Implementing a cornerstone of culture change: Consistent staff assignment in VHA community living centers.

2017 ◽  
Vol 14 (3) ◽  
pp. 327-336 ◽  
Author(s):  
Sonne Lemke ◽  
Penny L. Brennan ◽  
Sonya SooHoo ◽  
Kathleen K. Schutte
Keyword(s):  
Culture Change ◽  
Community Living ◽  
Staff Assignment ◽  
Community Living Centers

scholarly journals An Unintended Consequence of Culture Change in VA Community Living Centers

2017 ◽  
Vol 18 (4) ◽  
pp. 320-325 ◽  
Author(s):  
Jill Harrison ◽  
Denise A. Tyler ◽  
Renée R. Shield ◽  
Whitney L. Mills ◽  
Kristen E. Morgan ◽  
...  
Keyword(s):  
Culture Change ◽  
Unintended Consequence ◽  
Community Living ◽  
Community Living Centers

scholarly journals Barriers to a Timely Discharge From Short-Term Care in VA Community Living Centers

2019 ◽  
Vol 32 (2) ◽  
pp. 141-156
Author(s):  
Denise A. Tyler ◽  
Renée R. Shield ◽  
Jill Harrison ◽  
Whitney L. Mills ◽  
Kristen E. Morgan ◽  
...  
Keyword(s):  
Community Living ◽  
Short Term ◽  
Term Care ◽  
Community Living Centers

scholarly journals National trends in the treatment of urinary tract infections among Veterans’ Affairs Community Living Center residents

2019 ◽  
Vol 40 (10) ◽  
pp. 1087-1093 ◽  
Author(s):  
Haley J. Appaneal ◽  
Aisling R. Caffrey ◽  
Vrishali V. Lopes ◽  
Christopher J. Crnich ◽  
David M. Dosa ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Antibiotic Use ◽  
Veterans Affairs ◽  
Community Living ◽  
Days Of Therapy ◽  
Community Living Centers ◽  
Tract Infections ◽  
National Trends ◽  
Culture Positive ◽  
Culture Negative

AbstractObjective:To describe urinary tract infection (UTI) treatment among Veterans’ Affairs (VA) Community Living Centers (CLCs) nationally and to assess related trends in antibiotic use.Design:Descriptive study.Setting and participants:All UTI episodes treated from 2013 through 2017 among residents in 110 VA CLCs. UTI episodes required collection of a urine culture, antibiotic treatment, and a UTI diagnosis code. UTI episodes were stratified into culture-positive and culture-negative episodes.Methods:Frequency and rate of antibiotic use were assessed for all UTI episodes overall and were stratified by culture-positive and culture-negative episodes. Joinpoint software was used for regression analyses of trends over time.Results:We identified 28,247 UTI episodes in 14,983 Veterans. The average age of Veterans was 75.7 years, and 95.9% were male. Approximately half of UTI episodes (45.7%) were culture positive and 25.7% were culture negative. Escherichia coli was recovered in 34.1% of culture-positive UTI episodes, followed by Proteus mirabilis and Klebsiella spp, which were recovered in 24.5% and 17.4% of culture-positive UTI episodes, respectively. The rate of total antibiotic use in days of therapy (DOT) per 1,000 bed days decreased by 10.1% per year (95% CI, −13.6% to −6.5%) and fluoroquinolone use (ciprofloxacin or levofloxacin) decreased by 14.5% per year (95% CI, −20.6% to −7.8%) among UTI episodes overall. Similar reductions in rates of total antibiotic use and fluoroquinolone use were observed among culture-positive UTI episodes and among culture-negative UTI episodes.Conclusion:Over a 5-year period, antibiotic use for UTIs significantly decreased among VA CLCs, as did use of fluoroquinolones. Antibiotic stewardship efforts across VA CLCs should be applauded, and these efforts should continue.

