Preventing Falls in Special Care Units: A Simple Solution
Falls sustained by long-term care residents can often be serious.
Research shows that nearly a fourth of elderly residents who fall
sustain a serious injury, and only about 50 percent of persons
over 70 years old requiring hospitalization from a fall survive
longer than one year.
A report in the January/February 1996 issue of Geriatric Nursing describes a relatively simple way to help make the environment safer for cognitively impaired residents, particularly those who are at risk from falling during attempts to get up and reach the bathroom during the night.
"Special Socks for Special People" describes a successful intervention that was used to decrease the incidence of falls in a special care unit for residents with probable dementia of the Alzheimer's type.
On retiring for the night, all residents of the 24-bed unit had rubber-treaded slipper socks placed on their feet; residents who had been monitored retrospectively for falls for the previous 104 days were followed up for 104 days after the slipper-sock intervention was instituted. Results showed a 9 percent decrease in falls overall, with a clinically significant decrease in falls resulting from slipping in urine-down from 38 percent of falls to 5 percent (one fall).
Read All About It
Rep. Richard Durbin (D-Ill.) has introduced H.R. 3059, "The Prescription Drug Consumer Information Act of 1996," containing a proposal that would require the U.S. Secretary of Health and Human Services to prepare and publish a consumer guide to prescription drug prices.
The guide would be required to contain the following information:
The guide would be published annually, with periodic bulletins describing changes in prescription drug prices that take place in interim months.
For a nominal fee, the general public, health care providers, and organizations representing senior citizens, health care consumers, and health care professionals could purchase the guide. In addition, the guide would be found on a computer network easily accessible to the public.
Credit for Controlled Substances: A Clarification
DEA Liaison and Policy Chief G. Thomas Gitchell, speaking at ASCP's Seventh Annual Conference on Legislative and Regulatory Affairs in Washington, D.C. earlier this year, reiterated his agency's position regarding the return of controlled substances to pharmacies for credit from long-term care facilities.
Because the Controlled Substances Act only provides for transfer between registered individuals and facilities until the drug is dispensed to the ultimate user, pharmacies are only permitted to receive controlled substance returns from facilities that are registered with DEA.
Gitchell also pointed out that when federal statutes are more stringent, they take precedence over any state administrative codes that might provide for return of controlled substances for credit from long-term care facilities.
New Class of Diabetes Drugs
Bayer has received approval from FDA to market Precose (acarbose), an oral alpha-glucose inhibitor that slows carbohydrate digestion in the small intestine. Acarbose is given three times daily at the start of each main meal to minimize the post-prandial rise in blood glucose levels experienced by persons with diabetes mellitus; the starting dose is 25mg t.i.d. with increases made at four- to eight-week intervals, not to exceed 100mg three times daily.
Acarbose is contraindicated in patients with chronic intestinal diseases or those predisposed to obstruction. Because it can also inhibit the breakdown of sucrose, patients and nurses should be warned to use glucose, not juice or hard candy, for signs and symptoms of hypoglycemia.
FDA Rejects New H. Pylori Test
Citing insufficient evidence of the test's efficacy, the Food
and Drug Administration's Gastrointestinal Drugs Advisory Committee
decided on February 23 to turn thumbs down on a new breath test
to detect Helicobacter pylori, probably delaying the test's availability
until the end of this year.
The breath test, called PYtest, requires patients to swallow a radioactive isotope, carbon 14. The capsule decomposes in the stomach, where the carbon 14 activates gastric urease, an enzyme found in the stomach when H. pylori is present. The patient then exhales into a balloon, and the breath sample is tested for indications of the presence of H. pylori.
The FDA panel expressed concern over the breath test's safety because of the radioactive dose patients would be required to ingest. Nuclear experts from the firm that will market the new product argued that the radioactive dose would be smaller than patients would receive from many imaging or X-ray procedures.
The FDA panel has requested another clinical trial of the product.
Any Willing Provider: Second Generation
Many state legislatures are rejecting "any willing provider" legislation in favor of "direct access" and "due process" bills, according to information from the American Association of Health Plans. In 1995, only Texas and Arkansas approved any willing provider legislation, and both of those laws are being challenged in court.
AAHP attributes the decline in any willing provider legislation to the fact that the proposed bills were too broad and attempted to take on several powerful industry lobbies.
However, the decline in any willing provider/freedom of choice legislation may be leading to a second generation of proposals that are more specific in their targets than the broader bills.
Direct access provisions, for instance, would allow health plan members to use the services of specialists without first obtaining a referral from a primary care physician. Due process legislation would require HMOs and other health plans to provide a specific appeals process for enrollees.
