Brush Up on Fall Risk Factors

Do you know which of your residents are most likely to suffer a fall? Can you spot environmental hazards at your facility? The Agency for Healthcare Research and Quality (AHRQ) recently posted a new training module to help nursing home personnel strengthen their fall prevention and management skills.

In the module, the AHRQ notes that there are two primary groups of risk factors: those tied directly to residents and those linked to the environment. They list the following as the biggest risk factors related to residents¹:
Previous falls: If residents have fallen in the past, they are much more likely to do so in the future.
Diminished strength: Strength is measured by a resident’s ability to stand and walk unaided. Residents with diminished strength in their lower limbs are more likely to fall.
Gait and balance impairments: Abnormal patterns of steps and difficulty maintaining balance can lead to falls.
Medications: Certain drugs, such as sedatives, hypnotics, antidepressants and benzodiazepines, have been associated with falls.
Alzheimer’s disease or dementia: In general, residents with dementia are both more likely to fall and more likely to be injured in a fall. They are also more likely to fall during the late afternoon and at night.
Vision impairment: Difficulty seeing clearly is tied to increased fall risk.

Falls can also be caused by problems in the environment, such as¹:
Design problems: Call buttons that are inaccessible, insufficient lighting and floor that are wet, uneven or slippery can lead to falls.
Lack of space: If rooms are small or overcrowded, residents are more likely to fall while trying to navigate them.
Obstacles: Items left in crowded rooms or hallways, such as wheelchairs, linen carts, medicine carts and cleaning equipment, can lead to falls.
Equipment malfunction or misuse: Residents are more likely to fall if the equipment they rely on doesn’t work properly, such as wheelchairs that don’t lock.
Staffing and organization or care: Inadequate staffing can lead residents at a high risk of falls without supervision.

The AHRQ module also includes guidance on limiting falls that cause injury, responding to falls and a list of additional tools and resources for use in your fall prevention efforts. To access the module, click here.

   

Reference

1 Agency for Healthcare Research and Quality. Improving Patient Safety in Long-Term Care Facilities, Module 3. Available at: http://www.ahrq.gov/qual/ptsafetyltc/ltcmod3sess1.htm#Safe. Accessed July 25, 2012.

Nursing Homes to See FY 2013 Medicare Pay Raise

Late Friday, CMS released an announcement that they will raise Medicare payments to nursing homes by 1.8 percent in fiscal year 2013. This will result in a cumulative $670 million pay hike that takes effect on October 1.

This is undoubtedly good news for those who were expecting either a freeze or reduction in the FY 2013 Prospective Payment System rates for skilled nursing homes.

Click here to read the notice.

How to Create a "Senior Summer Survival Kit"

With this summer one of the hottest on record, we all need to take precautions when going outside. This is especially important for the elderly population, who often have more trouble dealing with extreme heat. Senior Helpers, one of the largest in-home senior care companies, recommends creating "Senior Summer Survival Kits."


These kits are low-cost and easy to assemble. Examples of contents include: 

• A reusable water bottle to encourage proper hydration
• Copies of all prescriptions and health insurance cards
• Phone numbers of healthcare providers and information about any health conditions
• Sunscreen (at least SPF 30) to prevent serious burns
• Multivitamins to keep the immune system strong
• Hand-held fans 

To learn more, click here. 

ProMed Video Tutorials: Helping You Get the Most Out of Our Products

We’re proud to offer an online library of video tutorials to guide you through the use of many of our most popular products and resources. We regularly add new videos to the site, so be sure to check back often! We currently offer in-service videos for the following items:

·        Incontinence products

·        Blood glucose monitoring systems

·        Fall monitors

·        Bladder scanners

We also have a video that walks you through getting the most out of our website, promedsupply.com! Click here to view the entire video library. 

Nightlights Linked to Mild Depression

Depression can be caused by many different factors - but did you know your nightlight could be one of them?

A new study of animals suggests that constant exposure to light at night can cause depression. In the study, hamsters that were exposed to dim light at night for four weeks showed signs of depression (such as not being interested in treats they usually enjoyed), compared to animals who were not exposed to light at night. 

The researchers theorize that exposure to artificial light at night might have contributed to the rising rates of depression over the past 50 years. There's good news, though - the researchers found that the negative effects of light at night were reversed in the animals after just two weeks of normal lighting conditions. 

