Preliminary evidence suggests multiple psychotropic and psychoactive drugs may increase the risk of falls in a skilled nursing facility in proportion to the total load of these agents. Minimization of inappropriate prescribing of psychotropic and psychoactive medications in elderly nursing facility residents, as mandated by current federal guidelines, may affect the risk of falls in nursing facility patients.

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BackgroundThe purpose of this study was to determine the relationship between hypothesized pain behaviors in the elderly and a measurement model of pain derived from the Minimum Data Set-Resident Assessment Instrument (MDS-RAI) 2.0 items.MethodsThis work included a longitudinal cohort recruited from Medicare-certified longterm care facilities across the United States. MDS data were collected from 52,996 residents (mean age 83.7 years). Structural equation modeling was used to build a measurement model of pain to test correlations between indicators and the fit of the model by cognitive status. The model evaluates the theoretical constructs of pain to improve how pain is assessed and detected within cognitive levels.ResultsUsing pain frequency and intensity as the only indicators of pain, the overall prevalence of pain was 31.2%; however, analysis by cognitive status showed that 47.7% of the intact group was in pain, while only 18.2% of the severely, 29.4% of the moderately, and 39.6% of the mildly cognitively impaired groups were experiencing pain. This finding supports previous research indicating that pain is potentially under-reported in severely cognitively impaired elderly nursing home residents. With adjustments to the measurement model, a revised format containing affective, behavioral, and inferred pain indicates a better fit of the data to include these domains, as a more complete measure of the pain construct.ConclusionPain has a significant effect on quality of life and long-term health outcomes in nursing home residents. Patients most at risk are those with mild to severe cognitive decline, or those unable to report pain verbally. Nursing homes are under great scrutiny to maintain standards of care and provide uniform high-quality care outcomes. Existing data from federally required resident surveys can serve as a valuable tool to identify indicators of pain and trends in care. Great responsibility lies in ensuring pain is included and monitored as a quality measure in long-term care, especially for residents unable to communicate their pain verbally.

PURPOSE:The purpose of this systematic review was to identify and evaluate the use of prophylactic foam dressings for prevention of hospital-acquired pressure injuries (HAPIs). METHODS: A systematic review was conducted in accordance with the Preferred Reporting Items of Systematic Reviews and Meta-analysis Statement (PRISMA). SEARCH STRATEGY: Four researchers independently conducted searches in Health Source, Cochrane of Systematic Reviews, CINAHL, and PubMed. Search terms included: "pressure* OR skin breakdown AND sacrum*"; "ICU patient* OR critical care patient*"; and "foam dressing OR prophylactic* or prevent*." FINDINGS: The search identifi ed 380 articles; 14 met eligibility criteria. The methodological quality of the included studies was variable. Findings from all studies included in our review support a decrease in HAPI incidence with use of sacral foam dressings. IMPLICATIONS: Findings from this review suggest that prophylactic foam dressings decrease sacral HAPI occurrences in critical care patients. While additional research is needed, current best evidence supports use of prophylactic foam sacral dressings for patients at risk for HAPI.

Purpose To document and compare the outcomes from monthly drug regimen review recommendation acceptance and rejection in one skilled nursing facility by one consultant pharmacist (CP) in the fourth year of evaluation with the prior 3 years' data. Method A non-randomized, observational, prospective cohort study with all patients being residents for at least 30 days over the 12-month period (October 1, 1997 to September 30, 1998) in a skilled nursing facility with more than 100 beds. The admission problem-oriented records of all patients and their respective CP reports were screened for pharmacotherapy recommendations and subsequent acceptance and rejection on a monthly, repeated-measures basis for 12 months. There were 2,004 monthly drug regimen review (DRR) reports. The percentage of DRR reports that made recommendations was tabulated. Written recommendations made to attending physicians that were either accepted or rejected within 3 months were analyzed. The charges for adverse outcomes were calculated from billing records or prior studies of the outcome. These results were compared with prior 1- and 2-year studies of outcomes within the same setting. Carryover effects of recommendations implemented in prior periods were also calculated. Results There were 178 recommendations made in 2,004 DRR reports (8.9%). A low acceptance rate, 27 of 178 recommendations (15.2%), resulted and was combined with carryover of prior acceptance in a cost savings of $113,962. The 151 recommendations that were rejected resulted in $226,503 of presumed unnecessary costs to the health care system. A prior 2-year study of recommendations with an acceptance rate of 89% showed costs savings of $111,609 per year with acceptance and $112,297 added costs per year with 11% rejection. The first-year study had a 93% acceptance rate at a projected cost savings of $43,854 and costs increased by $60,825 with a 7% rejection. The costs of recommendation rejection in the fourth year were substantially higher, with a higher rejection rate than was seen in the prior 3 years of observation. Conclusion Documentation of the costs from CP intervention should factor in costs of rejection that may increase with the percentage rejection of recommendations, length of observation period, and may vary between facilities.