Use In Long-term Care Facilities Research Articles

Nursing students' experiences regarding physical restraint use in long-term care facilities: A qualitative descriptive study

BackgroundDespite many harmful effects, physical restraints are still used in long-term care facilities. Most existing studies have focused on staff. Nursing students observe staff's use of restraints during gerontological nursing practicums, but there are few studies on nursing students' experiences regarding restraint use in long-term care settings. ObjectiveThis study aimed to explore nursing students' experiences with physical restraint use in order to enhance nursing education and improve care quality in long-term care facilities. MethodsUsing convenience sampling method, three nursing schools from three provinces were recruited. Twenty-six senior undergraduate nursing students who had taken a gerontological nursing practicum course participated in this study. A qualitative descriptive method was utilized to provide a clear account of the students' experiences. In-depth interviews were conducted using a semi-structured interview guide. Thematic analysis was used for data analysis. ResultsFour themes were identified, which included overuse of restraints, ambivalent response to restraints, becoming accustomed to restraints, and lack of education regarding restraints. Students frequently observed the use of various restraints, which elicited both negative and positive responses, ultimately leading to their desensitization to the overuse of restraints. They expressed a lack of knowledge and educational needs regarding restraint reduction. ConclusionNursing students encountered the overuse of various restraints, exhibited ambivalent responses, and became desensitized to this practice in long-term care facilities. They perceived a lack of education and educational needs regarding restraint reduction. This study adds important new knowledge to existing literature and provides important insights into restraint use in long-term care facilities. Future studies need to develop and evaluate educational programs for restraint-free and person-centered care targeting nursing students. Long-term care facilities should offer organizational support and implement continuous mandatory training to promote restraint-free care.

Attitudes to long-term care in India: a secondary mixed-methods analysis

BackgroundIndia is the world's most populous country, and overseas Indians the world's largest diaspora. Many of the more than 1·4 million UK-based Indians will be providing care at a distance for parents living in India. Globalisation has contributed to a shift in India from traditional joint family systems to more nuclear structures. We investigated how commonly Indian parents consider and use long-term care facilities and attitudes to their use. MethodsWe did a secondary mixed-methods statistical analysis of the LASI (Longitudinal Ageing Study in India), a national, cross-sectional household survey administered in 2017–18 to 73 396 randomly selected adults aged 45 years and older in all Indian states and Union Territories (42 261 [58%] women, 31 135 [42%] men). We report the proportion and sociodemographic predictors of respondents’ parent(s) living in a care home. We also did a secondary thematic analysis of the qualitative interviews from the Moving Pictures India Study, exploring attitudes to long-term care in 2022. These interviews included 19 carers (nine [47%] women; age range 31–79 years) for people with dementia and 25 professionals (19 [76%] women; age range 24–56 years) purposively selected for diversity from networks of the team based at a Bangalore hospital, India. Findings24 LASI participants reported that their parent was living in a long-term care facility (father [n=8], mother [n=15], both parents [n=1]). Although rare overall, use and consideration of use of long-term care were more frequently reported in urban areas (n=14, 58%), by people in middle-income quintiles (n=17, 71%) with higher levels of education (n=7, 29%), who rated their health as good or very good (n=15, 63%). The themes identified in qualitative interviews were the use of long-term care facilities as a last resort, social expectations, and limited availability of long-term care facilities. InterpretationAlthough interviews were only conducted in Bangalore and respondents could misrepresent living arrangements due to ongoing societal stigma, the data show that very few people reside in old age homes across India, with strong preference towards intergenerational and community care. With the UK home to a growing diaspora of nuclear Indian families, our findings illustrate the contexts in which they provide care at a distance, navigating cross-cultural attitudes and social norms around long-term care. FundingAlzheimer's Association US.

