Here - American Geriatrics Society

P OSTER
A BSTRACTS
In addition to 7 specific factors that patients identify as probable
cause, a miscellaneous category exists for qualitative explanation.
Furthermore, objective factors such as number of prescribed medications,
primary care visit between hospitalizations, and mental health
or cognitive diagnoses are also tracked for these individuals.
Results: While no specific factors have been isolated as a primary
cause for readmission, patient feedback such as pre-mature discharge,
quality of post-discharge care, and medication issues are
being reviewed. Preliminary results show patients believe their condition
will require readmission (28.33%) while some patients believe
they were discharged prematurely (26.67%). When paired with the
objective data collected as noted above, we surmise that embracing
the patient and family perspective in discharge planning may reduce
the likelihood of their readmission.
Conclusions: Bringing the patient and family’s perspective into
care promotes a holistic approach to healthcare that enhances successful
discharge planning. The role of social work in completing
these assessments from a psychosocial perspective has been a successful
model in our institution in obtaining this information as they
are then also able to implement clinical interventions and connect
persons with appropriate resources that will reduce the likelihood of
a readmission.
D126
Identification of medication discrepancies in discharge paperwork
among patients in the CO-OPERATE Geriatrics/Surgery comanagement
program.
L. M. Walke, 1,2 R. A. Rosenthal, 1,2 M. F. Perkal, 1,2 S. Jeffery, 1,3
M. Maiaroto, 1 R. Marottoli. 1,2 1. VA Connecticut, West Haven, CT; 2.
Yale School of Medicine, New Haven, CT; 3. Univ of CT, Storrs, CT.
Background: Accurate communication regarding medication
regiments is critical to efforts to decrease preventable rehospitalizations
as older adults transition across treatment environments. Electronic
medical records (EMR) can improve communication between
providers and patients but discrepancies in medication list documentation
may thwart these efforts.
Aim: To describe the prevalence of medication discrepancies in
the documentation provided to surgical patients and nursing agencies
or facilities at discharge.
Methods: Surgery patients aged ≥70 years with an expected
peri-operative course ≥ 48 hours are eligible for CO-OPERATE, a
co-management program between geriatrics and surgery. The geriatrics
team consists of a geriatrician, geriatric NP and clinical pharmacist.
We examined the EMR of CO-OPERATE patients discharged
home with nursing services or to nursing facility for
discrepancies in the medication lists included in the patient discharge
instructions and the W10. A medication discrepancy was defined as
the omission of a medication on either list or differing dosing instructions.
Various surgical subspecialties participate in CO-OPERATE
including General Surgery, Cardiothoracic, Orthopaedics, Plastics,
Urology, and Vascular.
Results: The average age of our patients was 83.5 years. All were
discharged on ≥5 medications; 65% received ≥10 medications. In the
first year of the program, ≥1 medication discrepancy between the
W10 and patient discharge instructions was noted for 30% of patients
regardless of the number of medications prescribed. Discrepancies in
documentation occurred most frequently for pain medications, antidepressants,
and vitamins to supplement deficiencies.
Conclusion: Almost two thirds of the surgical patients in our comanagement
program were discharged with ≥10 medications; discrepancies
in documentation varied by medication class. Determining
if other factors contribute to discrepancies, and grading the severity
of discrepancies, may help target our quality improvement efforts.
Redesigning the EMR to alert clinicians of discrepancies in discharge
documentation could improve communication between providers
while aiding efforts to decrease adverse drug effects and preventable
hospitalizations among older adults transitioning through the continuum
of care.
D127
Breaking Down the Silos in Geriatric Inpatient Care.
L. Tank, M. Parulekar, J. Previdi, N. Benoit, A. Sarkar, L. Mansour.
Geriatrics, Hackensack University Medical Center, Hackensack, NJ.
Background: Incidence of delirium is high in elderly patients
and it is associated with increased mortality and morbidity and increases
length of stay.
Objective: To integrate Hospital Elder Life program (HELP) in
Geriatric Service Line (GSL) to improve perceptions of care, treatment
and services for geriatric patients (age 70yrs and over) by preventing
delirium, functional decline and length of stay (LOS) in hospital
setting.
Method: The GSL with HELP presented a proposal for disease
specific certification (DSC) for Joint Commission on the Accreditation
of Healthcare Organization (JCAHO).Random sample of 40 patients
per month on 6 HELP units were enrolled using the inclusion
criteria (70 year or older with at least one risk factor such as cognitive
impairment, mobility impairment, vision impairment, hearing
impairment, dehydration, and should be able to communicate verbally
or in writing) through nursing assessment, in multidisciplinary
rounds, and/or by chart review. Metrics included were number of indwelling
urinary catheter days, fall and pressure ulcer rate and use of
psychotropic medication (Haldol, Ativan, Ambien, and Benadryl)
and LOS.
Results: Data was collected from January–August 2011.The
mean indwelling Foley days was 3.4, mean fall rate was 0.6%, pressure
ulcer rate was 0.3%, mean rate of psychotropic meds used was
13.75% and LOS was 3.7 on HELP units as compared to 6.2 on other
units (40% reduction).
Conclusion: The GSL in addition to the multidisciplinary team
has HELP volunteers which has made this a unique model and has
received the distinct honor by JCAHO for disease specific certification
in geriatrics, 1st in the nation.
D128
MEDICAL SERVICE USE IN DEPRESIVE PATIENTS
RECRUITED AT A COLLABORATIVE CARE
MANAGEMENT PROGRAM IN AMBULATORY ELDERLY.
M. Schapira, M. Smietniansky, M. F. Albornoz, P. Hernan,
D. Matusevich, C. Guerra, J. Esteban, M. E. Ramos, L. Camera.
Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
Supported By: Hospital Italiano de Buenos Aires
CONTEXT: Depression is a common disorder among older
adults sustaining high morbidity, mortality and health care utilization.
Nonetheless, depression remains underdiagnosed and undertreated
leading to adverse outcomes.
In a previous interventional study, we demonstrated that using a
managed care approach depression a reduction of the depressive
symptoms in our population. However, we did not evaluated outcomes
related to medical service use.
OBJETIVES: To determine the rates of medical services utilization
including consults and in depressive patients recruited from our
“Collaborative Care Management Program”.
METHODS: A before/after study was designed to assess the impact
of multifactorial interventions in older adults with depression.
PARTICIPANTS: 91 patients aged 65 and older referred to the
program by primary care physician, with a diagnosis of clinical depression
at baseline assessment. Age mean 77 years. Female 72%.
Intervention: Patients were recruited for an initial comprehensive
geriatric evaluation. Intervention patients had bimonthly followup
visits, social evaluation, access to psychiatric consultation, support
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AGS 2012 ANNUAL MEETING