This discussion article highlights the challenges of providing hospice care in nursing homes since the start of the COVID-19 (coronavirus disease 2019) pandemic and illuminates practice changes needed in nursing homes. The article provides an overview of the expectations of hospice care, explains the differences in delivering hospice care during the COVID-19 pandemic, examines social isolation and emotional loneliness and the role of familial caregivers, and describes policy changes related to the COVID-19 affecting hospice care delivery in nursing homes. This article answers the following questions: (1) How did residents receiving hospice care have their needs met during the COVID-19 pandemic? (2) What areas of nursing home care need to be improved through governmental policy and restructuring? This article also summarized the lessons learned as a result of the COVID-19 pandemic and provided practical implications for nursing, specific to changes in hospice care deliveries for nursing home residents.
Introduction Studies have reported higher infection and mortality rates from coronavirus disease 2019 (COVID-19) for disadvantaged groups in the U.S. population. However, racial and ethnic differences in fatality rates, which measure deaths among those infected, are not as clear. Objectives The objectives were to (1) estimate the fatality rate after COVID-19 infection by racial and ethnic groups and (2) determine the extent preexisting health conditions account for differences in fatality rate between the racial and ethnic groups. Methods Data for all adults aged 18 and older (n = 24,834) who had a confirmed COVID-19 infection captured in the electronic health records (EHRs) of a major health care organization (HCO) from the beginning of the pandemic to March 28, 2021 were used to estimate the fatality rates for three racial and ethnic groups: Hispanic, non-Hispanic African American, and non-Hispanic White. Elixhauser's comorbidity index was calculated using the enhanced ICD-9-CM and the ICD-10 diagnosis codes. Logistic regression models were used to compare differences in fatality between racial and ethnic groups. Odds ratios and 95% confidence intervals were reported for all models. Results The age-specific fatality rates non-Hispanic White, non-Hispanic African American, and Hispanic groups were 0.23%, 1.05%, 0.55% for age group 18–59 years old; 2.44%, 4.50%, 5.28% for 60–69; 5.42%, 10.11%, 8.49% for 70–79, and 17.33%, 20.79%, 20.39% for 80–90. After adjusting for age, sex, and preexisting conditions, the fatality risk remains significantly higher for non-Hispanic African American (adjusted odds ratio [adj. OR] = 1.85, 95% CI 1.41–2.44) and Hispanic individuals (adj. OR = 1.91, 95% CI = 1.53–2.39) compared to non-Hispanic White individuals. Conclusion Hispanic and non-Hispanic African American individuals have a higher risk of fatality from COVID-19 compared to non-Hispanic White individuals. The higher risk remains after adjusting for sex, age, and preexisting conditions. Health care providers could help to increase vaccination rates in these vulnerable populations by addressing the social and cultural barriers with their patients.
BackgroundAccording to the American Society of Health System Pharmacists (ASHP) and the American Society of Parenteral and Enteral Nutrition (ASPEN), the pharmacist is responsible for proper preparation of parenteral nutrition (PN), for control during the process and for the final product.The European Medicines Agency (EMA) and the United States Pharmacopoeia (USP) postulate that 100% of PN must be prepared with a gravimetric error <5% for larger volumes of 100 mL.Quality control of the elaboration process includes components and gravimetric tests, which are used to identify areas with potential errors and therefore areas that could be improved.PurposeTo evaluate the quality control established in PN elaboration for 6 months, to determine the number and types of errors, and to identify opportunities for improvement.Material and methodsA data collection notebook was designed for prior checking, which describes the type of error and the number of times it occurs. The process begins with preparation of the components required for each PN by the nursing assistant. Then the pharmacist checks the occurrence of the components, and records any discrepancies found. Finally, the nurse makes a second check before compounding the PN.Regarding control of the finished product, PN solutions were weighed checking that the gravimetric error did not exceed 3%. In the case of this limit being exceeded, possible causes were investigated and the preparation was repeated.Results1238 PN were performed (1127 adults, 111 paediatric). 109 errors were found in 62 PN (5% of the total), with an average of 0.1 errors per PN, distributed as shown in table 1.Abstract PP-026 Table 1Adult PNPaediatric PNError typePharmacistNursePharmacistNurseTotalLack of product3779356 (51%)Extra product861823 (21%)Misrepresentation1401015 (14%)Wrong product623415 (14%)Total65 (60%)15 (14%)14 (13%)15 (14%)109Regarding the gravimetric test, 9 PN (0.7%) had to be prepared again because the gravimetric error exceed the 3% limit.ConclusionQuality control of the PN has proven effective in detecting errors, noting that the second check can correct errors unnoticed in the first checkup. It is highly important that the staff involved are trained in advance to avoid errors during the process.No conflict of interest.
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