Background and purpose: Skilled nursing facilities (SNFs) are penalized for hospital readmissions within 30 days. Medication errors often precipitate hospital returns. The Centers for Medicare and Medicaid Services mandates that health care providers must determine whether medications pose significant risks and implement corrective actions. Federal restrictions exist regarding nurse practitioners (NPs) in long-term care; however, NPs are efficient in the health care of patients requiring a SNF, including completing thorough medication reconciliation and correcting deficiencies. Local Problem: A needs assessment of a 90-bed SNF revealed inadequate medical coverage and no formalized program to reduce hospital readmissions, including a mandated medication reconciliation process. The problem contributed to an average 30-day readmission rate of 24.15%. Methods: The investigators sought to determine whether an NP-led medication reconciliation on admission would reduce hospital readmissions from a SNF. A pre- and postimplementation design was used to compare 30-day hospital readmission rates over a 30-day project period. Interventions: An evidence-based workflow process for systematic medication reconciliation was designed. A full-time NP used the workflow process to complete stabilization visits with medication reconciliation on each facility admission. Results: Results revealed a hospital readmission rate of 19.2% preimplementation and 13.5% postimplementation, reflecting a 29.7% decrease in the rate of hospital readmissions within a 30-day period. Conclusion: A chi-square analysis conveyed no statistical significance; yet, the positive benefits of NP intervention included reduced hospitalizations, increased revenue, improved quality measures and survey results, and preparation for the Centers for Medicare and Medicaid Services mandates. Implications for practice: Nurse practitioners have the necessary education and skills to provide quality care as well as achieving CMS mandates and improving quality measures in SNF settings.

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Errors in programming patient-controlled analgesia (PCA) pumps unfortunately occur in hospitals. At this hospital, quality improvement efforts were combined with staff development programming to decrease PCA pump errors. A significant decrease in PCA pump errors was found after 1:1 staff education.

The progressive nature of dementia marks this disease as a terminal illness in the advanced stage, and palliative care rather than curative treatment is indicated. The use of feeding tubes to deliver artificial nutrition and hydration at end of life is often part of the plan of care for people with dementia. Current evidence, however, suggests that tube feeding in advanced dementia is not beneficial and the burdens of the procedure and the feedings themselves outweigh any benefits. Evidence also reveals that healthcare providers may lack evidence-based knowledge about artificial nutrition and hydration to adequately inform families and surrogate decision makers. This article examines the evidence regarding use of artificial nutrition and hydration for patients with end-stage dementia and offers implications for home care clinicians.