October 2015

Vol. 44 No. 10

October

Cover Story

https://www.providermagazine.com/Issues/2015/October/Pages/The-Road-To-Antibiotic-Stewardship.aspx

The Road To Antibiotic Stewardship

<div id="__publishingReusableFragmentIdSection"><a href="/ReusableContent/4_.000">a</a><a href="/ReusableContent/4_.000">a</a></div><div> </div> <div>The rampant prescription of antibiotics for conditions that don’t necessarily merit them is creating a whole new generation of antibiotic-resistant bacteria. The struggle to stem the overreliance on antibiotics doesn’t begin and end with physicians, however. It takes cooperation across the entire continuum of care.</div> <div> </div> <div>Thanks to initiatives such as the recently convened White House Forum on <a href="/Issues/2015/October/PagesOne-Snapshot-From-The-Road.aspx" target="_blank" title="One Snapshot From The Road">Antibiotic Stewardship</a>, a road map on this issue is being developed for post-acute and long term care.</div> <div> </div> <div>Whether a facility is just beginning to plan its stewardship journey, has already begun its trip, or is farther down the road, most will be asking, “Are we there yet?” before reaching the final destination. Fortunately, along the road, there are lessons to be learned, best practices to share, <a title="Key Resources" target="_blank" href="/Issues/2015/October/PagesKey-Resources-For-Antibiotic-Stewardship-Strategies.aspx">resources to tap</a>, and partnerships to form. </div> <h2 class="ms-rteElement-H2"><span></span><span><img src="/Issues/2015/October/PublishingImages/LenRuss.jpg" alt="Len Russ" class="ms-rteImage-1 ms-rtePosition-1" style="margin:10px 15px;" /></span>Antibiotics Not A Panacea</h2> <div>“This is a growing issue and a challenging one. Most of us grew up in a generation where antibiotics were miracle drugs, and now we’re seeing a lot of negative byproducts,” says Leonard Russ, owner/administrator of New York-based Bayberry Care Center and chair of the American Health Care Association Board of Governors.<br><br></div> <div>“There is still a health care culture of relying heavily on antibiotics—to a fault,” he says. “We’ve come a long way toward realizing that antibiotics aren’t necessary in treating conditions such as asymptomatic urinary tract infections. However, the larger issue with stewardship is determining when an antibiotic is warranted in a given clinical situation.”<br><br></div> <div>The first step—awareness that antibiotic overutilization is causing resistant bacteria and other negative outcomes—is already happening, thanks to the White House Forum and other national initiatives. “The challenge over the next few years is for our profession to devise solid parameters that foster responsible and effective antibiotic stewardship widely accepted by all stakeholders. We should do this before regulatory prescription comes in and takes away clinical discretion,” says Russ. He adds, “We still have a way to go on this issue. We still live in a society where people expect a pill to be a cure-all.” <br><br></div> <h2 class="ms-rteElement-H2">The Problem</h2> <div>According to the Centers for Disease Control and Prevention (CDC), more than 2 million people in the United States annually contract infections that are resistant to antibiotics, and at least 23,000 die as a result. In addition to the illness and deaths caused by resistant bacteria, Clostridium difficile (C. difficile), a serious diarrheal infection, is associated with antibiotic use. This condition alone causes at least 250,000 hospitalizations and 14,000 deaths every year, CDC reports. <br><br></div> <div>Antibiotic resistance hinders the ability to resolve or prevent routine infectious diseases and undermines the treatment of infectious complications in patients with other diseases. Many medical treatment advances, such as joint replacement and cancer therapies, depend on the ability to fight infections with antibiotics. This is of significant concern, especially with frail elders for whom an otherwise minor infection can exacerbate quickly and become life-threatening in a short time.<br><br></div> <div>The use of antibiotics is the key cause of antibiotic resistance worldwide. Considering that antibiotics are among the most commonly prescribed medications and that up to half of antibiotic use is unnecessary or inappropriate, this suggests a problem of enormous proportions, CDC says.</div> <h2 class="ms-rteElement-H2">What Is Antibiotic Stewardship? </h2> <div>The Society for Healthcare Epidemiology of America defines antibiotic stewardship as “coordinated interventions designed to improve and measure the appropriate use of antimicrobial agents by promoting the selection of the optimal antimicrobial drug regimen, including dosing, duration of therapy, and route of administration.”<br><br></div> <div><span><img class="ms-rtePosition-1" alt="Sharon Bradley, RN" src="/Issues/2015/October/PublishingImages/SharonBradley.jpg" style="margin:10px;" /></span>Sharon Bradley, RN, CIC, senior infection prevention analyst at the Pennsylvania Patient Safety Authority, suggests that a stewardship program should promote improved patient outcomes by reducing treatment failures, lengths of stay, morbidity, and mortality. The program also should aim to increase infection cures and appropriate prescribing; reduce adverse effects, C. difficile rates, and antibiotic resistance; and improve pathogen susceptibility profiles.<br><br></div> <div>With the rise of antibiotic-resistant “superbugs” such as methicillin-resistant Staphylococcus aureus and escalating rates of C. difficile infections, antibiotic stewardship started to come into the spotlight earlier this century.<br><br></div> <div>How serious is the problem? CDC estimates that antibiotic-resistant infections cost $20 billion to $35 billion in direct health care costs each year and add as many as 8 million additional days to hospital stays. <br></div> <div>The cause for resistance is primarily extensive exposure of the bacteria to antibiotics. While the antibiotic kills susceptible bacteria, resistant strains survive and multiply. These resistant strains could eventually rebuff all current antibiotics, thus either prolonging time spent healing or even result in death.<br><br></div> <div>CDC has determined that four core actions are necessary to combat antibiotic resistance: preventing infections and the spread of resistance, tracking antibiotic-resistant infections, improving antibiotic use/stewardship, and developing drug and diagnostic tests.</div> <h2 class="ms-rteElement-H2">Tackling The Problem</h2> <div><span><a href="http://www.cdc.gov/longtermcare/prevention/antibiotic-stewardship.html" target="_blank" title="Click for link"><img src="/Issues/2015/October/PublishingImages/coverstory2.gif" class="ms-rtePosition-2 ms-rteImage-1" alt="Key Elements For Nursing Center Programs" style="margin:5px;" /></a></span>In 2013, President Obama tasked his President’s Council of Advisors on Science and Technology with establishing actionable recommendations about how the federal government can address the rise of antibiotic resistance. In 2014, the council released a report that focused on three areas:<br><br></div> <div>■ Improving surveillance of the rise of antibiotic-resistant bacteria to enable an effective response, stop outbreaks, and limit the spread of resistant organisms;<br><br></div> <div>■ Increasing the longevity of current antibiotics by improving the appropriate use of existing drugs, preventing the spread of antibiotic-resistant bacteria, and shoring up proven interventions to decrease the rate at which microbes develop antibiotic-resistance; and<br><br></div> <div>■ Increasing the rate at which new antibiotics and interventions are discovered and developed.<br><br></div> <div>Earlier this year, the White House released a comprehensive plan identifying actions to be taken by federal departments and agencies to tackle antibiotic resistance. The National Action Plan for Combating Antibiotic-Resistant Bacteria is organized around five goals:<br><br></div> <div>■ Slow the emergence of resistant bacteria and prevent the spread of resistant infections;<br></div> <div>■ Strengthen the national One Health surveillance efforts to combat resistance;<br><br></div> <div>■ Advance the development and use of rapid and innovative diagnostic tests for identification and characterization of resistant bacteria;<br><br></div> <div>■ Accelerate basic and applied research and development for new antibiotics, other therapeutics, and vaccines; and<br><br></div> <div>■ Improve international collaboration and capacities for antibiotic resistance, prevention, surveillance, control, and research/development.