Neuropsychiatric symptoms in geriatric patients admitted to skilled nursing facilities in nursing homes for rehabilitation after stroke: a longitudinal multicenter study

2011 ◽  
Vol 27 (7) ◽  
pp. 734-741 ◽  
Author(s):  
Bianca I Buijck ◽  
Sytse U Zuidema ◽  
Monica Eijk ◽  
Alexander CH Geurts ◽  
Raymond TCM Koopmans
Keyword(s):  
Nursing Homes ◽  
Multicenter Study ◽  
Geriatric Patients ◽  
Neuropsychiatric Symptoms ◽  
Skilled Nursing Facilities ◽  
Nursing Facilities ◽  
Skilled Nursing

scholarly journals A Qualitative Study of Antibiotic Stewardship Implementation at Arizona Skilled Nursing Facilities

2020 ◽  
Vol 41 (S1) ◽  
pp. s101-s101
Author(s):  
Theresa LeGros ◽  
Connor Kelley ◽  
James Romine ◽  
Katherine Ellingson
Keyword(s):  
Nursing Homes ◽  
Antibiotic Stewardship ◽  
Population Level ◽  
Skilled Nursing Facilities ◽  
Care Transition ◽  
Antibiotic Prescribing ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
The Core ◽  
Core Elements

Background: The CDC Core Elements of Antibiotic Stewardship (AS) include 7 evidence-based best practices adapted for a variety of healthcare settings, including nursing homes. We aimed to identify barriers and facilitators related to AS implementation in skilled nursing facilities (SNFs) within 18 months of the CMS mandate for AS implementation in SNFs, and to examine their relevance to the CDC’s Core Elements for Nursing Homes. Methods: We conducted 56 semistructured interviews with administrators, clinicians, and nonclinical staff at 10 SNFs in urban, suburban, rural, and border regions of Arizona. All interviews were recorded, transcribed, and imported into NVivo v12.0 software for constant comparative analysis by 3 researchers using a priori and emergent codes. After iterative coding, we confirmed high interrater reliability (κ = 0.8), finalized the code book, and used matrix coding queries to examine relationships and generate themes. Results: We identified 7 themes as “influencers” that were less (barrier) or more (facilitator) supportive of AS in SNFs. Intra- and interfacility communication were the most frequently described: respondents described stronger communication within the SNF and between the SNF and hospitals, labs, and pharmacies as critical to robust AS implementation. Other influencers included AS education, antibiotic tracking systems, SNF prescribing norms, human resources, and diagnostic resources. The Core Elements were reflected in all influencer themes except interfacility communication between SNFs and hospitals. Additionally, themes pertaining to systems emerged as critical to successful AS implementation, including the need to address: the interactions of multiple roles across the traditional SNF hierarchy, stewardship barriers from the lens of patient-level concerns (as opposed to population-level concerns), the distinction between antibiotic prescribing gatekeepers and stewardship gatekeepers, and care transition policies and practices. The Core Elements target many aspects of these systems themes—for example, they recognize the importance of creating a culture of stewardship. However, they do not address care transition policies or procedures beyond recommending that transfer-initiated antibiotics be tracked and verified. Conclusions: Because the interactions of various agents within and beyond the SNF can facilitate or inhibit stewardship in complex ways, our findings suggest the use of a systems approach to AS implementation that prioritizes communication within the SNF hierarchy, and between SNFs and hospitals, diagnostic facilities, and pharmacies. When followed, the CDC’s Core Elements can provide crucial guidance. However, SNFs need support to overcome the challenges of incorporating these elements into policy and practice. Additionally, more work is needed to understand and enhance stewardship-related care transition, which remains under-addressed by the CDC.Disclosures: NoneFunding: None

scholarly journals Discharge Communication of Dementia-Related Neuropsychiatric Symptoms and Care Management Strategies During Hospital to Skilled Nursing Facility Transitions

2020 ◽  
pp. 089198872094424 ◽  
Author(s):  
Andrea L. Gilmore-Bykovskyi ◽  
Melissa Hovanes ◽  
Jacquelyn Mirr ◽  
Laura Block
Keyword(s):  
Neuropsychiatric Symptoms ◽  
Management Strategies ◽  
Skilled Nursing Facility ◽  
Skilled Nursing Facilities ◽  
Nursing Facilities ◽  
Care Needs ◽  
Skilled Nursing ◽  
Poor Outcomes ◽  
Omission Rate ◽  
Discharge Communication

