Pre-Conference Workshop on INTERACT II Sold Out!
by Debra Bakerjian, PhD, MSN, FNP
originally posted August 2010
The Pre-Conference Workshop on INTERACT II was sold out two weeks before the conference. In fact, we started a waiting list of interested facilities in case anyone dropped out, but none did. A few minutes before starting, I looked about and the room was noisy, the tables crowded already and they kept on coming. Nursing home administrators, directors of nursing, medical directors, directors of staff development, and other key staff sat together at round tables ready to listen to our expert panel of speakers about a topic that is and will continue to be essential to ensuring the safety of residents and will certainly be critical to the financial success of organizations in the future. Interventions to Reduce Acute Care Transfers (INTERACT II) are designed to improve the early identification, assessment, documentation, and communication of changes of condition in residents in order to prevent avoidable hospital transfers. Hospital transfer put our patients at higher risk for morbidity and mortality and cost billions of dollars in unnecessary costs to the healthcare system.
Project Director Joe Ouslander, MD (center), Co-Director Gerri S. Lamb, PhD, RN, FAAN (right), and Project Coordinator Laurie Herndon, GNP/ANP (left) shared their research, knowledge, and the INTERACT II resources with 22 nursing home leadership teams. Then the leadership teams worked with other teams to better understand how to implement the processes and resources in their own nursing homes. At the end of the afternoon, each table shared their successes and lessons learned with everyone and all went home with many ideas of what they wanted to implement back home. CALTCM intends to check in with those leadership groups in about a month to see what kind of progress they are making. We think this group will have a real head start in getting ready for healthcare reform AND we know their residents will benefit from the processes they put in place that are based on the INTERACT II project.
Keeping Residents Safe: An Essential Task of Nursing Home Leaders
by Debra Bakerjian, PhD, MSN, FNP
originally posted August 2010
The theme of CALTCM's 36th Annual Meeting was Creating a Culture of Patient Safety. The Saturday morning session was dedicated to helping conference attendees understand the fundamentals of what creating a culture of patient safety means to nursing home leaders. Dr. Debra Saliba provided an excellent foundation of what it means to keep patients safe from harm, how that is defined, and what it means in the modern healthcare world. Over twenty national organizations are talking about patient safety. Dr. Saliba emphasized the fundamental principles of patient safety cultures that are blameless, vigilant and just, are system-based, and data driven.
She was followed by Linda Hooper who went through the entire process of how to develop a patient (resident) safety program. Her presentation again emphasized the importance of creating the right patient safety culture and what nursing homes must do to transform the culture of their nursing homes.
Dr. Joe Ouslander followed with a more general presentation on INTERACT II, highlighting the patient safety concepts of the program. He emphasized the human and financial costs of avoidable hospitalizations, shocking some with facts such as 1 in 5 older adults discharged from a hospital are rehospitalized within 30 days and this is even higher (almost 1 in 4) for SNF patients. This is at a cost of $4.3 billion annually.
Dr. Barbara Bates-Jensen did an outstanding job of using pressure ulcers as an example of ensuring patient safety around a specific condition. Attendees were treated to specific strategies around pressure ulcer prevention that correspond to the National Patient Safety Initiatives. Prevention of pressure ulcers is one of the most relevant patient safety events in nursing homes, and as nursing home operators and owners consider "bundled payments", having a system to prevent and monitor pressure ulcers is critical to future success.
The last presentation of the morning by Dr. Deb Bakerjian focused on using a patient safety dashboard to monitor patient safety issues. Dr. Bakerjian presented the specifics of the California Patient Safety regulatory requirements and the ten national patient safety goals for long term care. She also provided the specific requirements of a patient safety dashboard including the standards, the metrics, targets and process owner. The sample patient safety dashboard and all of the speaker slides are available for download on the CALTCM website for everyone who attended the conference.
