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Flu Season: A Brief Update on this Year's Influenza Activity

As a service to CALTCM members, and to encourage our clinicians to actively recommend influenza vaccination to their LTC and community dwelling patients, we are sharing recent information on resurgence of Flu activity in California.
 
From the California Department of Public Health:
  • Deaths: 54 since Sept. 29, 2019
  • Outbreaks: 16 since Sept. 29, 2019
  • Laboratory: 27.7% positive
  • Outpatient Influenza-Like Illnesses*: Above expected levels
  • Hospitalizations: Above expected levels

For more information from the CDC on this years Flu activity, go to: https://www.cdc.gov/flu/index.htm

Rules Governing Use of Antipsychotics Loosened; What Should We Do About It?

As we approach the November 28, 2019 deadline to fully implement the Phase 3 changes in the “Mega Rule,” it is important to note that some of the “changes” that were implemented in Phase 2 are expected to change in Phase 3. Specifically, under Phase 2 rules, antipsychotics could not be prescribed PRN for more than 14 days unless a resident was examined by a prescriber (every 14 days). This was ostensibly to avoid the issue of off-label overprescribing of antipsychotics in our population, especially those suffering dementia-related psychosis (DRP) or other behavioral issues that could not be attributed to an Axis 1 diagnosis of a mental condition (i.e. bipolar disorder, schizophrenia, major depression, etc.). The rule as written mentioned a tendency to “place the convenience of the caregivers above the residents’ interests.”

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Passport to Better Care

I recently wrote an article for the WAVE on the potential value of sharing personal pictures on your smartphone, for developing relationships and engaging patients with dementia, prior to providing medication and care plan directed care.  

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Medical Apps – General Principles and Some Recommendations

Do you wonder if you are most effectively using the technology you carry in your pocket? Is your phone cluttered with medical apps that you downloaded and now you can’t even remember what they are supposed to do? Here is a guide to walk you through my approach. Caveats – this is based primarily on my own experience, and I use an iPhone not Android, so my Android info is limited. Medical apps seem to disappear from the app store with remarkable frequency, so please check availability.

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A Taste of AMDA is Evolving

In the second issue of the WAVE for June this year, I wrote about how to access “AMDA on the Go” podcasts, which are offered free to post-acute and long-term care professionals.  Over the summer, AMDA has added a number of new features including expert discussion from the Colorado Geriatric Journal Club, and now, practical clinical applications from the August issue of JAMDA.  In this podcast, Dr. Philip Sloane, the new co-Editor-in-Chief, summarized take-home lessons from: Increasing the Value of ER visits, Reducing Avoidable Transfers, Quantifying the Impact of Incomplete nursing home transfer documentation, and Measuring the Value of High-Intensity Telemedicine in Senior Living communities.  I found this podcast to whet my appetite for the details of these articles, which I can now more effectively share with my facilities and home health agency.

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Telemedicine or No Telemedicine: This is the Question

The debate and enthusiasm about telemedicine visits, as an alternative for an in person visit, are lurching in parallel tracks. Early adopters who are using it in rural areas have mainly adopted Telehealth for behavioral health and possibly dermatological consults. 

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Court of Appeals Says Epple is Still in Effect: CANHR v. Smith Decision

In late July, after some four years of legal wrangling, a California Court of Appeals decision was handed down in the CANHR v. Smith (previously CANHR v. Chapman) case, which had sued the California Department of Public Health (CDPH) to challenge the constitutionality of Health & Safety Code 1418.8, also known as the Epple Law. This law, in effect for over 20 years in California, allows the interdisciplinary team (IDT) in a nursing home to make decisions—including giving informed consent for interventions that require it—on behalf of incapacitated, unrepresented residents.  

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Update on Disclosing Medical Errors

In a February 2017 WAVE, I asked the question whether your facility had been stress tested (see link to this article below).  At one of my facilities, I had become aware of a serious medication error and activated a process with some of my colleagues and the administration on how to best manage the consequences of this error.  This patient and family appreciated the timely disclosure and proposed care plan adjustments, as well as our commitment to better understand what happened so that we could minimize the risk of similar future errors.  To date, there hasn’t been a lawsuit or payout with this case.

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New Changes in the CMS Nursing Home Compare Five-Star Quality Rating System

Five-Star Quality Rating System (QRS) has been developed by the Centers for Medicare & Medicaid Services (CMS) to assist consumers compare nursing homes more easily based on their performance on health inspection(s), staffing and quality measures (QM) domains. Over the years, CMS has updated and enhanced the five-star QRS methodology numerous times to improve the accuracy of the rating system. The nursing facilities and medical directors need to stay up-to-date with all the changes in the 5-star QRS.  

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The Shortage Of Tuberculin Antigens; Can Anything Be Done?

For as long as most of us can remember, we have been subject to regulatory oversight regarding testing for tuberculosis in our residents. For most of us, this equates to a “mandatory” skin test upon admission (as well as mandatory tests for our employees!) to check for possible “exposure” to TB. The efficacy of these tests, or even the accuracy of chest x-rays, in diagnosis of the disease is tenuous at best, but we still must comply with the regulation.

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Should You Be Concerned About the “Integrity” of Your Facility’s POLST Forms?

In 2008, I attended the UCLA LMG (Leadership and Management in Geriatrics) course that has continued under the leadership of CALTCM.  I was paired with a nursing professor at Sacramento State who was quite helpful as a mentor for my project which was the implementation of the new POLST Form in Sonoma County.  I teamed with Susan Keller, who energetically partnered with many people and provided detailed trainings in many settings of care. Sadly, despite our efforts, I still find POLST forms initiated by frontline SNF admitting nurses that don’t have choices congruent with the ones I find on my assessments.  In addition, many of the forms fail to record basic information like care contacts, presence of AHCDs/DPOAs, and who assisted with completion of the form.  

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