Challenges with Insulin administration: How to avoid an IJ!

by Flora Bessey, PharmD, BCGP

Those of us who have been in long-term care for awhile have seen the evolution in the treatment of diabetes, specifically insulin options. From “regular (short-acting)” to “NPH (intermediate-acting”) to “long-acting” to “analog (rapid and long-acting).” Patients with type 2 (or type 1) diabetes, and their health care providers, now have many options when choosing insulin.

Until recently, in our setting the administration of insulin was accomplished exclusively the “old-fashioned” way: with a vial and syringe. In the non-institutional world, however, patients were able to access an administration platform that is less cumbersome, and easier, for a non-clinician to utilize: insulin pens.
The Problem of Chronic Non-Cancer Pain

by Timothy Gieseke MD, CMD

Since the CDC guidelines for managing pain were published in early of 2016, state medical boards are increasingly scrutinizing physician practices to insure that we are managing acute and chronic pain in a way that minimizes the risk for opioid addiction and drug overdose death.  I have attached the CDC Summary Fact Sheet for these guidelines which unfortunately provides little guidance for the care of chronic non-cancer pain patients who are already on potentially unsafe doses of opioids.  The guidelines discourage a daily MME (morphine mg equivalents) > 50, but many of the patients I receive from the acute hospital for rehab are already on MME > 90- 100, which has an 8 times greater risk of accidental overdose. The CDC has a nice handout for Calculating Total Daily Dose of Opioids for safer opioid prescribing.  The CDC has a free new mobile app for android and apple phones called “CDC Opioid Guideline” which has a calculator within it.

Strange Bedfellows to Convene Before CALTCM Annual Meeting

by Karl Steinberg, MD, CMD, HDMC

Over the years, a perennial favorite educational activity at CALTCM’s meetings has been medicolegal and risk management sessions—often presented in a mock trial format.  This year, by popular demand, CALTCM has created an evening half-day pre-conference summit focusing on medicolegal risk management, and the nexus connecting quality of care, communication and documentation with improved outcomes and reduced exposure to civil and regulatory actions, including elder abuse lawsuits.  It will also provide information about the importance of the expert witness, including physicians, to the legal process.

Updates For Busy Physicians, Nurse Practitioners, Physician Assistants, Therapists and Other Clinicians (and Curious Administrators) On The Go!

by Albert Lam, MD

Saturday mornings at our CALTCM Annual Meeting are geared to deliver high yield updates for the clinician on the go.  Our planning committee is excited to offer six superb high yield updates separated into two back to back sessions.

The first half of the morning spotlights neurologic and rehabilitation care in post acute and long term care.  Dr. Randall Espinosa, clinical professor of geriatric psychiatry at UCLA, will be reviewing the types of dementias seen in nursing homes and connect the diagnosis with options for management and guidance for advance care planning.  After that, UCLA neurorehabilitation specialist Dr. Michael Su will update us on the latest in acute stroke management and how we should respond in nursing homes. Rounding out the 3 early talks will be physiatrist Dr. Lawrence Miller.  Dr. Miller will be reviewing common reasons for rehab in nursing facilities and we’ll learn about how to set reasonable goals in these situations.

Navigating Healthcare in the Frail Elderly Amidst a Sea Of Change and a Fragmented Care System

by Vanessa Mandal, MD

With the aging of our population, by 2035 the elderly population will outnumber children for the first time in U.S. history. This change in demographics, coupled with the accelerated changes in health care delivery, poses significant challenges for health care providers managing patients with complex chronic illnesses. The shift from fee-for-service to value-based care adds even more complexity. The Saturday May 20th afternoon session brings together a panel of speakers who will present a person-centered approach to providing quality of care near the end of life. End-of-life care entails conversations where providers have to address prognosis, and shared decision making.

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