All Were Winners in the Poster Session
by Debra Bakerjian, PhD, MSN, FNP
originally posted August 2010
This year marked the second annual poster session for CALTCM and we had more poster submissions and a greater diversity of topics than last year. There were 21 submissions in all and 18 posters that were presented at the conference. This year, the posters were divided into two categories: 1) Research and 2) Project | Demonstration. It was fantastic that we had so many nursing home-specific submissions this year! The posters were displayed late on Saturday afternoon immediately following the adjournment of the main program through the evening reception. Poster authors were available to discuss their posters and there was a lot of interest displayed by the conference attendees. This year’s competition had four poster judges: Dr. Terry Hill, MD, CMD and Dr. Mira Cantrell, MD judged the research posters while Dr. Karl Steinberg, MD, CMD and Ms. Leslie Evertson, GNP judged the project/demonstration posters. Judges ranked the submissions in their respective categories and the top three posters received awards. Please see below for a complete list of poster submissions and the respective award list for each category:
RESEARCH CATEGORY
1. Possible Target Conditions for Treating Rejection of Care Behaviors [ 1ST PLACE ]
Shinya Ishii, MD, Joel E. Streim, MD and Debra M. Saliba, MD, MPH
2. “Shhh, Do Not Interrupt”: An Inexpensive Intervention to Improve Med Pass Times [ 2ND PLACE ]
Rebecca Ferrini, MD, MPH, CMD and Nancy Beecham, RN, Elise Harvey, RN, Soon Chu, RN, and Sarah Johnson, LVN
3. Reducing Perceived Barriers to Nursing Home Data Collection [ 3RD PLACE ]
Debra Bakerjian, PhD, MSN, FNP, Alice Bonner, PhD, GNP, Carol Benner, ScM, and Mary Jane Koren, MD, MPH
4. The California LANE Experience Participation in Advancing Excellence
Jennifer Wieckowski, MSG and Debra Bakerjian, PhD, RN, FNP
5. Bringing Home to Nursing Homes – Creating a Calm Environment
Ed Long, NH Administrator and Culture Change Guide
6. Consistent Assignment: A Key Step to Individualized Care
Bonnie Darwin, KJ Page and Mary Margaret Chappell
7. Improving Management of Skin Tears
Thomas Douglas
8. Promoting Nursing Home Quality Through Best Practices: Measuring Pressure Ulcer Prevention Behaviors of
Certified Nursing Assistants
Mary Ellen Dellefield, PhD, Martha Shively, PhD, RN, Claudia Der-Martirosian, PhD, and John Schnelle, PhD
9. The Right Information Makes a Difference: The impact of Electronic Medical Records on The Quality and
Quantity for Data Available for Clinical Decision-Making
Gwenmarie Hilleary, Margo Beamon, and Michele Curley
10. Management of Sex Offenders in Long Term Care: A Guideline for Planning
Rebecca Ferrini, MD, MPH, CMD and Thomas Gibson PhD, JD
11. Effectiveness of a Continence Care Program in the Long Term Care Setting: A Collaborative Approach from the
NH Staff and a Continence Specialist Nurse Practitioner
Cara Stone MDN, WHNP-BC
PROJECT | DEMONSTRATION CATEGORY
1. A Practical Approach to Improve a Community Skilled Nursing Facility’s CMS 5 Star Rating [ 1ST PLACE ]
James Jordan, NHA and Ashkan Javaheri, MD
2. Bring the Edge of Non-Traditional Facility In-Service Through Podcasting:
Hear It When You Want It [ 2ND PLACE ]
Janice Diez, MSNc, BSN, RN, DNS and Bertha Martinez, BSN, RN, ADON
3. Nurse Practitioner In-Home Primary Care [ 3RD PLACE ]
Deborah I. Wolf-Baker, MSN, CHPN, FNP-BC and Timothy Gieseke, MD, CMD
4. A New Approach to Improve Quality in End of Life Care
Laurie Walsh, GNP and Sharon McCoy, FNP
5. Improving Patient Safety in Using the Fentanyl Patch
Flora Brahmbhatt, PharmD, CGP
6. Why Sort My Way Cards?
Stanley A. Terman PhD, MD
7. The Ins and Outs of Care Transitions: A Model in Long-Term-Care
Debra Bakerjian, PhD, RN, FNP
Next year, we hope to have even more posters and will be expanding the time of the poster session. In addition, we will be offering an online training session on poster submissions and how to create a poster abstract well prior to the poster abstract submission due date. So, we encourage all of you to think about what you might submit for next year. Quality improvement projects make excellent poster submissions as well as process change ideas and patient, family, or staff satisfaction topics. Consider using the Advancing Excellence in America's Nursing Homes goals as a way of creating a poster. Your poster can then be displayed in the lobby of your nursing home for visitors and staff to enjoy. Look for further information on the poster session on our website in the near future.
