Influenza Toolkit for Long-term Care

All long term care facilities are required to have an effective immunization program that reflect current standards of practice.  Receipt of vaccinations is essential to the health and well-being of long-term care residents.  Influenza outbreaks place both the residents and staff at risk of infection.  If your facility does have an outbreak, the CDC offers the following guidance. Flu Vaccines must be offered to patients October 1st through March 31st.   Facilities are encouraged to promote 100% staff participation in flu shots to prevent outbreaks.  Got to for useful information and resources for your Influenza Vaccination Program. The following forms can be used for education, promotion and documentation of your facility’s Immunization Program.  CLICK HERE for the CDC Long-Term Care Toolkit for valuable information. INFLUENZA VACCINE INFORMATION SHEET (English) INFLUENZA VACCINE INFORMATION SHEET (Spanish) POSTER/FLYER 65 YEARS+ (English) POSTER/FLYER 65 YEARS+ (Spanish) POSTER/FLYER HEALTHCARE WORKER (English) POSTER/FLYER HEALTHCARE WORKER (Spanish) Sample Consent Form  

Elderly at high risk of PTSD after hurricanes

Post Traumatic Stress and the Elderly After Hurricane Irma that displaced thousands of people and left them without power many elderly patients find it hard to “bounce back” from the stress. The sudden and overwhelming nature of natural disasters can leave many shocked, emotional and uncertain about their future. The constant warning and 24/7 news coverage of destructive weather this year can take a major toll on anyone’s mental health. People can develop PTSD (post-traumatic stress disorder” at any time after experiencing a traumatic event, but 30 days is the minimum to receive a diagnosis. After Hurricane Harvey and the catastrophic flooding, many people are suffering acute symptoms such as depression, anxiety, panic disorder and fear of the unknown. For the elderly and those who have a history of mental illness or dementia they are at a greater risk for developing PTSD. Signs of PTSD include flashbacks and nightmares, avoidance of situations that bring them back to the trauma, heart pounding, trouble breathing. The condition can also lead to feelings of depression and anxiety as well as insomnia. Being displaced during a storm, staying with other people (even family) needing to throw away damaged items, having to buy a refrigerator’s food, dealing with blocked streets and downed trees are stressful for healthy adults and even more so for an elderly



Important Information about 2018-19 Flu Shots

One month delay in FDA Release of this season’s Flu Vaccine Every year, the FDA is responsible for the analysis, review and release of every lot of Influenza Vaccine submitted by each manufacturer. This review must be completed to ensure that their product meets the necessary standards required to safely combat the flue virus.  With the extensive review process, this year according to the manufacturer’s the FDA is running approximately 3-4 weeks behind schedule, which has affected the timing and release of approved flue vaccine lots to the manufacturers. With the FDA’s slower than expected release of flue vaccines, fewer approved vaccine lots have been released from the manufacturer’s, which is causing a delay in orders. We understand the importance of implementing you vaccination programs but due to the unpredictability of timing this situation, the Centers for Disease Control and Preventions Advisory Committee on Immunization Practices recommends to schedule immunization programs toward the end of October.  Be assured that we will keep you informed and as soon as our vaccines are delivered we will send your orders.      

Medication Management Program

On October 1,  2018, data will be collected to ensure that medication reconciliation is also completed at the time of admission.  The new Quality Measure – Drug Regimen Review, will evaluate the percentage of resident stays in which drug regimen review was conducted at time of admission and if facility staff followed up with the physician before midnight the next calendar day.   Facilities that are found non-compliant will have their Medicare Payment reduced 2%. Skilled nursing facilities are required to reconcile patient medications prior to discharge back to the community.  F661 – Discharge Summary states “Facility staff must compare the medications listed in the discharge summary to medications the resident was taking while in the facility.  Any discrepancies must be assessed and resolved, and resolution documented in discharge summary with rationale.” The Advancing Excellence “Medications at Transitions and Clinical Handoffs” (MATCH) toolkit incorporated experiences and lessons learned from staff of facilities that have implemented MATCH.  The toolkit helps facilitate a review and improvement of current practices to strengthen the process and improve patient safety. The World Health Organization has developed a Standard Operating Protocol for Medication Reconciliation and assuring medication accuracy in transitions in care. To write your policy and start your program, click the link below:  

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