Archive for 'Clinical Notes'

Combat SNF Wound Infection With These 4 Key Strategies

Posted on 23. Nov, 2009 by .


Find out the first signs that the bugs may be getting the upper hand.

Preventing, identifying, and treating wound infection can head off serious negative resident outcomes — not to mention actual harm or even immediate jeopardy citations. To pull off this difficult feat, wound-care experts suggest covering these essential bases.

Strategy No. 1. Recognize when a skin ulcer shows early signs of trouble. To do that, look for signs of critical colonization, which include a wound that stops healing for unexplained reasons, advises Dorothy Doughty, MN, RN, CWOCN, director of the Emory University Wound, Ostomy, and Continence Nursing Education Center. Or you may see “sudden deterioration in the quantity or quality of the granulation tissue, increased exudate, and increased pain.”

Left untreated, “critical colonization typically progresses to invasive wound or systemic infection,” cautions Joyce Black, PhD, RN, CPSN, CWCN, FAPWCA, former president of the National Pressure Ulcer Advisory Panel and a nursing professor at the University of Nebraska in Omaha. “Usually the bacteria are Staph, Strep, Pseudomonas, although there can be others.”


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Check Out This Breakthrough: Weight Lifting for Lymphedema Patients

Posted on 15. Nov, 2009 by .

Just for grins, weight lifting in the 1930s. Photo: RobMan2000.

Just for grins, weight lifting in the 1930s. Photo: RobMan2000.

Weight-lifting program needs these 2 key components.

Evidence from a recent study gives some weight to a therapeutic approach that clinicians have normally advised women with breast-cancer-related lymphedema to forego: weight lifting in any form.

A group of researchers at the University of Pennsylvania School of Medicine have found that weight lifting may be beneficial. Researchers observed 141 breast cancer survivors with arm lymphedema in a randomized, controlled trial of twice-weekly 90-minute, progressive exercise classes for 13 weeks. Then, for an additional 39 weeks, the women continued with unsupervised exercise twice a week.

The women wore a custom-fitted compression garment on their affected arm during their workouts, and each week reported changes in symptoms, according to a press release from Penn Medicine. In addition, researchers measured the subjects’ arms each month. Meanwhile, 70 control group participants did not change their exercise level.

Findings: Women in the weightlifting group experienced fewer exacerbations of arm lymphedema and a reduction in symptoms compared to the women who did not lift weights. Also, no serious adverse events related to the weight lifting occurred. In fact, researchers theorized that a controlled weightlifting program may have protective benefits by boosting strength in affected limbs enough to ward off injuries from everyday activities that can aggravate lymphedema symptoms, according to the release. (more…)

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Experts Share Their SNF Resident Restorative Dining Tips

Posted on 09. Nov, 2009 by .


Dish Up Positive Outcomes With a Top-Notch Restorative Dining Program

Looking for a way to improve residents’ quality of life and safety, rein in weight loss, and free up staff? Spend time in the dining room to identify candidates for a restorative dining program, suggests Cheryl Field RN, MSN, CRRN, senior healthcare specialist with PointRight in Lexington, Mass. Identify people who have trouble feeding themselves, as well as those who appear poorly positioned or seem to be tiring during the meal, she adds. Then assess them further and develop an individualized restorative program.

3 Pointers Help Ensure Success

A three-prong approach will make sure your restorative program makes the grade with residents and families, as well as surveyors and payment auditors.

1. Develop resident-specific, measurable goals. They don’t have to be fancy to get the job done, however. For example, “you might write a goal [stating] Mr. S will feed himself using (filling in the blank for the adaptive equipment),” says Field. Or suppose a resident has difficulty sitting up during the meal.You might write a goal stating that the resident will be able to sit upright for the first five minutes of the meal and consume 25 to 40 percent of his meal, Field suggests. Make sure to specify a particular postural cushion, lift in the chair, or weighted spoon the resident will use, she instructs. (more…)

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Study Shows Cracks in the CCRC Model

Posted on 02. Nov, 2009 by .


Social barriers throw a wrench into goals for ‘aging in place,’ resident insider finds.

A continuing care retirement community (CCRC) is supposed to ease residents’ concerns about moving from independent living to assisted living or to the nursing home. Turns out there might has well be a huge concrete wall between independent living and other CCRC settings, according to a study recently published in The Gerontologist.

Purdue University researcher Tetyana Shippee, then 21, moved into a CCRC for two years to thoroughly understand how the aging-in-place ideal works in real life, reports The New York Times.

“In Ms. Shippee’s facility … the health and vigor required for independent living had become an important source of status,” explains the Times. “To leave an independent living apartment meant not only losing one’s home and social network, but also a part of one’s identity.” Even though the physical distance was minor, friendships dissolved as if residents were now miles apart.

Independent living residents became so stressed about moving that they concealed their illnesses … More from The New York Times.

Is your facility addressing mood and behavior issues in the smartest way possible? If not, listen to this audio CD or MP3 training session from Reta Underwood.

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Surf’s Up, Long-Term Care Activities Directors

Posted on 25. Oct, 2009 by .


It just might be that Soduku’s old news. If you want to help your residents build their brains’ decision-making and reasoning centers, take them surfing. That’s Internet surfing, dude.

A study presented at the at the annual meeting of the Society for Neuroscience in Chicago used MRI to compare brain activity in two groups within a larger group of 24 folks between age 55 and 78. Half the participants were Internet ‘kahunas’ and the other half had very little Internet experience.