<br><span id="__publishingReusableFragment"></span></div> <h2 class="ms-rteElement-H2"><a href="http://www.cdc.gov/getsmart/week/overview.html" title="Click for link" target="_blank"><img src="/Issues/2015/October/PublishingImages/coverstory1.gif" class="ms-rtePosition-1" alt="" style="margin:10px 15px;" /></a>Achievable Outcomes</h2> <div>Working through the action plan, the government anticipates several significant outcomes by 2020. These include establishment of antimicrobial stewardship programs in all acute care hospitals and improved stewardship across all health care settings, 50 percent reduction in antibiotic use in outpatient and 20 percent in patient settings, establishment of state antibiotic-resistance prevention programs in all 50 states, and elimination of medically important antibiotic use for growth promotion in food-producing animals.<br><br></div> <div>Elsewhere, this summer representatives from more than 100 health organizations participated in the White House Forum on Antibiotic Stewardship to discuss implementing relevant programs and their critical role in addressing antimicrobial resistance. “One positive result of the forum is that it established a dialogue about state-of-the-art thinking and best practices regarding stewardship,” Russ says.<br><br></div> <div>Current Centers for Medicare & Medicaid Services (CMS) regulations require antibiotic review as part of hospital and long term care facility infection control programs. However, earlier this summer, CMS announced changes to skilled nursing facility (SNF) regulations, including a proposal to require SNFs to have an antibiotic stewardship program.<br><br></div> <div>According to the proposal, “Nursing homes need to have the tools to participate in surveillance, learn and use infection control and containment practices, and adopt a proactive approach to preventing spread while being good stewards of antibiotics to preserve effectiveness of the agents we have today.” The proposal was still open to comments at press time.</div> <h2 class="ms-rteElement-H2">Getting The Message Out </h2> <div>Facilities need to spread the word about antibiotic use. James Keegan, MD, an infectious disease specialist who leads the antibiotic stewardship team at Knoxville, Tenn.-based health care management consulting firm, PYA, explains, “In the past, we would use antibiotics as a precautionary measure, but we’ve found that we actually make things worse by using them as a measure of insurance. Now our strategy has to be to steward each patient’s treatment conservatively, using therapeutics and reducing antibiotic use generally.” He adds, “We need to get the message out that this revised strategy is effective.”<br></div> <div><br></div> <div>This messaging starts with facility leadership, Keegan says. “We’ve been educating health care leaders and champions of facilities: Altered mental status generally isn’t caused by infection in the absence of fever and other symptoms. The medical director needs to be willing to communicate this to prescribers and hold them accountable to those standards,” he says.</div> <h2 class="ms-rteElement-H2">How To Start</h2> <div>Old habits die hard, and it may be difficult for some prescribers and nurses to think beyond antibiotics. </div> <div>“Part of the change in management strategy with prescribers is to share literature on best practices and provide evidence-based protocols,” says Keegan. “When physicians have the opportunity to review this information, they are more likely to make good decisions and are less resistant to change.”<br><img alt="James Keegan" class="ms-rtePosition-2" src="/Issues/2015/October/PublishingImages/JamesKeegan.jpg" style="margin:10px;" /><br>Keegan suggests sharing such information with new attending physicians and ensuring that they understand policies and procedures regarding infection control and antibiotic use.<br><br></div> <div>“We outline this for new health care providers so that they know what is expected of them. Someone coming from a different geographic region or practice setting may have an approach that isn’t appropriate or effective here,” he says.<br><br></div> <div>All of this is an ongoing process, Keegan suggests. “We pay attention to the literature as it comes out, and we share this to try and help others be successful as well.” He adds, “Communication and cooperation over time need to be aligned so that you can help the team of providers to see the big picture regarding antibiotics.”</div> <h2 class="ms-rteElement-H2">Surveillance And Communication</h2> <div>Active surveillance of antibiotics is necessary, Keegan says. “If you’re vigilant on a daily basis, you’re ahead of the game. You will pick up on problems and issues quickly and can address patterns in prescribing such as attending physicians, shifts, or units who exhibit higher antibiotic prescribing rates.”<br><br></div> <div>For example, surveillance helped Keegan and his team identify a nursing care center that was over-using Foley catheters. “We were able to go in and talk with their team about why these aren’t necessary and offer suggestions for alternative measures they can take,” he says.<br><br></div> <div>Access to data such as information in electronic health records can have a huge impact. <br><br></div> <div>“We were able to reduce overall antibiotic use by 30 percent without additional morbidity or hospitalizations,” says Robin Jump, MD, PhD, assistant professor at Case Western Reserve University and infectious disease physician at the Louis Stokes Cleveland VA Medical Center. “The difference was having a records system that enabled us to see what providers were doing.”<br><br></div> <div><img class="ms-rteImage-1 ms-rtePosition-1" alt="Robin Jump" src="/Issues/2015/October/PublishingImages/RobinJump.jpg" style="margin:5px;" />Data and statistics can be helpful when medical directors need to deal with physicians who are over-prescribing antibiotics. “Evidence from the literature suggests that peer-to-peer communication works best, and it is helpful to have data to support these efforts,” says Jump. “Have a prescriber with a low rate of antibiotic prescribing counsel one with a high rate.”<br><br></div> <div>Knowing what happens in one’s own facility can lead to improvement, says Zachary Palace, MD, medical director at The Hebrew Home at Riverdale in New York. “We found that when a urine test came back positive for nitrates, it would automatically trigger a culture. We decided to fine-tune our ordering of cultures. We educated our practitioners to be more judicious in ordering cultures.”<br><br></div> <div>Palace watches his numbers like a hawk. “If there is a rise or spike in our UTI [urinary tract infection] rate, I work closely with our infection control nurse. We go back and conduct a root-cause analysis to determine what is causing the increase. Then we can address it promptly.”<br><br></div> <div>Mark Coggins, PharmD, CGP, FASCP, a South Carolina-based consultant pharmacist who serves as senior director of pharmacy services for Diversicare Management Services in Brentwood, Tenn., suggests that facilities also look at their antibiograms, lab results that show the sensitivity of an isolated bacterial strain to various antibiotic medications. This information, he says, can help prescribers choose the best antibiotic for each patient.<br><span id="__publishingReusableFragment"></span></div> <h2 class="ms-rteElement-H2">Team Talk</h2> <div>While the medical director and attending physicians are players in antibiotic stewardship, don’t forget other team members. For example, Jump says, “Nurses have a huge influence over what happens with patients. If we help them understand how to work and communicate with physicians effectively, we can reduce antibiotic use.”<br><br></div> <div><img src="/Issues/2015/October/PublishingImages/ZacharyPalace.jpg" class="ms-rtePosition-2" alt="Zachary Palace" style="margin:5px 10px;" />It is essential to encourage staff to think outside the box and avoid knee-jerk reactions to issues such as behavioral changes, she says.<br><br></div> <div>“For example, we had a woman who refused to talk to family or staff for a day. They didn’t know what was wrong. We checked her urine. It was positive for bacteria, but she was asymptomatic,” she says. Instead of putting the individual on an antibiotic, a physician spoke with her.<br><br></div> <div>“It turned out that she was angry because she was supposed to get stuffed cabbage for dinner the night before and received something else,” Jump says. “By taking the time to talk to the resident and explore all the possibilities, we were able to avoid unnecessary treatment and find a simple resolution.”</div> <h2 class="ms-rteElement-H2">Get Families Involved</h2> <div>Of course, no antibiotic stewardship program is complete without the involvement of patients and families.