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Wednesday, March 22, 2017

Alzheimer’s Association offers online tools to empower people to live well with dementia

Living a quality life in the early stage of dementia is an individual choice. With input from people living with the disease, the Alzheimer’s Association has launched a series of online tools to help individuals cope with and live a better life with dementia.
The resources are meant to address five key components of early-stage dementia:
·        Life After Diagnosis – Watch video clips from individuals with dementia who reflect on their emotions after receiving a diagnosis and explain how they have come to accept it
·        You Are More Than Your Diagnosis – Explore unique aspects of your identity and create a personalized word cloud
·        Live Healthy – Discover how you can lead a healthy and balanced life with dementia
·        Maximize Your Independence – Determine your strengths and learn strategies for living an independent life, such as by identifying how much you want other people to help you
·        Live In The Moment – View videos from individuals who share how their diagnosis changed their outlook on life
To view the resource, visit the Alzheimer’s Association website at: http://bit.ly/2o4t3Tl

Wednesday, March 15, 2017

What is the role of healthcare assistants in administrating drugs to nursing home residents?

Older people in nursing homes are one of the most vulnerable groups in our society. Their medical and support needs are increasingly complicated: most care home residents are over 85 years old and have multiple comorbidities, including dementia and frailty (Office for National Statistics, 2014; British Geriatrics Society, 2011). Many rely on nursing home staff to meet their everyday needs, including taking prescription medicines (Centre for Policy on Ageing, 2012).

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Thus, it is important to adopt appropriate medication procedures in care homes (Alldred et al, 2009). To reduce the risk of harm associated with medicine administration, it is recommended that care home staff undertake appropriate training and development, and care home providers are clear on staff's roles and responsibilities (National Care Forum, 2013; 2011).

The National Institute for Health and Care Excellence (2014) has published guidance on all aspects of managing medicines in nursing homes. However, the role of healthcare assistants in administering medicines to residents of care homes is poorly documented, and whether they should be performing this task has been raised by managers and staff. Often the concern is whether administering medicines is legal, or appropriate, especially if there is a registered nurse in the care home.

Some key points include:
  • Nurses can delegate the administration of medicines to a care assistant, but they are accountable for making sure those medicines are administered correctly
  • Care workers should only administer medicines they have been trained, and are competent, to give
  • Any HCA accepting the delegated task must take responsibility for ensuring their actions are carried out safely and correctly
To read the full set of guidelines, click on the following link:
https://www.nursingtimes.net/download?ac=3024062

References:

Alldred D.P. et al. (2009). Care home use of medicines study (CHUMS): Medication errors in nursing and residential care homes- prevalence, consequences, causes and solutions. Retrieved March 13, 2017 from http://www.birmingham.ac.uk/Documents/college-mds/haps/projects/cfhep/psrp/finalreports/PS025CHUMS-FinalReportwithappendices.pdf

British Geriatrics Society (2011). Quest for quality. Retrieved March 14, 2017 from http://www.bgs.org.uk/campaigns/carehomes/quest_quality_care_homes.pdf

Centre for Policy on Aging (2012). Managing and administering medication in care homes for older people. Retrieved March 14, 2017 from http://www.cpa.org.uk/information/reviews/Managing_and_Administering_Medication_in_Care_Homes.pdf

National Care Forum (2013). Safety of medicines in the care home: Final project report- Phase Two. Retrieved March 14, 2017 from http://patientsafety.health.org.uk/sites/default/files/resources/safety_of_medicines_in_the_care_home_0.pdf

National Care Forum (2011). Medication safety in care homes: Project summary. Coventry: NCF.

National Institute for Health and Care Excellence (2014). Managing medicines in care homes. Retrieved March 14, 2017 from https://www.nice.org.uk/guidance/sc1

Office for National Statistics (2014). Changes in the older resident care home population between 2001 and 2011. Retrieved March 13, 2017 from https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/ageing/articles/changesintheolderresidentcarehomepopulationbetween2001and2011/2014-08-01

Spilsbury K. et al. (2017). Guidance on administration of medicines by care assistants in nursing homes. Nursing Times 113 (2): 26-28. Retrieved March 13, 2017 from https://www.nursingtimes.net/download?ac=3024062




Wednesday, March 08, 2017

Delirium in nursing homes needs to be taken more seriously, study claims

Delirium among nursing home residents often goes undiagnosed and needs to be treated more seriously than it currently is by long-term care professionals, a new research review has found.

