Natural course of care dependency in residents of long-term care facilities: prospective follow-up study

Abstract Background Nebraska (NE) Infection Control Assessment and Promotion Program (ICAP) is a quality improvement initiative supported by the NE Department of Health and Human Services. This initiative utilizes subject matter experts (SMEs) including infectious diseases physicians and certified infection preventionists (IP) to assess and improve infection prevention and control programs (IPCP) in various healthcare settings. NE ICAP conducted on-site surveys and observations of IPCP in many volunteer facilities to include long-term care facilities (LTCF) between November 2015 and July 2017. SMEs provided on-site coaching and made best practice recommendations (BPR) for priority implementation. Impact of this intervention on LTCF IPCP was examined. Methods Using a standardized questionnaire, follow-up phone calls were made with LTCF to evaluate implementation of the BPR one-year post-assessment. Descriptive analyses were performed to examine BPR implementation in LTCF that had follow-up between 4/4/17 to 4/17/18 and to identify factors that promoted or impeded BPR implementation. Results Overall, 45 LTCF were assessed. The top 5 IC categories requiring improvement were audit and feedback practices (28 of 45, 62%), PPE supplies at point of use (62%), IC risk assessments (58%), TB risk assessments (56%), and supply and linen storage practices (56%). Follow-up assessments were completed for 270 recommendations in 25 LTCF. Recommendations reviewed ranged from three to 26 per LTCF (median = 15). The majority of the 270 recommendations (n = 162, 60%) had been either completely (35%) or partially (25%) implemented by the time of the follow-up calls. The ICAP visit itself was reported as the most helpful resource for BPR implementation (77 of 162). Lack of staffing was the most commonly mentioned barrier to implementation when LTCF implemented BPR partially or implementation was not planned (37 of 85). BPR Implementation most frequently involved additional staff training (64 of 162), review of policies and procedures (38 of 162), and implementing audit (34 of 162) and/or feedback (23 of 162) programs. Conclusion Numerous IC gaps exist in LTCF. Peer-to-peer feedback and coaching by SMEs facilitated implementation of many BPR directed toward mitigating identified IC gaps. Disclosures All authors: No reported disclosures.

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Perceived chewing ability and need for long-term care in the elderly: a 5-year follow-up study

Journal of Oral Rehabilitation ◽

10.1111/j.1365-2842.2012.02302.x ◽

2012 ◽

Vol 39 (8) ◽

pp. 568-575 ◽

Cited By ~ 10

Author(s):

S. MORIYA ◽

K. TEI ◽

A. MURATA ◽

M. MURAMATSU ◽

N. INOUE ◽

...

Keyword(s):

Long Term Care ◽

The Elderly ◽

Term Care ◽

Follow Up Study ◽

Chewing Ability

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A follow-up study on fall and fracture incidence in long-term care including the role of formal caregiver time on fall incidence rates

Zeitschrift für Gerontologie und Geriatrie ◽

10.1007/s00391-006-0399-x ◽

2006 ◽

Vol 39 (4) ◽

pp. 292-296 ◽

Cited By ~ 9

Author(s):

Clemens Becker ◽

S. Loy ◽

Th. Nikolaus ◽

U. Rißmann ◽

K. Rapp ◽

...

Keyword(s):

Long Term Care ◽

Incidence Rates ◽

Fracture Incidence ◽

Term Care ◽

Caregiver Time ◽

Follow Up Study ◽

Formal Caregiver

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Pharmacoepidemiology of Urinary Tract Infections in Iowa Medicaid Patients in Urban Long-Term-Care Facilities

Annals of Pharmacotherapy ◽

10.1177/106002809703100704 ◽

1997 ◽

Vol 31 (7-8) ◽

pp. 837-841 ◽

Cited By ~ 1

Author(s):

Darrel C. Bjornson ◽

John P. Rovers ◽

Julie A. Burian ◽

Nancy L. Hall

Keyword(s):

Urinary Tract ◽

Patient Outcomes ◽

Urinary Tract Infections ◽

Long Term Care ◽

Treatment Preference ◽

Term Care ◽

Care Facilities ◽

Tract Infections

OBJECTIVE: To describe the therapeutic management of Medicaid patients with urinary tract infections (UTIs) in urban long-term-care facilities (LTCFs) and to link individual therapies to patient outcomes. DESIGN: Retrospective review of medical records in LTCFs of patients who had documented UTIs. METHODS: Patient data were collected from 17 LTCFs in the Des Moines, IA, metropolitan area during a 1-year period starting January 1, 1995. Patients with UTIs were selected from the LTCF infection control logs. Data collected on patients included demographics, concomitant diseases, type of UTI (i.e., symptomatic, asymptomatic, catheter-related), process measures for management, UTI treatment, patient outcomes, and follow-up. Patient outcome data were defined as either cure or no cure. A UTI cure was defined as a negative urine culture while taking antibiotic therapy and/or complete resolution of signs and symptoms, as well as no further treatment given within 2 weeks after the end of treatment. RESULTS: Data were collected on 310 patients who had at least one UTI over the 1-year study period. Patients were primarily elderly (mean age 82.2 ± 12.3 y), white (95.1%), and female (83.9%). Concomitant diseases were common and about one-fourth (23.0%) of the patients were catheterized. There were 536 UTI events (the unit of analysis) documented over the 1-year period, with about one-half (45.9%) being UTIs with symptoms consistent with uncomplicated lower UTI. Nearly two-thirds (62.3%) of the patients were cured, based on the study definition; there was no association between cure and type of antimicrobial therapy (p = 0.99). Over one-third (35.2%) of the UTIs were treated with a quinolone antibiotic. Others were treated with trimethoprim/sulfamethoxazole (24.4%), nitrofurantoin (13.9%), a cephalosporin (10.4%), or ampicillin/amoxicillin (9.8%). Sixty-day follow-up showed no association between type of therapy and hospital readmission, physician follow-up visits, or subsequent UTIs. CONCLUSIONS: There were no differences in cure rates when comparing LTCF UTI patients receiving various regimens. With outcomes being the same, the clinician should closely consider costs of drug therapy in selecting a treatment preference.

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