ProMed New Year Closure Reminder

ProMed will be closed Tuesday, December 31 and Wednesday, January 1 to celebrate the arrival of 2014. Orders that were placed by noon on Friday, December 27 will be delivered by Friday, January 3.

If you have any questions or concerns, please contact our Customer Care team at (800) 648.5190.

Happy New Year!

Don't Be SAD: Identifying and Treating Seasonal Affective Disorder

Winter can cause even the most buoyant spirits to sink. It's cold outside, the sun disappears earlier and many people find themselves staring at the same four walls day in and day out. It's a dreary situation indeed – but for many people, perhaps including your residents, it's far more serious than a case of the winter blues. Seasonal affective disorder, or SAD, occurs repeatedly at the same time of year, typically beginning in the fall and ending in spring. Although rare, some people experience the opposite – they become depressed when spring or summer roll around.

Causes

Despite extensive research, the exact causes of SAD are unknown. According to the Mayo Clinic, it's likely that, as with many other mental health conditions, genetics, age and a person's natural chemical makeup play a role in developing the disorder. Being female, living far from the equator and having a family history of SAD are also risk factors for developing the condition.1

Other causes are thought to include1:

• Melatonin levels. Melatonin, a natural hormone, plays a role in sleep patterns and moods. When the seasons change, the melatonin balance can be disrupted.
• Circadian rhythm. Fall and winter bring with them a reduced amount of sunlight. This can upset the body's circadian rhythm, or internal clock, which tells a person when they should be awake or sleeping. This disruption can lead to depression.
• Serotonin levels. Serotonin is a brain chemical (neurotransmitter) that affects mood. Reduced sunlight can cause serotonin levels to drop, leading to depression.

Symptoms

SAD is a cyclic condition, which means that symptoms come back and go away at the same time every year. Symptoms include1:

• Depression
• Hopelessness
• Anxiety
• Loss of energy
• Social withdrawal
• Oversleeping
• Loss of interest in activities
• Changes in appetite (especially a craving for high-carbohydrate foods)

Symptoms might start out mild and grow worse as the season progresses. If left untreated, SAD can lead to suicidal thoughts or behavior, social withdrawal and substance abuse.1

Diagnosis

In order to receive a diagnosis of SAD, individuals need to have experienced depression and other symptoms for at least two consecutive years, and during the same season each year. Those periods of depression also need to have been followed stretches of time without depression. Finally, there must be no other explanations for the change in mood or behavior.1

Treatment

There are a number of available treatments for residents who are experiencing SAD. Common treatments for SAD include phototherapy (also known as light therapy), psychotherapy and medication.1

During light therapy, the affected person sits several feet away from a specialized box designed to expose users to bright, outdoor-like light. Light therapy has few side effects, is easy to use and appears to cause a change in the brain chemicals linked to mood.1 For light therapy to be effective, SAD sufferers should be exposed to a 10,000-lux (about the intensity of the sun at dawn) light source for 30 to 45 minutes a day.2

Even though SAD is thought to be related to biochemical processes, mood and behavior can also complicate symptoms of the disorder. Psychotherapy can be beneficial for identifying and changing negative thoughts and behaviors as well as learning healthy ways to cope with SAD and manage associated stress.1

Finally, a doctor might choose to treat someone with SAD with antidepressants such as bupropion (Wellbutrin XL), paroxetine (Paxil), sertraline (Zoloft), fluoxetine (Prozac and Sarafem) and venlafaxine (Effexor).1

Altering your facility's environment to combat SAD

While severe SAD might require treatment with medication, there are a number of ways to make your facility a more welcoming place for those suffering from the disorder. For starters, try opening blinds, pulling back curtains and trimming any tree branches that block sunlight from entering the facility. Sunshine appears to boost mood, so encourage residents to sit in sunny rooms. Exposure to outdoor light is also highly beneficial, even if just for short periods of time.

Physical exercise can also relieve stress and anxiety. Make sure that there are abundant opportunities to get up and move around your facility, even if it's just taking a few laps up and down the hallways.

While SAD can hit residents hard, simple adjustments to the environment, combined with other treatment options, can help ease the depression and anxiety associated with this disorder.

