| Creating Seamless Transitions in Challenging Tımes | https://www.providermagazine.com/Articles/Pages/Creating-Seamless-Transitions-in-Challenging-Tımes.aspx | Creating Seamless Transitions in Challenging Tımes | <p>“The best transition of care is when there is no transition at all.” James Lett, MD, coined this maxim many years ago, and it’s still the mantra of post-acute and long term care providers.<br></p><p><img src="/PublishingImages/Headshots/RajeevKumar.jpg" alt="Rajeev Kumar, MD" class="ms-rtePosition-1" style="margin:5px;width:145px;height:186px;" />“Of course, sometimes transitions are necessary, so we need to focus on doing this as seamlessly as possible,” says Rajeev Kumar, MD, CMD, FACP, chief medical officer of Symbria in Warrenville, Ill. “Even though we are well into the third decade of meaningful EHR [electronic health record] use, we still have discordant records, and what happens in the hospital doesn’t always filter back to the nursing home, and vice versa.”</p><h2>Working Toward the Ideal Transition</h2><p>The Centers for Medicare and Medicaid Services (CMS) defines transitions of care as the movement of a patient from one setting of care to another. This setting may include hospitals, ambulatory care practices, ambulatory specialty care practices, long term care facilities, home health, and rehabilitation facilities. It involves care coordination that ensures accurate clinical information is available to support medical decisions by both patients and providers.<br></p><p>“An ideal transition is grounded in knowing who the patient is—their goals, wishes, needs, and support systems,” says Kathleen McCauley, PhD, RN, FAAN, FAHA, professor of cardiovascular nursing at the University of Pennsylvania School of Nursing. “And there have to be partnerships that happen between the person and their network and where they’re going in the continuum.”<br></p><p>McCauley refers to a study she was part of—a qualitative analysis of what patients and families feel on discharge: “One thing that stood out was they often felt like they were out in the wilderness,” she says. “Good transitions anticipate what will be needed and help the patient and family prepare. You can’t do this in a 30-minute interview at the bedside. Everyone needs to work together, starting with identifying what’s important to the person and knowing what their goals are.” </p><h2>From Miscommunication to Connection</h2><p>Transitions have always been a challenge, plagued by miscommunication, lack of communication, and delays in communication. Value-based care initiatives have helped, suggests Kumar, “because no one wants to be penalized for high readmission rates or wasteful utilization.” This has motivated better communication between settings, but gaps still exist, he says, and while it may seem obvious that better communication is the answer, it’s easier said than done. <br></p><p>While EHRs have evolved over the years to improve communication, Kumar says, “Even today, we are facing challenges getting hospitals to understand what is happening in nursing homes. The hospitals and hospitalists are looking after their facilities’ interests and want to move COVID patients out sooner, but we need to protect our vulnerable residents, so we want patients tested first before they can enter our facilities.”<br></p><p>Nonetheless, some good has come out of the pandemic. Robert Choi, chief executive officer of Caraday Healthcare in Austin, Texas, says, “The pandemic revealed that hospital and skilled nursing facility partnerships are strong, and that nursing homes are seen as an essential part of the health care continuum. It also exposed opportunities for greater innovation, integration, and <a href="/Articles/Pages/Interoperability-Where-Do-We-Stand.aspx" target="_blank">interoperability</a>.”<br></p><p>Having a care management company or dedicated team to follow up on and track patients throughout the continuum can help promote seamless movement. “We formed our own home health and home-based care program to navigate patients from the hospital to the skilled nursing facility to home,” Choi says. “We also have strong partnerships with physician groups through the continuum of care who are essential across these transitions.” <br></p><p>Choi says his company has focused its internal analysis, research, and development of systems and processes with the goal of facilitating a safe discharge home. “We are building integrations and working with our health care partners and physicians to ensure we aren’t beholden to 17-plus different communication platforms and software subscriptions,” he says.