Implementation of a centralized, web-based surveillance for healthcare associated infections among residents of long-term care facilities in Italy

ObjectiveThe Italian National Action Plan to contrast AMR identified among its objectives the development and implementation of a national Healthcare-Associated Infection (HAI) surveillance system based on European Centre for Disease Prevention and Control (ECDC) indications, through point prevalence surveys (PPS) of HAIs and antibiotic use in acute-care hospitals and long-term care facilities (LTCFs). We aimed to assess feasibility and appropriateness of proposed tools for a national surveillance system of HAIs and antibiotic use in LTCFs. Study designPoint prevalence survey. MethodsA pilot PPS was conducted between May–June 2022, among 15 LTCFs of 7 Italian regions. Data were collected in a single day in each LTCF, at the LTCF, ward, and resident levels, using a web-based data collection tool developed ad hoc. Data collector teams of each facility were invited to complete a questionnaire investigating opinions on the proposed tools. ResultsAmong 1025 included residents, the prevalence of residents with at least one HAI was 2.5% (95% CI 1.7%-3.7%) considering all HAIs and 2.2% (95% CI 1.3%–3%) without considering SARS-CoV-2 infections. The prevalence of antimicrobial use was 3% (95% CI 0.2%–4.3%). Overall, most respondents were satisfied with the web-based software, training and protocol, even though some difficulties were reported. ConclusionsA national surveillance network was established, which will facilitate future surveillance efforts. Further studies are necessary to evaluate the impact of the pandemic on HAI transmission and antibiotic use in LTCFs.

Digital Distance in Times of Physical Distancing: ICT Infrastructure and Use in Long-Term Care Facilities

Although information and communication technologies (ICTs) such as smartphones, tablets, and the internet have all become increasingly important during the COVID-19 pandemic, we often forget that not everyone has access to the internet or uses ICT devices. Individuals on the wrong side of the digital divide are often older adults living in long-term care facilities (LTCFs), such as “old–old” adults, who often have various functional impairments. To shed light on the initial situation shortly before the pandemic, three data sources from Switzerland were used in this study to answer the following questions: (1) Do older adults want to have internet access if and/or when they move into a LTCF? (2) What form does ICT use take (specifically internet, smartphone, and tablet use) among LTCF residents, and what need do they have for ICT support? (3) What is the state of LTCFs’ ICT infrastructure and residents’ level of involvement in the decision-making process related to acquiring new technologies? Community-dwelling older adults in this study reported a desire to have internet access when moving into LTCFs, and 21% of LTCF residents reported using the internet just before the pandemic began. Internet access and ICT infrastructure in LTCFs, in general, are both limited, however, and LTCF managers seldom involve older adults in the ICT decision-making process. While modern ICT usage has reached the long-term care sector, the results of this study show that compensating for a lack of physical social contacts by relying on digital solutions during the COVID-19 pandemic cannot be the sole solution. The current pandemic has reminded us that a digital gap exists and that non-use of ICTs during the pandemic can produce additional feelings of social isolation.

P17 National antimicrobial point prevalence survey in adult inpatient mental health facilities in Ireland

Abstract Background Antimicrobial use in mental health inpatient settings has not been extensively examined in Ireland. The Healthcare-Associated Infection and Antimicrobial Use in Long-Term Care Facilities (HALT) study 2016 found that Irish long-term care facilities caring for residents with psychiatric conditions had an antimicrobial prevalence rate of 7.7%, higher than the European average of 4.9%. National community antimicrobial prescribing guidelines are available at www.antibioticprescribing.ie. In addition, a preferred antibiotic initiative for community settings advocates prescribers to choose ‘Green’ (preferred) antibiotics over ‘Red’ (reserved) agents. Reserved agents are considered to have more adverse effects, drug interactions and potential for development of antimicrobial resistance. The patient safety implications of antimicrobial stewardship along with an ageing population, and potential drug–drug interactions between many antimicrobials and psychotropic medications prompted a review of antimicrobial use practices in mental health services. Methods A sample of adult inpatient mental health facilities (MHF) operated by the state's Health Service Executive (HSE) were surveyed by community antimicrobial pharmacists (AMPs) between November 2021 and January 2022. AMPs reviewed patients’ medication charts for systemic antimicrobial prescriptions in the previous 30 days in addition to medical notes and laboratory results (where available). Adherence to HSE National community antimicrobial guidelines and the systems and structures in place to support antimicrobial stewardship were assessed. Results In total, 1003 patients in 51 MHFs were surveyed. At the time of survey, 6.3% (n=66) patients were on a systemic antimicrobial and 15% (n=153) had received a systemic antimicrobial within the previous 30 days. Prophylaxis accounted for 50% of antibiotic use (3.3% of all patients), with the most common indication being the prevention of urinary tract infection (UTI) (58%). Prophylaxis duration exceeded six months in 61% of prescriptions. The median duration of treatment courses was seven days. The proportion of ‘Green’ (preferred) antimicrobials versus ‘Red’ (reserved) antimicrobials was 58% versus 38%. Co-amoxiclav, a ‘Red’ agent was the most commonly prescribed antibiotic for treatment of infection (31%). Adherence with choice of antimicrobial agent as per national antimicrobial guidelines was 76%; adherence of dosing regimen was 75% and adherence with recommended duration was 46%. The main themes for non-adherence with choice of agent were use of unnecessarily broad spectrum agents, nitrofurantoin prescribed in renal impairment and inappropriate formulation of nitrofurantoin chosen. Dipstick urinalysis was performed routinely (on admission and/or at designated intervals) for persons asymptomatic of UTI in 53% (n=27) of MHFs. Conclusions This PPS established antimicrobial use practices in HSE MHFs and identified opportunities for improvement relating to the safe and optimal use of antimicrobials. Key national recommendations from this survey were:

