Depression and Alzheimer's Disease: Did you know that, according to a new Dutch study, depression can more than double the risk of Alzheimer's Disease? And according to the results of a three year study recently published in the journal Neurology, changes in white matter in the brain affect how well older adults can move and keep their balance.
Results of STNA testing for the past six months show a 78% pass rate for the written test and an 81% pass rate for the skills portion of the testing. Problem areas are care impaired, personal care, and documentation in the written portion and vest restraint, perineal care-female, and left side positioning on the skills. It is also noteworthy that vocabulary is a major problem area related to the words adduction, anti-emboli, immobility, pressure ulcers, shearing of skin, and cognitively impaired. 100% of applicants taking the tests missed questions containing these words or answers. Maybe it's a problem with the questions? If you have concerns about any questions on the STNA written tests please bring them to the attention of Patsy Strouse or Shannon Richey at the ODH. And you can request to be on the panel that reviews these questions for accuracy and content. Contact Patsy or Tracy Uhl at the NATCEP unit of ODH if interested.
Survey Tips: Surveyors are watching that facility policies are being followed. For example, weekly skin assessment means seven days not eight; one missed resident mantoux results in a citation; each step of a protocol must be followed, no skipped steps; take with meals means take with meal, not 20 minutes prior; same for with food, not just a spoon of applesauce or equivalent. All nursing staff should be aware of the need to follow policy and procedure to the letter and facilities should be careful not to make policy more stringent than the rule or regulation requires. Sometimes we just set ourselves up for failure.
With survey focus continuing on falls, pressure ulcers, and incontinence it may be a good idea to review the new guidelines in these areas and to utilize tools provided by division of quality assurance, KePro, TAPS, and provider associations to name a few. Floor staff should be aware of how the processes flow through training and use of guidelines such as the guideline for restraint use that walks you through the process of determining if a device is a restraint or not.
The Ohio "Healthy Families" Act is creating a lot of talk. It is a mandated sick leave proposal and will probably show up on the November ballet. Questions about the act can be directed to the Ohio Chamber Director, Labor and Human Resources Policy Tony Fiore, at 614-228-4201 or afiore@ohiochamber.com.
STRIVE: The most recent Staff Time and Resource Intensity Verification study (STRIVE) conducted by the Iowa Foundation for Medical Care is now available. strive@ifmc.org.
OHCA's Immediate Jeopardy Task Force recently received and reviewed the ODH immediate jeopardy reports for the first Quarter of 2008. There were eleven immediate jeopardy citations during this time frame that relate to elopement; Coumadin monitoring; sexual abuse by other residents and by staff; emergency care; and F373 (paid feeding assistants feeding any resident who has been assessed as having swallowing difficulty).
House Bill 413 is sponsored by Representative Peter Ujvagi and would allow RN's to determine and pronounce death in Ohio. The Board of Nursing and provider associations are monitoring the progress of this bill.
Several F-tags that have been on hold in draft form should be released before the end of the year. These include F-309, Guidance for End of Life Issues and Pain Management, F-325 Nutritional Parameters, and F-371 Safe Food Handling.
CMS released a Survey and Certification Letter (08-21) explaining their development of an updated Quality Indicator Survey (QIS) brochure. The brochure provides an overview of the implementation plans and an explanation of the federal training for surveyors. This information can be found on the QIS Survey webpage.
According to a report from the Agency for Healthcare Research and Quality, C Difficile cases doubled over a four year period between 2001 and 2005.
Ritalin might aid in elderly fall prevention according to Israeli researchers. The drug helps elderly people concentrate on their stride, resulting in improved performance on falls screening tests. Two hours after taking the attention-enhancing drug senior performed noticeably better on the test than those who received a placebo. Although additional studies are required, the present findings suggest that Ritalin and other drugs designed to enhance attention may be a therapeutic option for reducing fall risk in older adults. The study was published in the latest issue of the Journal of the American Geriatric Society.
Recalls: There is a new CMS S&C letter on recalls. Due to the recent recalls of heparin, digoxin, and fentanyl patches facilities are being asked for their policy and procedures to handle recall and how this information is conveyed to staff. Visit the FDA website www.fda.gov for details.
OHCA is giving testimony related to oxygen reimbursement reductions. Make sure that residents receiving oxygen have an appropriate diagnosis and pulse ox below 88% on room air to get oxygen covered.
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