The review showed that delirium affects nearly 1 in 5 (18%) long-term care residents, and carries a 40% one-year mortality rate. Due to the similarities between delirium symptoms and dementia, the former often goes undiagnosed or misdiagnosed in older patients, the review's authors said in the Journal of the American Osteopathic Association.

Some of the studies included in the review showed links between delirium and a long-term care facility's environment. Restraints also upped the risk for delirium. 

Lead author Martin Forsberg, M.D., with the Rowan University School of Osteopathic Medicine, advised providers to reduce residents' non-essential surgeries, hospitalizations and medications in order to help prevent delirium.“I think, historically, we have thought of delirium as a relatively benign condition,” Forsberg said. “The data tells us we need to treat it more scientifically and more seriously than we do.”

The review also found antipsychotic medications to be a successful treatment for delirium, a finding that came with the caveat that such medications also have been linked to increased risk of death for patients with dementia.

To read he full study, click on the following link:
http://jaoa.org/article.aspx?articleid=2595723 

References:

Delirium in nursing homes not taken seriously enough, study asserts. (2017, January 09). Retrieved March 7, 2017, from http://www.mcknights.com/news/delirium-in-nursing-homes-not-taken-seriously-enough-study-asserts/article/630527/ 

Forsberg, M.M. (2017) Delirium Update for Postacute Care and Long-Term Care Settings: A Narrative Review. The Journal of the American osteopathic Association, 117 (1), 32. Retrieved March 7, 2017, from http://jaoa.org/article.aspx?articleid=2595723




Monday, February 27, 2017

AHRQ releases new resource to help nursing homes with pressure ulcers

The Agency for Healthcare Resource and Quality (AHRQ) has released a new resource to help nursing homes address pressure ulcers that are slow to heal. 


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Pressure ulcers are still a serious problem in nursing homes despite best efforts to encourage their prevention and treatment.  In Canada, compromised wounds were reported in almost 10% of continuing long-term care residents.Along with pain, disfigurement, and an increased infection risk, pressure ulcers are associated with longer hospital stays and increased morbidity and mortality.

The On-Time Pressure Ulcer Healing was developed to provide nursing homes that have an electronic medical records (EMRs) system with tools to effectively monitor and manage pressure ulcers. 

The resource includes five electronic reports and a menu of suggested implementation strategies for using each report to support clinical decision-making and promote effective collaboration and care coordination among disciplines.2

For more information, visit the AHRQ website at:
https://www.ahrq.gov/professionals/systems/long-term-care/resources/ontime/pruhealing/index.html 

1 Compromised Wounds in Canada: Executive Summary. CIHI. Retrieved February 27, 2017 from https://secure.cihi.ca/free_products/AiB_Compromised_Wounds_EN.pdf

AHRQ's Safety Program for Nursing Homes: On-Time Pressure Ulcer Healing. Agency for Healthcare Research and Quality (AHRQ). Retrieved Feb. 27, 2017 from https://www.ahrq.gov/professionals/systems/long-term-care/resources/ontime/pruhealing/index.html 

Friday, February 24, 2017

New study suggests that dying patients who receive palliative care spend less time in the ER

According to a new study, community-based palliative care care delivered at home was associated with a 50 % reduction in emergency department visits for patients in their last year of life. 

Researchers studied nearly 12,000 records for patients who died of cancer, heart failure, kidney failure, chronic obstructive pulmonary disease and/or liver failures in Western Australia from 2009 to 2010. Dying patients visited the emergency department on average twice a year during their last year of life. The average number of emergency department visits was reduced when patients received palliative care.

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"It is encouraging that palliative care was associated with reduced emergency department visits for five different diseases, so isn't limited to just cancer or heart failure, for example," said study lead Lorna Rosenwax, PhD. of Curtin University in Perth, Australia. "Most patients who were in their last year of life visited the emergency department at least once, with one person visiting 74 times in the space of a year. Only about one-third (32 %) of the patients we studied received community-based palliative care but they were much less likely to require emergency medical treatment as a result."

The greatest reduction in emergency department visits for patients receiving palliative care was seen in patients who were older, had a partner, lived in major cities, lived in more affluent areas and had no prior history of emergency department visits. The proportion of end-of-life patients who had three or more emergency department visits increased with younger age, geographic remoteness, social disadvantage and end-stage liver failure.
End-of-life cancer patients were most likely to receive community-based palliative care (47 %) while end-of-life liver failure patients were least likely to receive it (13 %).

"Ideally, high-quality palliative care should be able to manage the most common acute symptoms of the dying person without the need for hospitalization," said Ms. Rosenwax. "For these fragile patients, providing care at home should be the goal, but how we get there is the question. When planning community-based palliative care service delivery in the last year of life, it is important to consider patients' social, demographic and health factors." 