Keep Your Brain HAP-B: Group Psychoeducation to Promote Behaviors which Support Healthy Brain Aging.

Positive health behaviors can promote brain health with age. We developed a novel health education and implementation group for older Veterans called the "Healthy Aging Project: Brain" also known as HAP-B. We had these primary goals: provide psychoeducation, focus on 'what matters', improve awareness of health behaviors, and promote behavioral change through individualized goal-setting, monitoring, and support. The scientific literature + needs assessment-based content addresses 4 key areas: physical activity, sleep improvement, cognitive stimulation, and social interaction. Each of the 6 "classes" are 90 minutes long. Pre-pandemic n=37 Veterans across 6 groups participated. To mitigate health risk exposure and reach Veterans for whom travel is a barrier, we have adapted the group to a virtual format with n=18 participants across 3 virtual groups (another group is ongoing, n=6). This QA/QI project collects optional pre/post self-report measures which target satisfaction with the group, depressive symptoms, sleep quality, social support, and subjective well-being. Additions along the way include in-session self-ratings for targeted goal behavior adherence and a pre/post self-efficacy questionnaire. Our population tends to be predominantly male and White. Results and qualitative findings are promising. The group has successfully been run in 3 outpatient in-person settings: Mental Health Services, Geriatrics Memory Health Clinic, and Primary Care Mental Health Integration. In-person results suggest a significant decline in report of depressive symptoms. Lessons learned for implementation for both the in-person and virtual formats will be shared, as well as analyses on associations between self-efficacy and satisfaction with life over time. Future directions include ongoing data collection to increase power, continued efforts to increase participant diversity, and direct comparison of in-person vs virtual formats. We will also present our initiated adaptation for flexible use in long-term care facilities and among those with cognitive impairments.

Evaluation of antifungal use in long-term care facilities using pharmacy dispensing data in the USA, 2019.

Evaluation of antifungal use in long-term care facilities using pharmacy dispensing data in the USA, 2019.

Association Between Long-Term Care Facility Staffing Levels and Antipsychotic Use in US Long-Term Care Facilities.

Inappropriate use of antipsychotics is an indicator of quality of care in long-term care (LTC) facilities. There is evidence to suggest that staffing levels in LTC may be associated with the rates of inappropriate antipsychotic use. This study sought to examine the association between staffing and antipsychotic prescribing in LTC facilities. Cross-sectional study investigated the association between reported staffing levels and the frequency of inappropriate antipsychotic prescribing at US LTC facilities between 2016 and2018. Data from the Nursing Home Compare and LTCFocus datasets were linked, which contain information from the Minimum Data Set database on facility characteristics and staffing measures from the Payroll-Based Journal system. A final sample set of 10,436 facilities was used. Descriptive statistics were calculated for all variables of interest. An unadjusted linear correlation analysis and linear regression were performed. Potential confounders were investigated by comparison across low-vs high-staffing facilities where adjusted for in regression analyses. The mean staff level for the facilities was identified as 3.69 (SD= 0.67) staffing hours per patient per day, and the mean antipsychotic use rate across all facilities was 15.24% (SD= 8.62%). There was a 0.75% decrease in inappropriate antipsychotic prescribing per unit increase in overall staff-to-patient ratio. When looking at staffing types, a 3.09% decrease in inappropriate antipsychotic prescribing was observed per unit increase in licensed staff hours. More specifically, we saw a 2.25% decrease per unit increase in RN staffing hours, a 1.83% decrease per unit increase in LPN staffing hours, and nursing aide staffing hours were not associated with antipsychotic use. These findings provide support for policy-based interventions to decrease antipsychotic use in LTC facilities by improving staffing skill mix and staffing levels. The results may also inform nursing staff education and training on antipsychotic prescribing practices.

