Background: In long-term care facilities, there is often inappropriate dosing of renally-dosed medications (Sönnerstam, 2017). The Beers Criteria highlights potentially dangerous medications that require reduced dosing in renal impairment to reduce the risk of toxicities. The goal of this project was to identify residents on renally-dosed medications with doses higher than recommended in the elderly living within a Skilled Nursing Facility (SNF) and raise awareness to prescribers. Secondary outcomes include whether a dose reduction was attempted and whether medications were discontinued.

Elderly discharged from an observation, or an Emergency Department visit, in the Hospital are likely to return (20%) for a visit or admission. That means, as far as NH’s are concerned, a person post ED or Observation stay, should be closely followed by a clinician to address whatever problems that led to the original dominion or ED visit. Care Transition protocols, spearheaded by Eric Coleman, for community transfers should be tweaked to address the NH process of care. It should include at least a pharmacy review of medications, and an exam by NP/MD within a reasonable time from return to NH (24-72hrs).

At this year’s annual meeting, Dr. Jane Weinreb gave an excellent update on glycemic care in our setting for persons with Type 1 or 2 Diabetes noting that many of our patients already have significant complications and reduced stress tolerance.  About 1/3 of our patients have diabetes.  Because of loss of muscle mass with aging and disability, our patients typically have pre-breakfast finger stick glucose at goal, but commonly have prolonged postprandial hyperglycemia, which requires our attention.  Healthy lifestyle with regular exercise to improve exercise and a nutritious reduced-carbohydrate diet are effective first line interventions that are safe and improve quality of life.  Individualized A1C goals were recommended using helpful criteria.  In addition, typical FS Glucose readings before meals and bedtime were specified for the different recommended A1Cs.

Background/Objective

For many residents with severe impairments, it is difficult to find recreation activities that they can engage in, particularly between scheduled activities. Many have minimal response to the environment, short attention spans, and a lack of connections with others. Reviews of nonpharmacological treatments for dementia find little research supporting robotic pet therapy (O’Neil et al 2011), but anecdotal evidence (Herzog 2016, Hunter 2017) show that animal therapy can improve quality of life, interaction and engagement.