<br></p><p>Despite these kinds of advances, data exchange continues to be a challenge. “We always strive to keep open lines of communication and provide real-time information,” Kumar says. “And we continue to highlight the challenges related to EHRs and the importance of nursing homes having access to real-time data. In particular, real-time medication reconciliation is crucial.”</p><h2>Warm Handoffs Are Hot</h2><p>Warm handoffs have always been shown to be effective, Kumar notes. Communication is important, but sometimes a lack of time gets in the way. “However, a quick text or a two-minute phone call can be a tremendous help when a patient is being transferred,” he says. “In fact, it goes a long way to help the physician and care team understand what is happening with that patient. It’s important to put some time and effort into it.” <br></p><p>Kumar says that it is also essential to have a protocol for “mandatory warm handoffs.” One option is to have a dedicated liaison who can talk to families, patients, and providers when patients leave or come back to the facility. That can go a long way toward ensuring patient safety, he says.<br></p><p>“It would be helpful to have nurse practitioners onsite who are trained in transitions of care and who can be contacted if a patient experiences an acute change,” McCauley adds. “They can focus on putting the pieces together and keeping patients out of trouble and, whenever possible, out of the hospital.”<br></p><p>It helps to have a good rapport with hospitalists so that patient transfers aren’t the only time providers initiate communication. “Periodically I go to their meetings, and sometimes they ask me to do educational presentations,” Kumar says. “For instance, I’ve talked about the Beers list and medications that should be prescribed carefully, particularly in frail, older patients.”<br></p><p>It also can help, McCauley suggests, to have tip sheets or checklists to address problems the patient is likely to experience, such as constipation or ambulation challenges. This can help prevent surprises and issues that can fall through the cracks after a transition. <br></p><p>Telemedicine helped enable virtual communication during the pandemic. However, Choi notes, “As a veteran of telemedicine and virtual care, I am the largest supporter of digital health. However, a telemedicine visit doesn’t solve the need for more information sharing and care coordination. There is a lot of communication and interactions among multiple parties that need to happen. There also are processes that need to be designed and implemented between health care ecosystem partners.”</p><h2>Education Makes a Difference</h2><p>“The tool I’ve found to be most useful is education,” Kumar says. “People want to do the right thing, but there is a lot of misinformation, doubts, and questions. Having something like a one-on-one dialogue or a webinar to ensure everyone has consistent, up-to-date information helps.” <br></p><p>The need for education isn’t limited to providers and staff. “Sometimes families or patients misunderstand what they are told, and by the time they come to us, they can have a lot of misconceptions,” he says. “First we need to sit down and find out where they’re coming from and what happened. It’s all about transparency, honesty, and humility.”<br></p><p>Family communication and education also need to involve what the patient will need on returning home and what that involves, McCauley says. “We don’t have a system designed to meet the needs of elders when they go home. We expect family members to deliver care that would be challenging for a trained nurse, and the patient is stuck in the middle.”<br></p><p>Strong partnerships and consistent, ongoing communication between nursing homes and their primary care provider are key to ensuring no one feels that they’re in the wilderness or being asked to provide care that is beyond their skill and knowledge levels.<br></p><p>Most people are open to communication “if you take a blame-free approach and not point fingers,” Kumar says. “If there is a problem at the other end, we need to be able to talk about it, and we expect them to tell us if we could have done something better or different.” It is essential to espouse patient-safety culture with a focus on brainstorming for success instead of placing blame or making excuses. “We need to prioritize patient-safety culture to enable everyone to perform at their best,” he says. </p><h2>The Road Home</h2><p>“In our research, the most common goal patients have is to go home, live and function in their house, and not be a burden,” McCauley says. “That’s a phenomenal goal, but first you have to be safe, be able to make or get meals, take medications safely, and so on. You have to participate in physical therapy to get stronger and have the stamina to care for yourself and not deteriorate.