AMDA Offers Sessions to Prepare CPG Trainers

Abstract

The American Medical Directors Association's clinical practice guidelines not only help to systematically assess and manage disease and conditions, they are based on research, evidence, and expert consensus, with a focus on long-term care. Initial studies and anecdotal results from those who have used them indicate they have successful outcomes when implemented. “AMDA's CPGs have been helpful in setting up diagnostic and therapeutic plans for my patients. At our state Quality Improvement Organization, the CPGs are one of the first resources we look to for help in specific quality improvement initiatives,” said Dr. George Voigtlander, a medical director in Nebraska. In the past 10 years, AMDA has released 20 process-oriented clinical practice guidelines (CPGs) on common medical disorders and geriatric syndromes affecting the elderly in institutional settings. The guidelines were developed by interdisciplinary work groups and address each disorder, using the general framework of recognition, assessment, treatment, and monitoring, with emphasis on the process and the role of care team members. Clinical practice guidelines ensure consistent approaches to clinical care across disciplines, as well as facilities. Yet, AMDA has seen little institutional support for CPGs, and the value of their use is not well understood. In addition, long-term care professionals' schedules and staffing issues present a challenge to finding time for training and implementation of the guidelines. To encourage greater implementation, AMDA is offering a “Train the Trainer” workshop series to equip the entire long-term care team (see announcement on this page). During the training, attendees will break into small groups and work with experienced facilitators, who will lead them through a specific clinical practice guideline, among other things. “We are here to support and educate LTC staff in improving the quality of care that our Medicare beneficiaries receive,” said Lorri Gibbons, R.N., B.S.N., and senior interventions specialist with South Carolina's Quality Improvement Organization. “In doing so,” she said, “the staff is charged with implementing many changes within their facilities to align with current clinical practices in the long-term care setting. AMDA provides validated clinical practice guidelines for practitioners,” which are uniquely applicable to the long-term care setting, she said, adding that “we believe that this bridge of support between facility, staff and practitioner is crucial to improve the quality of care delivered to residents in this setting.” Guidelines from other sources often limit or omit considerations that are relevant to the long-term care population, especially the frail elderly. For example, “falls are a significant problem for all of us in the long-term care arena, and optimal management” has a major impact on older adults, said Barbara Resnick, Ph.D., C.R.N.P., of the department of adult health at the University of Maryland, Baltimore. Dr. Resnick has conducted several studies utilizing AMDA's Falls and Fall Risk CPG, and says the results show that falls decreased significantly and consistently following the implementation of this guideline. “All too often, the tendency is to respond to a fall by limiting physical activity which only further exacerbates the problem,” Dr. Resnick explained. “Use of guidelines such as the AMDA Falls and Fall Risk clinical practice guideline provides clinicians with an effective interdisciplinary strategy that not only decreases the number of falls” but also makes sure older adults in long-term care settings obtain and maintain their optimal level of function, health, and quality of life. “Training, such as that provided in the Train the Trainer workshop, on how to implement these guidelines is crucial to making it happen successfully,” she said. AMDA believes long-term care professionals can partner to motivate and help nursing facilities implement CPGs to improve care in key clinical areas. Attendees (physicians, pharmacy consultants, nurse-practitioners, and nurses) will receive a certificate upon completing the course.