</div> <div>“We have run into scenarios where families or patients think antibiotics are a magic bullet and insist on a prescription. Educating physicians to educate patients is an important part of getting the public to understand the implications of the misuse or overuse of antibiotics,” says Bradley of the Pennsylvania Patient Safety Authority.<br><br></div> <div>One way to deal with patients and families is to “help them understand that you are doing something even if you don’t prescribe antibiotics,” says Alec Pruchnicki, MD, staff physician at The Lott Residence, an assisted living facility New York, N.Y. “Assure them that you will be monitoring the situation and start medications if and when it is deemed appropriate.<br><br></div> <div>“Explain to them the problems with antibiotic resistance and that it can cause gastrointestinal problems or C. difficile diarrhea. Tell them that taking an antibiotic unnecessarily can cause a yeast infection. If they trust you, they will follow your guidance,” he says.</div> <h2 class="ms-rteElement-H2">Follow Through On Compliance</h2> <div>When antibiotics are prescribed, Pruchnicki stresses the importance of ensuring that patients comply with dosing instructions. “Here, three-quarters of our residents get their medications directly from the nurses, so when a medication is prescribed, I know the patient will get the full dose,” he says. However, some patients will refuse medications or stop taking them after a few doses.<br><br></div> <div><span><span><span><span><img src="/Issues/2015/October/PublishingImages/MarkCoggins.jpg" alt="Mark Coggins" class="ms-rtePosition-1" style="margin:0px 10px;" /></span></span></span></span>“You have to explain to patients that they have to take the medication until the last pill is gone or their infection will come back and be worse than before. Most will understand this,” Pruchnicki says. He notes that patients may not admit if they’ve stopped taking their medication, but a nurse or family member might.<br><br><span></span>Therefore, he says, “you really have to explain everything to all the players.”<br><span><span></span></span><br></div> <div><span><span><span></span></span></span>Another important key to dealing with family members, says Keegan, is to determine a diagnosis. “If someone is confused, you need to find out why. If you can tell families that you’ve conducted aggressive diagnostics and determined that the problem is a virus that antibiotics won’t help, they are more likely to be agreeable,” he says. He also recommends that care centers make consumer-oriented information about antibiotics available in lobbies and waiting areas.<br><br></div> <div>When residents go to the emergency department (ED), the family should be informed about what to expect. “We need to tell them that the ED physician likely will do a urine test and find bacteria. As a result, the resident will come back to the facility on antibiotics, and we likely will discontinue this prescription,” says Jump.<br><br></div> <div>Educating residents and families should start at admission. Jump says, “When someone is admitted, we need to offer reassurance to the family that we want to get to know mom or dad and be able to identify what is causing various symptoms and behaviors. They need to know that before we expose their loved one to a potentially unnecessary narcotic, we want to conduct a thorough assessment.” While it may be tempting to give in to family pressure and prescribe antibiotics when they aren’t needed, Palace says, “We’ve learned that standing our ground is very effective. We offer a risk-benefit analysis and explain that when the risks outweigh the benefits, we shouldn’t use these drugs.” Families are more receptive when the facility has worked on building relationships and trust from the start, he says.</div> <div class="ms-rtestate-read ms-rte-wpbox"><div class="ms-rtestate-notify ms-rtestate-read 99dd7287-2002-4775-9c4e-a5abcbe021a3" id="div_99dd7287-2002-4775-9c4e-a5abcbe021a3" unselectable="on"></div> <div id="vid_99dd7287-2002-4775-9c4e-a5abcbe021a3" unselectable="on" style="display:none;"></div></div> <h2 class="ms-rteElement-H2">The Bounty of Low-Hanging Fruit</h2> <div>While the idea of an antibiotic stewardship program can seem daunting, it can be manageable by “starting small,” says Jump, with low-hanging fruit such as going from IV to oral conversions and antibiotic “time-outs where you re-evaluate the patient after a few days and try to either stop or at least narrow the antibiotic.” She says, “Report and share outcomes of your quality improvement efforts. Let people know when they’ve made a difference. Celebrate small successes.”<br><br></div> <div>Nimalie Stone, MD, medical epidemiologist for long term care in CDC’s Division of Healthcare Quality Promotion, agrees that starting small is the way to go. “Facilities will want to work in a stepwise fashion. Take one or two activities to start with, then take one or two more. Perhaps the first step is to assess current practices and activities,” she says.<br><br></div> <div><img class="ms-rtePosition-2" alt="Alec Pruchnicki" src="/Issues/2015/October/PublishingImages/Pruchnicki.jpg" style="margin:10px;" />“Whatever you do, a successful effort requires the support of leadership—I can’t emphasize this enough. To get sustained change, you need resources and support from the top.”<br><br></div> <div>The team at Masonic Village, a long term care facility in Elizabethtown, Pa., picked its own low-hanging fruit: urinary tract infections (UTIs). Medical Director J. Kenneth Brubaker says, “We noticed that our UTI rates were high and that we were ordering hundreds of urinalyses every year.”<br><br></div> <div>After examining the situation carefully, the team determined that tests were being ordered even when there were no symptoms or when the patient exhibited symptoms that could have been related to other problems such as pain or hunger.<br></div> <div>A patient would have a behavioral issue, and staff would assume that he or she had a UTI—even when there were no other symptoms—and request a urinalysis. As a vast majority of residents have some bacteria in their urine, the tests would come back positive, and an antibiotic would be prescribed.<br><br></div> <div>“We implemented a process in which urinalyses were not ordered for asymptomatic UTIs,” Brubaker says. <br><br>“We also trained staff to look more closely at the root causes of behavioral issues. As a result, we were able to cut urine testing and the use of antibiotics for UTIs in half.”</div> <h2 class="ms-rteElement-H2">Worth the Effort</h2> <div>Another potential starting point is dose/drug de-escalation. The consultant pharmacist is uniquely positioned to assist with this, says Coggins. “The pharmacist should be looking at each resident taking antibiotics and determine the appropriateness of the prescription, the specific drug choice, and the duration of the course of the treatment,” he says, adding, “We make sure that any use of antibiotics is monitored carefully. We want to get patients off of these drugs as quickly as possible.”<br></div> <div><span><span><h2 class="ms-rteElement-H2"></h2></span></span><span><span><span><h2 class="ms-rteElement-H2"><img class="ms-rtePosition-1" alt="Nimalie Stone" src="/Issues/2015/October/PublishingImages/NimalieStone.jpg" style="margin:0px 10px;" /></h2></span></span></span>Antibiotic stewardship requires a commitment on the facility’s part, but it is well worth the effort. “When we institute and sustain processes that result in appropriate use of antibiotics, we see fewer incidences of complications such as C. diff and fewer antibiotic-resistant infections,” says Brubaker. “This contributes to improved outcomes and quality of life, as well as reduced costs and fewer hospitalizations.” <br></div> <div>There can be no question of stewardship’s value, Coggins agrees.<br><br></div> <div>“Everyone needs to know that antibiotic stewardship is a focus and that there are expectations for each practitioner and staff member. For staff such as housekeeping or maintenance personnel, it may be as simple as proper handwashing techniques. For nurses, it might be getting prompt, complete, and accurate information to physicians regarding a resident’s condition change,” Coggins says. “But when we get everyone involved and committed, we can make a real difference.” <br></div> <br><em>Joanne Kaldy is a freelance writer and communications consultant based in Harrisburg, Pa.</em>

The rampant prescription of antibiotics for conditions that don’t necessarily merit them is creating a whole new generation of antibiotic-resistant bacteria. The struggle to stem the overreliance on antibiotics doesn’t begin and end with physicians, however. It takes cooperation across the entire continuum of care.

