Clinical Issues
1.
Helpful
Organizations,
Web Sites,
and Associated
Tools
2.
Dementia
Care
3.
Falls
4.
Incontinence
5.
Infection
Control
6.
Pain
7.
Restraints
8.
Skin Integrity
9.
Nutrition
and Hydration
Helpful Organizations,
Web Sites and Associated
Tools:
Geriatrics
at Your Fingertips.
All your assessment
questions regarding
a extensive list of
diseases just a click
away.
Center
for Medicare and Medicaid
(CMS) web site “Sharing
Innovations in Quality
(SIQ)
http://siq.air.orgg
American
Medical Directors Association:
The American
Medical Directors Association
is the professional
association of medical
directors and physicians
practicing in the long
term care continuum,
dedicated to excellence
in patient care by providing
education, advocacy,
information, and professional
development. Information
includes: guidelines,
toolkits, forms and
tools and protocols
for notification of
the Physician. Information
can be ordered online
for a fee.
www.amda.com/tools
Borun
Center for Gerontological
Research: A
joint project by the
UCLA School of Medicine
and the Jewish Home
for the Aging of Greater
Los Angeles. Contains
protocols, guidelines
and other support information
on pressure ulcers,
weight loss, pain, incontinence,
mobility and quality
of life.
www.borun.medsch.ucla.edu
Geriatric Education
Resource Training Institute
(GERTI):
GERTI provides clinical,
educational, and resource
opportunities in geriatric
medicine and gerontology
for care providers serving
the older population.
www.gerti.info
Medline:
Medline
Plus brings together
authoritative information
from National Library
of Medicine (NLM), the
National Institutes
of Health (NIH), and
other government agencies
and health-related organizations
to give you easy access
to medical journal articles.
www.medline.com
MedQic-Medicare
Quality Improvement
Community:
MedQic
is sponsored by the
Centers for Medicare
and Medicaid Services
(CMS) to support and
promote its Quality
Improvement Program
and the Quality Improvement
organizations across
the country like the
Kansas Foundation for
Medical Care (KFMC).
Click on "Nursing Homes"
in the left-hand margin
on the home page to
find tools, literature
and success stories
on these and other topics:
ADL’s, Delirium, Depression,
Immunizations, Incontinence,
Infections, Mobility,
Pain, Physical restraints,
Pressure Ulcers, Urinary
Catheters, UTI, Walking
Improvement and Weight
Loss.
www.medqic.com
National
Guideline Clearinghouse:
www.guideline.gov
Hartford
Foundation for Geriatric
Nursing: Provides
assessment tools on
topics such as overall
assessment, ADL’s, mental
status, depression,
pressure ulcer risk,
sleep quality, pain,
fall risk, nutrition,
sexuality, incontinence,
hearing, and abuse and
neglect.
www.hartfordign.org/resources/education/tryThis.html
University
of Iowa Gerontological
Nursing Intervention
Research Center Evidenced
Based Protocols:
GNIRC strengthens and
expands intervention
focused research in
nursing and related
disciplines regarding
the health of elders
in a variety of care
settings. Guidelines
can be ordered online
for a nominal fee.
www.nursing.uiowa.edu/consumers_patients/EvidenceBasedPracticeGuidelines
Program
of Excellence in Extended
Care. Understanding
Bladder Conditions:
Diane Newman author.
www.dxu.com
Bladder
Management for Older
Adults:
University of North
Carolina at Chapel Hill,
www.med.unc.edu/aging/documents/NursingMaterials.pdf
CDC
web site for updates
on TB, Isolation Procedures
and Drug Resistance.
Also
has additional information
regarding bird flu,
C Diff, MRSA, VRE etc.
www.cdc.gov/ncidod/dhqp/pdf/guidelines/isolation2007.pdf
www.cdc.gov/ncidod/dhqp
for both TB and Drug
Resistance
Top
Dementia Care
Much
progress has been made
in the diagnosis and
management of Alzheimer’s
Disease and related
dementia’s. The long
term care community
has resources regarding
Best Practices in Quality
of Care and Life for
the sufferers of this
disease. These are a
few resources for this
issue.
