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P OSTER
A BSTRACTS
with the least efficacy and greatest potential for short term
ADR(e.g.diphenhydramine) may be most amenable to this type of
alert system. Follow up studies to test such systems are warranted.
Ref:
1. Kennedy LD et al. Double-blind trial of acetaminophen vs
diphenhydramine pretransfusion. Transfusion 2008;48:2285-91.
2011 vs 2010 and 2009
C101
Assessment of knowledge gaps relevant to antibiotic stewardship
among health care workers in long term care facilities.
A. Krishna, 1,2 C. Biedron, 2 L. Mody, 5 P. Lichtenberg, 3 R. Severson, 2
C. Cassidy, 3 C. M. Pickney, 4 K. S. Kaye, 1,2 T. Chopra, 1,2 M. Johnson. 4 1.
Infectious Disease, Detroit Medical Center, Detroit, MI; 2. Infectious
Disease, Wayne State University, Detroit, MI; 3. Nexcare Health
System, Westland, MI; 4. Dominican Life Center, Westland, MI; 5.
University of Michigan, Ann Arbor, MI.
Background: Long Term Care Facilities (LTCFs) provide a
major reservoir for multi-drug resistant organisms (MDROs), however
standard Antibiotic Stewardship Programs (ASPs) are lacking in
most LTCFs. The objective of our survey was to identify knowledge
gaps of health care workers [HCWs] relevant to antibiotic stewardship
(AS) at LTCFs.
Methods: A 71 item voluntary survey was completed by health
care workers in August 2011 at two LTCFs (Dominican Life Center a
174 bed facility and Nexcare Health System, a 111 bed facility) in
South East Michigan.
Results: 44 HCWs (36 nurses, 4 infection control professionals, 2
physician assistants and 1 staff physician) responded to the survey.
Mean age of respondents was 42 + 14 and 93% were females. 61% of
respondents believed that over prescribing of antibiotics was a very
important cause of antibiotic resistance. Most respondents believed
that prescriber education [51%], institution specific guidelines [54%]
or accessible advice from infectious disease physician [58%] were effective
interventions in reducing antibiotic resistance.
100% of the respondents were familiar with methicillin-resistant
Staphylococcus aureus [MRSA], 73% were familiar with vancomycin-resistant
enterococci [VRE], 34% were familiar with Klebsiella
pneumoniae carbapenemase [KPC] and 27% were familiar with
extended-spectrum beta lactamase [ESBL]. Percentage of respondents
confident in caring for a patient with MRSA, VRE, KPC and
ESBL were 98, 95, 56 and 47 respectively. 30% and 26% of the respondents
were not familiar with differences between definitions of
colonization and infection respectively.
Conclusions: Significant knowledge gaps among HCWs remain,
specifically related to treating infections with KPCs and ESBLs. Educating
HCWs on the differences between colonization and true infection
is crucial. Formal ASPs are urgently needed in LTCFs to optimize
antibiotic use and decrease colonization pressure by MDROs.
C102
Staff Responses to Resident-to-Resident Elder Mistreatment in
Nursing Homes: Results of a Multi-Site Survey.
A. Rosen, 1,2 M. S. Lachs, 1 K. Pillemer, 3 J. Teresi. 4,5 1. Medicine,
Geriatrics, Weill Cornell Medical College, New York, NY; 2. Emegency
Medicine Residency, New York Presbyterian Hospital, New York, NY;
3. Human Development, Cornell University, Ithaca, NY; 4. Research
Division, Hebrew Home at Riverdale, Riverdale, NY; 5. Columbia
University Stroud Center and New York State Psychiatric Institute,
New York, NY.
Background: Resident-to-resident elder mistreatment (RREM)
in nursing homes is a likely frequent phenomenon that may lead to
severe outcomes for victims and perpetrators. Nursing home staff actions
in response to this behavior may significantly mitigate its impact,
but little is known about prevention and management strategies.
Objective:To identify the most common staff responses to RREM
Methods: We conducted this study as part of a large, multisite
NIA-funded study attempting to estimate the prevalence of RREM
in long term care facilities. For this project, the behavior of 1,688 residents
of 5 nursing homes in New York City was evaluated. Certified
nursing assistants primarily responsible for the care of residents
under study in the parent project were asked about their responses to
RREM during the previous two weeks. A modification of a validated
instrument initially created to measure behavioral problems in nursing
home residents was used.
Results: Staff reported taking some action for RREM incidents
involving 277 residents (16.4%) during the previous two weeks, and
22 different responses were described. Most common responses were:
physically intervening / separating residents (84), talking calmly to
settle residents down (65), and verbally intervening to defuse the situation
(59). Not included among staff responses was requesting consultation
of a physician or psychiatrist.
Conclusion: RREM is a potentially common and dangerous occurrence,
and nursing home staff report many varied responses to it.
Despite this, physicians and psychiatrists are seldom called upon to
assist in RREM prevention and management. The effectiveness of existing
responses and the potential for physician contribution needs to
be examined in greater detail, and comprehensive evidence-based interventions
should be developed.
C103
Care Delivery Consequences of Poor Quality Hospital-to-Skilled
Nursing Facility Transitions: A Qualitative Study.
B. King, 1 A. Kind, 2 A. Gilmore, 1 R. Roiland, 1 K. Pecanac, 1
M. Hovanes, 1 N. Husain, 2 B. Bowers. 1 1. Nursing, University of
Wisconsin, Madison, WI; 2. Medicine, University of Wisconsin,
Madison, WI.
Supported By: This study is funded by a NIA Beeson K23 Award
Background: Poorly executed, transitions from the hospital to
home can result in care fragmentation and lapses in patient safety.
Research has focused on transitions from hospital to home with few
studies on the highly vulnerable population: older adults transferring
from the hospital to a Skilled Nursing Facility (SNF). Nurses in SNFs
design a resident’s plan of care based on orders/information received
from the hospital physician and nursing staff. The purpose of this
study is to explore how nurses in SNFs transition care of residents admitted
from hospitals, the barriers they experience and their views of
the consequences of poor quality care transitions.
Methods: This qualitative study utilized Grounded Dimensional
Analysis, a variant of Grounded Theory. Registered nurses (n=9) employed
at 3 SNFs in Wisconsin participated in focus groups with indepth
interviews. Constant comparisons were used to expand the
richness of the data. Data was analyzed using open, axial and selective
coding.
Results: Nurses in SNFs engage in a complex process of getting
prepared to transition residents from hospital-to-SNFs. Despite this
complex preparation, the information SNF nurses receive from the
hospital is often incorrect or incomplete. Nurses cited multiple inadequacies
of hospital discharge information, including regular problems
with medication orders (including the lack of opiod prescriptions for
pain), little information on resident’s psychosocial/functional history,
and inaccurate information regarding the resident’s current health
status. These inadequacies necessitated repeated call backs to the discharging
hospital, created delays in care delivery to SNF residents
(including delays in pain control), increased SNF staff stress and frustrated
patients/family members. SNF nurses identified a specific list
of information/components that they need to initiate a high-quality
SNF plan of care.
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AGS 2012 ANNUAL MEETING