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Improving Long-Term Care Admissions Policy: A Voice of Change Thirty minutes before evening shift change and you receive the call. A new admission is in route to your facility. The patient is reported to be of high acuity, requires intravenous antibiotics, and has a diagnosis of chronic pain. In some health care settings this would be considered a typical new patient admission. However, for rural long-term care facilities there is potential for considerable complications. In a setting where registered nurses are only required to be in the facility eight hours within a twenty-four hour time frame, significant complications can arise during admissions that require certain specialty care specific to the RN. Ineffective discharge planning between any health care settings can be detrimental to patient care. To provide appropriate care, long-term care admissions must be well thought-out and explicit tasks fulfilled prior to the patient’s arrival. There should be a smooth transition between facilities to promote continuity of care (LaMantia, Scheunemann, Viera, Busby-Whitehead & Hanson, 2010). If discharge planning is inadequate, patient safety and health can be compromised. For example, scheduled drug regimens, such as antibiotics and controlled medications, must be available within a timely manner. Most long-term care facilities do not support an in-house pharmacy. In addition, many pharmacies require original hard scripts before filling controlled medications. If admitting orders are inadequate or cannot be carried out within the appropriate time span, the admitting facility may be unable to meet critical needs. I have experienced this first hand on more than one occasion. The most recent o... ... middle of paper ... ...ely reinforce quality-nursing practice. When nurses taking an active role in patient advocacy, we do what nursing does best, we care. Reference Kirsebom, M., Wadensten, B., & Hedstrom, M. (2013). Communication and Coordination during transition of older persons between Nursing Homes and Hospital Still in Need of Improvement. Journal of Advanced Nursing, 69, 886—895. DOI: 10.1111/j.1365-2648.2012.06077.x.v LaMantia, M., Scheunemann, L., Viera, A., Busby-Whitehead, J., & Hanson, J. (2010). Interventions to Improve Transitional Care Between Nursing Homes and Hospitals: A Systematic Review. Journal of the American Geriatrics Society, 58(4), 777—82. Tjia, J., Bonner, A., Briesacher, B., McGee, S., Terrill, E., & Miller, K. (2009). Medication discrepancies upon hospital to skilled nursing facility transitions. Journal of General Internal Medicine, 24(5), 630-635.
When doctors prescribe medication for their patients, a local retail pharmacy is most likely to be utilized to fill the order. However, there is a growing population of older Americans that are no longer able to live independently and must reside in nursing homes or assisted living facilities. In order for this vulnerable population to receive their medications, a different kind of pharmacy is needed, these are known as LTC, long term care pharmacies. Within these specialized pharmacies there are highly trained employees called CPhTs, certified pharmacy technicians who are overseen by state licensed RPHs, otherwise known as pharmacists.
We also evaluated the proportion of residents requiring assistance in their activities of daily living (ADLs) according to the KATZ scale. Within our cohort of residents ≥65 years old, the majority of residents with CHD needed assistance with 3-4 ADLs (p=0.18) (Figure 1). However, this was found this to not be statistically significant.
United Hospital Fund (2013). New York’s Nursing Homes: Shifting Roles and New Challenges. Medicaid Institute at United Hospital Fund.
The Omnibus Budget Reconciliation Act ,(OBRA), was established officially in 1987. This act was necessary as a result of abuse, neglect and poor quality care that was present in all nursing facilities. Children, veterans, mentally handicapped, and elderly were the prime populations in nursing institutions. In this essay, OBRA of '87, under the Nursing Home Care Act regarding the elderly, will be explored and addressed. The policy was established due to severe issues in elderly population facilities. Severe issues included: frequent use of restraints and psychotropic drugs, low quality care, and understaffed facilities. Standards of nursing home care and certain rights for for the elderly residents in the U.S. were enforced by Federal law. State and Federal government were required by law to scrutinize nursing homes and create higher quality standards by using a variety of sanctions. Some of the sanctions included: residents be handed their bill of rights manually, frequent one-on-one evaluations to be implemented, and a requirement of complete care plans and services. Overall, this bill was crucial with respect to a fast growing population that was filling up nursing facilities across America.
Kralik, D., Visentin, K., & Van Loon, A. (2006). Transition: a literature review. Journal Of Advanced Nursing, 55(3), 320-329. doi:10.1111/j.1365-2648.2006.03899.x
When a member of someone’s family goes ill or is no longer able to live on their own and take care of themselves; it is up to the family members to decide the best course of action for them to get the best care that they can. There several different options that need to be considered when looking at long-term care facilities for older adults. In this paper, I will briefly discuss two of the most common options that people choose between when looking at long-term care options. One option is home care and the other is assisted and/or independent living facilities. These two options are some of the best ways to take care of ill elders.