<br></p><p>“Using goals as a driver is a way to get people motivated and help them appreciate small successes in physical therapy. “ <br></p><p>To identify these goals, it is essential to give patients and families, including family members who know the patients and their history, a place at the table and really listen to their goals and expectations. It’s important to realize they may have unrealistic expectations.<br></p><p>To help them focus on what they can do and to set realistic expectations, “We need to find out what gives them joy and what quality of life means to them,” McCauley says. “Start with what’s important to the patient, and then you can put a plan into place that includes good symptom management.”</p><h2>When Readmissions Happen</h2><p>It’s imperative to look at each readmission and understand what happened, Kumar says. “We do a root-cause analysis of every hospitalization—what happened, what caused it, and if/how it was avoidable.”<br>McCauley says that while it’s essential to prevent avoidable readmission, there are times when it’s appropriate to send a patient out.<br></p><p>“An urgent visit with the physician is better than an ER [emergency room] visit, and an ER visit is better than a hospitalization. But we need partnerships between nursing homes and the hospital to plan, communicate, and determine when a transfer is essential and what it will take to ensure a smooth transition.”<br></p><p>Putting all the pieces in place to ensure smooth transitions of care is easier than it used to be because value-based care principles and technology are available. However, transitions aren’t yet as smooth as they can be. Everyone has been stretched, but there will be greater opportunities to improve care transitions as the entire health care industry gains bandwidth. Then, all the lessons learned will present ways and means to re-evaluate and re-engineer gaps in care and communication. <br></p><p>Read More: <a href="/Articles/Pages/Make-Advance-Directives-Mobile.aspx">Make Advance Directives Mobile</a></p><p><em>Joanne Kaldy is a freelance writer and communications consultant based in Harrisburg, Pa.</em></p> | Care coordination between nursing homes and hospitals is critical to ensure a timely exchange
of clinical information. | 2021-10-01T04:00:00Z | <img alt="" src="/Articles/PublishingImages/2021/1021/1021_CF1.jpg" style="BORDER:0px solid;" /> | Culture Change;Quality | Cover Feature | Joanne Kaldy | 48 | 10 |
| Getting Physical for Mind, Body, and Spirit | https://www.providermagazine.com/Articles/Pages/Getting-Physical-for-Mind-Body-and-Spirit.aspx | Getting Physical for Mind, Body, and Spirit | <p>There is no question that physical activity has tremendous benefits for everyone, including older adults. But enabling and implementing activities and programs has been challenging during the pandemic.<br></p><p><span><img src="/PublishingImages/Headshots/KevinO%27Neil.jpg" alt="Kevin O'Neil" class="ms-rtePosition-1" style="margin:5px;width:135px;height:174px;" /></span>Now providers are grappling with ways to get residents active and strong while planning for ways to maintain physical conditioning during future quarantines or other crises. <br></p><p>“Our residents are mostly excited to get out and be more active and social, but we have to be cautious because there has been some muscle wasting and strength decline due to the pandemic-related lockdowns,” says Kevin O’Neil, MD, CMD, chief medical officer of North Carolina-based ALG Senior.<br></p><p>“While we made a concerted effort to do things creatively to engage them in the past year and a half, the ability to get out and spend time with family, friends, and other residents has really created a welcomed energy for residents.”</p><h2>Body, Mind, Spirit, and Safety</h2><p>Physical activity is a key factor in the prevention of numerous diseases, including diabetes, cardiovascular disease, stroke, and even some types of cancer. It is also associated with improved mental health, delays in the onset of dementia, and quality of life.<br></p><p>“We know physical activity plays a major role in fitness and training, as well as falls prevention,” O’Neil says. “Fitness involves the mind, body, and soul. What happens in one area affects the others.” However, he stresses, “We need to make sure physical activity is safe.”<br></p><p>To promote safe exercise, it is important to start by determining each person’s baseline and limitations. The Exercise Assessment and Screening for You (EASY) is one tool for this. It was developed specifically to help older adults, their providers, and others (such as physical therapists and lif-enrichment staff) to identify what types of exercise or activities can be tailored to people’s needs, interests, and abilities.