References
1 MayoClinic.com. Seasonal affective disorder (SAD). Available at: http://www.mayoclinic.com/health/seasonalaffective-disorder/DS00195. Accessed December 27, 2013.

2 The Harvard Medical School Family Health Guide. A SAD story: seasonal affective disorder. Available at: http://www.health.harvard.edu/fhg/updates/Seasonal-affective-disorder.shtml. Accessed December 27, 2013.

ProMed Holiday Closure Reminder

Professional Medical will be closed on Tuesday, December 24 and Wednesday, December 25 in honor of Christmas. We will also be closed Tuesday, December 31 and Wednesday, January 1 to celebrate the new year. Orders that are placed by noon on Friday, December 27 will be delivered by Friday, January 3.

If you have any questions or concerns, please contact our Customer Care team at (800) 648.5190.

Navigating the Holidays with Diabetes

With the holidays approaching, many of your residents are likely making plans to spend time at home with their families. For residents with diabetes, this will bring the added challenge of navigating meals served at festivities. Family members who are unaccustomed to preparing food for diabetic loved ones might also be unsure of their specific nutritional needs.

Luckily, there are resources available to help ease worry over holiday meals. You might want to share the following strategies (courtesy of the CDC) for sticking to a healthy diabetic meal plan with your residents and their families:

• Eat a healthy snack before a party to avoid overeating.
• Choose smaller portions.
• Ask beforehand what food will be served so that you can see how it fits into your meal plan.
• Choose low-calorie drinks such as sparkling water, unsweetened tea and diet beverages.
• Alcohol should only be consumed with a meal and should be limited to one drink a day for women and two for men.
• Choose fresh fruit instead of pies, cakes and other fat- and sugar-laden desserts.
• Watch out for sauces such as a gravy and sugar glazes that can add calories to otherwise healthy foods.
• Focus on friends, family and activities instead of food.

Residents should also make sure that they have any items that they might need during their time away from the facility, including blood glucose monitoring supplies and a glucagon emergency kit for those who use insulin.

To learn more, click here.

OIG Releases Its Top Management and Performance Challenges

The Office of the Inspector General (OIG), a branch of the Department of Health and Human Services (HHS), has released its annual list of management and performance challenges. According to the OIG, this list reflects "continuing vulnerabilities that OIG has identified for HHS over recent years as well as new and emerging issues that HHS will face in the coming year."

The 10 challenges identified by the OIG are:

1. Overseeing the health insurance marketplaces
2. Transitioning to value-based payment for health care
3. Ensuring appropriate use of prescription drugs in Medicare and Medicaid 
4. Protecting the integrity of an expanding Medicaid program 
5. Fighting fraud and waste in Medicare Parts A and B
6. Preventing improper payment and fraud in Medicare Advantage 
7. Ensuring quality of care in nursing facilities and home- and community-based settings 
8. Effectively using data and technology to protect program integrity 
9. Protecting HHS grants and contract funds from fraud, waste and abuse
10. Ensuring the safety of food, drugs and medical devices 

To learn more about each of these challenges, click here. 

FDA Scrutinizing Antibacterial Soaps

On Monday, the FDA issued a proposed rule that would take closer look at antibacterial hand soaps and body washes to determine if they provide benefits beyond those of “plain” (non-antibacterial) soaps. The FDA notes that there is currently no research that supports these soaps being any more effective at preventing illness.

The agency is also concerned that chemicals commonly contained in these soaps, such as triclosan and triclocarban, might carry unnecessary risks, such as bacterial resistance to antibiotics and hormonal effects.

The FDA is proposing that manufacturers of antibacterial soaps be required to provide more substantial data that demonstrates the safety and effectiveness of antibacterial soaps. The agency is asking consumers, clinicians, environmental groups, scientists, industry representatives and others to weigh in on this proposal in the next 180 days, so it will be some time before a final rule is issued.

We want you to know that ProMed offers a complete range of hand soaps that do not contain triclosan, including DermaKleen. Our knowledgeable sales team is ready to meet with you to discuss your needs and help you select the best products for your facility.

We will continue to monitor the progress of this proposed rule and keep you updated.

For additional information  from the FDA, please click here.