Preventable hospital admission is a key patient safety and quality concern. A major cause of preventable readmission is poor coordination and communication of care during transitions. Transitions beteeen settings are vulnerable periods for patients. Transition contains admission and discharge between skilled nursing facilities, long-term care facilities, acute care hospitals, and assisted living facilities. Indigent coordination between a cure setting and primary care provider can results in poor longitudinal planning. About 50% of patients go see their primary care providers within a two week time period after discharge. Comprehensive programs can improve care while transitioning between setting, which can reduce a thirty day hospital readmission.
Physicians write a prescription order for inpatients, the prescription orders are sent to the central pharmacy. Pharmacists check the prescription order and give an okay for pharmacy technicians to place drugs in unit-does carts. The carts have drawers with patient’s medications in it. Each drawer is labeled with the patient’s name, identification number, ward, and room number. The a medication chart includes: the Rx number, generic name of the drug along with strength number, how much the patient need to take, directions, PARs, and number of medications need to return to the pharmacy. Pharmacy technicians finish filling the medications for each patient and place in the drawers. Pharmacists check each drawer’s medications for accuracy in case
Federal and State laws require that nursing homes develop a plan of care and employ sufficient staffing to provide all the care listed on the care plan. Most corporate owned nursing homes today are not sufficiently staffed, and they can not provide all the care listed on the care plan. Consequently, residents are not taken to the toilet when necessary; they’re often left lying in urine and feces. They also develop painful and life-threatening decubitus ulcers, and are not fed properly, they’re not given sufficient fluids. They are also over-medicated or under-medicated, and dropped causing painful bruises and fractures, are ignored and not included in activities, are left in bed all day, call lights not answered. These are all forms of negligence, performed daily in nursing homes.
Nursing assistants work in many types of settings including nursing homes, hospice, mental health centers, assisted living residences, home care agencies, hospitals, rehabilitation and restorative care facilities (Sorrentuino & Remmert, 2012). There are many types of Long-term care centers. For this paper, I will focus on the long-term care centers often referred to as nursing homes. These LTCs are "licensed facilities that provide extended care for individuals who do not require the acute care provided in a hospital but who need more care than can be given at home" (U.S Department of Health And Human...
The public agencies such as CMS have periodically made drastic changes to their reimbursement policies. In 2003, the CMS began the hospital quality initiative and Home Health quality Initiatives ( Denisco & Barker, 2013). The hospital quality initiative mainly focused on Acute Myocardial Infarction (AMI), heart failure ( HF), and pneumonia( PNE). The home health quality initiatives also focused on quality measures for individuals receiving home care services ( DeNisco & Barker, 2013). In 2001 about 3.5 million disabled and elderly Americans received care from 7,000 Medicare certified home health agencies and about 3 Million elderly and disabled Americans received care from 17,000 Medicare and Medicaid certified Nursing Homes ( DeNisco & Barker, 2013). In 2004, CMS Nursing home Quality Initiative started 14 quality measures in the areas of delirium, pain( acute and chronic), incontinence, decline in activities of daily living, physical restraints, worsening of anxiety and depression, pressure sores, indwelling catheters, mobility decline, bedfast, weight loss and urinary tract infections( DeNisco & Barker, 2013). The National...
All patients that are admitted to the inpatient unit would have their medications reviewed on admission, if there was a change in their disease trajectory and upon discharge as standard. All patients attending day-therapies would have an initial clerking to include a medication review and this would be revisited at twelve weekly intervals. All patients should be given the opportunity to discuss their medications and that we should work in partnership with patients and their families. If patients were admitted for end of life care and were only prescribed end of life medications, then they would be obvious outliers.
Administration of medicines is a key element of nursing care. Every day some 7000 doses of medication are administered in a typical NHS hospital (Audit Commission 2002). So throughout this essay I will be evaluating and highlighting the learning that took place whilst on placement at a day unit.
In my research about transitional care, I learned that it is focused on coordination and continuity of care within older adults during their transfer between locations or new care providers (Weeks et al., 2016). Transitional care providers are commonly referred to as “health navigators” and communicate with various colleagues at multiple sites to ensure that these transitions occur smoothly, safely and effectively (Weeks et al., 2016). Some research studies have shown that the benefits of transitional care include “reduced unnecessary hospital admissions, readmissions and premature nursing placements” (Weeks et al., 2016). This is important to note because another report I found mentioned how the constant movement of patients
Brown. J, (2013). Reducing Medication Errors in Nursing Homes Admissions. Retrieved on March 29, 2014 from http://www.elderbranch.com/blog/reducing-medication-errors-in-nursing-home-admissions/