Non-surfers were taught Internet basics and asked to use the Web to answer questions over a two-week period. “Two additional activity centers were activated in the second scan among those who were new to the Internet,” reports an article in WebMD. “When performing an Internet search, people make use of the ability to hold information in working memory and extract important points among distracting graphics and words.”

Possible study drawbacks: Ages 55 thru 78? Young dudes in today’s geriatric set I would say. A sample size larger than 24 also would have been more conclusive. However, many of us know at least one senior who’s staying sharp on the Internet. Excuse me, I have to go check my nearly octogenarian father-in-law’s latest Tweet.

Available on CD & MP3: Activities in Long Term Care: Pumping Up Your Programming. With Reta Underwood, ADC.

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SNF Staffing: Scheduling Crunches Can Hurt Infection Control, Spread Flu

Posted on 19. Oct, 2009 by .


Case Study: What one facility is doing to stay flu-proof

When the third shift is short two CNAs, the last thing on a scheduler’s mind may be infection control issues. Yet, that’s exactly what everyone, staff included, should be considering, stresses Deborah Burdsall, RN, MSN, CIC, infection preventionist at Lutheran Home in Arlington Heights, Ill.

The problem: “Someone will try to call in sick and the person doing staffing will convince the person” to come on in because the facility is short, she says.

Instead: Lutheran Home has implemented “strict policies that say if a staff person has symptoms, he or she needs to stay home, and not just during an outbreak” of flu or other contagious illness, Burdsall reports. “We want to make sure we don’t have people afraid to call in sick,” she emphasizes. What about staff members who seem to call in sick a lot? “If certain people seem to be taking advantage of that policy and have high absenteeism, then you deal with that individually,” Burdsall says. (more…)

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Should You Restrain the Unaffected Limb in Stroke Rehab?

Posted on 12. Oct, 2009 by .


Researchers show this clinical move doesn’t prevent ‘learned non-use.’

If you think restraining a limb unaffected by stroke will help a patient learn to use the affected limb, a recent study may well have proved you wrong.

Restraining patients’ unaffected upper limbs during the subacute phase following stroke does not appear to generate greater improvements in motor impairment and capacity than standard rehab alone, according to a pilot study published in the June issue of Physical Therapy.

Researchers randomly assigned patients, one to six months following stroke, to either a constraint-induced movement therapy (CIMT) group or the standard training group. All patients trained five days per week for two weeks. (more…)

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SNF Resident With Behavioral Symptoms? Check Out This ABC Assessment Format

Posted on 05. Oct, 2009 by .

Bon-bon therapy. Not the way to go.

Bon-bon therapy. Not the way to go.

This calorie-free approach works whether residents are cognitively impaired or not.

What might screaming, hitting, weeping, and refusing staff requests have in common?

The behaviors may all be serving the same underlying function for a particular resident, says Michael Partie, principal of Therapeutic Options in Newark, Del. And if you can figure out what that is, you’re well on your way to coming up with an effective behavioral care plan.

Possibilities: Perhaps the person is “trying to control his environment or to make himself feel safe,” Partie suggests. Or he may be trying to make people interact with him or go away when he becomes stressed or fatigued, he adds. “Even a person with serious cognitive impairments will try to order his world as best he can within his understanding of his world,” Partie says. (more…)

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FDA Approves Onsolis for Breakthrough Cancer Pain

Posted on 03. Sep, 2009 by .


REMS required to prevent drug diversion.

The FDA has approved Onsolis to treat severe breakthrough pain for cancer patients ages 18 and up. The drug delivers fentanyl through an absorbable film that adheres to the buccal membrane inside the mouth, according to an FDA release. Onsolis is indicated to treat breakthrough pain for patients who are already receiving opioid pain medications around the clock and can safely take high doses of an additional opioid.

To reduce the risk of abuse and misuse of Onsolis, the FDA required the drug to have a Risk Evaluation and Mitigation Strategy, or REMS — a tactic that the agency is undertaking to combat a growing epidemic of prescription drug diversion involving mostly opioids.

As part of the REMS, Onsolis will only be available through a restricted distribution program called the FOCUS program that will provide clinicians and pharmacy personnel prescribing or dispensing the medication to receiving training and educational materials. Patients will receive an educational counseling call before the pharmacy dispenses Onsolis to ensure they understand how to use the drug appropriately.

“Prescription orders will be filled only by participating pharmacies that send the product directly to the patients’ homes,” stated the FDA in the release.

“The REMS for Onsolis was specifically tailored to that drug and should not be viewed as a model REMS for long-acting and extended-release opioid products,” said Douglas Throckmorton, MD, deputy director of CDER.

For more information on REMS, go to this page at the FDA.

To read the FDA press release on the drug, go here.

AUDIO: The central thrust of the proposed F309 survey guidance on pain. Hint: Many facilities fall short on the old concept.

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Long-Term Care Safety Tip: Beware This Drug for First-Timers

Posted on 03. Sep, 2009 by .


Resident opioid naïve? Prevent falls, oversedation.

Doing a medication history can pay off by identifying patients who haven’t taken opioids before. This information can give you a heads up about who may not be a candidate for a fentanyl patch.

A lot of surgeons order the patches because they are easy to use, cautions Albert Barber, PharmD, with Golden Living in Fort Smith, Ark. “But we have seen people with no tolerance to opioids use the patches and fall or worse,” he cautions.

Bottom line: “The fentanyl patches should be reserved for people who for some reason can’t swallow pills but have been on other opioid medications, so you are transferring them to fentanyl,” counsels Barber.

AUDIO TRAINING EVENT: What to do when a resident who doesn’t seem to be in pain asks for his PRN pain med every time it’s due.


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