TIP OF THE WEEK
Pain assessment in the nonverbal resident with dementia
In a 2006 position paper, the American Society for Pain Management Nursing recommended the following for assessing pain of nonverbal residents 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 Resident 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.
RESOURCE SPOTLIGHT
Readiness for Change Self-Survey (PDF)
Distribute this survey to members of your organization and use their responses to gauge how ready your organization is for implementing and sustaining change.
IN THE NEWS
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 >>
May 2007 -- GAO -- The U.S. Government Accountability Office (GAO) recommends that the Centers for Medicare & Medicaid Services (CMS) Administrator (1) further increase the number of low-performing homes that QIOs work with intensively, (2) improve monitoring and evaluation of quality improvement organization (QIO) activities, and (3) require QIOs to share with CMS the identity of homes assisted intensively in order to facilitate evaluation. CMS agreed with the first two recommendations, but did not specifically indicate if it agreed with the third. Read more (PDF) >>
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 >>
OHIO KEPRO EVENTS
THE GOOD APPLES: TIPS FOR ATTRACTING AND RETAINING THE RIGHT EMPLOYEES
In this half-day workshop, we will delve into key strategies for improving workforce retention in the nursing home, including:
- The impact of turnover and absenteeism on an organization and what you can do about it.
- Strategies to improve the hiring and orientation process.
- Motivating employees and improving staff satisfaction.
- Setting goals and measure improvement in workforce retention.
Who should attend: Directors of Operations, Directors of Nursing, Nursing Home Administrators, Staff Development, and Human Resources.
7/17 – Cambridge | 7/31 – Lyndhurst | |
7/19 – Sylvania | 8/7 – Boardman | |
7/24 – Wooster | 8/15 – Columbus | |
7/24 – Oberlin | 8/21 – Wellston |
Download the flyer
INDUSTRY EVENTS
Medicare Learning Network:
Learning resources and products for the healthcare professional.
Alzheimer’s Association Training Events
Case Western Reserve University School of Medicine Courses
Ohio Department of Health, Technical Assistance Program – New Programs
Ohio Health Care Association Events
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