References:

"Dying patients who received palliative care visited the ER less" Medical Press. February 21, 2017. Retrieved on February 24, 2017 from https://medicalxpress.com/news/2017-02-dying-patients-palliative-er.html?_scpsug=crawled_2564611_88c55ed0-f8c9-11e6-a92a-00221934899c#_scpsug=crawled_2564611_88c55ed0-f8c9-11e6-a92a-00221934899c 

Spilsbury, K., Rosenwax, L., Arendts, G., & Semmens, J.B. (2017). "The association of community-based palliative care with reduced emergency department visits in the last year of life varies by patient factors." Annals of Emergency Medicine (Jan. 19, 2017). Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/28169049 



Wednesday, February 22, 2017

New guidelines for managing influenza outbreaks in long-term care facilities

The Centers for Disease Control and Prevention have released new guidelines related to managing influenza outbreaks in long-term care facilities for the 2016-2017 flu season.
Influenza is easily introduced into a nursing home by newly admitted residents, health care workers and loved ones who are visiting their relatives. Prevention is important as the transmission of such viruses can make residents severely or fatally ill.
The CDC makes the following recommendations:
·        Influenza vaccination should be provided routinely to all residents and health care workers of long-term care facilities, and when there is a suspected outbreak
·        Implement daily active surveillance for respiratory illness among ill residents, health care personnel and visitors to the facility
·        Implement Standard and Droplet Precautions for all residents with suspected or confirmed influenza
·        Be Aware of the Possibility of a Drug-Resistant Virus
·        Consider additional measures to reduce transmission among residents and health care personnel1
To read the full CDC report click on the following link: http://bit.ly/2kM7pWN
1 Interim Guidance for Influenza Outbreak Management in Long-Term Care Facilities. (2017, February 02). Retrieved February 21, 2017, from https://www.cdc.gov/flu/professionals/infectioncontrol/ltc-facility-guidance.htm

Friday, February 17, 2017

Canadian Seniors at Risk: New study warns against harmful prescription medication use, offers new strategies for improvement


Seniors use more prescription drugs than any other age group in Canada. Approximately 67% of seniors take five or more prescriptions drugs a year and 25% take ten or more prescriptions. Furthermore, it is projected that as many as half of the medications given to seniors are administered incorrectly or are over-prescribed, which can lead to harmful drug reactions and interactions. 1 In addition, many of these drugs have either not been studied extensively for this age group or have not been formally approved to treat the conditions for which they have been prescribed. In other words, some of these medications are prescribed to seniors without any concrete evidence that they are safe or effective and, sometimes, even when they are known to be risky. One example is antipsychotics, which have known adverse effects, but which are still often prescribed to patients with dementia. 2

In her study, “Improving Prescription Drug Safety for Canadian Seniors,” Nicole Bernier examines the unsafe and inappropriate use of prescription drugs by seniors and provides some possible solutions to the problem. 1 Although there are many joint educational initiatives that have been started by professionals, advocacy groups, and health authorities, Bernier posits that improving prescription drug safety among seniors will require more systematic change  from national bodies, such as Health Canada, provincial and territorial health ministries, as well as local health authorities. Such a strategy should include a revision of the drug approval process, tracking newly marketed drugs that are prescribed to seniors, and reporting adverse drug reactions.  Health providers should have access to in-depth information on their patients’ medical histories and to clinical decision-making tools which would allow them to conduct independent research into off-label prescription drug use. Canadian provinces and territories should also be mandated to update their prescribing guidelines on a regular basis, require medications reviews, and to provide coverage or alternative nonpharmacological therapies and interventions.

Much more can and needs to be done in order to protect seniors and to address this health issue for our increasingly aging population.
To see the full Institute for Research on Public Policy (IRPP) study, visit: http://irpp.org/research-studies/study-no61/
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1 1 Bernier, Nicole F. “Improving Prescription Drug Safety for Canadian Seniors.” IRPP. Jan. 12th 2017. Accessed February 2017 from http://irpp.org/research-studies/study-no61/

2 2 Maust, D. T., Kim, H. M., Seyfried, L. S., Chiang, C., Kavanagh, J., Schneider, L. S., & Kales, H. C. (2015). Antipsychotics, other psychotropics, and the risk of death in patients with dementia: number needed to harm. JAMA psychiatry, 72(5), 438-445. Accessed February 2017 from http://jamanetwork.com/journals/jamapsychiatry/fullarticle/2203833