2015-10-01T04:00:00Z

Clinical;Caregiving

e-Prescribing Makes Its Debut In New York	https://www.providermagazine.com/Issues/2015/October/Pages/e-Prescribing-Makes-Its-Debut-In-New-York-.aspx	e-Prescribing Makes Its Debut In New York	<div id="__publishingReusableFragmentIdSection"><a href="/ReusableContent/4_.000">a</a></div><p>For long term, post-acute care providers (LTPACs) working to enhance care delivery, the medication prescription process stands out as an area of opportunity and potential improvement. <br></p> <p>LTPACs have historically relied on manual ordering methods for prescriptions, which are often cumbersome, inefficient, and sometimes inaccurate. While hospitals and physician practices have embraced electronic prescribing (e-prescribing) to promote greater reliability and safety, LTPACs have struggled to adopt technology, due, in large part, to a lack of financial incentives to onboard costly systems. <br>All this is changing, however, with the advent of new rules and regulations that require organizations, including LTPACs, to engage in e-prescribing. <br></p> <p></p> <div>New York state is embracing the transition toward automation head on, creating both an electronic repository for controlled substance prescription data and an e-prescribing mandate that demands that all organizations migrate to automated medication ordering. </div> <h2 class="ms-rteElement-H2">New York State’s i-STOP Program </h2> <div>As a first step toward e-prescribing, New York created the i-STOP program for controlled substances. A main component of the initiative is a robust data repository that houses six months of information on all controlled substances dispensed in the state. <br><br></div> <div>Effective since Aug. 27, 2013, New York pharmacies and other dispensing organizations must report controlled substance data to the repository. Prescribers are required to consult the program’s registry when writing orders for Schedule II, III, and IV controlled substances.<br><br></div> <div>The advantage of the i-STOP program is that it gives practitioners direct, secure access to controlled substance prescription histories for their patients, which prevents overprescribing and allows providers to ascertain whether there is potential for abuse or nonmedicinal use.<br><br></div> <div>Using i-STOP as a jumping off point, New York then created the e-prescribing mandate, which goes into effect as of March 2016—after New York legislators delayed the initiative a year to ensure smoother implementation. <br><br></div> <div>The mandate takes i-STOP a step further, requiring all entities to e-prescribe both controlled and noncontrolled substances, whether prescriptions are internally or externally filled, during a patient’s care or after discharge.<br><br></div> <div>To comply with this mandate, all prescribers will have to switch from paper-based processes to e-prescribing technology supporting controlled substances, noncontrolled substances, and discharge scripts for both.<br><br></div> <div>The ruling also requires greater physician involvement in prescribing, demanding the prescriber submit an order directly, instead of delegating the work to a nurse or a physician’s assistant (PA). While a nurse or PA can still start the prescription process, the physician must personally review, edit, and approve the order before submitting it to the pharmacy. This distinction represents a substantial process change for many long term care organizations that have historically relied on nurses and PAs to handle the logistics involved with medication orders.<br><br></div> <div>To be in compliance with the mandate, New York’s LTPACs will need to revisit their workflows and change their approach to generating prescriptions.</div> <h2 class="ms-rteElement-H2">Implications For Other States’ Providers</h2> <div>Although New York is currently the only state with an e-prescribing mandate on the books, many other states are closely monitoring its progress. Florida, for example, has a program similar to i-STOP. <br><br></div> <div>Given the current trajectory, it is understandable why other states are actively tracking the implementation of the mandate in New York and examining the global benefits of early e-prescribing preparations, including:<br></div> <div><ul><li><em>Effective reduction of rehospitalizations.</em> By digitally routing discharge scripts to pharmacies and reconciling orders, e-prescribing technologies can ensure continuity of critical medications and improve overall care transitions by mitigating transcription errors and reducing breakdowns in communication. </li></ul></div> <ul><li><em>Improved operational efficiencies. </em>Automating the historically cumbersome transcription process allows for more top-of-license roles for staff, which in turn yields increased bedside time and improved patient experience and outcomes. </li></ul> <em> </em><div><ul><li><em>Increased preparation time for ICD-10 onboarding</em>. With ICD-10 finalized (as of Oct. 1), early adoption of e-prescribing processes allows for improved medication management and resident safety, facilitating a more seamless transition to ICD-10 compliance when the time comes. </li></ul></div> <h2 class="ms-rteElement-H2"><span id="__publishingReusableFragment"></span><br></h2> <h2 class="ms-rteElement-H2">No Time Like The Present</h2> <div>While the aforementioned preparatory benefits are persuasive, the road to seamless e-prescribing implementation can be long. LTPACs should therefore not put off preparing for these efforts. Although e-prescribing is not yet mandated, organizations looking to be successful in the long term should adopt proactive strategies for implementing technology to ensure they are reaping the full benefits of e-prescribing.<br><br></div> <div>Three specific reasons why organizations should get started right away include: </div> <div><ul><li><em>Compliance requires a complete workflow evaluation.</em> For many LTPACs, e-prescribing will demand a whole new approach to medication ordering. As such, organizations must thoroughly assess current workflows and determine how they might change. This will involve pulling together a group of key stakeholders and walking through the various processes.</li></ul></div> <div>The group will then need to figure out how onboarding technology will alter existing policies and procedures and prepare to lay the groundwork for change. Organizations should not rush this exercise, as getting the workflows right is a foundational step in transitioning to automation. <br><br></div> <div><ul><li>Garnering physician support takes time. As mentioned before, physicians will play a role in prescribing that is different and more comprehensive than traditional processes have been in the past. Organizations therefore need to educate physicians on their responsibilities and gain buy-in. This may involve identifying a champion to guide the effort and/or bringing physicians into the workflow design process to ensure everyone is comfortable with the new normal.</li></ul></div> <div>Again, organizations should allow plenty of time for this transition, as rushing it can lead to frustration, lack of support, and even retention issues. <br><br></div> <div><ul><li><em>IT vendors may have limited bandwidth.</em> While many New York state health care providers currently e-prescribe noncontrolled substances, most do not use technology for controlled substances. </li></ul></div> <div>This is because vendors must be certified to offer controlled substance e-prescribing. It is going to take vendors some time to obtain the necessary certification and get all their clients up to speed prior to compliance deadlines. <br><br></div> <div>LTPACs shouldn’t delay implementing e-prescribing because as deadlines loom, vendors will likely become inundated and be unable to accommodate last-minute implementations. </div> <h2 class="ms-rteElement-H2">Taking A Proactive Step Forward </h2> <div>Although e-prescribing is likely not top-of-mind within many LTPACs, the profession will experience this paradigm shift in procedure sooner than later. Those who delay will be at risk, both in regards to compliance and overall patient outcomes.<br><br></div> <div>By allowing sufficient adoption time and taking a concerted approach to technological implementation, organizations can ensure they are in compliance while also keeping their residents safe and their employees satisfied.<br><br><em>Steve Pacicco is chief executive officer at <a target="_blank" href="http://www.sigmacare.com/">SigmaCare</a>. He can be reached at spacicco@sigmacare.com or (212) 268-4242.</em><br></div> <p></p>	New York state is embracing the transition toward automation head on, creating both an electronic repository for controlled substance prescription data and an e-prescribing mandate that demands that all organizations migrate to automated medication ordering.	2015-10-01T04:00:00Z	<img alt="" src="/Issues/2015/October/PublishingImages/caregiving_t.jpg" style="BORDER:0px solid;" />	Caregiving	Column
