Ineffective nurse–physician communication in the nursing home setting adversely affects resident care as well as the work environment for both nurses and physicians. Using a repeated measures design, this quality improvement project evaluated the influence of SBAR (Situation; Background of the change; Assessment or appearance; and Request for action) protocol and training on nurse communication with medical providers, as perceived by nurses and physicians, using a pre–post questionnaire. The majority (87.5%) of nurses respondents found the tool useful to organize information and provide cues on what to communicate to medical providers. Limitations expressed by some nurses included the time to complete the tool, and communication barriers not corrected by the SBAR tool. Project findings, including reported physician satisfaction, support the use of SBAR to address both issues of complete documentation and time constraints.

To ascertain the need for and to inform development of guidelines for voting in long-term care settings, we conducted a telephone survey of Philadelphia nursing (n = 31) and assisted living (n = 20) settings following the 2003 election. Substantial variability existed in procedures used for registration and voting, in staff attitudes, and in the estimated proportion of residents who voted (29%+/-28, range 0-100%). Residents who wanted to vote were unable to do so at nearly one-third of sites, largely due to procedural problems. Nearly two-thirds of facilities indicated they assessed residents' voting capacity before the election. However, methods differed and may have disenfranchised residents who were actually competent to vote. Current procedures in many facilities fail to protect voting rights. These data suggest that rights might be better protected if election officials took charge of registration, filing absentee ballot requests, ballot completion, and trained LTC facility staff on voters' rights and reasonable accommodations.

A 69-year-old man presented with parkinsonism (asymmetric pill-rolling tremor, bradykinesia, and rigidity) and a distinctive serpentine tongue dyskinesia (video). The movement was constantly present at rest, stopping only when speaking, swallowing, or sleeping. There had been no known exposure to neuroleptic medication. The lingual dyskinesia was noted before levodopa was introduced as a treatment for presumed Parkinson disease. However, beneficial response to levodopa was poor and led to worsening of the dyskinesia. The patient subsequently developed fecal and urinary incontinence as well as symptomatic orthostatic hypotension.Multiple system atrophy is most likely, with an associated orofacial dyskinesia exaggerated by levodopa.

No abstract