On August 17, a summit of leaders in long-term care, including officials from the California Department of Public Health and the District Office of the Centers for Medicare and Medicaid Services was convened in San Francisco to hammer out some practical strategies to reduce unnecessary antipsychotic use in skilled nursing facilities in our state. CALTCM had an important presence at this first of three meetings, entitled “California Partnership to Improve Dementia Care.” CALTCM Past President Karl Steinberg, MD, CMD presented to this stakeholders group on the importance of staff and physician education, and of engaging prescribers and medical directors (Powerpoint slides available upon request). The presentation also introduced CALTCM to some attendees who were not familiar with our organization, and emphasized our successes with Process Improvement initiatives in other areas—making us a natural choice to assist with statewide educational efforts. On October 2, the group reconvened with CALTCM President Jim Mittelberger, MD, CMD attending, and with CALTCM Board Member Flora Brahmbhatt, PharmD, presenting to the entire assembly.

Several workgroups were created at the first meeting, and specific strategies were to be devised with both short-term and long-term goals. CALTCM is participating on the Informed Consent workgroup, along with Jocelyn Montgomery of CAHF, several important CDPH officials including Acting Director Debby Rogers and Assistant Deputy Director Pam Dickfoss, as well as pharmacists Rob Menét and Debra Brown, Tony Chicotel of CANHR (California Advocates for Nursing Home Reform). One short-term goal is to remind prescribers of the importance of ensuring that informed consent is obtained for the use of antipsychotics (and all psychotropics) in our nursing home population—which this article should serve to do.

by Paul Duranczyk, NHA

Some years ago, I was struck by a statement from a County Public Health Nurse who stated that skilled nursing facilities should be one of the safest places to be during an endemic or pandemic outbreak. She examined the eldercare patient population characteristics and concluded they have minimal risk factors from obtaining any community acquired condition like influenza. Our patients rarely leave the campus; they have very few visitors, thus little or no chance to come in contact with any dreaded virus.

However, further examination then identified the biggest exposure risk factor to our frail elders….the caring, compassionate health care worker. Huh? That just does not fit. Health care workers would not intentionally cause any harm to those they serve. Well, indeed they can. So we set out to address this disturbing condition and promote vaccinations.

by Flora Brahmbhatt, Pharm.D., CGP

I am a pharmacist and I hate injections! The trauma and anxiety associated with a needle coming towards me stimulates memories of childhood. My mom’s firm grip holding me steady as a nurse or doctor caused me displeasure haunts me to this day. So as an adult, and an informed one at that (or so I would like to believe), I have opted out of having injections. EVER!!
 
And to answer the question which may be forming in your mind, my displeasure has no limits. Whether it is IM, IV, or Sub Q, I don’t care. No one is going to puncture my skin with a sharp object. No one, that is, until I had to get the flu shot. With the current mandate in place, all healthcare professionals, including consultants, must have proof of receiving a flu vaccine prior to entering nursing facilities. And let’s be real here for a minute: I have full faith in the benefits of the flu vaccine. I recommend it to others; I ensure my parents are vaccinated, as well as friends and other family. But I wouldn’t do it to myself…or have someone do it to me.

Tim Gieseke MD, CMD

As chair of the Poster Session for our annual meeting next April 26, 27, 2013, I encourage each of you to consider what you have done or might do to improve the quality of care in your facilities.

With CMS introducing Quality Assessment and Performance Improvement (QAPI) as an expectation for our facilities in 2013, this is a particularly good time to become familiar with the QAPI process and tools. Part of QAPI is the expectation that facilities will develop PIPs (Performance Improvement Projects) as an ongoing part of their self-assessment and quality assurance/improvement program. Here is a helpful brief industry article on QAPI.