To learn more, click here. 

What Needs to Be Disinfected When?

Are you familiar with the Spaulding classification system? It was created more than 30 years ago as an approach to disinfection and sterilization of healthcare items and equipment and it remains the gold standard today. The system breaks items down into three categories: critical, semicritical and noncritical. Items are categorized based on the risk of infection involved in their use, and disinfection instructions are included for each category.

The categories are as follows¹:

Critical items are items that normally enter sterile tissue, or the vascular system, or through which blood flows. This category includes items such as needles, intravenous catheters and urinary catheters.

Disinfection: Equipment must be sterile when used.

Semi-critical items are objects that touch mucous membranes or skin that is not intact. This group includes items such as thermometers, podiatry equipment and electric razors.

Disinfection: These items require high-level disinfection using an FDA-approved agent. They may also be sterilized.

Noncritical items either come into contact with intact skin or do not touch the resident. This category includes items such as stethoscopes, blood pressure cuffs and over-bed tables.

Disinfection: These products require low-level disinfection. They should be cleaned periodically and after visible soiling with an EPA-registered disinfectant, detergent or germicide that is approved for healthcare settings.

Single-use disposable equipment can also be used in lieu of sterilizing reusable instruments (remember, devices that are labeled by the manufacturer for single use should never be reused). Manufacturers are also beginning to introduce touch-free devices, such as thermometers, that greatly reduce the need for constant disinfection. ProMed territory managers are ready to tell you more about our disinfecting products as well as our new, touch-free Infrared Thermometer. Give us a call at 800-648-5190 to learn more!

Reference

1 Centers for Medicare & Medicaid Services. State Operations Manual. Appendix PP – Guidance to Surveyors for Long Term Care Facilities (Rev. 70, 01-07-11). Available at: http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_pp_guidelines_ltcf.pdf. Accessed July 17, 2012. 

Under Pressure: Choosing the Right Support Surface

When it comes to the prevention and treatment of pressure ulcers, choosing the right support surface is key. According to Tag F-314, facilities should match a device's potential therapeutic benefit with a resident's specific situation. The effectiveness of a pressure redistribution device is based on its potential to address the individual resident's risk, the resident’s response to the product and the characteristics and condition of the product.¹


There are two primary types of support surfaces¹:

Static pressure redistribution devices are non-powered devices that may be indicated when a resident is at risk for pressure ulcer development or delayed healing. These devices include:

• Solid foam
• Gel-infused foam
• Convoluted foam (i.e., channel-cut or "egg crate" foam)
• Gel mattresses

Dynamic pressure reduction surfaces are powered devices that are indicated if a resident can't move into a variety of positions without placing weight on a pressure ulcer, if their weight completely compresses a static device that otherwise maintains its original integrity or if they have a pressure ulcer that is not healing as expected and it is determined that pressure could be contributing to the delay. Dynamic pressure reduction surfaces include:

• Alternating pressure mattresses and overlays
• Low air loss systems

Professional Medical stocks a comprehensive selection of both static and dynamic pressure reduction and redistribution surfaces, including the new Dynamic Elite Mattress^™ with Visco Gel Technology^™. Your territory manager is ready to help you choose the products that best meet your residents' needs! Give us a call at (800) 648-5190 to learn more.

Reference
1 Centers for Medicare & Medicaid Services. State Operations Manual Appendix PP – Guidance to Surveyors for Long Term Care Facilities (Rev. 70-01-07-11). Available at: http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/
som107ap_pp_guidelines_ltcf.pdf Accessed July 5, 2012.

Bladder Scanners Can Help Prevent Unnecessary Catheterizations

With 75 percent of urinary tract infections at healthcare facilities tied to indwelling urinary catheters, caregivers have a real incentive to avoid catheterizations.¹ Tag F315 makes it clear that indwelling catheters should be used as sparingly as possible. 