Christmas Movie Word Scramble

Test your knowledge of holiday movies by reading the clues below and then unscrambling the name of the movie. Be sure to print out this page, make copies and share them with your residents during your holiday party! If you get stumped, the answers can be found below.

1. This 1946 film was directed by Frank Capra and features an angel named Clarence Odbody.

SIT A LFENWURDO EILF

2. This 1983 comedy is based on a short story from Jean Shepherd’s book In God We Trust, All Others Pay Cash.

A MISTRASCH TORYS

3. In this 1988 comedy, Bill Murray puts his spin on a classic character created by Charles Dickens.

DEGROCSO

4. Starring Bing Crosby and Fred Astaire, this 1942 musical takes place at an inn that is only open on holidays.

DOLIHAY NIN

5. The Griswold family is back for more hilarious misadventures in this 1989 film starring Chevy Chase.

SAMRISTCH NOTIVACA

6. This 1954 musical features a popular song-and-dance team belting out tunes by Irving Berlin.

EHWTI SIRMASTCH

7. Set in London and released in 2003, this romantic comedy chronicles the love lives of eight very different couples.

EOLV YALTUACL

8. This film, based on a book by Doctor Seuss, has been released in both live action and animated formats.

WOH EHT CHINRG EOTSL SMATRISCH

9. In this 1990 film, a young boy is inadvertently left behind while his family takes a trip to Paris and must protect his home against intruders.

MOHE NOELA

10. Buddy, a human who was raised as one of Santa’s elves, is the hero of this 2003 comedy.

LEF

Answers
1. It’s a Wonderful Life 2. A Christmas Story 3. Scrooged 4. Holiday Inn 5. Christmas Vacation 6. White Christmas 7. Love Actually 8. How the Grinch Stole Christmas 9. Home Alone 10. Elf 

OSHA: Heavily Soiled Linens Are Not Regulated Waste

OSHA has confirmed that LTC facilities and other healthcare providers are not required to dispose of contaminated linen as "regulated waste" and that OSHA's regulatory standard governing regulated waste is not meant to apply to linens that are laundered and reused.

OSHA examined the issue after it was brought to the agency's attention by the Association for Linen Management (ALM) and American Reusable Textile Association (ARTA). They were concerned about the practice of placing heavily soiled linens in red bags, which is a sign to laundry operators that the bags must go to a waste department for disposal.

Rather than placing the linens in red bags, the ALM recommends that facilities place heavily soiled linens in impermeable bags so that they do not leak on the way to the laundry.

ALM noted that some facilities place linens contaminated by residents with C. diff in the red bags because they believe the infection is so virulent that the linens must be destroyed rather than washed. This is not the case, according to the ALM. Instead, the linens can be laundered using the requirements set by CMS.

To learn more, click here.

CDC Releases Statistics on LTC Services Provided in U.S.

According to "Long-Term Care Services in the United States: 2013 Overview," which was released by the CDC's National Center for Health Statistics, about eight million people in the U.S. received long-term care services in 2012.

According to the study, these individuals were served by the following regulated long-term care providers:

• 22,200 assisted living and similar residential care communities 
• 15,700 nursing homes 
• 12,200 home health agencies
• 4,800 adult day services centers
• 3,700 hospices

The researchers divided the U.S. into five sectors for the study. They found that in four of the five sectors, the majority of providers were for-profit, although the majority of adult day services providers tended to be nonprofit. 

To learn more and read the complete report, click here. 

CMS: Hospice Medication Claims Will Face Increased Scrutiny

CMS announced that Medicare claims for hospice medications will face heightened scrutiny from the agency in light of widespread inappropriate claims.

Medications for hospice patients should by and large be billed to Medicare Part A, with Medicare Part D only covering drugs that are needed for reasons unrelated to residents' terminal conditions. CMS believes that this guidance has been misinterpreted, resulting in Part D paying out $12.9 million in hospice claims for analgesics. These claims typically came from for-profit, new and/or rural hospice providers and half of the claims were for individuals receiving hospice care in nursing facilities.

To help remedy this, CMS plans to place prior authorization requirements on all hospice medication claims.

To learn more, click here.