Provided the complexity of managing dementia-related neuropsychiatric symptoms (NPS), accurate communication about these symptoms at hospital discharge is critical to facilitating safe and effective transitions, particularly transitions from hospitals to skilled nursing facilities (SNF), which are often poorly managed. Skilled nursing facilities providers have cited undercommunication regarding NPS as a major challenge that contributes to poor outcomes including rehospitalization. This multisite retrospective cohort study identified omission rates for NPS and associated management strategies in discharge communication as compared to medical record documentation in the 72 hours preceding discharge among hospitalized patients with dementia. High rates of omission were found across NPS and management strategies: anxiety (94%), agitation/aggression (77%), hallucinations (85%), 1:1 supervision (90%), high fall risk (89%), use of restraints (91%). Omission rate for new or modified antipsychotic medication was 12.9%. Findings underscore the need for additional research on cross-setting communication regarding care needs of patients with dementia—who often cannot communicate these needs on their own—in facilitating high-quality transitions.

scholarly journals Determinants of rehabilitation outcome in geriatric patients admitted to skilled nursing facilities after stroke: a Dutch multi-centre cohort study

2012 ◽  
Vol 41 (6) ◽  
pp. 746-752 ◽  
Author(s):  
M. Spruit-van Eijk ◽  
S. U. Zuidema ◽  
B. I. Buijck ◽  
R. T. C. M. Koopmans ◽  
A. C. H. Geurts
Keyword(s):  
Cohort Study ◽  
Geriatric Patients ◽  
Skilled Nursing Facilities ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
Rehabilitation Outcome

Predicting prosthetic use in elderly patients after major lower limb amputation

2012 ◽  
Vol 36 (1) ◽  
pp. 45-52 ◽  
Author(s):  
Monica Spruit- van Eijk ◽  
Harmen van der Linde ◽  
Bianca Buijck ◽  
Alexander Geurts ◽  
Sytse Zuidema ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Lower Limb ◽  
Geriatric Patients ◽  
Lower Limb Amputation ◽  
Skilled Nursing Facilities ◽  
Limb Amputation ◽  
Phantom Pain ◽  
Nursing Facilities ◽  
Transtibial Amputation ◽  
Skilled Nursing

Background: The main determinants of prosthetic use known from literature apply to the younger patient with lower limb amputation. Studies aimed at identifying determinants of outcome of lower limb amputation in elderly patients with multimorbidity that rehabilitate in skilled nursing facilities (SNFs) are scarce. Objectives: To predict prosthetic use and physical mobility in geriatric patients admitted to SNFs for rehabilitation after lower limb amputation and the impact of multimorbidity. Study Design: Prospective design. Methods: Univariate and multivariate logistic and linear regression analyses were used to identify determinants that were independently related to prosthetic use and the timed-up-and-go test (TUG test). Results: Of 55 eligible patients, 38 had complete assessments on admission and at discharge. Fifty per cent was provided with a prosthesis. Multimorbidity was present in 53% of the patients. Being able to ambulate independently, and having a transtibial amputation (rather than a higher level of amputation), without phantom pain determined prosthetic use (R2=56%), while cognitive abilities, low amputation level, and pre-operative functional abilities were independently associated with the TUG test (R2=82%). Conclusions: Elderly patients referred to an SNF for prosthetic training have a high probability of using a prosthesis when having an independent ambulation after transtibial amputation, without phantom pain. These patients should be considered for prosthetic training. Clinical relevance This study gives more insight into the outcomes of geriatric patients with lower limb amputation after rehabilitation in skilled nursing facilities. This is the first study that focuses on determinants of prosthetic use in these elderly patients, often with multimorbidity.

Regulatory requirements for recreational therapy in nursing homes

2017 ◽  
Vol 13 (1) ◽  
pp. 25
Author(s):  
Dawn De Vries, DHA, MPA, CTRS
Keyword(s):  
Nursing Homes ◽  
Long Term Care ◽  
Skilled Nursing Facilities ◽  
Recreational Therapy ◽  
Nursing Facilities ◽  
Regulatory Requirements ◽  
Term Care ◽  
Skilled Nursing

More recreational therapists than ever are practicing in long-term care and skilled nursing facilities (SNFs). Despite this increase in recreational therapists working in SNFs, there continues to be significant confusion about regulatory requirements, as well as practice and coverage issues. This article intends to provide information on regulatory, coverage, and practice issues related to recreational therapy in nursing homes.

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