ADVANCE Perspective: LTC : Safety

Fighting off Germs

Maureen Salera — Fri, 30 Oct 2009 16:40:00 GMT

We all know that washing our hands is the best way to guard against the spread of germs. But there are several other measures that can also help protect us from contamination.

In this Washington Post article, health care professionals share some other tips on how they stop the spread of infection.

Dialysis May Do More Harm Than Good

Heather Simons — Thu, 15 Oct 2009 20:34:00 GMT

A study published in The New England Journal of Medicine questions whether dialysis is the best treatment for nursing home patients. As reported by USA Today, more than half of older nursing home residents die within a year of starting dialysis and "nearly another third experience a significant decline in their ability to perform simple tasks, such as feeding themselves."

Study authors said they hope the results will encourage health care professionals to engage in "open and honest discussions" with residents about the risks of the treatment.

For frail elderly nursing home patients, permanent kidney failure "is like metastatic cancer with rapid deterioration and short life expectancy," [says Peter Aronson, Yale University nephrologist]. "The results of this study should inform end-of-life planning for such patients and encourage consideration of alternatives to dialysis, such as palliative care" to relieve symptoms.

Read the full article here.

Not Just Part of the Job

Maureen Salera — Fri, 18 Sep 2009 02:24:00 GMT

Most people figure that work-related injuries are just part of the job for nurses. With all that lifting, turning, repositioning and transferring that nurses do, injuries abound. In fact, a report on the American Nurses Association Web site indicates that an estimated 12 percent of nurses leave the profession every year because of back injuries and more than 52 percent experience chronic back pain.

But it doesn't have to be this way. As I've learned from researching this topic for an upcoming Safety column, no-lift policies--which can help prevent these injuries--are increasingly becoming a mandated policy at many types of health care facilities.

To learn more about safer patient handling, look for an article in the Safety column in an upcoming issue of ADVANCE.

Taking Aim at Safety

Liz Rosto — Thu, 10 Sep 2009 15:34:00 GMT

"We can make health care safer. Not just a little safer, a lot safer," The Joint Commission President Mark R. Chassin, MD, MPP, MPH, said in a press conference today announcing the launch of a new center to improve patient safety.

The Joint Commission Center for Transforming Healthcare is working with the nation's leading hospitals and health systems to use new methods to find the causes of and develop solutions for deadly breakdowns in patient care.

Read the full report here, or go to the Center's Web site: www.centerfortransforminghealthcare.org

The Center's first initiative is hand washing, which Chassin says is the simplest, most cost effective way to prevent health care-associated infections that kill nearly 100,000 Americans annually.

FDA to Review Acetaminophen Changes

Maureen Salera — Thu, 02 Jul 2009 19:14:00 GMT

The FDA is left to wonder what to do about acetaminophen after its panel urged it to reconsider dosing instructions, according to an article posted on the Washington Post's web site.

While acetaminophen is generally safe and effective, it can cause liver failure in excess doses. In fact, acetaminophen overdoses are the leading cause of liver damage in the United States. The FDA estimates that more than 400 people die each year from overdoses and thousands more are hospitalized.

Because public education hasn't resolved the problem, the panel recommended reducing the highest dose of acetaminophen allowed in over-the-counter medications. The drug is found in so many products that people often don't realize they are getting doses that could exceed the safe levels. The panel even narrowly recommended pulling Vicodin, Percocet and similar products that combine acetaminophen with powerful narcotics from the market altogether.

While the FDA often follows the advice of its advisory panels, it's not obligated to do so. For now, we'll have to wait and see what the FDA decides to do.

Are your residents expressing concern about this news? How are you handling it at your facility?

Can GPS Technology Help Track Wandering Seniors?

Liz Rosto — Mon, 08 Jun 2009 12:39:00 GMT

I recently saw this interesting news brief about a shoemaker and a technology company teaming up to develop footwear with a built-in GPS device that could be used to track down wandering seniors.