Articles
·
C. Williams
et al. Development of
Nurse Competencies to
Improve Dementia Care.
Geriatric Nursing
(26:2), 98-105.(12 references)
·
Alzheimer’s
Association Campaign
for Quality Residential
Care. Dementia Care
Practice Recommendations
for Assisted Living
and Nursing Homes,
Chicago, IL, 2005.
www.alz.org. Also
has national conferences
and professional resources
.
·
National
Alzheimer’s Foundation
specializes in research
and care issues.
www.alzfdn.org
·
This
web site gives state
of the art direction
related to the design
of environments for
residents with dementia.
ww.dementiadesigninfo.org/
·
This
web site is packed with
tools, supplies for
living with a person
with dementia.
www.alzstore.com
·
A video
called “Detecting Discomfort
in Dementia-Focus on
Behavior” can be ordered
at
www.trc.wisc.edu
Top
Falls
Resources
-
American
Medical Directors
Association (AMDA).
Falls and fall risk.
Columbia (MD): American
Medical Directors
Association (AMDA);
2003. 16 p. [1 reference]
-
Lyons
SS.
Fall
prevention for older
adults.
-
Mobily
K, Mobily P.
Progressive
resistance training.
-
Resnick
B. Preventing
falls in acute care.
In: Mezey M, Fulmer
T, Abraham I, Zwicker
DA, editor(s). Geriatric
nursing protocols
for best practice.
2nd ed. New York
(NY): Springer Publishing
Company, Inc.; 2003.
p. 141-64. [25 references]
-
Guideline
for the Prevention
of Falls in Older
Persons. JAGS
(49), 664-672,
2001. (93 references)
-
DHS.
Public Health Division.
Evidenced Based
Health Promotion:
Resources for Planning.
#3 Falls Prevention.
www.health.vic.gov.au/healthpromotion/quality/falls_prevention.htm
KAHSA
In-Service Toolkit,
Module 2.
Prevention
of Falls:
www.kahsa.org/content_new/pdfs/Toolkits/InserviceToolkit/PreventionFalls.pdf
(requires KAHSA membership).
KDOA
Resources on Falls
include assessment tools,
pharmacy, therapy and
quality assurance issues.
There are approximately
20 items for review.
Click on license and
certification and then
to Best Practices. Access
at:
www.agingkansas.org
Emory
Center for Health In
Aging, 2005, The
Falls Management Program
for Quality Improvement
in Nursing Facilities.
J. Taylor et al authors.
Excellent resource that
includes a 45 page manual
with tools, a PowerPoint
presentation, equipment
inspection checklists,
resources and information
in Spanish.
www.medqic.org
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Incontinence
The
basic components of
incontinence management
include:
1.
Assessment,
2.
Voiding
pattern studies,
3.
Individualized
care plans based upon
the assessment and study,
4.
Periodic
review of program effectiveness,
5.
Direct
care givers are aware
of individualized programs
and the products to
use, and
6.
Justification
for check & changes
programs and use of
Foley catheters with
physician input.
Web Sites
American
Medical Directors Association:
www.AMDA.com/tools
Borun
Center for Gerontological
Research:
www.borun.medsch.ucla.edu
MedQic-Medicare
Quality Improvement
Community:
www.medqic.com
Hartford
Foundation for Geriatric
Nursing:
www.hartfordign.org/resources/education/tryThis.html
University
of Iowa Gerontological
Nursing Intervention
Research Center Evidenced
Based Protocols:
www.nursing.uiowa.edu/consumers_patients/EvidenceBasedPracticeGuidelines
Program
of Excellence in Extended
Care. Understanding
Bladder Conditions:
Diane Newman author.
www.dxu.comm
Bladder
Management for Older
Adults:
University of North
Carolina at Chapel Hill,
www.med.unc.edu/aging/documents/NursingMaterials.pdf
Top
Infection Control
CDC
web site for updates
on TB, Isolation Procedures
and Drug Resistance.
