Evaluating Antibiotic Use in a Veterans Affairs Skilled Nursing Facility.

Objective To examine antibiotic use in long-term care residents at a VA skilled nursing facility. Design Quality improvement project. Setting Long-term care residents admitted to the Community Living Center of a Midwestern VA medical center. Patients Inclusion criteria were long-term care residents admitted to the VA skilled nursing facility who were prescribed an oral (including via percutaneous endoscopic gastrostomy tube) antibiotic from January 1, 2018, to December 31, 2018. Residents were excluded if they were admitted for hospice care, rehabilitation, or short-term skilled nursing. Residents were also excluded if they were on intravenous or topical antibiotics. Results Fifty-six unique antibiotic courses consisting of 13 different antibiotics were evaluated. Median days of therapy per 1,000 resident days was 39.7 overall, for quarter 1 was 51, quarter 2 was 42, quarter 3 was 49.3, and quarter 4 was 17.5. Average antibiotic days of therapy was 7.6 days. Fluoroquinolones comprised 26.8% of the courses, followed by beta-lactamase inhibitors at 25%. Of the 56 courses, 85.7% were found to have appropriate dose/frequency, while 73.2% had appropriate duration. No reports of Clostridioides difficile infection were noted. Thirty-one antibiotic courses had cultures obtained, of which 29 did not deescalate therapy. Of these, 5 (17.2%) were indicated for de-escalation. Conclusion Antibiotic use in this skilled nursing facility have opportunities for intervention, including reducing fluoroquinolone use, optimizing de-escalation, and shortening days of therapy. The implementation of an antimicrobial stewardship monitoring program within the long-term care setting could assist in maximizing therapy while reducing antibiotic exposure.

There's a New Sheriff in Town: When Enterprise IT Takes Over Imaging IT.

The consolidation of information technology (IT) teams from individual facilities to an enterprise-wide reporting structure and the transition of IT staff from operating within a diagnostic imaging department, such as Radiology, to an enterprise IT group is common. The plan to optimize this workforce can have undesirable and unintended consequences, if not done correctly. For those organizations seeking to optimize their workforce to deliver the best possible IT services, including to areas that produce and use medical imaging, this can be an exercise of balancing specialized knowledge and centralized staffing capacity planning. Successfully blending staff that have developed through careers in either general or imaging IT areas into a single team structure requires an understanding of their traditional attitudes, priorities, and skill sets. This paper explores the historic similarities and differences in the skill sets and work cultures between imaging and Enterprise IT, and how to use both to deliver the best outcomes.

Self-Medication Management in a Rehabilitation Setting: A Case Study.

Skilled nursing facilities are beginning to introduce Self-Medication Programs (SMP), in which patients meet with a staff member and learn how to manage their own medications throughout their rehabilitation stay. This program allows for patients to keep their medications in their room and take them on their own without direct nursing administration. In the process, it is the goal for patients to regain independence for their medical care prior to discharge from a skilled nursing facility with an outcome of increased adherence and medication knowledge. Herein we describe a veteran, 57 years of age, who participated in the Cincinnati VA SMP in order to regain his independence poststroke.

impact of Pharmacy-Directed Medication Management for Patients Experiencing Falls in a Veterans Affairs Community Living Center.

OBJECTIVE: To analyze medication interventions prior to and following implementation of the Pharmacy Medication Related Falls Risk Assessment consult service in an older adult population. DESIGN: Retrospective chart review. SETTING: This study involved patients admitted to the Cincinnati Veterans Affairs Medical Center's (VAMC) Community Living Center (CLC), an institutional practice setting. PATIENTS, PARTICIPANTS: Any patient who experienced a fall while admitted to the CLC during fiscal years 2013 or 2018 was considered for inclusion. Patients were excluded if falls were not evaluated by a provider, the patient expired within 10 days after falling, or falls in fiscal year 2018 that did not have a pharmacy consult placed. Fifty falls from each fiscal year were selected. MAIN OUTCOME MEASURES: The primary endpoint encompassed the number of pharmacy medication interventions made within 10 days postfall, with a secondary endpoint evaluating subsequent falls within 30 days of initial event. RESULTS: Following consult implementation, a larger number of pharmacist recommendations (40 vs. 123) and subsequent interventions (accepted recommendations) within ten days postfall (12 vs. 49) were completed. There were 14 subsequent falls within 30 days of the initial event for both fiscal years. A larger percentage of falls and patients experiencing falls from each fiscal year did not receive previous medication interventions. CONCLUSION: Consult implementation increased the number of pharmacist recommendations and subsequent interventions for patients within ten days postfall, reducing the risk of adverse effects, drug-drug interactions, subsequent falls, and polypharmacy.