<br></p><p>Screening in this population, say the authors, should be a dynamic process where participants are engaged to appreciate the importance of regular exercise and motivated to participate as much as possible on an ongoing basis. It is a paradigm shift from traditional screening approaches that focus on the benefits of physical activity. EASY involves six questions:<br></p><ul><li>Do you have pains, tightness, or pressure in your chest during physical activity (walking, climbing stairs, household chores, similar activities)?</li><li>Do you currently experience dizziness or lightheadedness?</li><li>Have you ever been told that you have high blood pressure?</li><li>Do you have pain, stiffness, or swelling that limits or prevents you from doing what you want or need to do?</li><li>Do you fall, feel unsteady, or use an assistive device while standing or walking?</li><li>Is there a reason not mentioned why you would be concerned about starting an exercise program?</li></ul><p>“If someone answers ‘yes’ to any of these questions, it’s important to have a physician or nurse conduct a further evaluation,” says O’Neil. “We have to rely on clinical partners to help assess and identify patients who may need special attention or additional assessments.”</p><h2>Continually Monitor</h2><p><img src="/Articles/PublishingImages/2021/1021/CF2_ARISE.gif" class="ms-rtePosition-2" alt="" style="margin:5px;width:479px;height:623px;" />There are other assessments, including the ARISE Flowchart, which provides an algorithm for decision making about fall risk and possible interventions to build strength and balance and improve gait.<br></p><p>Kelly Cooney, CCC-SLP, CHC, vice president of clinical compliance at California-based Therapy Specialists, a HealthPRO-Heritage company, says, “In skilled nursing, we are conducting quarterly MDS [minimum data set] assessments and identifying people with changes in function, range of motion, and fall risk, but we should be looking at residents even more frequently so we know their fitness level and what barriers there are to them participating in fitness activities or outings.<br></p><p>“We have been doing a lot of bus rounds,” she adds. “Getting on and off a bus is no joke, particularly if someone is deconditioned.”</p><h2>Start Small, Go Slow</h2><p>“Our residents have been somewhat confined during the past year, so we have to reintroduce them to activities and exercise slowly, whether they are enthusiastic and eager to get out and about or they are hesitant,” says O’Neil. <br></p><p>For those residents who are eager, he says, “We bring them out to activities and monitor them to ensure their safety. For those who are hesitant, we bring activities to them—things to keep them engaged—and slowly start to get them more engaged.”<br></p><p>Even for those who are enthusiastic about engagement, O’Neil says, “We started with three-person groups, then five people, then seven. That’s as large as we’ve gotten so far.”<br></p><p>To keep people’s energy and motivation up, as well as to keep them safe, O’Neil says, “We can’t just plug in a video. We need activities with a trained instructor guiding the program. We want to look for issues or red flags that could indicate a problem that needs to be addressed.”<br></p><p>Many older adults haven’t participated in balance and resistance training during the pandemic, so they will need to focus on these, not only to improve their mobility and reduce their fall risk but also to increase their confidence. One option is Tai Chi, which has been shown to be effective in improving balance and coordination, as well as stability and flexibility. </p><h2>Can’t Wait for ‘When Things Open’</h2><p>“There are a lot of people, including residents and families, saying, ‘I will be more active and exercise more when things open up.’ We just can’t wait for this. We need to figure out how to make the most of the ‘now,’” says Cooney. “We need to get used to doing things we need and want to do that aren’t dependent on the public emergency.”<br></p><p><img src="/PublishingImages/People%20on%20the%20Move/POTM%202021/1021/potm_KellyCooney.jpg" alt="Kelly Cooney, RN" class="ms-rtePosition-2" style="margin:5px;width:147px;height:186px;" />This might mean virtual groups for exercise and activities, things that can be held in a room with staff onsite and the leader at a remote location, she says. “We can’t wait to hold programs and activities like they used to do. We need to figure out how to do things when our facilities are open and when they’re closed.”<br></p><p>For instance, she notes, “We have a Healthy Living On-The-Go program that involves prerecorded items that bring expertise to places where they don’t have it onsite, such as chair Zumba classes, ‘laughter is the best medicine’ activities, and education about topics like hydration.”