Also
has additional information
regarding bird flu,
C Diff, MRSA, VRE etc.
·
www.cdc.gov/ncidod/dhqp/pdf/guidelines/isolation2007.pdf
·
www.cdc.gov/ncidod/dhqp
for both TB and Drug
Resistance
Rhode
Island QIO has an Immunization
Toolkit.
www.RIqualitypartners.org
NEW!
KDOA
has issued TB
guidelines in the
Sunflower
Connection, January
2008.
These are based upon
the
CDC TB guidelines.
NEW!
KDOA
has issued MRSA guidelines
in the
Sunflower
Connection, April
2008.
NEW!
Top
Pain
Pain
contributes to many
resident issues including:
resisting care, moaning,
crying out, insomnia
and decline in ADL’s
to name a few. As clinicians,
we must begin to view
pain as a daily assessment
process. Steps and processes
should include:
1.
Screens-5th
vital sign and as a
cause of behavior issues
2.
In-depth
assessment of the pain
3.
Development
of an individualized
plan of care to manage
pain that can be acute
or chronic in nature
4.
Review
of the plan of care
at least monthly to
note effectiveness of
the plan and to make
changes in the plan
based on resident goals.
5.
Ensuring
that the plan of care
follows best practices
regarding pain management.
Pain
Resources
-
Kansas Foundation for
Medical Care has
an excellent resource
for pain management.
www.kfmc.org
-
M. McCaughey et al. Pain:
Clinical Manual.
Mosby, MO, 1999.
-
American
Association of Pain
Management Nurses.
www.aspmn.org
-
Joint Policy Statement
of the Boards of
Healing Arts, Nursing
and Pharmacy on
the use of Controlled
Substances for the
treatment of Pain.
June 2002.
www.ksbn.org.
Click on legal.
-
The Management of Persistent
Pain in Older Adults.
AGS Panel on Persistent
Pain in Older Persons.
JAGS (50) 5205-5224,
2002.
-
The Life Project is a
Kansas based organization
that assists persons
with chronic disease
with end of life
issues that focus
on quality of life
and care.
www.lifeproject.org
-
American Pain Foundation
has numerous resources
on pain management
and support.
www.painfoundation.org
-
Brown University for
Gerontology and
Health Care Research
has a list of tools
that are quick and
easy to use regarding
pain management
from assessment
to changing an opiod
dose. They also
have information
regarding severe
pain and end of
life issues.
www.chcr.brown.edu/commstate/fastfacts.htm
-
American Pain Society.
www.ampainsoc.org,
Great resources
and conferences
on this issue.
-
Person resource. Kansas
University Medical
Center, Kansas City,
KS. 913-588-7708.
Melanie Simpson.
Email:
msimpsom@kumc.edu.
KU does a yearly
workshop to educate
nurses to be pain
resources. Melanie
is also available
for consultation.
-
FDA Safety News: preventing
patient deaths from
Fentanyl Patches.
NEW!.
www.accessdata.fda.gov/psn/transcript.cfm?show=67#3
-
Caution on No Name Drug
Patches. Catepres
TTS.
www.accessdata.fda.gov/psn/transcript.cfm?show=67#5
NEW!
Top
Restraints: Side rails
Web Sites
Food
and Drug Administration:
www.fda.gov/
and the FDA Med-Watch
e-list
www.fda.gov/medwatch/elist.htm
Video:
“Do No Harm” Kendall
Corp.
www.ute.kendal.org//
CMS Web
Site:
www.cms.hhs.gov/
CMS Clarification
of Terms on the use
of physical restraints:
www.cms.hhs.gov/SurveyCertificationGenInfo/downloads/SCLetter07-22.pdf
Top
Skin
Integrity
Resources
- Articles
Arterial
Wounds
Pressure
Ulcers
-
Agency for Health Care Policy
and Research (AHCPR).