The Utilization and National Variation of Plain X-Ray Services by Australian Residents of Long-Term Care Facilities.

To (1) estimate incidence, trends, and determinants of government-subsidized diagnostic radiography (ie, plain x-ray) services utilization by Australian long-term care facility (LTCF) residents between 2009 and 2016; (2) examine national variation in services used. A repeated cross-sectional study. Australian LTCF residents who were ≥65years old. Medicare Benefits Schedule subsidized plain x-rays employed for diagnosing fall-related injuries, pneumonia, heart failure, and acute abdomen or bowel obstruction were identified. Yearly sex- and age-standardized utilization rates were calculated. Poisson and negative binomial regression models were employed. Facility-level variation was examined graphically. Overall and examination site-specific analyses were conducted. A total of 521,497 LTCF episodes for 453,996 individuals living in 3018 LTCFs were examined. Themedian age was 84years (interquartile range 79-88), 65% (n= 339,116) were women, and 53.9% (n= 281,297) had dementia. In addition, 34.5% (n= 179,811) of episodes had at least one x-ray service. Overall, there was a 12% increase in utilization between 2009 and 2016 (from 535/1000 in 2009 to 602/1000 person-years in 2016, incidence rate ratio=1.02, 95% confidence interval 1.02-1.02). Factors associated with x-ray use included being 80-89years old, being a man, not having dementia, having multiple health conditions (4-6 or ≥7 compared to 0-3), being at a smaller facility (0-24 bed compared to 50-74), facility located in the Australian state of New South Wales, or in major cities (compared to regional areas). National variation in x-ray service use, with largest differences observed by state, was detected. Plain x-ray service utilization by LTCF residents increased 12% between 2009 and 2016. Sex, age, dementia status, having multiple health conditions as well as facility size, and location were associated with plain x-ray use in LTCFs and use varied geographically. Differences in x-ray service utilization by residents highlight lack of consistent access and potential over- or underutilization.

Determining the effect of COVID-19 on antibiotic use in long-term care facilities across Tennessee

Background: Nationally, a decrease in total antibiotic use in nursing homes during the COVID-19 pandemic was observed with an increase in select agents used for respiratory infections. Currently there is minimal data on antibiotic use in long-term care facilities (LTCFs) in Tennessee. To address this issue, the Tennessee Department of Health (TDH) developed a monthly point-prevalence survey of antibiotic use. Utilizing this tool, we sought to determine the effect the pandemic had on antibiotic use in Tennessee LTCFs. Method: We developed a REDCap questionnaire to collect information on selected antibiotics administered in Tennessee LTCFs. Antibiotic use percentage was determined by dividing the number of residents who received an antibiotic on the day of survey by facilities’ average censuses. Data were divided into a prepandemic period (January 2019–February 2020) and a period during the pandemic (March 2020–December 2021). Antibiotic prescriptions were grouped into 4 classes according to their most common uses: Clostridium difficile infections, urinary tract infections, skin and soft-tissue infections (SSTIs), and respiratory infections. Average percentage of residents on antibiotics were compared between study periods. Results: In total, 37 facilities participated in the survey during the prepandemic period and 32 facilities participated during the pandemic period; 14 participated during both periods. The average percentage of residents on antimicrobials before the pandemic was 16.3%, which decreased to 11.5% during the pandemic period (P = .04). During the prepandemic period, 40.2% of antibiotics prescribed were in the common for SSTI category and 38.3% were in the common for respiratory infections category (P = .01); during the pandemic period, 64.3% of antibiotics prescribed were in the common for SSTI category and 45.8% were in the common for respiratory infections category (P = .01). The 3 most prescribed antibiotics in the prepandemic period were amoxicillin (148 prescriptions), doxycycline (140 prescriptions), and levofloxacin (135 prescriptions). The 3 most prescribed antibiotics during the pandemic were doxycycline (141 prescriptions), levofloxacin (125 prescriptions), and trimethoprim–sulfamethoxazole (115 prescriptions). Conclusions: Survey results revealed that antibiotic prescriptions commonly used for respiratory infections increased 7.5% during the pandemic study period. Additionally, the average percentage of residents on antimicrobials fell 4.8% during this period. Both statistics reflect what has been seen nationally with a decrease in antibiotic use with an increase in respiratory antibiotics. This could be due to multiple factors including decreased reporting, a change in healthcare delivery during the pandemic, and facilities seeing an increase of respiratory tract infections. These data will be used to guide future TDH antibiotic stewardship efforts in the long-term care setting.Funding: NoneDisclosures: None

