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D120
Geropsychiatric NP Practice in LTC: Not Just a Med Check.
K. A. Bickerstaff, G. Rogers, C. Chaperon. Community Based
Health, University of Nebraska Medical Center College of Nursing,
Omaha, NE.
Supported By: HRSA Grant 1 D62 HP 15054-01-00
Purpose: This pilot study examined the effectiveness of a
Geropsychiatric Nurse Practitioner in a Long Term Care facility.
Background: Older residents of long term care facilities have
numerous challenging unmet physical and mental health needs. Medications
are frequently used as a rapid resolution to manage mood
and behavioral symptoms. Studies have shown that many of the medications
available are not appropriate for a population over the age of
65. Among the adverse effects can be delirium, life-threatening side
effects, and serious drug-drug interactions as well as a decrease in active
socialization.
Methods: Core interventions that all participants received were
a gold standard comprehensive psychiatric exam and review of all
psychotropic medications. Validated tools used included MDS3
BIMS, MDS3 Behavior, MDS3 Mood, and MDS3 ADLs during time
period of one year.
Design: Retrospective Chart Review of 10% of randomly selected
residents seen by a Geropsychiatric NP in a long term care facility
over a one year period.
Setting: A corporately owned, 150 bed, inner city skilled nursing
home in a large mid-western city.
Population: N=14 long term care facility residents over age 65
seen after referral by staff for evaluation and treatment of cognition,
mood, or behavioral symptoms.
Outcomes:
1. Numbers and types of psychotropic medications used.
2. Mental health modalities ordered by Geropsychiatric NP:
non-pharmacological interventions, cognitive therapy, and increased
socialization.
3. MDS3 Domains of Cognition, Behavior, and ADL function
over a one year period.
Preliminary Results: Analysis of MDS3 records for 3 residents
show positive trends of improved mood and behavior while maintaining
cognition and function. Overall unnecessary psychotropic medications
were eliminated or doses reduced on average of one med discontinued
and 1.3 dose reductions per resident. Each resident had
one added psychotropic medication during the year appropriate for
current symptoms at the time. Each resident received individualized
cognitive, behavioral, and socialization therapy on a monthly basis by
a Geropsychiatric NP.
Conclusion: Geropsychiatric NP intervention may decrease unnecessary
medication use among elderly residents of long term care
facilities and improve both mood and social behaviors.
Key Words: geropsychiatric, nursing, practice
D121
The importance of medication reconciliation in post-hospitalization
patients in an ambulatory geriatric clinic in Singapore.
K. Tan, T. Tan. Department of Geriatric Medicine, Tan Tock Seng
Hospital, Singapore, Singapore.
Even though medication reconciliation is an essential part of
clinical practice, it is often neglected in a busy ambulatory practice.
Older adults who had a recent hospitalization for acute illnesses often
had their medications changed or doses adjusted during the hospital
stay. With these changes, older adults may face medication-related
problems which may lead to poor outcomes if not addressed.
Objective:
To investigate the incidence of medication discrepancies and
medication related problems in older adults post hospitalization.
Methods:
All patients with scheduled appointment at the outpatient geriatric
medicine clinic at Tan Tock Seng Hospital were screened for a
recent admission (within the prior 3 months).
Patients identified were interviewed by a clinical pharmacist on
the day of the appointment prior to their doctor’s consultation. Any
medication discrepancies as compared to the discharge medication
list and medication-related problems noted during the interview will
be highlighted to the patient’s physician. These issues will be examined
in this pilot study.
Results:
295 patients (65.4% female, mean [S.D.] age, 82.3 [7.8] years)
were reviewed between the months of November 2010 to June 2011.
146 patients (49.5%) have 1 or more medication discrepancies detected
during the interview by the pharmacist.
Medication discrepancies due to medication changes by patients
or their caregivers accounted for 58.9% of the discrepancies identified.
These discrepancies include omission of medications that should
be continued (54.3%), failure to discontinue medications that were
stopped during the admission (22.8%), and administering medications
at the wrong doses or frequency (22.8%).
The remaining 41.1% of the medication discrepancies were secondary
to prescribing or dispensing errors made during hospitalization
(40.0%) or changes made by physicians from another specialty
(21.7%) or institution (38.3%) after the discharge from the hospital.
Conclusion:
Medication discrepancies are highly prevalent in older adults in
the post-hospitalization period. Medication reconciliation is an essential
tool at identifying these discrepancies so that it can be addressed
to improve patient safety and quality of patient care.
D122
Clostridium difficile-Associated Disease Recurrence in US Long
Term Care Facilities.
H. Friedman, 1 P. Navaratnam, 1 G. Reardon, 2 K. P. High, 3 M. Strauss. 4
1. DataMed Solutions LLC, Hillard, OH; 2. Informagenics, LLC,
Columbus, OH; 3. Wake Forest School of Medicine, Winston Salem,
NC; 4. Optimer Pharmaceuticals, Inc, San Diego, CA.
Supported By: Optimer Pharmaceuticals provided funding for
this study.
Howard Friedman, Prakash Navaratnam, and Gregory Reardon are
paid consultants engaged by Optimer. Marcie Strauss is an employee
of Optimer. Kevin P. High served on the Optimer Advisory
Council and is a consultant for Optimer.
BACKGROUND: Predictors of recurrent Clostridium difficileassociated
disease (rCDAD) and its association with patient characteristics,
resource utilization, and outcomes in the long term care
(LTC) setting were assessed. METHODS: Demographics, Minimum
Data Set (MDS) 2.0 assessments, and pharmacy records of residents
were analyzed (AnalytiCare LTC database). Residents with an MDS
CDAD code (1/01/07–9/30/10; earliest=index date), ≥1 MDS assessment
≤120 days both pre-and post-index, and metronidazole (MET)
or vancomycin (VAN) received ±7 days of index date were included.
Patients were censored at the earliest of: discharge with no re-admission
≤30 days, latest MDS+90 days, end of study, or death. rCDAD
was defined as MET or VAN being dispensed after >28 day washout
after last fill/refill for the initial episode. Descriptive statistics were
used to compare patient characteristics and resource utilization between
rCDAD and non-rCDAD cohorts. Cox proportional hazard
analysis of index drug cohorts were constructed to identify predictors
of time to recurrence. RESULTS: Of 1145 selected CDAD patients,
225 (19.7%) had ≥1 rCDAD before censoring. Mean age (77–78 y)
and Charlson Comorbidity Index scores (mean=3.0) were similar for
both rCDAD and non-rCDAD cohorts. Prevalence of 26 different comorbidities
was also similar for rCDAD and non-rCDAD cohorts;
most common were recent urinary tract infection (54% and 51%, re-
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AGS 2012 ANNUAL MEETING