Antacid Use Tied to Vitamin B12 Deficiency

A new study suggests that popular antacid drugs, such as those used to treat gastric reflux and peptic ulcers, can contribute to a serious vitamin B12 deficiency.

The study found that people who are diagnosed with the deficiency are more likely to be taking proton-pump inhibitors (PPIs) and histamine 2 receptor antagonists (H2RAs) compared to those not diagnosed with the deficiency. The researchers explained this is because the body absorbs vitamin B12 with the help of stomach acid.

A vitamin B12 deficiency can lead to people becoming tired, weak, constipated and anemic. When left untreated, it can also lead to nerve damage and dementia.

Common PPIs include omeprazole (Prozac), esomeprazole (Nexium) and lansoprazole (Prevacid). H2RAs include cimetidine (Tagamet), famitodine (Pepcid) and ranitidine (Zantac).

The researchers' findings suggest that the drugs should be used for as short a time as possible and at the lowest dose that is still effective.

To learn more, click here.

Could Your Facility's Beds Contribute to Entrapment?

Entrapment can happen in the blink of an eye and its consequences can be serious, even fatal. Between January 1, 1985 and January 1, 2013, the FDA was notified of 901 incidents of people becoming caught, trapped, entangled or strangled in healthcare beds. Of these incidents, 531 resulted in death, 151 led to nonfatal injuries and 220 required staff to intervene in order to prevent injuries. The majority of the individuals were frail, elderly or confused.1

To help combat entrapment, the FDA and Hospital Bed Safety Workgroup collaborated to draft guidance for healthcare facilities on developing bed safety programs. The guidelines recommend using a multi-faceted approach that includes evaluating bed design, performing clinical assessment and monitoring, meeting the needs of vulnerable residents and seeking input from product manufacturers as well as facility staff.2

Here are some questions to ask yourself when evaluating the beds in your facility for
entrapment risk:

• "Are some components worn?" For example, do rails wobble, have the rails been damaged, is the mattress softer than it should be? These can increase entrapment risk.
• "Does the bed still have its original parts?" Many beds that are currently in use do not have their original mattresses or bed rails. The risk of entrapment is increased if there are gaps or spaces between the components of the bed system, which can happen when pieces are replaced or removed.
• "Have I contacted my supplier to see if any entrapment-preventing accessories are available?" These could include mattresses, rails and other accessories.
• "Is the mattress the correct size for the bed?" Not all beds and mattresses are interchangeable.

The FDA has a number of resources available on preventing entrapment at your facility.To view them, click here.

References
1 U.S. Food and Drug Administration. Hospital Beds. Available at: http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/GeneralHospitalDevicesandSupplies/HospitalBeds/default.htm . Accessed December 4, 2013. 

2 U.S. Food and Drug Administration. Hospital Bed System Dimensional and Assessment Guidance to Reduce Entrapment. Available at: http://www.fda.gov/downloads/MedicalDevices/DeviceRegulationandGuidance/GuidanceDocuments/
ucm072729.pdf. Accessed December 4, 2013. 

Santa Claus Goes Global

Here in the United States he's known as Santa Claus, but the jolly man in the red suit takes on many different names and roles around the world. We dug into Santa Claus traditions around the world to give you a leg up during holiday trivia contests (or help you come to rescue when there's a lull in Christmas party conversation!). 

The Netherlands: Known as Sinterklaas, the Dutch version of Santa reportedly lives in Spain during the off season. He takes a steamboat to Holland in mid-November and spends three weeks delivering gifts to good children. Naughty children don't get presents, though. Instead, according to legend, Sinterklaas kidnaps them and takes them back to Spain! 

Italy: La Befana is a friendly holiday witch who delivers goodies to children on either Christmas or Epiphany (January 6). Unlike Santa, she prefers wine over milk and cookies and Italian parents often leave her a glass to enjoy during her stop. A Santa Claus figure, known as Babbo Natale, is also becoming more popular in Italy.

Russia: Ded Moroz, or Grandfather Frost, looks a lot like the Santa we know in the U.S., but he also carries a magical staff and travels with his granddaughter Sengurochka, or Snow Girl. The pair plan New Year's Eve parties for Russian children and hand out gifts.

