Inpatient Hospital Setting Research Articles

Optimizing Older Adults' Medication Use Nurses can partner with caregivers to promote safe medication administration.

This article is the third in a series, Supporting Family Caregivers in the 4Ms of an Age-Friendly Health System, published in collaboration with the AARP Public Policy Institute as part of the ongoing Supporting Family Caregivers: No Longer Home Alone series. The 4Ms of an Age-Friendly Health System (What Matters, Medication, Mentation, and Mobility) is an evidence-based framework for assessing and acting on critical issues in the care of older adults across settings and transitions of care. Engaging the health care team, including older adults and their family caregivers, with the 4Ms framework can help to ensure that every older adult gets the best care possible, is not harmed by health care, and is satisfied with the care they receive. The articles in this series present considerations for implementing the 4Ms framework in the inpatient hospital setting and incorporating family caregivers in doing so. Resources for both nurses and family caregivers, including a series of accompanying videos developed by AARP and the Rush Center for Excellence in Aging and funded by The John A. Hartford Foundation, are also provided. Nurses should read the articles first, so they understand how best to help family caregivers. Then they can refer caregivers to the informational tear sheet—Information for Family Caregivers—and instructional videos, encouraging them to ask questions. For additional information, see Resources for Nurses. Cite this article as: Zonsius, M.C., et al. Optimizing Older Adults' Medication Use. Am J Nurs 2022; 122(3): 38-43.

Recognizing and Acting on Mentation Concerns Caregivers are key partners in addressing depression, dementia, and delirium in older adults.

This article is the fourth in a series, Supporting Family Caregivers in the 4Ms of an Age-Friendly Health System, published in collaboration with the AARP Public Policy Institute as part of the ongoing Supporting Family Caregivers: No Longer Home Alone series. The 4Ms of an Age-Friendly Health System (What Matters, Medication, Mentation, and Mobility) is an evidence-based framework for assessing and acting on critical issues in the care of older adults across settings and transitions of care. Engaging the health care team, including older adults and their family caregivers, with the 4Ms framework can help to ensure that every older adult gets the best care possible, is not harmed by health care, and is satisfied with the care they receive. The articles in this series present considerations for implementing the 4Ms framework in the inpatient hospital setting and incorporating family caregivers in doing so. Resources for both nurses and family caregivers, including a series of accompanying videos developed by AARP and the Rush Center for Excellence in Aging and funded by The John A. Hartford Foundation, are also provided. Nurses should read the articles first, so they understand how best to help family caregivers. Then they can refer caregivers to the informational tear sheet—Information for Family Caregivers—and instructional videos, encouraging them to ask questions. For additional information, see Resources for Nurses. Cite this article as: Mack, L., et al. Recognizing and Acting on Mentation Concerns. Am J Nurs 2022; 122(5): 50-55

The Prevalence of Psychiatric Disorders in General Hospital Inpatients: A Systematic Umbrella Review.

To inform the future development of consultation-liaison psychiatry services, we need accurate information on the prevalence of psychiatric disorders in the general hospital inpatient setting. Systematic reviews have summarized the literature on specific aspects of this broad topic, but there has been no high-level overview that aggregates their findings and identifies gaps in the relevant literature. We aimed to produce a comprehensive overview of the field, summarizing the research literature on the prevalence of psychiatric disorders (i.e., interview-based psychiatric diagnoses) in general hospital inpatients. We did this using a systematic umbrella review (systematic review of systematic reviews), which is the best and most efficient method for summarizing a broad area of research. We searched Ovid Medline, Ovid Embase, Ovid PsycINFO, EBSCO CINAHL, and Scopus from database inception to September 2021 for systematic reviews that provided a pooled prevalence estimate, or prevalence range, for interview-diagnosed psychiatric disorders in general hospital inpatients. Two reviewers independently assessed articles and extracted data. The review is registered with PROSPERO, number CRD42019125574. We screened 11,728 articles and included 10 systematic reviews in our umbrella review. We were able to extract pooled prevalence estimates from these as follows: major depression 12% to 20%, any anxiety disorder 8%, generalized anxiety disorder 5%, panic disorder 3%, delirium 15%. We were only able to extract a prevalence range for dementia, which was 3% to 63%. We found no systematic reviews from which we could extract prevalence data for the other psychiatric disorders that we included in our searches, indicating important gaps. Fromthese data, we estimated that approximately one-third of inpatients have a psychiatric disorder. Psychiatric disorders are very common in general hospital inpatients. While the planning of consultation-liaison psychiatry services will benefit from more research on the prevalence of each of the full range of disorders encountered in the inpatient setting, our findings indicate that we already know enough to justify increased and more population-based service provision.