Combining remaining life expectancy and time to death as a measure of old-age dependency related to health care needs.

Public concern about the rising number of older dependent citizens is still based mainly on standard population aging indicators. This includes the old-age dependency ratio (OADR), which divides the state pension age population by the working age population. However, the OADR counts neither the dependent elderly nor those who provide for them. This paper builds on previous research to propose several alternative indicators, including the health care (HC) need-adjusted real elderly dependency ratio and the HC need-adjusted dependent population-to-tax rate. These indicators consider improvements in old-age survival and time to death in order to better define the health care needs of the dependent old-age population and to better approximate their financial burden. We define the old-age population dependent on health care as those above the age at which remaining life expectancy is 15 years or less and are expected to die within 5 years. We use data from the US to illustrate differences between the proposed new and standard measures. Results show that, as a share of the total population, the old-age population dependent on health care has virtually not changed since 1950. Moreover, increases in GDP and state tax revenue have outstripped population aging almost continuously since 1970, irrespective of the indicator used, and they are expected to continue to do so during the coming decade. The demand for health care services is therefore not being fueled by population aging but instead by other factors such as progress in medical knowledge and technology, costs of hospitalization, and the increasing use of long-term care facilities.

COVID-19's Influence on Information and Communication Technologies in Long-Term Care: Results From a Web-Based Survey With Long-Term Care Administrators.

BackgroundThe prevalence of COVID-19 in the United States led to mandated lockdowns for long-term care (LTC) facilities, resulting in loss of in-person contact with social ties for LTC residents. Though information and communication technologies (ICTs) can be used by LTC residents to support their socioemotional needs, residents must have access to ICTs to use them.ObjectiveThis study explored ICT access and use in LTC facilities and how LTC facilities adapted to try to enhance social connections for their residents during the COVID-19 pandemic.MethodsLTC administrators in South Carolina (United States) were invited to complete a web-based survey exploring ICT access and use in LTC facilities and whether access and use changed as a result of the COVID-19 pandemic.ResultsLTC administrators (N=70, 12 nursing homes [NHs], and 58 assisted living facilities [ALFs]) completed the web-based survey. Since March 2020, a total of 53% (37/70) of the LTC facilities have purchased ICTs for residents’ use. ICTs have mainly been used for videoconferencing with family members (31/36, 86%), friends (25/36, 69%), and health care providers (26/36, 72%). NHs were 10.23 times more likely to purchase ICTs for residents’ use during the COVID-19 pandemic than ALFs (odds ratio 11.23, 95% CI 1.12-113.02; P=.04). Benefits of ICT use included residents feeling connected to their family members, friends, and other residents. Barriers to ICT use included staff not having time to assist residents with using the technology, nonfunctional technology, and residents who do not want to share technology.ConclusionsOur results suggest that over half of the LTC facilities in this study were able to acquire ICTs for their residents to use during the COVID-19 pandemic. Additional research is needed to explore how residents adapted to using the ICTs and whether LTC facilities developed and adopted technology integration plans, which could help them be prepared for future situations that may affect LTC residents’ engagement and communication opportunities, such as another pandemic.

