Archive for 'Clinical Notes'

Boost Quality of Life For Your SNF Residents

Posted on 03. Sep, 2009 by .


This case study will give you a bright idea to try at your own LTC facility.

Just because a resident is turning 100 and rarely comes out of her room anymore doesn’t mean she wouldn’t enjoy helping others. That’s what a team of occupational therapy researchers found in a research project in which they helped the elderly woman rekindle a basic interpersonal trait: altruism.

“Humans have an urge to help other people on a regular basis,” a need that some research shows people maintain as they age, says Joseph Cipriani, EdD, OTR/L, a professor in the Department of Occupational Therapy at Misericordia University in Dallas, Pa., who oversaw graduate students there who conducted the research project.

Birthday Gifts Hit the Spot

The resident who participated in the project had historically enjoyed an active life and had performed service work in the community. She was still able to attend activities but wasn’t usually interested in participating, Cipriani tells Eli’s Long-Term Care Survey Alert.

Yet when approached by the researchers about participating in a project to convey her caring to others, the woman agreed. She chose to make artificial flower arrangements and greeting cards for people having a birthday in the same month she was turning 100.

Overcoming concerns: A somewhat private person, the resident didn’t know many of the residents because she seldom left her room. And she worried that the other residents might not like her gifts. So the researchers did a trial run and confirmed that the residents would accept the offerings. (more…)

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Gear Up to Retrofit MDS as a SNF Diabetes Risk Management Tool

Posted on 03. Sep, 2009 by .


Think J4 is irrelevant to diabetes care & outcomes? Think again.

Imagine a good plaintiff’s attorney whipping out a nursing home resident’s MDS, care plans, and medical record to show the jury how the facility’s care team didn’t attempt to prevent serious diabetic-related outcomes.

You can avoid that kind of nightmare scenario and improve care by using the MDS as a risk management tool. The assessment can not only ensure you’re providing the right services, but it can also help you home in on the big picture, including problems that could be caused by diabetes.

First of all, make sure you code in Section 1 that the resident has diabetes mellitus, and related complications, such as diabetic retinopathy. Also code a diabetic ulcer using a specific ICD-9-CM code in I3.

Next: Take a close look at whether you assessed the resident for these following conditions coded on the MDS where applicable. Also make sure you have the documentation and care plan in place. (more…)

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SNF H1N1 Update: This Year’s Flu Vaccination Effort Won’t Be Business As Usual

Posted on 27. Aug, 2009 by .


Who’s first in line for swine flu vaccinations? Answer may surprise you.

Your long-term care facility will have more shots at keeping staff and residents flu-free in the coming months — literally.

Although the seasonal influenza vaccine will reduce morbidity, including hospitalization, and mortality from seasonal flu — it won’t do so for the novel A/H1N1 strain, cautions Stefan Gravenstein, MD, clinical director of quality improvement and an influenza immunization expert. Only a new novel H1N1 vaccine or natural infection with the virus will confer protection, Gravenstein tells Eli’s Long-Term Care Survey Alert.

1, 2, 3: To be fully protected against the flu, people will need to receive the seasonal flu vaccination, as usual. And they will need two separate vaccinations against the novel H1N1 administered three to four weeks apart, says James Marx, RN, MS, CIC, an infection control expert in San Diego. “The novel virus vaccine is most likely coming out in late October and early November,” and will be free, he says.

9/11/09 Note: Our long-term care editor, Karen Lusky, has received a note from the CDC that one H1N1 shot may suffice as a vaccination. This is not yet an official decision yet, so please stay tuned & Karen will keep us updated.

Odd twist: Healthcare workers are on the list of people ranked as high priority for receiving novel H1N1 vaccination, whereas people over age 65 aren’t, Marx notes. Thus, “nursing facilities that get 100 doses of the vaccine should use those for staff first,” he advises. The tier 1 list also includes people from ages 25 to 65 who are at higher risk for novel H1N1 because they are immunocompromised or have chronic health disorders, according to the Centers for Disease Control & Prevention’s Advisory Committee on Immunization Practices (ACIP).

Good news: The Centers for Disease Control & Prevention doesn’t anticipate a shortage of the novel H1N1 vaccine, according to a press statement. “There is some possibility that initially the vaccine will be available in limited quantities,” however, noted the release.

The CDC’s APIC advises people over the age of 65 to receive the seasonal value vaccination as soon as it is available.

In case you’re wondering: “Seasonal flu and novel H1N1 vaccines may be administered on the same day,” states the CDC-issued release.

Training CD: Long-Term Care Survey Prep 101.

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New Ways To Stop Clostridium Difficile in SNFs?

Posted on 19. Aug, 2009 by .


Scientific Sleuths Are Closing in on How  Antibiotics Spur C. Diff Transmission

Clostridium difficile is definitely one difficult superbug for SNFs, particularly because people over 65 are more vulnerable to C. diff than most.

But researchers may be closing in on how the microorganism causes intestinal illness —and the role antibiotics play in getting the transmission ball rolling.

Researchers at Monash University have found evidence that toxin B rather than toxin A “is essential for virulence” of Clostridium difficile, according to their work published in Nature. The work suggests that if that’s the case, toxin B “would be a more promising potential target for therapeutic or preventative measures,” according to the editor’s summary of the article in Nature. (more…)

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