Anterior Cervical Discectomy and Fusion in the Ambulatory Surgery Center Versus Inpatient Setting: One-Year Cost-Utility Analysis.

Retrospective analysis of prospectively collected data. Assess the cost-utility of anterior cervical discectomy and fusion (ACDF) performed in the ambulatory surgery center (ASC) versus inpatient hospital setting for Medicare and privately insured patients at one-year follow-up. Outpatient ACDF has gained popularity due to improved safety and reduced costs. Formal cost-utility studies for ambulatory versus inpatient ACDF are lacking, precluding an accurate assessment of cost-effectiveness. A total of 6504 patients enrolled in the Quality Outcomes Database (QOD) undergoing one-level to two-level ACDF at a single ASC (520) or the inpatient hospital setting (5984) were compared. Propensity matching generated 748 patients for analysis (374 per cohort). Demographic data, resource utilization, patient-reported outcome measures, and quality-adjusted life-years (QALYs) were assessed. Direct costs (1-year resource use×unit costs based on Medicare national allowable payment amounts) and indirect costs (missed workdays×average US daily wage) were recorded. Incremental cost-effectiveness ratios were calculated. Complication rates and improvements in patient-reported outcome measures and QALYs were similar between groups. Ambulatory ACDF was associated with significantly lower total costs at 1 year for Medicare ($5879.46) and privately insured ($12,873.97) patients, respectively. The incremental cost-effectiveness ratios for inpatient ACDF was $3,674,662 and $8,046,231 for Medicare and privately insured patients, respectively, reflecting unacceptably poor cost-utility. Inpatient ACDF is associated with significant increases in total costs compared to the ASC setting without a safety, outcome, or QALY benefit. The ASC setting is a dominant option from a health economy perspective for first-time one-l to two-level ACDF in select patients compared to the inpatient hospital setting.

A Study of Old Age Delirium and Quality of Life of Family Caregivers

Objectives: To study the aetiology of patients of delirium in old age, to study the severity of delirium in old age and to study the quality of life of family caregivers of delirium patients. Design: Prospective, observational, and cross sectional. Setting: Inpatient tertiary care hospital setting. Participants: Subjects with the diagnosis of Delirium qualifying according to ICD-10 (international classification of disease-10) and confirmed with CAM scale aged >60 years and Patient or patient’s family members willing to give consent. Measurements: Socio-demographic questionnaire, Confusion assessment method, Delirium index, Delirium aetiology check list, ICD -10 DCR, WHO QOL BREF and the Barthel index. Results: There is no significant association between delirium severity and WHOQoL. There is no significant association between Barthel index and WHOQoL. There is no significant association between WHOQoL and delirium aetiologies. There is no significant association between gender and WHOQoL. There is no significant association between marital status and WHOQoL. There is no significant association between religion and WHOQoL. There is no significant association between WHOQol and education. There is significant association between WHOQoL and occupation. Emloyed subjects have better quality of life than unemployed. There is no significant association between WHO QoL and residence. There is no significant association between WHOQoL and duration of delirium. There is no significant association between WHOQoL and medical comorbidities. There is no significant association between WHOQoL and substance use. There is no significant association between medical comorbidities and delirium aetiology. There is significant association between delirium severity and duration of delirium. As duration of delirium increases severity of delirium increases. There is no significant association between duration of delirium and delirium aetiology. There is no significant association between delirium severity and medical comorbidities. Conclusions: In this study results showed that there is significant association between delirium is an acute illness with sudden onset with maximum percentage of duration 2-4 weeks, delirium is more in males than females, majority of the care givers are spouses and parents, multiple aetiologies, diminished psychological QoL are associated with increased care giver burden. Family history of delirium is associated with better care giver burden. Employed subjects with delirium have better overall QoL. As duration of delirium increases, delirium severity increases.

