 380,000 deaths every year. In acute care settings, rates of HH compliance > 70% have been associated with lower incidence rates of HAIs such as methicillin-resistant staphylococcus aureus (MRSA).

JAMDA
March 1, 2016

The Goodman Group defines resident wellbeing as encompassing mind, body, and spirit. Spirituality, defined as the affective approach that seeks to give meaning to life, has been found to be associated with physical and mental health and an important resource for those coping with stress. Yet a comprehensive assessment of spirituality and a related plan of care was nonexistent for the residents of the AL facilities.