The developers of the project claim that the technology will provide the location of the individual wearing the shoes within 30 feet, anywhere on the planet.

Most LTC residents already have some type of wander monitoring device on their body, such as a bracelet or lanyard. For people with Alzheimer's living at home, this type of tracking technology could be very useful. But, I am still not sure this isn't just another marketing gimmick.

What do you think?

Elderly May be Immune to Swine Flu

Maureen Salera — Fri, 22 May 2009 15:49:00 GMT

Several of our recent blogs have been about how swine flu may be impacting your residents. If you still fear an outbreak at your facility, you may not need to panic about this just yet. The CDC recently announced that some older people have antibodies to the H1N1 virus that causes swine flu, according to an article in the Washington Post.

By analyzing stored blood samples, CDC researchers found that one-third of people older than 60 have antibodies that might protect them from infection with the new virus. The findings suggest that many older people may have been exposed to a flu virus decades ago that is similar to the new strain and triggered an immune response. Seasonal flu shots appear to boost that "memory" response a little, according to the article.

A vaccine made from the new strain should increase and sharpen the response to the point that a single shot would provide enough protection. Still, people who've never been exposed to a flu strain even remotely like the new one would almost definitely need two shots for protection.

While these findings are promising for the elderly and are important in the quest for a vaccine, Anne Schuchat, CDC's deputy director for science and public health, said it's too early to draw firm conclusions from the research, according to the article.

A better fall

Maureen Salera — Fri, 15 May 2009 19:04:00 GMT

A recent report on the science of falls caught my attention on Good Morning America this week. The segment featured the research of Mark Grabiner of the University of Illinois at Chicago.

Grabiner and his research team put women age 62 and older--the most at-risk group for slip and trip falls--through various slip and trip tests to study how they fall. The researchers perform the slip test by leading each woman--who wears a safety harness and 22 sensors to monitor movement--over a Plexiglass sheet and then greasing up the sheet behind her to create an unsuspecting fall. During the trip test, a small bar pops up in front of the women and researchers note if they stumble or fall.

Red lights read the sensors, which send a picture of the body's movements to the computer. The researchers then use the data to interpret which movements kept the women upright and which led them to fall.

The researchers hope that the findings will ultimately help create exercises that will teach people to fall better and minimize the risk of injury.

Mice-on-Resident Violence

Adkins-Ali Carrie — Fri, 01 May 2009 13:11:00 GMT

A news item about a mouse-on-resident attack in an Australian nursing home is hitting the U.S. media. Tales of mice chewing off residents' ears are, we can only hope, extremely rare, but certainly stir up a lot of attention and fear.

Do you think the U.S. long-term care community should respond to this news report on a national level? How about a local level? Have you heard from any of your residents' families inquiring about your rodent control program?

Is Swine Flu a Real Threat?

Adkins-Ali Carrie — Thu, 30 Apr 2009 16:41:00 GMT

Swine flu is primarily affecting people between the ages of 18 and 50 and is markedly absent from the senior population. Do you consider it a threat to your residents? Are you taking any additional precautions to protect your population? Finally, do you think it is a real threat or a lot of hype?

Fall-prevention shoes

Maureen McAndrews — Thu, 31 Jul 2008 17:41:00 GMT

By using the same technology that helps astronauts regain balance after zero-gravity flights, scientists have discovered an insole that could prevent elderly people from falling, according to an article on CNN.com.

The "iShoe," developed by Erez Lieberman, a graduate student who was an intern at NASA, is an insole that contains balance sensors to help signal fall warning signs. While it's not an alarm, the iShoe's six sensors will send out a signal if the person wearing it actually falls. It's comparable to a data recorder that a doctor or balance specialist can use to assess dangerous pressure patterns.

Lieberman and Katharine Forth, a visiting scientist at NASA who also works on the iShoe, say the iShoe insole can be slipped inside any shoe and would cost about $100.