Canadian Hospital Pharmacists' Perceptions of Workplace Preparedness and Personal Well-Being during the COVID-19 Pandemic.

Little is known about hospital pharmacists' experiences during the COVID-19 pandemic, as studies to date have focused on community pharmacy practices. To determine hospital pharmacists' perceptions of their workplace preparedness for the COVID-19 pandemic and to measure their mental well-being with the Warwick-Edinburgh Mental Well-being Scale (WEMWBS). Pharmacists working in Canadian hospital inpatient settings during the COVID-19 pandemic were invited to participate in a 2-part online survey. Part A was a 46-item survey containing statements related to directions and support from leadership, personal protective equipment practices, work environment, and emotions. Part B assessed respondents' mental well-being using the validated 14-item WEMWBS. Responses to both parts of the survey were based on Likert scales. The survey was open from July to September 2020. Descriptive analyses were applied. A total of 432 hospital pharmacists consented to participate in the study. Most respondents were women (337/432, 78%), and most were 25 to 44 years old (293/432, 68%). Most respondents were confident that their workplace and pharmacy department were effectively managing patient demand (314/389, 81%) and the pandemic more generally (263/394, 67%). They also felt that their workplace teams were working well together (314/386, 81%). Interestingly, 22% (86/391) of the respondents did not agree that they had received training for COVID-19 infection prevention and control practices. The mean WEMWBS score was 48.9 (standard deviation 8.6), which indicated average mental well-being. After the initial wave of the COVID-19 pandemic, respondents perceived their hospitals and departments as being able to manage the pandemic and reported average mental well-being. Ensuring that all hospital pharmacists receive training for effective COVID-19 infection prevention and control practices is crucial. How their perceptions and well-being have changed since the time of the survey is unknown.

64.3 Implementation of the Attachment Self-Regulation Competency Framework Within an Inpatient Hospital Setting

The goal is to review efficacy and adaptability of the Attachment, Self-Regulation, and Competency (ARC) framework in its implementation at the University of Massachusetts Adolescent Continuing Care Unit (ACCU).

Minimally Invasive Surgery in the United States, 2022: Understanding Its Value Using New Datasets

IntroductionWhile minimally invasive surgery (MIS) has transformed the treatment landscape of surgical care, its utilization is not well understood. The newly released Nationwide Ambulatory Surgery Sample allows for more accurate estimates of MIS volume in the United States—in combination with inpatient datasets. Materials and methodsMultiple nationwide databases from the Healthcare Cost and Utilization Project (HCUP) were used: the Nationwide Ambulatory Surgery Sample and National Inpatient Sample. The volume of MIS and robotic procedures were calculated from 2016 to 2018. An online query system, HCUPNet, was queried for inpatient stays from 1993 to 2014. ResultsIn 2017, 9.8 million inpatient major operating room procedures were analyzed, of which 11.1% were MIS and 2.5% were robotic-assisted, compared with 9.6 million inpatient operating room procedures (11.2% MIS and 2.9% robotic-assisted) in 2018. There were 10.6, 10.6, and 10.7 million ambulatory procedures in 2016, 2017, and 2018, respectively. Ambulatory MIS procedures showed an increasing trend across years, representing 16.9%, 17.4%, and 18%, respectively. HCUPNet data revealed an increase in inpatient MIS cases from 529,811 (8.9%) in 1993 to 1,443,446 (20.7%) in 2014. ConclusionsThis study is the first to estimate national MIS volume across specialties in both inpatient and ambulatory hospital settings. We found a trend toward a higher proportion of MIS and robotic cases from 1997 to 2018. These data may help contribute to a more comprehensive understanding of MIS value within surgery and highlight limitations of current databases, especially when categorizing robotic cases on a national scale.