Budget Impact Analysis of Veterans Affairs Medical Foster Homes versus Community Living Centers

2017 ◽  
Vol 20 (1) ◽  
pp. 48-54
Author(s):  
Bryce S. Sutton ◽  
Étienne Pracht ◽  
Arthur R. Williams ◽  
Farrokh Alemi ◽  
Allison E. Williams ◽  
...  
Keyword(s):  
Impact Analysis ◽  
Budget Impact ◽  
Veterans Affairs ◽  
Budget Impact Analysis ◽  
Community Living ◽  
Foster Homes ◽  
Community Living Centers

Risks and Benefits of Bladder Antimuscarinics Among Elderly Residents of Veterans Affairs Community Living Centers

2013 ◽  
Vol 14 (10) ◽  
pp. 749-760 ◽  
Author(s):  
Daniela C. Moga ◽  
Ryan M. Carnahan ◽  
Brian C. Lund ◽  
Jane F. Pendergast ◽  
Robert B. Wallace ◽  
...  
Keyword(s):  
Veterans Affairs ◽  
Community Living ◽  
Risks And Benefits ◽  
Community Living Centers ◽  
Bladder Antimuscarinics

Measuring Use of Psychotropic Drugs in Veterans Affairs Community Living Centers

2014 ◽  
Vol 29 (9) ◽  
pp. 588-601 ◽  
Author(s):  
Michael Harvey ◽  
Dawn Currie ◽  
Amy Furman ◽  
Scott Mambourg
Keyword(s):  
Psychotropic Drugs ◽  
Veterans Affairs ◽  
Community Living ◽  
Community Living Centers

scholarly journals Nurse Workforce Characteristics and Infection Risk in VA Community Living Centers

Medical Care ◽  
2015 ◽  
Vol 53 (3) ◽  
pp. 261-267 ◽  
Author(s):  
Mayuko Uchida-Nakakoji ◽  
Patricia W. Stone ◽  
Susan K. Schmitt ◽  
Ciaran S. Phibbs
Keyword(s):  
Infection Risk ◽  
Community Living ◽  
Nurse Workforce ◽  
Community Living Centers

scholarly journals De-implementing and sustaining an intervention to eliminate nursing home resident bed and chair alarms: interviews on leadership and staff perspectives

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Christine W. Hartmann ◽  
Christopher Gillespie ◽  
George G. Sayre ◽  
A. Lynn Snow
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Community Living ◽  
Position Change ◽  
Improvement Program ◽  
Cross Sectional ◽  
Convenience Sample ◽  
Local Leadership ◽  
Positive Effects ◽  
Community Living Centers

Abstract Background Improving nursing home quality of care relies partly on reducing or stopping ineffective or harmful practices, a process known as de-implementation. We know little about de-implementation in this setting. Relatively recent policy changes reclassified resident position-change (bed and chair) alarms, which monitor resident movement, as restraints. This created an optimal environment in which to study impressions of an alarm de-implementation and sustainment intervention. Methods This cross-sectional interview study focused on understanding participants’ experience of a quality improvement program in the Department of Veterans Affairs Community Living Centers (nursing homes). The program’s goal was to improve resident outcomes and staff communication and teamwork through, among other foci, eliminating resident position-change alarms. The Community Living Centers were located in geographically dispersed areas of the continental United States. Interview participants were leadership and staff members from seven Community Living Centers. We conducted in-depth, semi-structured qualitative interviews using a convenience sample and used a thematic analytic approach. Results We conducted seventeen interviews. We identified five main themes: Initiating De-implementation (compelling participants with evidence, engaging local leadership, and site-level education and training), Changing Expectations (educating staff and family members), Using Contrasting Approaches (gradual or abrupt elimination of alarms), Witnessing Positive Effects of De-implementation (reduction in resident falls, improved resident sleep, reduction in distressing behaviors, and increased resident engagement), and Staying the Course (sustainment of the initiative). Conclusions Findings highlight how participants overcame barriers and successfully eliminated resident position-change alarms and sustained the de-implementation through using convincing evidence for the initiative, local leadership involvement and support, and staff and family member education and engagement. These findings and the resulting three-phase process to support nursing homes' de-implementation efforts expand the de-implementation science knowledge base and provide a promising framework for other nursing home-based de-implementation initiatives.

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