</p><h2>Re-establishing Routines</h2><p>Getting out after a year in isolation is a big change for everyone. “We’ve learned how to help people feel more secure and safe. For many people, this means creating a comfortable and familiar routine,” Cooney says. During the pandemic, sitting in their room became the routine for many residents, she says. “We have to establish new routines that give them back some joy and control.”<br></p><p>At the same time, she stresses that it is important to find a way to maintain some of these new routines if another lockdown or quarantine were to happen. “These are things we all want to be paying attention to and knocking down barriers to participation,” she says.<br></p><p>To help, Cooney says, occupational therapists can create occupational profiles on residents, figuring out what they love to do, what creates joy, and what is meaningful to them. Then they can identify which activities or programs will bring people out and enhance their quality of life.<br></p><p>Getting to know each resident is essential, Cooney says. “By finding what they love to do, we can get them out and doing things they enjoy safely,” she says, adding, “I like to tap into other residents who are outgoing to reach out to more reticent people and get them involved.”<br></p><p>Sometimes, it’s about small steps, Cooney emphasizes. “We have a Get Up and Get Connected program to help residents practice self-care and calming techniques for when they feel anxious,” she says.</p><h2>Role For Therapists</h2><p>Don’t assume that someone can’t move safely or be active because they are old or frail, cautions Colleen Hergott, PT, DPT, assistant professor and interim chair of the Department of Physical Therapy at the Augusta University College of Allied Health Sciences. “Health is negatively affected by being inactive. At a minimum, we need to focus on decreasing sedentary time and increasing movement,” she says.<br></p><p>A physical therapist (PT) can help by performing an assessment and developing a plan to optimize balance, strength, and mobility, she says. For those who are reluctant to become more active due to concerns about safety or falls, the PT can identify compensatory strategies such using a cane or walker that may provide a temporary boost in confidence to get out and be more active.<br></p><p>Of course, don’t forget the emotional and psychological aspects of physical activity. “It’s all in the delivery,” says Hergott. “We have to make it fun for them to get active. We have to be enthusiastic and energetic in our efforts. They don’t want to hear the negative consequences of being inactive. We have to make the message positive: ‘What matters most to you? These recommendations will help you get there.’”</p><h2>Team Takes the Field</h2><p>Whatever approach taken to enable and encourage residents to pursue safe physical activity, success depends on the team.<br></p><p>“Partnerships, such as between therapy providers and life enrichment teams, can’t be overstated. Working together, we can identify what brings joy to residents, what limitations or barriers they face, and how to get and keep them safely active. If we fail to do this, inactivity becomes a cycle and people continue to decline,” says Hergott. <br></p><p>“There are so many health benefits of physical activity, and some are immediate. When we are focusing on balancing physical health, disease management, quality of care, and quality of life, physical activity needs to be in the mix in a meaningful way.” </p> | While residents are excited to be more social, providers must screen them carefully to determine fitness levels for each activity. | 2021-10-01T04:00:00Z | <img alt="" src="/Articles/PublishingImages/2021/1021/1021_CF2.jpg" style="BORDER:0px solid;" /> | Caregiving;Mental Health | Cover Feature | Joanne Kaldy | 48 | 10 |
| Taking the Mystery Out of Seizures in Older Adults | https://www.providermagazine.com/Articles/Pages/Taking-the-Mystery-Out-of-Seizures-in-Older-Adults.aspx | Taking the Mystery Out of Seizures in Older Adults | <p>Epilepsy and seizures are more common in the nursing home than in any other population. In fact, epilepsy is the third-most common neurological disorder affecting older adults. “Seizures often cause panic,” says Ilo Leppik, MD, FANN, professor of pharmacy and neurology and director of the Epilepsy Research and Education Program at the University of Minnesota. <br></p><p>“Because they can be scary and staff are unsure how to handle them, they often send patients out to the emergency room [ER].”<br></p><p>It is time to take the mystery out of epilepsy by developing and promoting protocols and a streamlined approach to treating this condition, he says, especially new-onset seizures.