Medication Safety: Key Opportunities for QI and Regulatory Compliance
by Flora Brahmbhatt, PharmD, CGP
originally posted August 2010
Sunday morning at the CALTCM Annual Meeting kicked off with a bang! We were fortunate to have Dr. Loriann De Martini, PharmD from the California Department of Public Health with us. She presented on a panel with Dr. James Mittelberger, MD, MPH, CMD, FACP and myself. She discussed the importance of medication safety with reference to Coumadin, Fentanyl and Antipsychotic use. She also provided detailed information on informed consent documentation, which is the responsibility of the physician in the case of psychotropics. Gradual dose reductions and the need for a facility pharmaceutical services committee (whose minutes are not protected by peer-review or QI privilege) were discussed as well. Now with annual OBRA surveys, CDPH is also surveying to Title 22. This was an exciting and informative session, with many lively questions and scenarios entertained. Medication errors and adverse effects are a huge problem in long-term care and elsewhere, and our efforts to improve quality and safety in this arena are welcomed and supported within CALTCM.
Elder Abuse Lawsuits Alive and Well in California
by Karl E. Steinberg, MD, CMD
originally posted August 2010
At our recent Annual Meeting, I had the privilege of co-presenting the final lecture of the conference, on elder abuse lawsuits, risk management, and liability, with two superlative veteran attorneys—defense attorney Bill Wilson of Wilson Getty, and plaintiffs’ attorney Randy Walton. We reviewed the theories behind elder abuse lawsuits, and explained how prevailing on an elder abuse cause of action invalidates the $250,000 cap on non-economic damages imposed by the MICRA legislation of the 1970s. To prevail in an elder abuse case, plaintiffs have to demonstrate that there was oppression, malice, recklessness or fraud, which have specific legal definitions. They can also prevail if there is clear and convincing evidence of neglect, which also has a specific meaning, but can be a bit vague and perhaps does not lie that far beyond simple negligence.
The basic required elements of a medical malpractice lawsuit were also reviewed—a duty to the patient (a provider-patient relationship), a breach of the standard of care (that level of care that a reasonable professional of similar training and licensure would demonstrate under the same or similar circumstances), damages that resulted from the breach of the standard of care, and causation (a causal link between the breach and the damages). Standard of care is determined by expert testimony, and attendees were encouraged to consider serving as expert witnesses—since many of CALTCM’s members and attendees are indeed experienced experts in the long-term care arena.
Some recent verdicts were discussed, including a $650 million dollar class-action lawsuit against a skilled nursing facility chain, that was based on a claim under Health and Safety Code 1430 essentially stating that all residents of nursing homes in California have a right to be in a facility that is staffed at 3.2 nurse hours per patient day or higher. The jury had the option to assess anywhere from zero to $500 per resident per day that one of the facilities was staffed under 3.2 (based on very old and possibly inaccurate “key factor reports”)—and they decided to award the maximum, resulting in the multi-million dollar outcome that is still being contested as of press time.
Strategies to improve patient care, accuracy of documentation, and liability exposure were also discussed in our talk, and many important questions and comments were addressed from the audience. All in all, this two-hour presentation was well received and provided plenty of information as well as some practical pointers for everyday practice, to optimize quality of care, documentation, and understanding of the current medicolegal landscape.
Action: Response Requested on DEA Notice, Solicitation of Information
by Kathleen M. Wilson, AMDA Director of Government Affairs
originally posted August 2010
On June 29, 2010, the Drug Enforcement Administration (DEA) issued a Notice seeking comments from the public to help determine whether any further revisions to the DEA regulations on controlled substances in long-term care are feasible and warranted. Specifically, the DEA solicitation contains a series of questions on issues ranging from communication between practitioners to the use of chart orders to the number of facilities a medical director serves. AMDA has reviewed the Notice and selected those questions that are most relevant to physician practice. Read more
How to Post Comments About the DEA Policy on Controlled Substances
Dispensing in LTC Facilities
originally posted August 2010
Related to the dispensing of controlled substances to residents residing at long-term care facilities (LTCFs), the DEA is soliciting information on this subject from practitioners, pharmacists, LTCFs, nurses, residents and family of residents in long-term care facilities, state regulatory agencies, and other interested members of the general public. Specifically, the DEA is exploring whether --- while adhering to the framework of the Controlled Substances Act --- any further revisions to the DEA regulations are feasible and warranted toward the goal of making it easier for residents of LTCFs to receive controlled substance medications. This notice recites the pertinent statutory considerations and contains a series of questions designed to elicit public comment that will assist the DEA in making this decision. Read more
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