'White Collar' Overtime Eligibility May Broaden	https://www.providermagazine.com/Issues/2015/October/Pages/White-Collar-Overtime-Eligibility-May-Broaden-.aspx	'White Collar' Overtime Eligibility May Broaden	<div>A rule proposed by the U.S. Department of Labor this June could drastically increase the number of salaried white collar employees eligible for overtime pay.</div> <div> </div> <div>The department last updated its regulations under the 2004 Fair Labor Standards Act (FLSA), which governs which employees are entitled to overtime pay. It is now proposing to raise the salary threshold for workers who qualify for overtime.</div> <div> </div> <div>Currently, employees who make $455 a week, or $23,660 a year, are generally ineligible for overtime. The department sets the salary threshold for the white collar exemptions at the 40th percentile of weekly earnings for full-time salaried workers nationwide. When the final rule goes into effect in 2016, the salary threshold to qualify for overtime will rise to $970 per week, or $50,440 per year. </div> <div> </div> <div>The department estimates that 4.7 million Americans will become newly eligible for overtime by this update. What will such an increase in the overtime threshold mean to health care providers and their employees? </div> <h2 class="ms-rteElement-H2">Who Falls Under Exemption Now</h2> <div>The FLSA establishes, among other things, minimum wage and overtime pay standards for employees in the private sector. Unless an employee is considered exempt, an employer must pay employees overtime pay for all hours worked over 40 in a work week, at a rate not less than one and one-half times their regular rate of pay.<br><br></div> <div>Certain executive, professional, and administrative employees fall within the white collar exemption from overtime eligibility. Under the current guidelines, to fall within these exemptions, the employee must:</div> <div><ul><li>Receive a salary of $455 per week or $23,660 annually;</li> <li>Receive a predetermined salary on a weekly (or less frequent) basis that cannot be reduced due to the quality or quantity of the employee’s work; and</li> <li>Perform executive, administrative, or professional duties.<br></li></ul></div> <div>Depending on the specific exemption applicable to a given employee, duties that exempt an employee from overtime eligibility include but are not limited to:<br><ul><li>Managing the enterprise or a department or subdivision;</li> <li>Directing the work of at least two or more full-time employees;</li> <li>Having the authority to hire or fire other employees or having the power to weigh in on the hiring and firing of other employees;</li> <li>Exercising discretion and independent judgment regarding significant matters; and</li> <li>Performing tasks requiring advanced knowledge in a field of science or learning.</li></ul></div> <div>Highly compensated employees making $100,000 per year or more are exempt from overtime eligibility provided that they regularly perform some executive, administrative, or professional functions. The Department of Labor is now proposing to raise this threshold to $122,148 per year. </div> <h2 class="ms-rteElement-H2">How The Proposed Rule Will Affect Health Care Providers</h2> <div>The department determines whether an employee falls within one of the many white collar exemptions, depending on whether the employee’s salary and duties meet the regulatory standards. In other words, if a health care provider hires someone as an “office manager” but the person does not exercise administrative or professional duties and does not make at least $455 a week, he or she will be eligible for overtime.<br><br></div> <div>The department’s proposed rule is a game changer in that a whole category of white collar employees who were making between $455 a week and $970 a week will now be eligible for overtime, even if they perform professional, administrative, or executive duties. <br><br></div> <div>Let’s say a health care provider employs a nutritionist and pays her an annual salary of $50,440. She exercises her own judgment when it comes to a resident’s nutrition plan; supervises a staff of three; and, while she cannot hire and fire the staff, manages values and uses her judgment when it comes to staffing decisions.<br><br></div> <div>As of now, this nutritionist is not eligible for overtime if she worked 40 or more hours in a given work week because she makes more than $455 per week. However, if the rule goes into effect and the new salary threshold in 2016 is $970 a week, she is automatically eligible, even though she is performing professional/administrative duties.<br><br></div> <div>What should a health care provider do? A provider should start planning now before the rule is put into effect. It could hold white collar salaried workers to no more than 40 hours a week and thus not pay overtime. Alternatively, a provider could increase a white collar employee’s salary to above the threshold and, by doing so, make him or her ineligible for overtime. A provider could also hire other employees to do the work that was being done by the white collar employees in their previously unpaid overtime.<br><br></div> <div>In short, it is up to the individual provider to develop a plan that is efficient and that satisfies the company’s budgetary needs. A provider should carefully evaluate the classification status of its workers now to determine who will be and who will not be exempt from overtime eligibility.<br><br></div> <div>A health care provider should tread carefully in this area. Along with government enforcement of the FLSA, a successful private litigant can recover the following from his or her employer in an overtime case:</div> <div><ul><li>Payment of the earned overtime going back up to two years or, if the employer’s violation was willful, up to three years;</li> <li>Liquidated damages of up to 100 percent of the earned overtime for a willful violation; and</li> <li>Reasonable attorneys’ fees and costs.</li></ul></div> <h2 class="ms-rteElement-H2">Next Steps In The Rule-Making Process </h2> <div>The proposed rule has been published in the Federal Register, and the Department of Labor is now reviewing public comments. The final amended regulation will likely go into effect in 2016.<br><br></div> <div>The department, it should be noted, is proposing that the salary and compensation thresholds be adjusted on an annual basis so that they do not become outdated between updates to the regulations.<br><br></div> <div>In light of this proposed raise in the minimum salary threshold and the profound financial effect it will have on the workforce, a health care provider should consult with legal counsel to evaluate its options for the future. <br><br><em>Andrew I. Bart is a New York City lawyer specializing in commercial litigation and labor and employment law. He may be reached at andrewibart@gmail.com or (917) 572-7828.</em></div>	Currently, employees who make $455 a week, or $23,660 a year, are generally ineligible for overtime.	2015-10-01T04:00:00Z	<img alt="" src="/Issues/2015/October/PublishingImages/legal_t.jpg" style="BORDER:0px solid;" />	Legal	Legal Advisor
2015 AHCA/NCAL Annual Awards	https://www.providermagazine.com/Issues/2015/October/Pages/2015-AHCANCAL-Annual-Awards.aspx	2015 AHCA/NCAL Annual Awards	<div> </div> <div> </div> <div>Following are brief stories about some of the most compassionate and accomplished caregivers in the profession: American Health Care Association/National Center for Assisted Living annual award winners. They will be presented with their plaques at the AHCA/NCAL 66th Annual Convention & Expo this month.</div> <div> </div> <div> </div> <div> </div> <div><hr class="ms-rteElement-Hr" /> <div> </div> <h2 class="ms-rteElement-H2B">Maryann Greco</h2> <div><em>Adult Volunteer of the Year</em></div> <div> </div> <div><img class="ms-rtePosition-1" alt="Maryann Greco" src="/Issues/2015/October/PublishingImages/specialawards_MaryannGreco.jpg" style="margin:5px 10px;" />Maryann Greco is the 2015 AHCA/NCAL recipient of the Adult Volunteer of the Year award. Greco volunteers at the Allendale Community for Senior Living, Allendale, N.J. <br><br></div> <div>Volunteers nominated for this award represent the crème de la crème of individuals who give freely of themselves for others. Yet Greco stands out among her peers even at this high level of volunteerism. Indeed, her recruitment of volunteers from the community is a great asset to the care center and, coupled with her intimate familiarity with residents, has already earned her accolades as a Volunteer Extraordinaire! <br><br></div> <div>A hallmark of Greco’s three-year tenure at Allendale is her program called Growing Relationships and Making Memories, aka GRAMM. “GRAMM provides us with a steady flow of new volunteers,” said Activity Director Eucille Brown. “Through GRAMM, volunteers are assigned [to residents] to build relationships by sharing life stories, playing games, going for walks, just relaxing, or whatever it takes to bond,” she said. <br><br></div> <div>For GRAMM to be effective, Greco coordinates closely with the care center and places ads in local newspapers for volunteers. She meets with prospective volunteers for an interview and then returns to Brown to discuss potential resident candidates and the best use of the volunteer’s talents. <br><br></div> <div>The result has been extraordinary for the residents. “Maryann’s dedication to recruitment, training, and support for one-to-one visits has resulted in volunteers who are real advocates for Allendale residents,” said Administrator Kathy Manger.