<br></p><p>The good news, Leppik says, is that there seems to be a growing interest in the issue. He is currently working on a survey/study to gain insights into how facilities approach managing a first seizure in nursing home residents. In the meantime, much clinical knowledge and evidence are available to help ensure the best possible care for people who have epilepsy or experience a seizure.</p><h2>Why Epilepsy? Why Now?</h2><p>According to the Centers for Disease Control and Prevention (CDC), about 3 million adults in the United States aged 18 or older have active epilepsy, and about a million of these are 55 or older. The growing incidence of epilepsy in the elderly is linked to the increased prevalence of stroke, dementia, and brain tumors. The Cardiovascular Health Study confirmed that patients with a history of stroke have a higher risk of developing epilepsy. <br></p><p>“The number of people who develop epilepsy in the nursing home is about 12 times higher than in the community at large, and about 1.6 percent of residents develop epilepsy every year,” Leppik says. Individuals age 60 and older also are about twice as likely to develop a first unprovoked seizure than younger people, and they are more likely to have subsequent seizures in the first year after the initial event.</p><h2>Sometimes Secretive Nature of Seizures</h2><p>People often think of seizures as involving convulsions. However, in fact, seizures can be much more subtle, particularly in older people. For instance, they may exhibit brief episodes of memory problems, confusion, falls, or dizziness. A resident may stare into space; wander; be unable talk, answer questions, or respond to instructions; or exhibit a chewing motion with the mouth. These may last a few minutes or hours. If staff aren’t trained to recognize these behaviors as signs of a seizure, a patient’s epilepsy may go undiagnosed and untreated. <br></p><p>There are three main categories of seizures: generalized-onset, focal-onset, and unknown-onset. Generalized-onset seizures affect both sides of the brain, or neurons on both sides simultaneously. For these types of seizures, symptoms may include sustained rhythmical jerking movements, muscles becoming limp or weak, muscles getting tense or rigid, brief muscle twitching, or epileptic spasms where the body flexes and extends repeatedly. People also may experience absence seizures, which are staring spells. <br></p><p>Focal-onset seizures can start in one area or group of neurons in one part of the brain. Focal-onset aware seizures happen when the person is awake and aware during the seizure. This used to be called a simple partial seizure.<br></p><p>Focal-onset impaired awareness, which used to be called a complex partial seizure, is when the person is confused or their awareness is affected in some way during the seizure. Symptoms may include jerking, limp or weak muscles, tense or rigid muscles, brief muscle twitching, and repeated movements such as clapping or rubbing hands, lipsmacking or chewing, or running. Patients also may exhibit changes in sensation, emotions, thinking or cognition, gastrointestinal sensations, waves of heat or cold, goosebumps, or a racing heart. <br></p><p>If an unknown-onset seizure of this type isn’t witnessed by anyone, it may be diagnosed later as a focal or generalized seizure. </p><h2>Education Needed</h2><p>When people think of epileptic seizures, they often imagine what used to be called Grand Mal seizures. These are convulsions and can be very alarming for staff, Leppik says. People begin to jerk around and might lose control of their bladder or bowels. These types of seizures are easy to recognize, but when staff don’t know how to handle them, they may send patients to the hospital when they could be managed onsite. <br></p><p>“The first thing we need to do is educate everyone on what to do in terms of first aid for convulsive seizures,” Leppik says. “We have cards in our clinic we hand out to people with this information. In addition, every facility should have a protocol in place.” He suggests that videos and other materials can be helpful as well. <br></p><p>Seizures with more subtle signs are easy to miss or misinterpret. Sometimes practitioners and other team members need to be detectives and ask a lot of questions to determine if someone is indeed having seizures.<br></p><p><img src="/Articles/PublishingImages/2021/1021/RebeccaO%27Dwyer.jpg" alt="Rebecca O'Dwyer" class="ms-rtePosition-1" style="margin:5px;width:165px;height:210px;" />For example, Rebecca O’Dwyer, MD, assistant professor in the Department of Neurological Sciences at Rush Medical College, had an older patient who was excitedly looking forward to a family celebration. On the day of the event, his family reported that he “wasn’t quite himself, and he wasn’t excited.” They brought him to see O’Dwyer because he had no memory of the day and insisted he hadn’t been at the event.