Improving Hand Hygiene Compliance through Collaborative Computational Design

Hand sanitization by healthcare staff remains one of the most effective ways for controlling infection in healthcare settings. However, predicting faithful adherence to Hand Hygiene Compliance (HHC) is difficult in complex environments such as inpatient hospital settings. The main challenge is understanding how different components of human and built systems interact to achieve specific goals such as HHC at the critical moments of care delivery. The aim of this explorative study was to evaluate how Human Factors derived visual salience cues and proximity-compatibility principles might be used in the design of healthcare spaces to support nurse moments of HHC through increased perceived behavioral control and intention. The investigative team used a Collaborative Computational Scenario Planning (CCSP) Model approach to determine the integrative effects of reinforcing and detracting operational and environmental factors on discrete moments of HHC behavior. Supervised Machine Learning analysis was conducted on data collected by a large academic medical center that included HHC observance in clinical staff spanning from 2017 to 2021 in two inpatient hospital units. The probabilistic outcomes of unit based HHC observance likelihood were used to compute Fuzzy Cognitive Model Edge Probabilities between Hand Hygiene (HH) cues and detected HHC at key moments. Hospital infection control experts were then engaged to identify the weight of various reinforcing and detracting operational and environmental factors contributing to HHC observance. Combining the quantitative and qualitative methods, allowed the team to then develop integrative CCSP models which facilitated predictive insight into the development of targeted environmental improvements that might contribute to HHC control and intention to support safer patient care.

Addressing What Matters Aligning care with the priorities of older adults and their caregivers.

This article is the second in a series, Supporting Family Caregivers in the 4Ms of an Age-Friendly Health System, published in collaboration with the AARP Public Policy Institute and originally appearing in the American Journal of Nursing, Volume 122, issue 1, as part of the ongoing Supporting Family Caregivers: No Longer Home Alone series. The 4Ms of an Age-Friendly Health System (What Matters, Medication, Mentation, and Mobility) is an evidence-based framework for assessing and acting on critical issues in the care of older adults across settings and transitions of care. Engaging the health care team, including older adults and their family caregivers, with the 4Ms framework can help to ensure that every older adult gets the best care possible, is not harmed by health care, and is satisfied with the care they receive. The articles in this series present considerations for implementing the 4Ms framework in the inpatient hospital setting and incorporating family caregivers in doing so. Resources for both nurses and family caregivers, including a series of accompanying videos developed by AARP and the Rush Center for Excellence in Aging and funded by The John A. Hartford Foundation, are also provided. Nurses should read the articles first, so they understand how best to help family caregivers. Then they can refer caregivers to the informational tear sheet-Information for Family Caregivers-and instructional videos, encouraging them to ask questions. For additional information, see Resources for Nurses. Cite this article as: Carbonell, E., et al. Addressing What Matters. Am J Nurs 2022; 122(1): 54-58.

The 4Ms of an Age-Friendly Health System An evidence-based framework to ensure older adults receive the highest quality care.

This article is the first in a new series, Supporting Family Caregivers in the 4Ms of an Age-Friendly Health System, published in collaboration with the AARP Public Policy Institute and originally appearing in the American Journal of Nursing, Volume 121, Issue 11, as part of the ongoing Supporting Family Caregivers: No Longer Home Alone series. The 4Ms of an Age-Friendly Health System (What Matters, Medication, Mentation, and Mobility) is an evidence-based framework for assessing and acting on critical issues in the care of older adults across settings and transitions of care. Engaging the health care team, including older adults and their family caregivers, with the 4Ms framework can help to ensure that every older adult gets the best care possible, is not harmed by health care, and is satisfied with the care they receive. The articles in this new series present considerations for implementing the 4Ms framework in the inpatient hospital setting and incorporating family caregivers in doing so. Resources for both nurses and family caregivers, including a series of accompanying videos developed by AARP and the Rush Center for Excellence in Aging and funded by the John A. Hartford Foundation, are also provided. Nurses should read the articles first, so they understand how best to help family caregivers. Then they can refer caregivers to the informational tear sheet-Guide to the 4Ms of an Age-Friendly Health System for Family Caregivers-and instructional videos, encouraging them to ask questions. For additional information, see Resources for Nurses. Cite this article as: Emery-Tiburcio, E.E., et al. The 4Ms of an Age-Friendly Health System. Am J Nurs 2021; 121(11): 44-49.

