Cutting Down on Antipsychotics

Over-Prescribed

CMS, the Centers for Medicare & Medicaid, announced in May that they are embarking on a multi-year initiative to cut the use of antipsychotic drugs in skilled nursing facilities by 15% by the end of this year. CMS cited statistics showing that nearly 40% of residents with dementia were getting antipsychotics even though they did not have a diagnosis supporting their use.

Other statistics from CMS indicate that in 2010 more than 17% of SNF residents received antipsychotic doses that were over the recommended levels.

“In 2013 we will set another goal,’’ said Alice Bonner, director of the nursing home division of CMS. “At that point, we will be looking at even more significant reductions.’’

CMS plans to achieve the cuts through training state inspectors and nursing home staff on alternatives to using antipsychotics for agitation and aggressive behaviors.  Participation in the reduction program is voluntary, but SNF trade groups pledged to work with CMS.

“We believe these antipsychotics are overprescribed,’’ said Dr. David Gifford, senior vice president of quality and regulatory affairs at the American Health Care Association, a SNF trade group. “Many clinicians, physicians, and family members believe these medications are useful and necessary, but data show otherwise.’’

This article was originally published in Pathways & Partners Newsletter - Issue 25.  To download this issue in PDF format, or past issues, visit our newsletter archives online at www.pathwayshealth.org/publications.

Great Catheter Care: Preventing Infections

Good catheter care is the biggest factor in preventing catheter-associated urinary tract infections.  Here are some tips for great catheter care.

• Wash your hands.  It sounds simple, but this is the single most important step in preventing infections.  Wash your hands BEFORE and AFTER putting on gloves.
• Use catheters sparingly—only when necessary.
• Use the smallest catheter that will do the job.
• When inserting the catheter, lay out a sterile field and maintain it.  If a person is obese or has contractures you may need two people to insert the catheter while maintaining a sterile field.
• Lubricate the tip of the catheter to prevent damage to the urethra during insertion.
• Use good lighting.  If you accidentally insert the catheter in the vagina, leave it there as a marker until you have placed a second, sterile catheter.
• Keep the system (catheter, tubing and bag) closed if possible.  The system should never be opened simply for convenience.
• Keep the drainage bag below the level of the bladder (but not lying on the floor).  Use clean technique when emptying the bag.
• Secure the catheter to prevent bleeding, trauma, tissue damage or bladder spasms that can be triggered by the catheter or balloon.  Tape can be hard on the skin; use a commercial device when possible.
• Keep the perineum clean.  Treat the catheter area like any other part of the body, washing as you would any other body part.
• If the resident is also incontinent of stool, check frequently to prevent stool from contaminating the catheter.
• Keep residents with catheters away from residents with infections.

Suspected infection:

If you suspect a urinary tract infection, remove the catheter and replace it with a new one.  Get a urine sample for culture and sensitivity from the new catheter.  Antibiotics should only be used for infections that are symptomatic.

Leakage

If catheter leakage occurs, check that the balloon is inflated and that the catheter is in the right place.  Make sure the balloon is inflated completely.  It is never acceptable to use a 30 cc balloon partially inflated.  Before changing to a larger catheter, keep in mind that constipation and fecal impaction may also contribute to leakage.  Larger catheters with larger balloons can damage the neck of the bladder.

YOU are the key to good catheter care that can prevent infections and discomfort, and save time and money.

Vitamin D May Reduce Falls in the Elderly in SNFs

Dietary Supplements

Recent studies indicate that adding Vitamin D supplements to the diets of nursing home residents may reduce the frequency of falls, a leading cause of death and disability in the elderly.

Vitamin D deficiency is associated with muscle weakness, which can contribute to falls and fractures. Nursing home residents are especially vulnerable to falling due to advanced age, health problems, and weakened eyesight. In fact, approximately 50% of nursing home residents fall every year, and those who are injured become even more prone to future falls.

Although exercise, appropriate equipment, adequate staffing and a risk-free environment are important, research done at the Sydney Medical School at the University of Sydney in Ryde, Australia found that Vitamin D was a effective measure, although they are not sure why. 

Fall Prevention Resources, Available Online

In an effort to increase awareness about fall prevention hazards the Fall Improvement Taskforce (FIT) at Pathways created colorful flyers that can be printed and used as check-off lists to ensure your environment remains safe and to minimize the risk of falls.

Topics include: “Did you know that clothing can contribute to falls?”; “Medications can increase the risk of falls”’; and “People with vision deficits are twice as likely to fall”.

These helpful resources can be downloaded via our website at www.pathwayshealth.org/resources.