TIP OF THE WEEK
Pain assessment in the nonverbal patient with dementia
In a 2006 position paper, the American Society for Pain Management Nursing recommended the following for assessing pain of nonverbal patients with dementia:
- Self-Report -– Although self-report of pain is possible with mild to moderate cognitive impairment, as dementia progresses, the ability to self-report decreases and eventually self-report is not possible.
- Search for Potential Causes of Pain/Discomfort -– Consider acute pain from a recent fall, UTI or other Infection, or chronic pain from osteoarthritis, back pain, neuropathies, etc.
- Observation of Patient Behaviors -– Facial expressions, verbalizations/vocalizations, body movements, changes in interpersonal interactions, changes in activity patterns or routines, and mental status changes have been identified as categories of potential pain indicators in older persons with dementia.
- Surrogate Reporting of Pain (e.g., family, caregiver) -– Family members are likely to be the most familiar with typical pain behaviors or changes in usual activities that might suggest pain presence.
- Attempt an Analgesic Trial -– Estimate the intensity of pain based on information obtained from prior assessment steps and select an appropriate analgesic. For example, when mild to moderate pain is suspected, acetaminophen 500 to 1000 mg every 6 hours may be appropriate initially with titration to stronger analgesics if there is no change in behaviors and pain continues to be suspected. Low-dose opioids have been effective in validating agitation as a pain indicator (Manfredi et al., 2003). Opioid dosing in older adults warrants an initial dose reduction of 25% to 50%. Using an analgesic trial to validate the presence of pain before increasing or adding psychotropic medications has several advantages. Compared with psychotropic intervention, response will be seen more quickly with an analgesic intervention, the adverse reactions to analgesics are usually less serious, and pain will not be obscured by the sedative properties of psychotherapeutic agents.
For more information, go to http://www.aspmn.org/Organization/position_papers.htm.
Become a national campaign agency of the month
How can your agency register to become the HHQI National Campaign Agency of the Month? Just complete the Voluntary Best Practice Intervention Package (BPIP) Teletriage Survey at http://www.homehealthquality.org/hh/ (on right side of the Web page) within the designated time frame. An agency will be randomly selected from all survey participants. Agency of the Month entitles you to free media coverage (HHQI Web site, monthly publications) and a certificate. Previous Agencies of the Month include:
- July: Yellowstone Visiting Nurse Service, Billings, Mont.
- June: Florida Hospital Home Care Services, Orlando, Fla.
- May: Joyal Health Care Services, Jacksonville, Fla.
- April: Saint Joseph Home Care Services, Lexington, Ky.
The Teletriage BPIP became available July 2, 2007. This is an essential best practice for all agencies, because teletriage occurs at all home health agencies-every time a patient or caregiver contacts the agency. Twenty-four hours a day!
RESOURCE SPOTLIGHT
REMINDER: Complete the 2007 Ohio Home Health Immunization Survey
Please take five minutes to complete the survey relating to your immunization practices. Ohio KePRO’s Home Health Team is re-measuring the immunization practices at Ohio home health agencies to compare with last year’s survey and we need your help. The results will be compared with last year’s survey to identify trends over time. Your answers are confidential.
Set Targets, Achieve Results
Need help setting your STAR targets? Looking for a quick OASIS reference source for information about the publicly reported quality measures? Call the Ohio KePRO Home Health Team at 1.800.385.5080.
IN THE NEWS
HOME CARE INDUSTRY WILL ENCOUNTER 'CARE GAP' SOON
July 6, 2007 -- Kaiser Network -- As baby boomers "begin encountering the frailties of old age, the nation will face a widening 'care gap' that experts fear will compromise the quality of home care and force people into nursing homes too soon," the Dallas Morning News reports. The U.S., which today has about 1 million home care aides, will need as many as 1 million additional workers by 2017 and as many as 3 million more by 2030, according to experts. Read more >>
CDC UPDATES GUIDELINES FOR USE OF INFLUENZA VACCINE AND ANTIVIRAL AGENTS
July 3, 2007 -- Medscape *FREE CME/CE* -- The Centers for Disease Control and Prevention (CDC) has updated its 2006 recommendations for use of the influenza vaccine and antiviral agents. The revised guidelines ("Prevention and Control of Influenza: Recommendations of the Advisory Committee on Immunization Practices [ACIP], 2007") are published in the June 29 Early Release issue of the Morbidity and Mortality Weekly Report. Read more >>
AVERAGE BLOOD GLUCOSE INSTEAD OF HBA1C? CHANGE APPEARS TO BE COMING FOR DIABETES CARE
July 3, 2007 -- Medscape -- A small but clinically relevant change appears to be coming to the management of patients with diabetes mellitus. Hemoglobin A1c (HbA1c) levels, used to assess long-term glycemic control, might soon be replaced with average blood glucose, a change experts say will add clarity for diabetic patients looking to manage their disease. Read more >>
LIST EXCLUDES SOME TOP HOSPITALS FOR HEART ATTACK CARE
July 9, 2007 -- AHA -- U.S. News & World Report’s annual ranking of “best hospitals” excludes some top hospitals for heart attack care, according to a study in today’s Archives of Internal Medicine. Researchers at Yale University School of Medicine compared 30-day mortality rates for heart attack patients at 50 hospitals ranked best for “heart and heart surgery” by the magazine in 2003 with similar patients at more than 3,800 other hospitals. Read more >>
2007 -- CDC -- From the Public Health Service, US Department of Health and Human Services, Centers for Disease Control and Prevention, Atlanta, Georgia. Siegel JD, Rhinehart E, Jackson M, Chiarello L, and the Healthcare Infection Control Practices Advisory Committee, 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings, June 2007. Read more >>
COMING ATTRACTIONS
TRANSFORMATIONAL GRAND ROUNDS (Register Now)
Learn how the "Patient Care Can't Wait!" philosophy guided one agency to improve on 10 of 11 quality measures
Wednesday, July 18, 2007
Time 2:00 p.m. - 3:30 p.m. ET
Wright Memorial Home Health and Hospice is a rural home health agency in Trenton, Missouri that has in the last year improved on 10 of the 11 publicly reported quality improvement measurements, and now performs in the top 10th percentile nationwide for eight of those measures.
Wright Memorial attributes their remarkable improvements to teamwork, open communications, constant awareness, and always believing that patient care can't wait. The agency staff will share their key strategies, including front-loaded visits, Friday calls, keeping an eye on the numbers, and always finishing step one before moving onto step two.
These efforts have helped improve their clients' ambulation, dyspnea, pain, and other clinical measures, as well as avoid hospitalizations and increase their likelihood of being discharged to the community.
The Tip of the Week Archive is available on the Ohio KePRO Web Site.
Clinically driven. Client focused. Value based.