P89. Patient out of pocket cost burden with elective spine surgery

<h3>BACKGROUND CONTEXT</h3> Out-of-pocket (OOP) costs for medical and surgical care can result in substantial financial burden for patients and families. Relatively little is known regarding OOP costs for commercially insured patients receiving spinal fusion surgery. <h3>PURPOSE</h3> The aim of this study is to analyze the trends in OOP costs for common, elective spinal fusion surgeries performed in the hospital inpatient setting. <h3>STUDY DESIGN/SETTING</h3> Retrospective review. <h3>PATIENT SAMPLE</h3> This study utilized an employer-sponsored insurance claims database to analyze billing data of commercially insured patients who underwent elective spinal fusion between 2014 and 2019. Patients who received single-level anterior cervical discectomy and fusion (ACDF) and single-level posterior lumbar fusion (PLF) were identified. <h3>OUTCOME MEASURES</h3> OOP costs associated with the surgical episode and the ratio of OOP costs to total insurer contribution (payments from insurers to providers) were assessed. <h3>METHODS</h3> OOP costs associated with the surgical episode were calculated as the sum of deductible payments, co-payments and co-insurance. Monetary data were adjusted to 2019 dollars. General linear regression, Wilcoxon-Mann-Whitney and Krustal-Wallis tests were utilized for analysis, as appropriate. <h3>RESULTS</h3> In total, 10,225 ACDF and 28,841 PLF patients were analyzed. Most patients in our study sample had preferred provider organization (PPO) insurance plans (ACDF 70.3%, PLF 66.9%). The mean OOP costs for patients, by procedure were: ACDF $3,180 (SD=2,495) and PLF $3,166 (SD=2,529). Total OOP costs increased significantly from 2014 - 2019 for both procedures (p<0.0001). Among the insurance plans examined, patients with high-deductible health plans had the highest OOP costs. The ratio of patient contribution (OOP costs) to total insurer contribution (payments from insurers to providers) was 0.07 for ACDF and 0.04 for PLF. <h3>CONCLUSIONS</h3> Among commercially insured patients who underwent elective spinal fusion, OOP costs increased from 2014 to 2019. The OOP costs for elective spinal fusion represent a substantial and increasing financial burden for patients. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Outpatient palliative care during the COVID-19 pandemic: a retrospective single centre analysis in Germany

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has challenged health care systems worldwide. In Germany, patients in a palliative care setting have the opportunity to receive treatment by a specialised mobile outpatient palliative care team (OPC). The given retrospective single centre analysis describes the use of OPC structures for terminally ill COVID-19 patients during the height of the pandemic in Germany and aims to characterise this exceptional OPC patient collective.MethodsFirst, death certificates were analysed in order to collect data about the place of death of all deceased COVID-19 patients (n = 471) within our local governance district. Second, we investigated whether advance care planning structures were established in local nursing homes (n = 30) during the height of the COVID-19 pandemic in 2020. Third, we examined patient characteristics of COVID-19 negative (n = 1579) and COVID-19 positive (n = 28) patients treated by our tertiary care centre guided OPC service.ResultsThe analysis of death certificates in our local district revealed that only 2.1% of all deceased COVID-19 patients had succumbed at their home address (n = 10/471). In contrast, 34.0% of COVID-19 patients died in nursing homes (n = 160/471), whereas 63.5% died in an inpatient hospital setting (n = 299/471). A large proportion of these hospitalised patients died on non-intensive care unit wards (38.8%). Approximately 33.0% of surveyed nursing homes had a palliative care council service and 40.0% of them offered advance care planning (ACP) structures for their nursing home residents. In our two OPC collectives we observed significant differences concerning clinical characteristics such as the Index of Eastern Cooperative Oncology Group [ECOG] (p = 0.014), oncologic comorbidity (p = 0.004), as well as referrer and primary patient location (p = 0.001, p = 0.033).ConclusionsMost COVID-19 patients in our governance district died in an inpatient setting. However, the highest number of COVID-19 patients in our governance district who died in an outpatient setting passed away in nursing homes where palliative care structures should be further expanded. COVID-19 patients who died under the care of our OPC service had considerably fewer oncologic comorbidities. Finally, to relieve conventional health care structures, we propose the expansion of established OPC structures for treating terminally ill COVID-19 patients.