The tag's goals are to ensure that²:

• Each resident who is incontinent of urine is identified, assessed and provided appropriate treatment and services to achieve or maintain as much normal urinary function as possible
• An indwelling catheter is not used unless there is valid medical justification
• An indwelling catheter for which continuing use is not medically justified is discontinued as soon as clinically warranted
• Services are provided to restore or improve normal bladder function to the extent possible after the removal of the catheter
• A resident, with or without a catheter, receives the appropriate care and services to prevent infections to the extent possible

Bladder scanners are convenient, portable tools that help you determine a resident's particular type of incontinence and potentially avoid catheterization. These noninvasive units provide accurate bladder imaging that can help identify a resident's treatment needs. Using an ultrasound image, they automatically calculate bladder volume and determine post-void residual. These findings can help you determine whether a resident has urge or overflow incontinence, which often present with the same symptoms, and begin the proper treatment protocol.

Regular measuring of bladder volume can assist you with developing a volume-based toileting schedule to save time and reduce the number of incontinent episodes. Scheduled volume measurement can also help you determine when, if ever, catheterization is needed.

Professional Medical now offers the Portascan+^™ bladder scanner. We invite you to contact your territory manager or give us a call at (800) 648-5190 to learn more about this valuable tool.

References
1 Centers for Disease Control and Prevention. Catheter-associated Urinary Tract Infections (CAUTI). Available at: http://www.cdc.gov/HAI/ca_uti/uti.html. Accessed July 12, 2012.

2 Centers for Medicare & Medicaid Services. State Operations Manual. Appendix PP – Guidance to Surveyors for Long Term Care Facilities (Rev. 70, 01-07-11). Available at: http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/
som107ap_pp_guidelines_ltcf.pdf. Accessed July 12, 2012.

You Are What You Eat? Gut Health Tied to Frailty

Researchers in Ireland have made a discovery that could impact long-term care facilities' dietary departments. They found that the guts of elderly people who live on their own have more diverse intestinal flora and are healthier than those who live in long-term care facilities.

They were able to tie this disparity to the individuals' diets. The people who lived in LTC facilities ate less varied foods, such as puddings and mashed potatoes. Those who were living independently were more likely to eat a diverse diet with higher levels of fiber and protein.

The researchers anticipate that their findings could mean an increased demand for fiber-rich, fresh foods in institutional settings.

To learn more, click here.

CMS Announces 2012 Action Plan

On July 6, CMS released its 2012 Nursing Home Action Plan. You can read it in its entirety by clicking here.

The action plan is organized into five different strategies:

1. Enhance consumer engagement
2. Strengthen survey processes, standards and enforcement
3. Promote quality improvement
4. Create strategic approaches through partnerships
5. Advancing quality through innovation and demonstration

The action plan goes into effect immediately.

Study: LTC Liability Costs Rising 4% Annually

According to Aon Global Risk Consulting, claim severity and loss rates in long-term care have risen 4 percent every year since 2009. During that time, the frequency of claims has stayed the same.

In 2005, liability costs were around $1,000 per bed. By 2013, that number is expected to climb to $1,540 per bed. Claim severity is expected to reach $175,000 per claim by 2013.

The research was sponsored by the American Health Care Association and National Center for Assisted Living.

To download the report, click here.

Sebelius: States Can Opt Out of Medicaid Expansion, But Can't Tighten Medicaid Eligibillity

Health and Human Services Secretary Kathleen Sebelius is reminding state governors that although they can choose to opt out of the Affordable Care Act's Medicaid expansion, they still can't tighten current Medicaid eligibility requirements.

Sebelius added that low-income residents in states that elect not to participate in Medicaid expansion will not face federal penalties for not having health insurance. Instead, they will receive a "hardship" waiver from the ACA's individual mandate provision. 

To read Sebelius's letter to state governors, click here. 

FDA Endorses Opioid Painkiller Safety Measures

The FDA wants manufacturers of opioid pankillers to underwrite training and educational programs for physicians who prescribe them.

The agency is requiring manufacturers to underwrite voluntary physician training as part of their risk evaluation and mitigation strategy (REMS) program. The three key components of this program will be:

1. Education and training for prescribers
2. An updated medication guide and patient counseling document
3. An auditing and assessment process

Opioid painkillers have been linked to increased falls and fractures in the elderly as well as drug abuse and overdose-related deaths.

To learn more, click here. 

CDC Issues Tips for Surviving a Wedding

Fresh off last year's guidance on surviving a zombie apocalypse, the CDC has issued a new survival guide - for weddings. Yep, you read that correctly. The CDC wants you to take a minute and think about what could possibly go wrong on the so-called happiest day of your life.