<br><br></div> <div>When not in recruitment or training mode, Greco puts on a quintessential clown entertainment program, attends religious services, and is the busy bee of any social activities she attends. As one family member explained, “Maryann touches residents at many levels. It is an opportunity for residents to recall happy memories, experience pride in their accomplishments, and receive sympathy and understanding for their losses.” <br><br></div> <div>So here’s a salute to Greco and her Merry Band of GRAMM volunteers.</div> <div> </div> <h2 class="ms-rteElement-H2B">Reilly Sasaki</h2> <div><em>Young Adult Volunteer of the Year</em></div> <div> </div> <div><img class="ms-rtePosition-2" alt="Reilly Sasaki" src="/Issues/2015/October/PublishingImages/specialawards_ReillySasaki.jpg" style="margin:5px 10px;" />Reilly Sasaki is the 2015 AHCA/NCAL recipient of the Young Adult Volunteer of the Year award. Sasaki volunteers at the Good Samaritan Society Village, Boise, Idaho. <br><br></div> <div>In describing Sasaki, care center Administrator Brian Davidson said, “Whatever Reilly decides to do with his life, he will be a great success. Those that he serves will be greatly blessed.” <br><br></div> <div>This sentiment is echoed by a group of 11 residents who cosigned a recommendation letter for Sasaki, saying, “It is not always easy to live in a nursing home, sometimes we feel alone, but Reilly always makes us feel loved and cared for.”<br><br></div> <div>So what does he do to earn these accolades? Here’s a sampling: Dinner and Movie night, Tuesday Bingo, annual in-house fair, holiday decorating and parties, companion on visits to doctors’ offices, and a lot of one-on-one socializing. <br><br></div> <div>Sasaki is a whirlwind of activity and recruits other students to volunteer at the care center. Speaking of school, at nearly a 4.0 GPA, he is in the top tier of students, and his goal is to be a medical doctor. He has completed two years of a rigorous college level sports medicine program that also requires a heavy commitment of extracurricular time. <br><br>How does he do it? Eagle High School counselor Lucas Younger explained that Sasaki “is very disciplined and has a great ability to manage multiple tasks to find great success.” <br><br></div> Yet, sprinkled throughout the high praise, a young man emerges who is also described as “kind,” “humble,” “personable,” “compassionate,” and “fun.” The list could fill a thesaurus of “Traits of Truly Remarkable People.” <br><br><div>As the residents said in recommending Sasaki, “He is a true example of what a volunteer in a long term care facility should be.” And AHCA/NCAL wholeheartedly agrees.</div> <div> </div> <div></div> <div> </div> <h2 class="ms-rteElement-H2B"><img src="/Issues/2015/October/PublishingImages/specialawards_BethJarrell.jpg" alt="Beth Jarrell" class="ms-rtePosition-1" style="margin:5px 10px;" />Beth Jarrell </h2> <div><em>NCAL Administrator of the Year</em></div> <div> </div> <div>With more than 25 years of experience in long term care, Beth Jarrell has set the standard for exemplary leadership. For the past 16 years, she has been executive director of Heritage at Dover Assisted Living, Genesis HealthCare, in Dover, Del., where she has created an environment of person-centered care, advocacy, and community involvement. <br></div> <div>“She looks to changing systems rather than changing the resident and looks beyond the profession for resources that enhance individualized service,” said Vickie Cox, regional vice president of Genesis HealthCare, who nominated Jarrell for the award.<br><br></div> <div>Jarrell introduced family-style dining to help better forge connections between staff and residents with dementia. Residents also maintain a vegetable garden and often supply home-grown ingredients for their meals. <br><br></div> <div>A tireless advocate for the elderly, Jarrell has hosted local legislators at the community, so residents can meet with their elected officials. <br><br></div> <div>Her commitment as a leader in the profession is evident by her participation on NCAL committees, her initiation of a group for marketing and admissions professionals, and her service as a mentor for new assisted living executive directors. Jarrell serves as an NCAL State Leader and on the NCAL Customer Relations Committee. <br><br></div> <div>Jarrell has provided countless opportunities for residents to become involved within their local community. Heritage at Dover has many intergenerational programs, including a collaboration with the local art league and area youth to include artwork throughout the community. Additionally, the community hosts children’s dance classes and theater groups. <br><br></div> <div>Residents also give back to the larger Dover community, such as making scarves for the local homeless shelter, holding food and book drives, providing Valentine’s Day gifts to survivors of domestic abuse, and hosting a fundraiser to benefit the music program at a local school.<br><br></div> <div>Due to her leadership, Heritage at Dover Assisted Living enjoys impressive customer satisfaction and staff retention rates. In 2014, every single resident said they would recommend the community to others, and 75 percent of admissions to Heritage at Dover are due to word of mouth. “It is a testament to her ability to understand and engage her staff, residents, and family members,” said Cox. <br><br></div> <div>The community is a Bronze level recipient of the AHCA/NCAL National Quality Award program, and Jarrell is actively leading her team to apply for the next level, Silver.<br><br></div> <div>The NCAL Administrator of the Year award recognizes an assisted living administrator who demonstrates outstanding innovation, achievement, and capabilities.</div> <div> </div> <h2 class="ms-rteElement-H2B"><img src="/Issues/2015/October/PublishingImages/specialawards_VOY.jpg" alt="Group Volunteer of the Year" class="ms-rtePosition-2" style="margin:5px 15px;" />The American Legion Auxiliary, Post 9</h2> <div><em>Group Volunteer of the Year</em></div> <div> </div> <div>The American Legion Auxiliary (ALA), Post 9, is the 2015 AHCA/NCAL Group Volunteer of the Year. The group volunteers at the Maine Veterans Home, Machias, Maine. <br><br></div> <div>ALA members, often in full uniform, often blanket the Veterans Home with arts and crafts sessions, a cooking club, social events like Bingo, homemade goodies, military-style ceremonies, and dance parties. Oh, and they self-recruit and screen volunteers who want to make a regular commitment to the care center or just want to help once in a while.<br><br> </div> <div>These volunteers have a unique understanding of the sacrifices made by veterans and the challenges they’ve faced in conflicts across the globe. ALA is a perfect fit for the care center’s mission of “Caring for those who served.” <br><br>Resident family member Rhoda Hodgdon calls ALA’s contribution to life at the care center “immense,” and Stephanie Lavigne, RN, resident care director, sees the group’s commitment as “hard to parallel. They give so much to the people we care for and about.”<br><br></div> <div>It seems everybody in the nomination process mentioned the monthly birthday party and dance. ALA members dance to the music old soldiers and sailors remember, making them feel like they’ve been transported back in time to enjoy the Andrews Sisters, Glenn Miller, and other greats. Yet providers are aware that having fun in a care center takes work and planning, and ALA members handle those chores, too. Administrator Marcia Jackson, RN, said the group is creative and provides supervision during activities. “ALA members exemplify volunteerism and encourage community engagement with our veterans,” she said.<br><br></div> <div>A time-honored event ALA is particularly adept at is participation in the annual Remembrance Day ceremony. The community comes together to celebrate the lives of veterans who passed during the year with poems and special recollections and reflections. </div> <div> </div> <div></div> <div> </div> <h2 class="ms-rteElement-H2B">CARC Inc.</h2> <div><em>Not for Profit Program of the Year</em></div> <div> </div> <div><div style="text-align:left;"><img class="ms-rtePosition-2" alt="Not for Profit of the Year" src="/Issues/2015/October/PublishingImages/specialawards_nonprofit.jpg" width="270" height="190" style="margin:5px 10px;" />CARC Inc. is the 2015 AHCA/NCAL recipient for the Not for Profit Program of the Year award for its community benefit program called the Work Services Program (WSP), which provides opportunities and support for people with special needs in finding employment in the Carlsbad, N.M., community.</div> <div> </div></div> <div>In Carlsbad, if the local bank is happy, peace reigns. “The clients of CARC Inc. perform landscaping services for the bank under the direction of a coordinating supervisor, always performing in an above satisfactory manner,” said Executive Vice President of Carlsbad National Bank Chris Bird. Other supervised operations for the community include Rainbow Recycling, Document Destruction, running a country store, and landscaping.<br><br></div> <div>And how about the pecan business? Yes, CARC Inc. has a large pecan farm run by clients. The harvest goes to the Pecos Valley Pecans processing plant, which also handles orders from across the United States for CARC pecans. </div> <div>“The WSP identifies employment needs of the community and integrates its clients into that environment,” according to CARC Chief Executive Officer (CEO) Mark Schinnerer.