Information and Communication Technology Changes in Long-Term Care Due to COVID-19

Residents of long-term care (LTC) facilities (e.g., nursing homes, assisted living facilities) have historically been vulnerable to feelings of loneliness and social isolation. Due to the COVID-19 pandemic, LTC facilities were required to restrict public access in March 2020. LTC communities were not prepared for the residents’ increased socioemotional needs which arose because of the mandated facility lockdown. This study investigated ICT use in LTC facilities and how ICTs are being used by residents since the onset of the COVID19 pandemic. Seventy LTC administrators in South Carolina (12 nursing homes and 58 assisted living facilities) completed an online survey exploring ICT access and use in LTC facilities and whether access and use changed as a result of COVID-19. Administrators from fifty-three percent of LTC facilities reported purchasing ICTs for their residents to use for communicating with family members and telehealth since the onset of COVID-19. LTC administrators reported that using the ICTs helped residents to socialize more frequently and feel more socially connected to their family members, friends and/or other residents. Barriers to ICT use included staff not having time to assist residents with technology, broken technology, and residents not wanting to share technology. LTC facilities were not adequately prepared to support the socioemotional needs of their residents in the event of a federally mandated facility lockdown. Future research should investigate the ICTs available for residents’ use in a national sample of LTC facilities and how LTC administrators adapted the ICTs available as a result of their experiences with COVID-19.

Variation and appropriateness of antipsychotic use in long-term care facilities across Newfoundland and Labrador.

Objective:The use of antipsychotics to treat seniors in long-term care facilities (LTCFs) has raised concern because of health consequences (i.e., increased risk of falls, stroke, death) in this vulnerable population. This study measured geographic patterns of antipsychotic utilization among seniors living in LTCFs in Newfoundland and Labrador (NL) and assessed potential inappropriateness.Method:We analyzed prescription records among adults 66 years and older with provincial prescription drug coverage admitted to LTCFs in NL between April 1, 2011, and March 31, 2014. Patterns of use were analyzed across the 4 regional health authorities (RHAs) in NL and LTCFs. Logistic, Poisson and linear regression models were used to test variations in prevalence, rate and volume of antipsychotic utilization. To assess potential inappropriateness of antipsychotic use, we analyzed data from Resident Assessment Instrument–Minimum Data Set (RAI-MDS) 2.0 forms from NL LTCFs between January 1, 2016, and December 31, 2018. Pearson chi-squared analysis was performed at the RHA and LTCF levels to determine changes in percentage of total prescriptions or antipsychotic prescriptions without psychosis.Results:Between 2011 and 2014, 2843 seniors were admitted to LTCFs across NL; of these, 1323 residents were prescribed 1 or more antipsychotics. Within the 3-year period, the percentage of antipsychotic use across facilities ranged from 35% to 78%. Using data from 27,260 RAI-MDS 2.0 assessments between 2016 and 2018, 71% (6995/9851) of antipsychotic prescriptions were potentially inappropriate.Discussion:There is substantial variation across NL regions concerning the utilization of antipsychotics for senior in LTCFs. Facility size and management styles may be reasons for this.Conclusion:With nearly three-quarters of antipsychotic prescriptions shown to be potentially inappropriate, systematic interventions to assess indications for antipsychotic use are warranted. Can Pharm J (Ott) 2021;154:xx-xx.

An Application of the Theory of Planned Behavior to Predict the Intention and Practice of Nursing Staff Toward Physical Restraint Use in Long-Term Care Facilities: Structural Equation Modeling.

PurposeUnderstanding the factors that affect nursing staffs’ intention and practice of physical restraint (PR) on older adults help develop restraint-reduction programs. This study aimed to identify the relationship between the Theory of Planned Behavior (TPB) constructs and nursing staffs’ practice to use PR in long-term care (LTC) facilities.Patients and MethodsA cross-sectional survey was conducted via convenience sampling among 316 nursing staff in six Chinese LTC facilities. PR-TPB questionnaire and the practice subscale of the Chinese version of the Staff Knowledge, Attitudes and Practices Questionnaire regarding PR were used to collect the data. Structural equation modeling (SEM) was used to examine the relationship between variables.ResultsThe SEM fit well with the data (χ2/df =1.639, RMSEA = 0.045, CFI= 0.955, GFI=0.945). Attitude (β=0.536, P<0.001) and perceived behavioral control (PBC) (β=0.139, P<0.05) predicted intention (R2=0.359). PBC was a significant predictor of practice, with R2 accounting for 0.151.ConclusionTPB provided useful insight into better understanding nursing staffs’ PR practices, although it did not support all the TPB principles significantly. Prospective studies may be conducted to design and implement multi-component interventions based on TPB and explore the effectiveness of PR reduction in LTC facilities in-depth.

