Long-Term-Care slides

Question 1

What are the 5 Ms

Answer 1

Matters Most
Medicine
Mind
Mobility
Multi-Complexity

Question 2

Which disease is associated with the Mind-Element (5 M)?

What should be done against it?

Answer 2

Dementia

-screening and early intervention to reduce lifetime costs (nursing home), and healthcare costs

also Depression

Question 3

What are the signs of Dementia?

Answer 3

-gradual onset
-difficulty planning and problem-solving
-problems with time and space
-communication changes
-poor judgment
-change in mood
-impact on daily function

Question 4

Which tool is used in Dementia screening?

Answer 4

Minicog

Question 8

How often should patients be screened for risk falls?

Which patient population should be screened?

Answer 8

-once a year

-patients who are
older than 65
more than 4 meds
more than 1 high-risk med
any time when they fall

Question 9

Which risk factors can be changed to reduce fall risk? (modifiable risk factors)

Answer 9

Medications !!! (avoid 4 meds, 2 or more FRIDs, 3 or more CNS agents)
Orthostasis (drop in 20/10 mmHg)
Pain, neuropathy
Weakness
visual impairment
Environment !!! (carpet, light, wet floor, support for walking)

Question 10

What are the 3 factors of Multicomplexity (5 M)?

Answer 10

Medical Factors (chronic conditions)

Biological factors (renal impairment, elimination, metabolism of drugs)

Psychosocial factors (isolation, non-functional, income, literacy)

Question 11

Matters Most

Answer 11

provides healthcare that fits to individuals and their goals

-avoid harmful or unnecessary care

Question 13

What does the staff of a Skilled Nursing Facility (SNF) look like?

Answer 13

-need staff on a 24-hour basis
-M.D.
-Director of Nursing
-Supervising nurse (RN)
-RN or LPN (at least 1 on duty all the time)
-Nursing Assistant
-Adjunct (Therapist, Pharmacy service, Dietician, social service)

Question 14

What are the duties of a pharmacist in an LTCF?

Answer 14

-Monthly clinical consults
-Keep facility citation-free
-Achievement of high CMS ranking
-Manage drug costs
-Formulary management
-Therapeutic interchanges
-Manage administration issues
-Provide nurse training
-Infection control measures
-Reduce readmissions
-Psychotropic use metrics

Question 15

What are the Pharmacy Related F-Tags in an LTCF?

Answer 15

-Pharmacy Svcs/Procedures/Pharmacist/Records
-Drug Regimen Review, Report Irregular, Act On
-prevent Unnecessary Drugs
-prevent Unnecessary Psychotropic Meds/PRN Use
-prevent Medication Error Rates of 5% or greater
-Residents Are Free of Significant medical errors
-Label/Store Drugs & Biologicals

Question 16

PRN Psychotropic Drugs and Antipsychotics are limited to how many days?

Answer 16

14 days

Question 17

Is the use of Psychotropics for more than 14 days?

Answer 17

allowed with documentation and duration

Question 18

What has to be done before extending PRN use of Antipsychotics beyond 14 days?

Answer 18

appropriateness must be assessed and documented with each extension

Question 19

How many dose reductions are required for psychotic drugs during the first year and following years?

Answer 19

Two GDRs required during first year for scheduled
psychotropic drugs

One GDR required annually each year there after