Managed Care Continues to Expand
An article in the March issue of the publication Business Insurance cites study results indicating that by the year 2000, more than 110 million Americans will be enrolled in managed care plans, with Medicare beneficiaries and Medicaid recipients making up a significant portion of new managed care enrollees. About 60 million Americans currently are enrolled in managed care plans.
The study, "The Health Care Marketplace-The Move Toward Managed
Care Accelerates," cites the aging of the U.S. population
and the government's commitment to Medicare and Medicaid health
delivery through HMOs as major factors driving the continued explosive
growth of managed care.
Medicaid Drug Use Projects Pass the Midway Mark
Two Health Care Financing Administration demonstration projects examining Medicaid drug utilization have passed the halfway point, with a report on final results due in March of 1998. In the meantime, HCFA recently released preliminary status reports on the two studies:
An independent evaluation of the demonstration project will determine
if prescribing practices have improved, if reductions in health
care utilization and expenditures associated with prescription
problems have occurred, and whether these enhancements are cost
effective. Both studies were mandated by OBRA '90.
Tone It Down, Please!
Noise in long-term care facilities can be a problem for both residents
and staff-particularly when it's caused by a resident's disruptive
behavior, such as repetitive calls for help, screaming, loud talking,
or other noisy behavior. Repetitive noise-making can annoy and
even frighten other residents, staff, visitors, or the noisy resident
himself.
Solutions to the problem of noisy behavior are elusive, but by using a thoughtful and systematic approach, staff can usually uncover the source of the behavior and take some steps to bring it under control.
An article published in Long Term Care Magazine (Vol. 4, No. 3) gives these hints for dealing with disruptively noisy residents:
Uncover the cause of the behavior. Is the resident lonely, in fear, or in pain? Does the screaming occur at a particular time of day or night, on a certain day of the week, or is it related to a particular activity? Where does it happen? Do only some staff members witness the problem? Keeping a log for a week or two can be a good way to answer some of these questions.
Try different solutions. Does one staff member seem to have a knack for reassuring and quieting the resident? Ask that staff member what it is he does. Try paying more attention to the resident when he or she is not yelling. Quiet, soothing music-not the type usually found on AM radio-can help. Alter the resident's routine: If he or she is more agitated around bath or meal time, try changing the schedule of activities. If the resident is spending a lot of time alone, maybe he or she just needs some company. And if the resident is afraid-a common reason for disruptive behavior-perhaps holding his hand, talking, giving him a soft doll or animal to hold, or having familiar people around can reduce fear and uncertainty.
Solutions that usually don't work include reprimands or telling
the resident to stop, turning on the television or radio (which
can contribute to over-stimulation) too much isolation, or contact
with unfamiliar staff.
Mechanical Wizardry
Automated Healthcare, Inc.'s latest product offering has added
a new level of sophistication to integrated drug distribution
systems: RxOBOT uses a robotic arm and bar code technology to
electronically order, stock, inventory, and dispense unit-dose
medications.
Measuring 10 by 30 feet, the device reportedly can dispense millions of doses of medication without error.
Here's how it works: After a pharmacist enters a patient's medication order into the system, the RxOBOT's mechanical arm runs up and down a track, accurately picking a drug every four seconds from an inventory of medications.
According to Greg Santora, RPh, director of pharmacy services
at Elizabeth General Medical Center in New Jersey, which has begun
using the RxOBOT system, an average of 270 patients per day can
be served by the RxOBOT, freeing pharmacists from technical duties
and redeploying them to more clinical roles.
Just Hang Up
Elderly fraud victims are lonely, gullible, and out of touch,
right? Wrong, according to a recent study conducted by the American
Association of Retired Persons. Elderly fraud victims tend to
be outgoing, intelligent, and aware, and they lead an active social
life. Then why are these people falling victim to fraudulent telephone
solicitation schemes and other deceptive offers?
For one thing, the AARP survey found that many consumer education messages that warn the elderly against fraud don't work. Urging senior citizens to "just hang up" is singularly ineffective-most outgoing, friendly seniors don't like to slam down the receiver on anyone, be it friend or foe.
When they do become the victims of fraud, elderly persons may become evasive, hide funds in secret accounts, and even withdraw from close contact with relatives and friends.
This problem is frustrating to family members and to consumer groups attempting to gain some ground against fraud.
In an effort to reverse seniors' reluctance to heed the warnings
of family and friends against unscrupulous con artists, the National
Consumers League, working with the National Association of Consumer
Agency Administrators, the National Association of Attorneys General,
and other interested federal agencies, is undertaking a major
planning and consumer education effort aimed at convincing senior
citizens that the pleasant young man on the other end of the phone
is not "someone's grandson," but a hardened criminal
who is out to strip them of their financial independence.