노인장기요양시설에서의 웰니스 IT서비스 특성과 이용의도와의 관계

노인장기요양시설에서의 웰니스 IT서비스 특성과 이용의도와의 관계

Contribution of facility level factors to variation in antibiotic use in long-term care facilities: a national cohort study.

To examine national variation in systemic antibiotic use in long-term care facilities (LTCFs) and identify facility characteristics associated with antibiotic utilization. This retrospective cohort study included 312 375 residents of 2536 Australian LTCFs between 2011 and 2016. LTCFs were categorized as low, medium or high antibiotic use facilities according to tertiles of DDDs of systemic antibiotics dispensed per 1000 resident-days. Multivariable logistic regression estimated the associations between facility characteristics (ownership, size, location, medication quality indicator performance, prevalence of after-hours medical practitioner services) and antibiotic use (low versus high). LTCFs in the lowest and highest antibiotic use categories received a median of 54.3 (IQR 46.5-60.5) and 106.1 (IQR 95.9-122.3) DDDs/1000 resident-days, respectively. Compared with not-for-profit LTCFs in major cities, government-owned non-metropolitan LTCFs were less likely to experience high antibiotic use [adjusted OR (aOR) 0.47, 95% CI 0.24-0.91]. LTCFs with 69-99 residents were less likely to experience high antibiotic use (aOR 0.69, 95% CI 0.49-0.97) than those with 25-47 residents annually. Greater prevalence of medical practitioner services accessed after-hours was associated with high antibiotic use [aOR 1.10 (per 10% increase in after-hours services), 95% CI 1.01-1.21]. South Australian LTCFs (aOR 2.17, 95% CI 1.38-3.39) were more likely, while Queensland (0.43, 95% CI 0.30-0.62) and Western Australian (aOR 0.34, 95% CI 0.21-0.57) LTCFs were less likely to experience high antibiotic use than New South Wales LTCFs. Considerable facility level variation in systemic antibiotic use was observed across Australian LTCFs. Identification of facility characteristics associated with antibiotic use provides a basis for targeted stewardship initiatives.

Use of Long-Term Care Facilities for Primary Care Nurse Practitioner Students.

Family and adult-gerontology primary care nurse practitioner (NP) students must obtain patient clinical hours caring for older adults. Primary care occurs in a variety of settings, including long-term care (LTC) facilities. Anecdotal reports indicate that faculty in some primary NP academic programs do not recognize the robust primary care opportunities that exist in LTC settings. This article describes a professional nursing organization's process of researching the appropriateness of designating LTC clinical hours as allowable primary care clinical experiences for NP students. The NP serves as an integral member of the LTC team, providing the same elements of primary care provided in traditional ambulatory care settings. Older adults receiving primary care in LTC settings have a variety of health care needs, including assessment and management of acute and chronic conditions. A position statement was developed for primary care NP students and endorsed by 22 professional organizations and NP programs. [J Nurs Educ. 2021;60(2):99-102.].

A New Care Model Reduces Polypharmacy and Potentially Inappropriate Medications in Long-Term Care

