This study explores the use of a nurse practitioner-led paramedicine program for acute, home-based care of geriatric patients. This case series describes patients, outcomes, and geriatric primary care provider perspectives related to use of this independent paramedicine program. There were 40 patient visits from August 2016–May 2017. We reviewed patient demographics, medical conditions, healthcare utilization, and communication processes and used semi-structured interviews and content analysis to explore staff perspectives. The most commonly treated diagnoses were respiratory conditions, urinary tract infections, and gastrointestinal concerns. Two patients required an immediate transfer to a higher level of care. Six patients had emergency department visits and five patients were hospitalized within two weeks. Geriatric providers identified three themes including: potential benefits to geriatric patients, importance of enhanced care coordination and communication, and considerations for the specific role of nurse practitioner-led community paramedicine programs for geriatric patient care.

Move Free Advanced is a widely available dietary supplement in the United States, marketed to comfort sore joints and improve flexibility and mobility. This product contains glucosamine, chondroitin, hyaluronic acid, and Uniflex proprietary extract, which is a combination of Chinese skullcap and black catechu. We describe two patients who developed hepatotoxicity after ingesting a Move Free Advanced product. In both patients, the hepatotoxicity resolved after discontinuation of the supplement. Use of the Naranjo adverse drug reaction probability scale indicated a probable relationship (score of 6 for both patients) between the patients' development of hepatotoxicity and the Move Free Advanced supplement. Based on a review of the literature, the herbal extract Chinese skullcap is the most likely cause of the hepatotoxicity. To our knowledge, these two cases are the first to be published regarding possible hepatotoxicity associated with Move Free Advanced. Patients seeking dietary supplements for osteoarthritis may want to avoid glucosaminechondroitin products such as Move Free Advanced that also contain Chinese skullcap.

Purpose Medication reconciliation is a National Patient Safety Goal. Completing medication reconciliation minimizes the risk for preventable adverse drug events (ADEs). The elderly are at greatest risk for ADEs because of their high number of comorbidities and medications usage. The purpose of this quality improvement project was to improve medication management in a geriatric primary care practice. Interventions focused on improving medication reconciliation documentation, improving accuracy of medication lists, reducing inappropriate medication use, and minimizing duplicate medication therapy. Data sources A pre/post design was used over a 9‐month period. Interventions focused on educating providers, staff, and patients on medication management. Analysis of 1580 manual chart audits and 903 patient questionnaires were completed. Conclusions Outcomes improved in all four performance outcomes: medication reconciliation—χ2(1, N = 576) = 32.00, p < .0001, V = 0.4; patients bringing medications to clinic—χ2(1, N = 277) = 90.46, p < .0001, V = 0.7; reduction in use of specific medications—χ2(1, N = 267) = 19.49, p < .0001, V = 0.3; and duplicate therapy was reduced—χ2(1, N = 267) = 45.13, p < .0001, V = 0.5. Implications for practice Improved medication management had a significant impact in patient safety and quality of care in this clinic.

Medicare patients were successfully enrolled in a CCM service in a geriatrics primary care clinic led by clinical pharmacists and medical providers. The CCM services were more time-consuming than the allotted 20 minutes per patient per month with the CCM Current Procedural Terminology code used during this study.