<br><br></div> <div>“It’s a stepping stone for individuals to develop good work habits and learn social skills. The next career step is to advance to the Supported Employment Program, which provides greater autonomy and earning potential for clients.” </div> <div>CARC board President Carolyn Olson acknowledges the WSP’s value to the community and businesses, yet for her, “The best part of the program is seeing the satisfaction of the clients when they receive their paychecks. Words cannot explain the pride and self-worth they gain from their employment.”<br><br></div> <div>This award highlights a specific not-for-profit program that benefits the public and local community.</div> <div> </div> <h2 class="ms-rteElement-H2B"><img class="ms-rtePosition-1" alt="Alicia Goatley" src="/Issues/2015/October/PublishingImages/specialawards_AliciaGoatley.jpg" style="margin:5px 10px;" />Alicia Goatley </h2> <div><em>Noble Caregiver in Assisted Living</em></div> <div> </div> <div>Alicia Goatley of Riverside Lodge Retirement Community in Grand Island, Neb., is described as the epitome of what it means to be a caregiver—“dedicated, calm, caring, compassionate, and respectful.”<br><br></div> <div>As one of the community’s certified nurse assistants, she is always willing to go the extra mile. Every day, residents tell Riverside Lodge’s Executive Director Deb Friend how they appreciate Goatley’s attention to detail when it comes to their care. <br><br></div> <div>“I truly believe her best quality is the infectious smile on her face no matter the circumstance,” said Friend, who nominated Goatley for the award. “Her warm, gentle, and caring smile always lights up the room.”<br><br></div> <div>The 14-year veteran does her part to keep things festive. Goatley consistently dresses up for holidays and encourages other staff to do the same. Every year, she puts on an Easter bunny costume and delights residents and their grandchildren during the community’s annual Easter egg hunt.<br><br></div> <div>Always generous with her time, Goatley often takes residents shopping, even during her time off, to ensure that they have the everyday supplies and personal items they need. She is a trusted confidant to residents and staff and is often seen giving residents hugs and words of encouragement.<br><br></div> <div>For these reasons, Goatley was given the role of team leader for patient care assistance staff. She serves as an inspiration to other employees. <br></div> <div>“You can’t help but be a better person just by being around Alicia,” Friend said.<br><br></div> <div>Her compassion reaches beyond her residents. Goatley recently shaved her head and donated her hair to Locks of Love to offer support to a young boy in her community struggling with cancer. She also organizes the staff’s charitable efforts around Christmas time and encourages them to donate blood at area American Red Cross blood drives.<br><br></div> <div>According to Friend, Goatley is a shining example of how employees live out Riverside Lodge’s mission to care for residents as though they were the most loved member of their own family.<br><br></div> <div>The NCAL Noble Caregiver in Assisted Living award recognizes frontline caregivers, housekeeping, and maintenance staff or staff from any other department who have improved the quality of life for residents and created a better work environment for staff. </div></div> <div> </div> <div></div> <div> </div> <h2 class="ms-rteElement-H2B"><img class="ms-rtePosition-1" alt="Kara Larsen" src="/Issues/2015/October/PublishingImages/specialawards_KaraLarsen.jpg" style="margin:5px 10px;" />Kara Larsen</h2> <div><em>Intellectual and Developmental Disabilities (ID/DD) Hero of the Year</em></div> <div> </div> <div>Kara Larsen is the 2015 AHCA/NCAL Intellectual and Developmental Disabilities (ID/DD) Hero of the Year. Larsen works at the Mission at West Jordan Care Center, West Jordan, Utah. Over the years, West Jordan’s clients have changed from mainly behavioral to a medically fragile clientele. Eighty percent of residents are nonambulatory. The goal of West Jordan is to offer an individualized quality-of-life experience by providing excellent services and an advanced Eden Alternative environment.<br><br></div> <div>There are “givers” and “takers” in this world. Larsen, a ParaQualified ID Professional and Relife Marketer and community director, is clearly the former. A solid 15-year veteran at West Jordan, her career began there when she was 17 years old. Today, Heather Miller, Larsen’s supervisor, describes her as “extraordinary in the love and caring she brings to West Jordan Care Center and clients.”<br><br></div> <div>Kara has “solutions” to any activity situation; she thinks outside of the box, is creative and enthusiastic. She is adept at taking on an idea and following it through to completion, such as participating in the Miss Utah Wheelchair pageant, or leading other social events. A lot of the credit for the success Eden program goes to her, Miller says.<br><br></div> <div>All of Larsen’s responsibilities pale in comparison to her raison d’etre—building relationships with clients, families, and staff. It seems that Larsen is always able to rally support for her causes and fundraisers, as well as providing community volunteers for events. The intended consequence is that she does a wonderful job at keeping the community active at West Jordan Care Center to such an extent that the community has become a great supporter of the center’s mission and its clients.<br><br></div> <div>The Hero of the Year award recognizes an individual who works or volunteers in a group waiver home or an intermediate care facility for individuals with intellectual or developmental disabilities. </div> <div> </div> <h2 class="ms-rteElement-H2B">Neil Gulsvig</h2> <div><em>Not for Profit Trustee of the Year</em></div> <div> </div> <div><img class="ms-rtePosition-2" alt="Neil Gulsvig" src="/Issues/2015/October/PublishingImages/NeilGuisvig.jpg" style="margin:5px 10px;" />Neil Gulsvig is the inaugural recipient of the AHCA/NCAL Not for Profit Trustee of the Year award. Gulsvig was most recently the board chair for The Evangelical Lutheran Good Samaritan Society and prior to that served on the board in various committee leadership roles for four years of his six years’ total service. Good Samaritan has more than 240 locations across the country and is the largest not-for-profit provider of senior care and services in the United States.<br><br></div> <div>This award will recognize trustees who excel at being an effective board member. Key attributes include a strong commitment to faithfully carrying out the functions of the board and fostering effective board practices. A Trustee of the Year will demonstrate an unrivaled passion about the organization’s mission and a willingness to devote the time and energy necessary to be successful.<br><br></div> <div>“As an organization, Good Samaritan has benefitted greatly from Neil’s expertise and leadership,” David Horazdovsky, Good Samaritan’s president and CEO said. “He has devoted his entire professional life and career to senior living and health care service, and Neil’s contributions to better the lives of seniors is known by his colleagues and friends across the nation.”<br><br></div> <div>With 35 years as an innovator and leader in various capacities across the spectrum of long term care services, Gulsvig is perhaps best known for his years leading My InnerView. In 2005, he formed a joint effort with AHCA to promote and encourage the use of customer and staff satisfaction surveys at skilled nursing care centers. The same year, My InnerView published the first “National Survey of Consumer and Workforce Satisfaction in Nursing Homes,” which continued for several years.<br><br></div> <div>“Neil is receiving this award for his outstanding dedication and years of service to the field of senior living and long term care,” noted Steve Chies, current chair of AHCA’s Not for Profit Council and past national chair of AHCA/NCAL. “His amazing commitment to and love for the mission and ministry of Good Samaritan is evident to all. The entire AHCA/NCAL membership of over 12,000 skilled nursing care and assisted living centers appreciates Neil’s unwavering service to fostering quality outcomes and improving the lives of frail and vulnerable individuals.”<br><br></div> <div>Today, Gulsvig continues to help the long term care community transform how it provides services and supports and manages customers and employee feedback, as well as focusing on patient transitions. </div> <div> </div> <div></div> <div> </div> <h2 class="ms-rteElement-H2B"><img class="ms-rtePosition-1" alt="Bonnie Zeiler" src="/Issues/2015/October/PublishingImages/specialawards_BonneZeller.jpg" style="margin:5px 10px;" />Bonnie Zeiler, LPN, CDP </h2> <div><em>Assisted Living Nurse of the Year<br><br></em></div> <div>Bonnie Zeiler earned the nickname “Bonfire” because she brings passion and light to everything she does. As the program director of the memory care unit at The Village at Northrise—Homestead in Las Cruces, N.M., her passion is evident in the many initiatives and significant improvements she has spearheaded.