Contact Dermatitis in the Inpatient Hospital Setting–an Updated Review of the Literature

Contact Dermatitis in the Inpatient Hospital Setting–an Updated Review of the Literature

Factors influencing newly graduated registered nurses' voice behaviour: An interview study.

To gain insight into the factors that affect newly graduated registered nurses' voice behaviour. Employees with little work experience may experience difficulties with speaking up. Given that a lack of voice can negatively affect the delivery of safe client care and lower nurses' job satisfaction, it is important to understand which factors facilitate and hinder newly graduated nurses' voice behaviour. A qualitative descriptive study was conducted using semi-structured interviews with 17 newly graduated registered nurses working in inpatient hospital settings. In total, seven factors emerged from our data, which were grouped in four overarching themes. Whether newly graduated nurses speak up depends on (1) their levels of self-confidence, (2) whether they feel encouraged and welcome to speak up, (3) their relationship with the voice target and (4) the content of their voice message. Factors that affect newly graduated nurses' voice behaviour are multifaceted, but mostly centre around time spent in and relationships at the workplace. Nurse managers and colleagues can build an environment that fosters newly graduated nurses' voice behaviour. Specifically, induction programmes, assigning mentors and offering additional training can support newly graduated nurses in developing voice behaviour.

Reporting Hospital Services When Consultation Codes Are Excluded From Payment (Online Exclusive)

This article discusses reporting requirements for evaluation and management (E/M) services in hospital inpatient and observation settings when a payer’s policy does not allow payment for services reported with consultation codes. Key topics include Use of the AI modifier by the admitting or attending physician Codes reported by a consulting physician when a payer doesn’t accept consultation codes

Lessons in Linkage: combining administrative data using deterministic linkage for surveillance of sports and recreation injuries in Florida, United States.

Previous and ongoing epidemiological surveillance of sports and recreation injuries (SRI) has been cross-sectional in nature, utilised a subset of injuries based on athletic trainer availability, or focused on elite and professional athletes. In the United States, surveillance is often prohibitively expensive and not well funded by national organisations or agencies, except for the case of some professional and elite sports. This paper details the methodology, barriers, and successes of using deterministic linkage to combine emergency department and hospitalisation data with a single identifier for use in surveilling sports injuries for persons aged 5 to 18 years. Data linkage of a population cohort. We performed deterministic linkage of administrative emergency department and hospitalisation data from the state of Florida in the US. Data was acquired from the Florida Agency for Health Care Administration. With limited identifiers available due to privacy, we combined data across multiple years using a near universal identifier. We identified sport and recreation injuries using a modified External Cause of Injury Morbidity Matrix and ICD codes across all possible diagnoses. Finally, we obtained descriptive statistics of records that were successfully linked and those that were not to assess similarities between the groups. We found 384,731 visits for SRI over a seven-year period. We were able to link approximately 70% of the records using a single identifier. There were statistically significant differences by age, sex, payer, and race/ethnicity for the records that were linked compared to the records that were not linked. This study is significant because while similar methods have been used to examine other conditions (e.g. asthma), few have linked multiple types of administrative data especially with nearly no identifiers to examine sports and recreation injuries. This method was found useful to identify injuries over time for the same individuals seeking care in emergency departments, or in hospital inpatient settings, though future work will need to address the limitations of this method. If we expect to move health surveillance forward as budgets for it become even more limited, we must develop and improve methods to do it with fewer resources, including using data that has great limitations.