Pressure
ulcers in adults:
prediction and prevention.
-
American Medical Directors
Association (AMDA).
Pressure
ulcers.
Columbia (MD): American
Medical Directors
Association; 1996.
16 p. According
to the guideline
developer, this
guideline was reviewed
by the original
Steering Committee
and is still considered
to be current as
of Jan 2004.
-
American Medical Directors
Association.
Pressure
ulcer therapy companion.
-
Ayello EA.
Preventing
pressure ulcers
and skin tears.
-
Folkedahl BA, Frantz R.
Treatment
of pressure ulcers.
-
Folkedahl BA, Frantz R.
Prevention of pressure
ulcers.
-
National Collaborating Centre
for Nursing and
Supportive Care.
Pressure
ulcer prevention.
-
National Pressure Ulcer
Advisory Panel.
www.npuap.org
provides a wealth
of information and
tool and education
resources for assessment,
staging, prevention
and treatment for
pressure ulcers.
-
Wound, Ostomy, and Continence
Nurses Society (WOCN).
Guideline
for prevention and
management of pressure
ulcers.
-
USH tool for tracking the
healing process.
www.npuap.org.
Scroll down to tools.
Skin
Tears
Venous
Wounds
-
Registered Nurses Association
of Ontario (RNAO).
Assessment
and management of
venous leg ulcers..
-
Wound, Ostomy, and Continence
Nurses Society (WOCN).
Guideline
for management of
wounds in patients
with lower-extremity
venous disease.
KAHSA
Resources on Skin Integrity
www.kahsa.org/content_new/pdfs/Toolkits/RiskManagmentToolkit/SkinCarePressureUlcerProtocols_Complete.pdf
(Requires KAHSA membership
to login)
KAHSA
In-Service Toolkit.
Skin Care and Ulcer
Prevention
www.kahsa.org/content_new/pdfs/Toolkits/InserviceToolkit/SkinCarePressureUlcer.pdf
(Requires KAHSA membership
to login)
Top
Nutrition and Hydration
Resources
- Articles
-
Amella
EJ.
Mealtime
difficulties.
-
American
Medical Directors
Association (AMDA).
Altered
Nutritional Status.
Columbia (MD): American
Medical Directors
Association (AMDA);
2001. 32 p. [33
references]
-
American
Medical Directors
Association (AMDA).
Dehydration
and fluid maintenance.
-
Thomas
DR, Ashmen W, Morley
JE, Evans WJ.
Nutritional
management in long-term
care: development
of a clinical guideline..
Council for Nutritional
Strategies in Long-Term
Care. J Gerontology
A Bio Sci Med SCI
2000 Dec;55(12):M725-34.
PubMed.
-
US
Department of Health
and Human Services,
US Department of
Agriculture.
Dietary
guidelines for Americans,
2005..
Diabetic Nutrition
- Resources
-
Managing
diabetes in the
long-term care setting.
Columbia (MD): American
Medical Directors
Association (AMDA);
2002. 51 p. [49
references]
-
Care
Management Institute,
Kaiser Permanente.
Adult
diabetes clinical
practice guidelines.
-
White
JV. Diabetes mellitus.
Nutrition
management for older
adults.
Hydration - Articles/Web
sites
-
American
Medical Directors
Association (AMDA).
Dehydration
and fluid maintenance.
-
Mentes
JC. Hydration
management..
Iowa City (IA):
University of Iowa
Gerontological Nursing
Interventions Research
Center, Research
Dissemination Core;
2004 Feb. 43 p.
[99 references]
-
National
Policy and Resource
Center on Nutrition
and Aging has numerous
printable items
related to: food
and fluid intake,
dining programs,
hydration, food/hydration
aide position, assessments,
documentation tools,
accurate weight
and height, and
nutrition care,
food safety posters.
Also information
on disease and staffing.
nutritionandaging.fiu.edu
Top
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