So what are we talking about here? A groom who doesn't make it to the wedding? Overserved guests? Not so much. Rather, the CDC recommends that you:

1. Make a kit: Include the essentials from a home emergency kit in your bridal kit, such as a first aid kit, bottles of water, snacks, medications and extra cash. 
2. Make a plan: Have a plan for contacting guests in case of an emergency and make sure you have a list of emergency telephone numbers. Extra umbrellas for the wedding party aren't a bad idea, either. Oh, and don't forget to ask the reception venue for their emergency plans and evacuation routes. 
3. Stay informed: Be aware of possible issues and do your homework. Potential problems can range from tornadoes to health issues to a bridezilla on the loose! 

Click here to read the guidelines in their entirety. 

Large Doses of Vitamin D Can Help Reduce Fracture Risk

You've no doubt heard that vitamin D helps strengthen bones - but you're going to need to consume a lot more than a glass of milk if you want it to help prevent fractures.

According to researchers at Tufts University, the risk of most fractures (including hip, wrist and forearm) can be greatly reduced in people 65 and older by taking between 800 and 2,000 International Units (IUs) of vitamin D every day. The researchers also found that there was no benefit to taking less than 800 IUs a day.

Current Institute of Medicine guidelines recommend that people between 51 and 70 take 600 IUs of vitamin D and adults over 70 take 800 IUs daily.

To learn more, click here.

More Tips for Keeping Cool

This heat just isn't letting up, is it? Here in Chicagoland, we've had three straight days of temperatures in the 100s - only the third time that's happened since records have been kept!

Those who work with the elderly know that their bodies simply don't cool down as quickly as younger people, and they might not feel as hot when temperatures are dangerously high. They're also less likely to feel thirsty, even on the brink of dehydration.. In addition, there are a number of diseases, including heart disease and diabetes, that can make it more difficult to cope with oppressive heat and humidity.

The following strategies can help keep your residents safe in high temperatures:

• Even if residents are going outdoors for just a brief time, make sure they are wearing wide-brimmed hats, sunglasses and sunscreen (at least SPF 15). 
• Keep pests such as ants, bees and flies away from residents and make you sure you have a supply of unexpired EPI pens on hand. 
• Ensure that you have a plan in place for keeping residents hydrated. This can include frequently replenishing bedside water, encouraging frequent consumption of fluids, providing popsicles as treats and making carafes of water, iced tea and lemonade readily available. 
• Make sure that your building isn't too hot. Federal regulations require that nursing facilities that were certified after October 1, 1990 maintain a temperature between 71 and 81 degrees Fahrenheit in resident areas. 

Seven States Already Rejecting ACA Medicaid Expansion

A week after the Supreme Court upheld the Affordable Care Act, AKA "Obamacare," at least seven governors have indicated that they will not participate in the Medicaid expansion called for under the law.

The Supreme Court struck down the provision of the law that called for states to increase their Medicaid rolls or risk being penalized by the federal government. Governors still have a financial incentive to participate, since the government will be footing the bill for most of the bill through 2016.

The seven states whose governors have indicated that they will not take part in the Medicaid expansion are:

1. Florida
2. Iowa
3. Kansas
4. Louisiana
5. Nebraska
6. South Carolina
7. Wisconsin 

States that are undecided but appear to be leaning toward "no" include Alabama, Georgia, Indiana, Mississippi, Missouri, Nevada, Texas and Virginia. 

Reminder: ProMed is Closed July 4

Professional Medical will be closed tomorrow, July 4, in honor of Independence Day. All Wednesday deliveries will be made on Thursday, July 5. If you have any questions or concerns, we invite you contact our Customer Care team at (800) 648-5190.

We wish you a safe and happy Independence Day!

How Will "Obamacare" Affect Your State?

Now that the Supreme Court has upheld the Affordable Care Act, AKA "Obamacare," what comes next? Healthcare.gov (a website created by the U.S. Department of Health & Human Services) has added a section to their site titled "The Health Care Law & You." In this section, you'll find implementation resources and a state-by-state breakdown of how the new law will affect people across the country. It's packed with valuable information and we encourage you to check it out!