Trends of Fixed-Dose Combination Antibiotic Consumption in Hospitals in China: Analysis of Data from the Center for Antibacterial Surveillance, 2013-2019.

Background: Fixed-dose combination (FDC) antibiotics can be clinically inappropriate and are concerning with regards to antimicrobial resistance, with little usage data available in low- and middle-income countries. Methods: Based on retrospective data from the Center for Antibacterial Surveillance, we investigated the consumption of FDC antibiotics in hospital inpatient settings in China from 1 January 2013 to 31 December 2019. The metric for assessing antibiotic consumption was the number of daily defined doses per 100 bed days (DDD/100BDs). FDC antibiotics were classified according to their composition and the Access, Watch, Reserve (AWaRe) classification of the World Health Organization. Results: A total of 24 FDC antibiotics were identified, the consumption of which increased sharply from 8.5 DDD/100BDs in 2013 to 10.2 DDD/100BDs in 2019 (p < 0.05) despite the reduction in the total antibiotic consumption in these hospitals. The increase was mainly driven by FDC antibiotics in the Not Recommended group of the AWaRe classification, whose consumption accounted for 63.0% (6.4 DDD/100BDs) of the overall FDC antibiotic consumption in 2019, while the consumption of FDC antibiotics in the Access group only accounted for 13.5% (1.4 DDD/100BDs). Conclusion: FDC antibiotic consumption significantly increased during the study period and accounted for a substantial proportion of all systemic antibiotic usage in hospitals in China. FDC antibiotics in the Not Recommended group were most frequently consumed, which raises concerns about the appropriateness of FDC antibiotic use.

Promoting Safe Mobility.

This article is the fifth in a series, Supporting Family Caregivers in the 4Ms of an Age-Friendly Health System, published in collaboration with the AARP Public Policy Institute as part of the ongoing Supporting Family Caregivers: No Longer Home Alone series. The 4Ms of an Age-Friendly Health System (What Matters, Medication, Mentation, and Mobility) is an evidence-based framework for assessing and acting on critical issues in the care of older adults across settings and transitions of care. Engaging the health care team, including older adults and their family caregivers, with the 4Ms framework can help to ensure that every older adult gets the best care possible, is not harmed by health care, and is satisfied with the care they receive. The articles in this series present considerations for implementing the 4Ms framework in the inpatient hospital setting and incorporating family caregivers in doing so. Resources for both nurses and family caregivers, including a series of accompanying videos developed by AARP and the Rush Center for Excellence in Aging and funded by The John A. Hartford Foundation, are also provided. Nurses should read the articles first, so they understand how best to help family caregivers. Then they can refer caregivers to the informational tear sheet-Information for Family Caregivers-and instructional videos, encouraging them to ask questions. For additional information, see Resources for Nurses.

Avian Assisted Intervention During Covid-19 Pandemic Restrictions

Occupational Deprivation has been a present risk [ER1] for people in inpatient hospital settings such as Skilled Nursing Facilities (SNF) during the Coronavirus Disease 2019 (COVID-19) pandemic restrictions. Clients have described their days as “boring” and “unfulfilling.” Clients experiencing extended in-patient hospitalization, who already might experience great interruptions to their treasured roles, routines, and occupations, were further restricted from recreational and social opportunities usually present in those settings. This work describes the translation of the animal assisted intervention evidence base to an occupational therapy student-developed program at a SNF to address this deficit. A vibrant avian therapy partner gave moments of joy for clients whose activities were heavily restricted during widespread social isolation of the COVID-19 containment efforts. Connections to performance skills in the Occupational Therapy Practice Framework (AOTA, 2020). are discussed