Mexico: While Santa Claus does travel to Mexico to hand out gifts, they're also distributed by El Niño Dios (Baby Jesus). Depending on the region, either Santa or El Niño Dios may brings the bulk of the gifts.

Sweden: Jultomten, Sweden's answer to Santa Claus, is actually a hybrid of Santa, Julbocken (a Swedish Christmas goat) and a garden gnome. Jultomten visits homes on Christmas Eve and asks "Are there any good children here?" before unloading gifts from his pack. 

Australian Company Develops Electronic Brief

Simavita, a medical device company in Australia, has developed an electronic brief that can help caregivers efficiently determine when an incontinent resident needs to be changed as well as monitor their voiding patterns.

To use the brief, caregivers place an electronic sensor on a disposable pad in the brief. Simavita says it is especially useful during the first 72 hours that a resident is in a facility and can generate a "live bladder chart" that includes information on what triggers urinary discharge, such as changes in position, and the timing and frequency of voiding. This information can be used to develop a care plan.

To learn more, click here.

AHCA Members Close to Antipsychotic Reduction Goal

The American Health Care Association (AHCA) reports that their members are close to meeting the Quality Initiative goal of reducing antipsychotic use in nursing homes by 15 percent. As of the end of the second quarter of 2013, that number stands at 13 percent.

The 13 percent reduction means that an estimated 19,600 residents have been weaned off of antipsychotics. More than 3,600 AHCA member facilities, or about 47 percent of those reporting data, have already reached the goal.

To learn more, click here.

Dementia, Alzheimer's Onset Slowing

Researchers have found that education, better prevention and treating high blood pressure appear to be delaying the onset of signs of dementia and Alzheimer's disease. Lower blood sugar levels and regular exercise also appear to be slowing the onset of the diseases, according to the studies, which were published in the New England Journal of Medicine. 

To learn more, click here.

Deck the Halls, Don’t Contribute to Falls

As you get ready to break out your facility’s Christmas tree, take a second to review your decorating plans and ensure they won’t contribute to resident falls. According to the CDC, around 1,800 nursing home residents die from fall-related injuries every year.1

Ask yourself the following questions as you deck your halls:

• “Could our residents trip over these decorations or have trouble maneuvering around them with a walker or cane?” 
• “Am I adding any decorations to our banisters or hand rails that would make it difficult for residents to get a firm grip?”
• “Are our light cords tucked away from areas where residents walk? If the cords must cross hallways, are they secured with duct tape?”
• “Am I keeping my eyes open for any decorations that have fallen to the ground, creating a fall risk?” 
• “Do I have a trash can near where we are opening presents so that we can quickly dispose of paper and bows before residents trip over them?” 
• “Do our throw rugs have non-slip backings?” 
• “Do any of our decorations have flashing or pulsing lights on them that could cause residents to become disoriented and fall?” 

You should also stress the importance of safe decorating to your staff. Every year, about 6,000 people find themselves in the emergency room being treated for falls sustained while decorating.2 The majority of these falls came while people were on ladders, roofs, furniture (including step stools), stairs and porches.

Professional Medical can help you develop a comprehensive fall prevention strategy. To learn more, contact your ProMed territory manager or give us a call at (800) 648-5190.

References
1 Centers for Disease Control and Prevention. Falls in Nursing Homes. Available at: 
http://www.cdc.gov/HomeandRecreationalSafety/Falls/nursing.html. Accessed December November 20, 2013. 

2 Centers for Disease Control and Prevention. Study: Fall-Related Injuries During the Holiday Season, United States, 2000-2003. Available at: http://www.cdc.gov/media/pressrel/fs041210.htm. Accessed November 20, 2013.  

ProMed Holiday Closure Notice

Professional Medical will be closed Tuesday, December 24 and Wednesday, December 25 in honor of Christmas. Orders that are placed by noon on Friday, December 20 will be delivered by Friday, December 27.

We will also be closed on Tuesday, December 31 and Wednesday, January 1 in honor of the new year. Orders that are placed by noon on Friday, December 27 will be delivered by Friday, January 3.

If you have any questions or concerns, please contact our Customer Care team at (800) 648.5190.

Happy holidays from ProMed!