<br></p><p>“When we took a deeper history, we discovered he had days where he would just stare into space,” she recalls. It turns out that he was having seizures, but no one realized it. “The nice thing about seizures in the elderly is that when you get them under control, [the resident’s] cognition often improves,” says O’Dwyer, which was what happened with this patient.</p><h2>Hold Off on Hospitalization</h2><p>“We’ve found that many facilities don’t have a protocol for seizures, and staff often don’t know what to do when one occurs. As a result, they often send patients to the hospital or ER,” Leppik says, which is disruptive, costly, and often unnecessary. “Most patients recover in a few minutes, so the seizure is often over by the time the ambulance arrives.” <br></p><p>This situation can be avoided by having a seizure protocol that all staff are trained to follow, Leppik says. This would detail what to do to keep the patient safe and comfortable, what medications (if any) to use, and when it might be appropriate to send them to the ER. “A uniform plan will prevent confusion and give staff the confidence to care for patients who experience a seizure,” he suggests.<br></p><p>O’Dwyer adds, “Keeping the patient safe and comfortable can do more good than calling 911. Staff having appropriate training can give them the confidence to handle seizures safely and avoid unnecessary transfers to the hospital or ER.” <br></p><p>This means making sure they know what not to do as well as what to do.<br></p><p>For instance, O’Dwyer notes that people used to put something in a seizing person’s mouth to keep them from biting their tongue. “You don’t want to put anything in their mouth. They could bite you. Just get them flat, preferably on their side on the floor. Don’t try to stop their arms and legs from convulsing. Make sure there is nothing in their hands.” It can seem like a seizure goes on forever, O’Dwyer says, but in reality, it usually is only a few minutes. <br></p><p>If this is the person’s first seizure, O’Dwyer says, “Look for common triggers for when the patient is back to baseline.” These could include fever, stress, or lack of sleep. Often a further workup is necessary to determine what’s happening with the patient. A follow-up with a neurologist is important, but not immediately necessary. <br></p><p>However, O’Dwyer says, “Try to figure out why the patient had a seizure and follow up. If someone has an established diagnosis of epilepsy, their seizures will likely look similar every time. And this is important to know as well.” If the person becomes limp on one side, one side of the face droops, or doesn’t come back to baseline within 30 minutes, then consider that the patient has had a stroke and that an emergent evaluation will be necessary, she says.</p><h2>Meds or No Meds?</h2><p>Jumping right to pharmacologic treatment may not be the best intervention for long term care residents. All antiseizure drugs have significant drug interactions that may cause cognitive side effects. “We need more research to determine if it is appropriate to treat seizures with medications after the first seizure,” says Leppik. It may be advisable to monitor the person to see if they have additional seizures, realizing this could be an isolated event and not a condition requiring lifelong treatment. In fact, many older adults don’t experience another seizure episode after the first one.<br></p><p>Candidates for antiseizure medication therapy include those with recurrent seizures, an onset of epilepsy, or a clear predisposition for seizures. When medication is determined to be appropriate, it is recommended to start low and go slow with one antiseizure drug. </p><h2>Learning More for Better Care</h2><p>“We really need to get a current level of understanding and practice. Then we can develop resources for education programs based on what we find. We can’t develop these until we know what the level of knowledge and treatment is for facilities and practitioners,” says Leppik.<br></p><p>At that point, consistent information, clinical evidence, and best practices can be shared to improve seizure and epilepsy care and maximize quality of life for residents and confidence and peace of mind for staff. <br></p> | Staff need to be aware that seizures may present simply as confusion or an inability to respond to questions and may last a few minutes or hours. | 2021-10-01T04:00:00Z | <img alt="" src="/Articles/PublishingImages/2021/1021/1021_CF3.jpg" style="BORDER:0px solid;" /> | Management;Clinical | Cover Feature | Joanne Kaldy | 48 | 10 |