ObjectivesAssess the impact of a new pharmaceutical care model on (1) polypharmacy and (2) potentially inappropriate medication (PIM) use in long-term care facilities (LTCFs). DesignPragmatic quasi-experimental study with a control group. This multifaceted model enables pharmacists and nurses to increase their professional autonomy by enforcing laws designed to expand their scope of practice. It also involves a strategic reorganization of care, interdisciplinary training, and systematic medication reviews. Setting and ParticipantsTwo LTCFs exposed to the model (409 residents) were compared to 2 control LTCFs (282 residents) in Quebec, Canada. All individuals were aged 65 years or older and residing in included LTCFs. MeasuresPolypharmacy (≥10 medications) and PIM (2015 Beers criteria) were analyzed throughout 12 months between March 2017 and June 2018. Groups were compared before and after implementation using repeated measures mixed Poisson or logistic regression models, adjusting for potential confounding variables. ResultsOver 12 months, for regular medications, polypharmacy decreased from 42% to 20% (exposed group) and from 50% to 41% (control group) [difference in differences (DID): 13%, P < .001]. Mean number of PIMs also decreased from 0.79 to 0.56 (exposed group) and from 1.08 to 0.90 (control group) (DID: 0.05, P = .002). Conclusions and ImplicationsCompared with usual care, this multifaceted model reduced the probability of receiving ≥10 medications and the mean number of PIMs. Greater professional autonomy, reorganization of care, training, and medication review can optimize pharmaceutical care. As the role of pharmacists is expanding in many countries, this model shows what could be achieved with increased professional autonomy of pharmacists and nurses in LTCFs.

Impact of Training Consultant Pharmacists on Antimicrobial Stewardship Programs in Long-Term Care Facilities

Background: The CDC recommends that consultant pharmacists support antimicrobial stewardship programs (ASPs) in long-term care facilities (LTCFs). We studied CDC-recommended ASP core elements implementation and antibiotic use in LTCFs before and after training consultant pharmacists. Methods: Between August 2017 and October 2017, consultant pharmacists from a regional long-term care pharmacy attended 5 didactic sessions preparing them to assist LTCFs in implementation of CDC-recommended ASP core elements. Training also included creating a process for evaluating appropriateness of all systemic antibiotics and providing prescriber feedback during their monthly mandatory drug-regimen reviews. Once monthly “meet-the-expert” sessions were held with consultant pharmacists throughout the project (November 2017 to December 2018). LTCF enrollment began in November 2017 and &gt;90% of facilities joined by January 2018. After enrollment, consultant pharmacists initiated ASP interventions including antibiotic reviews and feedback using standard templates. They also held regular meetings with infection preventionists to discuss Core Elements implementation and provided various ASP resources to LTCFs (eg, antibiotic policy template, guidance documents and standard assessment and communication tools). Data collection included ASP Core Elements, antibiotic starts, days of therapy (DOT), and resident days (RD). The McNemar test, the Wilcoxon signed-rank test, generalized estimating equation model, and the classic repeated measures approach were used to compare the presence of all 7 core elements and antibiotic use during the baseline (2017) and intervention (2018) year.Results: In total, 9 trained consultant pharmacists assisted 32 LTCFs with ASP implementation. When evaluating 27 LTCFs that provided complete data, a significant increase in presence of all 7 Core Elements after the intervention was noted compared to baseline (67% vs 0; median Core Elements, 7 vs 2; range, 6–7 vs 1–6; P &lt; .001). Median monthly antibiotic starts per 1,000 RD and DOT per 1,000 RD decreased in 2018 compared to 2017: 8.93 versus 9.91 (P &lt; .01) and 106.47 versus 141.59 (P &lt; .001), respectively. However, variations in antibiotic use were detected among facilities (Table 1). When comparing trends, antibiotic starts and DOT were already trending downward during 2017 (Fig. 1A and 1B). On average, antibiotic starts decreased by 0.27 per 1,000 RD (P &lt; .001) and DOT by 1.92 per 1,000 RD (P &lt; .001) each month during 2017. Although antibiotic starts remained mostly stable in 2018, DOT continued to decline further (average monthly decline, 2.60 per 1,000 RD; P &lt; .001). When analyzing aggregated mean, antibiotic use across all sites per month by year, DOT were consistently lower throughout 2018 and antibiotic starts were lower for the first 9 months (Fig. 1C and 1D). Conclusions: Consultant pharmacists can play an important role in strengthening ASPs and in decreasing antibiotic use in LTCFs. Educational programs should be developed nationally to train long-term care consultant pharmacists in ASP implementation.Funding: Merck &amp; Co., Inc, provided funding for this study.Disclosures: Muhammad Salman Ashraf and Scott Bergman report receipt of a research grant from Merck.