by Flora Brahmbhatt, Pharm.D., CGP

The recent Beers criteria include sliding scale insulin as inappropriate in the elderly due to the increased risk of hypoglycemia. There are various strategies to avoiding hypoglycemia. One strategy is to better manage the dose of long-acting (basal) insulin and administer rapid-acting (bolus) insulin post meal based on amount consumed. This better manages the glycemic index and reduces the risk of hypoglycemia.

However, managing low blood sugar is a challenge in nursing homes. A common mistake is the overuse and misuse of glucagon. Historically, glucagon is almost impossible to get and when you can, it costs a fortune. For conscious patients who can take oral food or fluids, this is the preferred route.

Please provide a brief background of your training and practice setting and years in practice.
I am a Board Certified Hospice and Palliative Care Specialist with Board Certifications in Geriatrics and Family Medicine. I earned my Medical Degree from Western University of Health Sciences and have been in practice since 1994 providing care for hospice patients in the Long Term Care setting, Assisted Living and homes. I am currently the Palliative Program Director at HOAG Memorial Hospital Presbyterian in Newport Beach and Irvine. In this role, I provide administrative and medical services in the inpatient setting as well as developing HOAG’s outpatient palliative clinical program.

Prior to this role, I was the Medical Director of Geriatrics and Palliative Care Services at Monarch HealthCare for over 5 years. During my tenure, I developed a post-acute service in the Skilled Nursing Facility settings through consolidation of facilities and hiring full-time SNFists and NPs to care for Monarch’s 30,000 Seniors. In addition, I implemented a training program for mid-career Physicians in the art of Hospice and Palliative Medicine through UC Irvine, and am in the development phase of an outpatient palliative clinical service.

Donna Renee Williams, RN, MBA, CDONA/LTC

The Healthy People 2020 goal is for 90% of America’s health care personnel to be immunized annually against the flu.  According to the CDC (2012), during the 2010-11 influenza season, only 63.5 percent of health care personnel received the vaccine.

On October 5, 2012, in a highly controversial ruling, Rhode Island became the first state to mandate the influenza vaccination for health-care workers (Stokowski-Bisanti, 2012).  On August 28, 2012, the Health Officer of the County of Sacramento issued an order mandating that all health care facilities in Sacramento County require their health care workers to receive an annual influenza vaccination, or if they decline, to wear a mask during the influenza season.  According to the Health Officer, the goal is to increase the rate of influenza vaccination of health-care workers (HCWs), reduce employee absenteeism during influenza season, and reduce HCW transmission of influenza (Memorandum, O.Kasirye, MD, MS).

Tim Gieseke, MD, CMD

In the previous WAVE, a plea was made for better post acute care transitions from the nursing home to RCFE or Home settings.  The emphasis was on the comprehensive discharge summary as means to communicate to subsequent providers information that supports seamless continuity of care.  One of our esteemed members, Dr. Rebecca Ferrini, recognized gaps in the “Medication Reconciliation” part of the discharge summary. 

This is one of the 4 “Pillars” of Eric Coleman’s care transitions model and is a requirement for all acute care hospitals, because the evidence shows this prevent serious medication errors.