But don't expect to see the iShoe at a retailer just yet. It's still being tested, and Lieberman and Forth are still perfecting the software that identifies the faulty pressure patterns.

Falls Cause More Than Broken Hips

Maureen McAndrews — Thu, 26 Jun 2008 20:00:00 GMT

Fall-induced traumatic brain injuries caused almost 8,000 deaths and 56,000 hospitalizations in 2005 among Americans 65 and older, reports the Centers for Disease Control and Prevention in the June issue of the Journal of Safety Research.

In 2005, TBIs were responsible for 50 percent of unintentional fall deaths and 8 percent of nonfatal fall-related hospitalizations among older adults.

"Most people think older adults may only break their hip when they fall, but our research shows that traumatic brain injuries can also be a serious consequence," Dr. Ileana Arias, director of CDC's National Center for Injury Prevention and Control, said in a press release.

This study analyzed 2005 data from the National Center for Health Statistics' National Vital Statistics System and the Agency for Healthcare Research and Quality's Nationwide Inpatient Sample.

HHS to Help Medicare Beneficiaries and Providers in Iowa and Indiana

Maureen McAndrews — Mon, 16 Jun 2008 18:36:00 GMT

Acting under his authority in the Public Health Service Act, HHS Secretary Mike Leavitt today declared a public health emergency in the flood-stricken states of Iowa and Indiana. The action gives CMS Medicare beneficiaries and their health care providers greater flexibility in meeting emergency health needs, according to an HHS news release.

Because of flood damage to local health care facilities, many beneficiaries have been evacuated to neighboring communities, where receiving hospitals and nursing homes may have no health care records, information on current health status or even verification of the person's status as a Medicare beneficiary.

CMS is assuring those facilities that in this circumstance, the normal burden of documentation will be waived and that they can act under a presumption of eligibility.

CMS will make certain that health care providers that provide items and services in good faith are exempt from sanctions from noncompliance with otherwise applicable requirements, provided there is no fraud or abuse.

For more information ,visit CMS online.

A Safehaven for Abused Seniors

Liz Rosto — Tue, 10 Jun 2008 12:54:00 GMT

Long-term care facilities are respected for their role in caring for seniors when they (and their families) are no longer able to provide for themselves at home. Some facilities across the country are providing another refuge for seniors who have been abused.

Reports of elder abuse have reached 472,813 in 2000, the latest number available, according to the National Center on Elder Abuse, a research group financed by the United States Administration on Aging. Officials believe this number is probably low because not all abuse is reported. There is a tremendous need for domestic violence shelters suited to the continuum of needs of elder victims, including geriatric care, physical therapy and peer counseling.

The Hebrew Home at Riverdale is one such facility opening its doors to abused elders. The program provides not just shelter, but access to legal and financial services, social workers and other help for individuals who are being abused. The organization is now helping other nursing homes in Florida, New York, Connecticut and Rhode Island replicate the program.

Click here to read the New York Times article about this fascinating program.

Restraint Use a Thing of the Past?

Liz Rosto — Fri, 28 Mar 2008 15:34:00 GMT

A recent report shows that the use of physical restraints in nursing homes has drastically declined in recent years as the federal government, states and the long-term care industry has placed greater emphasis on eliminating them.

How do you feel about this issue? Many people think restraints are inhumane, and can cause entrapment. On the other hand, restraints might prevent people from injuring themselves.

Mary Jean Koren, assistant vice president at The Commonwealth Fund, a research group, said that changes to federal law in 1987 made it illegal for nursing homes to use restraints to discipline residents or as a matter of convenience. The restraints can only be used for medical reasons, such as to prevent a resident from tearing out an IV. Until the change in law, restraints were standard procedure in many homes.

"We didn't know better," Koren said. "We didn't understand what it did to people both physically and psychologically."

What is your facility's policy? Is anyone still using restraints in this day and age?