<br><br></div> <div>Most notable are her efforts to better care for those living with dementia. Through staff education, a focus on alternative strategies, and family involvement, she has helped nearly eliminate the community’s off-label use of antipsychotic medications.<br><br></div> <div>Zeiler has devised many innovative ideas to focus on these residents, such as recruiting art students from the local high school to paint murals over The Village’s exit doors. The murals have significantly decreased exit-seeking behaviors among those in the memory care unit.<br><br></div> <div>For family members of residents who struggle to feel a part of their loved ones’ lives, Zeiler also created activities that engage the two. One popular annual event is Rock and Bowl—a night of oldies and bowling.<br><br></div> <div>A fellow staff member learned of Zeiler’s compassion firsthand after admitting her own mother.<br><br></div> <div>“Bonnie taught me how to live in Mom’s world… how to accept, respect, understand, and love her again; even how to laugh and connect with her again,” the staff member said. “Her ability to inspire and lead others is nothing short of amazing.”<br><br></div> <div>Another son of a resident wrote, “She is kind, considerate, and passionate about her residents. She went out of her way to make sure my mother was comfortable and peaceful during her final hours.”<br><br></div> <div>Zeiler is committed to fighting Alzheimer’s disease as well. She has twice led her Walk to End Alzheimer’s team to raise the most money among the company’s more than 500 centers.<br><br></div> <div>The NCAL Nurse of the Year award recognizes a licensed practical nurse or registered nurse who demonstrates outstanding compassion, supervisory success, and innovation.</div> <div> </div> <h2 class="ms-rteElement-H2B"><img src="/Issues/2015/October/PublishingImages/Jess-Kathy-1.jpg" class="ms-rtePosition-2" width="246" height="164" alt="" style="margin:5px 10px;" />Kathy Pietrocola and Jessica Vogel </h2> <div><em>National Assisted Living Week® Programming Award</em></div> <div> </div> <div>In 2014, the theme for National Assisted Living Week was The Magic of Music. The national observance aimed to celebrate the role music plays in the daily lives of assisted living residents.<br><br></div> <div>At The Chelsea at East Brunswick in New Jersey, staff saw the theme as a way to have residents “hit the road” and explore how local cultures and music are intertwined. Executive Director Kathy Pietrocola, Country Cottage Director Jessica Vogel, and their team took their residents on a journey for the ages. Residents virtually traveled throughout the United States in search of The Magic of Music.<br><br></div> <div>The community started off the week by taking residents to Nashville, where country artist Chris Raymond shared his music and experiences with “Music City.” Residents kicked up their boots with a seated line dance cleverly named “sit in your saddle” fitness.<br><br></div> <div>The next day, residents traveled to New Orleans to celebrate jazz music with a Mardi Gras parade. The community’s chef, Jason, whipped up a Taste of New Orleans, and residents tested their knowledge on Louisiana with some travelogue trivia.<br><br></div> <div>Las Vegas proceeded, where residents enjoyed a Frank Sinatra impersonator and a trip to Chelsea’s casino (where everyone was a winner). <br><br></div> <div>Subsequently, everyone headed on to Boston, where a local acapella group, The Spotswood Seniors, serenaded residents with classic love songs. The East Brunswick High School Musicians Club also offered a captivating showcase.<br><br></div> <div>The last stop was the Big Apple. The sights and sounds of New York City echoed throughout the halls, allowing residents to reminisce with their favorite Broadway show tunes.<br><br></div> <div>With each destination, The Chelsea at East Brunswick immersed residents and their friends and family into the unique culture of each city. Beignets in New Orleans, Yankee pot roast in Boston, and bourbon chicken in Nashville were just a few of the culinary delights residents enjoyed.<br><br></div> <div>The community’s The Magic of Music programming not only exemplified what National Assisted Living Week represents, but also celebrated the extraordinary individuals who make The Chelsea at East Brunswick their home. <br><br></div> <div>The NCAL National Assisted Living Week® Programming award recognizes an individual or community that demonstrates successful incorporation of the week’s theme into their activity plans, resulting in outstanding special activities and events for their residents, families, staff, and volunteers. </div> <br>	Here are brief stories about some of the most compassionate and accomplished caregivers in the profession: American Health Care Association/National Center for Assisted Living annual award winners.	2015-10-01T04:00:00Z	<img alt="" src="/Issues/2015/October/PublishingImages/specialawards_t.jpg" style="BORDER:0px solid;" />	Quality Awards;Caregiving;Management	AHCA/NCAL Annual Awards
Key Resources For Antibiotic Stewardship Strategies	https://www.providermagazine.com/Issues/2015/October/Pages/Key-Resources-For-Antibiotic-Stewardship-Strategies.aspx	Key Resources For Antibiotic Stewardship Strategies						Column
The Quality Forum	https://www.providermagazine.com/Issues/2015/October/Pages/The-Quality-Forum-CMS-Proposed-Rule.aspx	The Quality Forum	<img src="/archives/2015_Archives/PublishingImages/headshots/AndyKramer2015.jpg" alt="Andy Kramer, MD" class="ms-rtePosition-1" style="margin:15px 10px;" /><br>I understand why the far-reaching proposed rule changes for skilled nursing facilities/nursing facilities (SNFs/NFs) might seem overwhelming. That said, a solution to addressing the wide range of issues in the proposed rule is actually embedded in the rule itself. Virtually all of the requirements in the rule can be addressed through robust Quality Assurance and Performance Improvement (QAPI): Develop, implement, and maintain an effective, comprehensive, data-driven QAPI program that focuses on systems of care, outcomes of care, and quality of life (section 483.75). <br><br>Even while the rule is still in the “proposed” period, you can begin conducting comprehensive assessments of your resident care, engaging staff, and implementing all aspects of QAPI. If you start there, you will not only begin to address the QAPI regulations when they are final, but you will begin improving quality to meet all the standards of the revised rule.<br><br>Most of the concepts in the proposed rule are not new to the evolving expectations of care for persons needing post-acute or long term care. Between the content contained in QIS, the Affordable Care Act, questions being asked by hospitals or networks in your area, and growing expectations of residents and family, many of you have already begun elevating your game in many sections of the proposed rule. And if you haven’t, then the time to start is now.<br><br>QAPI has a long history in industry and a growing evidence base in health care, such that the Office of Inspector General recommended it in its February 2014 report to reduce adverse events in SNFs. The Centers for Medicare & Medicaid Services has been articulating QAPI approaches for SNFs/NFs in their “QAPI at a Glance,” among other publications, since 2012. Also, there are many other resources available to learn about the principles and implementation of QAPI programs.<br><br>QAPI can, and should, be an essential part of your evolving care. We have provided QAPI training, systems, and accreditation to nursing centers and have been able to demonstrate quality improvements in national studies of hundreds of nursing centers. With over 1,300 centers accredited based on meeting measurable standards for QAPI processes, we have observed struggling centers improve to at least average in survey performance. And with a comprehensive QAPI approach, we have observed statistically significant improvement in quality and occupancy among average and high-performing centers.<br><br>QAPI provides the ideal starting place to meet the new regulatory standard and growing expectations of long term and post-acute care providers. It can help you improve in a wide array of quality domains, and help you overcome varied challenges. <br><br>But QAPI is not just another program: It only works when it is adopted into an organization’s culture and daily routine, when you implement data-driven systems that accompany all of the care you provide, and when you engage all types of staff in the QAPI process. And when leadership exemplifies and commits to a QAPI philosophy throughout your organization.<br><br><em>Andy Kramer, MD, is a long term care researcher and professor of medicine who was instrumental in the design and development of the Quality Indicator Survey (QIS).</em>	Even while the rule is still in the “proposed” period, you can begin conducting comprehensive assessments of your resident care, engaging staff, and implementing all aspects of QAPI. If you start there, you will not only begin to address the QAPI regulations when they are final, but you will begin improving quality to meet all the standards of the revised rule.	2015-10-01T04:00:00Z		Management;Caregiving	Column

October 2015

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