ASK THE PHARMACIST… about insulin sliding scales

Question: Sliding Scale orders for insulin is time consuming and sometimes confusing. Is there a better way to prescribe insulin for elderly patients? Answer: According to recent guidelines published in February 2017 by the American Diabetes Association sliding-scales are NOT RECOMMENDED in long-term care. Diabetes affects up to 33% of patients in long-term care facilities The most commonly prescribed insulin therapy for patients in long-term care is sliding-scale insulin (SSI), the use of finger-stick blood glucose testing to assess the need for insulin administration based on current blood glucose levels. Its sole use for long-term treatment is specifically not recommended Recent updates to several published guidelines, including CMS, the Beers criteria, the American Medical Directors Association, and the American Diabetes Association regarding the use of SSI-only insulin regimens for elderly patients in long-term care all advise simplified treatment regimens and avoidance of “sliding-scale” regimens. Below is a summary of the recommendations: Hypoglycemia risk is the most important factor in determining glycemic goals due to the catastrophic consequences in this population. Simplified treatment regimens are preferred and better tolerated. Sole use of SSI should be avoided. Liberal diet plans have been associated with improvement in food and beverage intake in this population. To avoid dehydration and unintentional weight loss, restrictive therapeutic diets should be minimized. Physical activity and exercise are important

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Pneumococcal Vaccine Toolkit

Pneumococcal Disease According to F883, Immunizations for pneumococcal pneumonia the requirements have five aspects: The resident is provided education regarding the benefits and potential side effects of the vaccination The facility must offer each resident pneumococcal immunizations unless the immunization is medically contraindicated, ore the resident’s immunization status is current The resident, or resident’s legal representative, has the right to refuse the vaccinations Each eligible resident is administered the pneumococcal vaccine (unless refused or contraindicated or the resident has already been immunized) The facility must document that education was provided and that the resident either received the vaccine or, if not received, that the vaccine was refused or medically contraindicated or the resident had already been immunized Make sure your facility policy includes all five requirements and that the resident’s medical record documents patient education, offering the vaccine, administering the vaccine. Two pneumococcal vaccines are recommended for adults: PCV13, Prevnar13 and PPSV23, Pneumovax 23.  One dose of PCV13 is recommended for adults 65 years and older who have not previously received PCV13.     For patients who have not received any pneumococcal vaccine or with unknown vaccination history, give 1 dose of PCV13, and administer 1 dose of PPSV23 at least 1 year later. Once a dose of PPSV23 is given at age 65 or older, no additional doses of PPSV23 should be

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Shamrock Smoothie detox in 5 min

  Lean, green fighting machine! Cucumber has a high water content and actually cools the body down, making this recipe cleansing and hydrating. SERVES: 2 2 c spinach 1 c peeled and chopped cucumber 1 c water (or coconut water) 1 orange, peeled 1  lime juiced 1 c diced fruit (pear, peach, apple, melon, berry) 1. BLEND the spinach, cucumber, and water until smooth. 2. ADD diced fruit and blend again. .

F 883 Influenza/Pneumococcal Immunizations Checklist

F 883  Guidance to Surveyors 483.80(d) Influenza and pneumococcal immunizations The intent of this regulation is to: Minimize the risk o resident acquiring, transmitting, or experiencing complications from influenza an pneumococcal disease by ensuring that each resident: Is informed about the benefits and risks of immunizations: and Has the opportunity to receive the influenza and pneumococcal vaccine(s), unless medically contraindicated, refused or was already immunized Ensure documentation in the resident’s medical record of the information/education provided regarding the benefits and risks of immunization and the administration or the refusal of or medical contraindications to the vaccine(s). Please see the Flu Vaccine Toolkit and Pneumococcal Disease Toolkit for forms and resources.