Exploring the Role of a Pain Management Protocol in Readmission Rates in a Skilled Nursing Facility

Exploring the Role of a Pain Management Protocol in Readmission Rates in a Skilled Nursing Facility

JAMDA 18 (2017) B8eB10 JAMDA journal homepage: www.jamda.com Education Education A Curriculum to Teach Internal Medicine Residents How to Communicat...

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JAMDA 18 (2017) B8eB10

JAMDA journal homepage: www.jamda.com

Education Education A Curriculum to Teach Internal Medicine Residents How to Communicate with People Living with Dementia Presenting Author: Rollin Wright, MD, MS, University of Pittsburgh Author(s): Peg Chabala, Victoria Hornyak, Richard Schulz, PhD; and Rollin Wright, MD, MS

Introduction/Objective: Health care providers receive little training about how to work with demented patients who have lost language and processing skills. We describe a curriculum to teach internal medicine residents how to work with families and patients living with dementia. Design/Methodology: We began implementation of a dementia communication skills training program that occurs in a required 4-week outpatient geriatrics rotation in July 2016. PGY2 residents receive an introductory lecture followed by hands-on skill-building with residents of a dementia support personal care home in Pittsburgh, PA. They are required to document 5 dementia encounters during the rotation which indicate the skill(s) practiced and a self-rated score of performance level achieved. Residents present 1 encounter and role-play the skill they practiced with geriatrics faculty and a dementia education specialist. Skill performance is evaluated by both. Results: Forty residents are anticipated to complete the curriculum in academic year 2016-17. Pre-test and post-test knowledge will be analyzed. Analyses will show which skills residents chose to practice and will compare their self-rated performance with observed level of skill achievement. Conclusion/Discussion: We suspect that a 1-month curriculum will improve internal medicine residents’ knowledge of, confidence in, and demonstration of at least 2 nonverbal communication skills they can use to work with or counsel patients and families living with dementia. Disclosures: HRSA Geriatric Workforce Enhancement Project (U1QHP28736, PI Schulz, Project Director Wright); HRSA Geriatric Academic Career Award (K01HP20484-01-00).

Exploring the Role of a Pain Management Protocol in Readmission Rates in a Skilled Nursing Facility Presenting Author: Jaren Howard, Purdue Pharma L.P. Author(s): Jaren Howard

score and pain treatment before and after readmission as well as hospital length of stay (LOS), SNF interventions, and associated costs. Results: Overall, 9 patients were re-admitted to the hospital with fewer readmissions in facility 1 (n¼4) than facility 2 (n¼5); 5 (55%) experienced pain prior to readmission. Of these 5 patients, 2 (40%) experienced cardiac pain (both in facility 1) and 3 (60%) experienced non cardiac pain (all patients in facility 2). In facility 1, data from the pain medication protocol was reviewed monthly and the nursing staff was well-educated and trained compared with facility 2, where INTERACT protocol was not used well and pain management was not well documented by the less trained nursing staff. The typical cost of managing pain in both SNFs was minimal and included the cost of treating pain prior to readmission, laboratory work, xrays interventions to treat pain and cost of treating pain after readmission. The cost of managing pain of hospitalized SNF patients in facility 1 was up to 4.9 times higher compared to facility 2 and was due to hospitalization costs alone, if the patient suffered from cardiac pain caused by myocardial infarction. In facility 2, where cardiac pain was not treated, the drivers of cost for non cardiac pain due to pneumonia/pleural effusion or pneumonia/ congestive heart failure were mainly due to longer than average LOS, laboratory costs, medication and oxygen used in the SNF. Conclusion/Discussion: This research showed that pain managed in a SNF setting resulted in a limited number of readmissions to the hospital while maintaining minimal costs. The facility with a well-developed pain management protocol, education for nursing staff, and a monthly pain medication protocol data review had minimal readmissions with prior non cardiac pain. These results underscore potential benefit of documentation, education, and monitoring in the treatment of pain in a SNF. Disclosures: This study was funded by Purdue Pharma, L.P., Stamford, CT. Evaluating Long Term Care Homes’ IntraVenous Therapy Experiences (LIVE Study) Presenting Author: Hrishikesh Navare, MSc, Medical Pharmacies Group Limited Author(s): Daphne Broadhurst, RN, Afeez Hazzan, PhD, Loretta Hillier, George Ioannidis, PhD, Mark Loeb, MD, Hrishikesh Navare, MS, Denis O’Donnell; and Alexandra Papaioannou, MD

Introduction/Objective: Traditionally, when long-term care (LTC) resiIntroduction/Objective: Inadequately managed acute pain can lead to hospital readmissions for skilled nursing facility (SNF) patients. This 2 month study was based on private, telephonic interviews conducted in patients of 2 Health Dimensions Group (HDG) managed SNFs to understand the role of pain management protocols in SNF acute care readmissions. Design/Methodology: Facility 1 was a 150 bed SNF that used an algorithm for treating cardiac pain and a pain protocol for other types of pain. Facility 2 was a 121 bed SNF that did not treat cardiac pain and used Interventions to Reduce Acute Care Transfers (INTERACT) protocols for pain. Controlling patients’ pain, which may assist in preventing hospital acute care readmission, was an important quality measure in both facilities. Data collected by HDG for pain related readmission included payer source, pain

dents in Ontario, Canada require intravenous antibiotics, they have been transferred to hospital for this treatment. Hospital is not always the ideal location for the elderly to receive treatment as it often results in unfavorable health outcomes. There is evidence that receiving care in hospital may be associated with a reduction in quality of life, a decline in functional status and other unfavorable health outcomes for the elderly. This project aimed to ensure timely administration of intravenous (IV) therapy for lower respiratory tract infections (RTI), urinary tract infections (UTI) and hydration within LTC homes and avoid where possible, transfers to hospital for this service as well as facilitate early discharge from hospital for LTC residents started on IV therapy in hospital. Design/Methodology: An in-home IV therapy service was pilot tested in four urban LTC homes in Southern Ontario. A number of resources/tools were