Nursing Assistants Detect Behavior Changes in Nursing Home Residents that Precede Acute Illness: Development and Validation of an Illness Warning Instrument

Boockvar, Kenneth S.; Brodie, Hazel; Lacks, Mph Mark

doi:10.1111/j.1532-5415.2000.tb04784.x

Cited by 65 publications

(60 citation statements)

References 23 publications

(21 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…[14][15][16] Guidelines, care paths, and other tools for assessing changes in condition and for the most common conditions associated with hospital readmissions, including heart failure, pneumonia, renal failure/dehydration, and urinary tract infections, as well as strategies to enhance advance care planning, are available. [17][18][19][20][21][22][23][24][25][26][27] Although implementing clinical practice changes in the NH setting is challenging for many reasons, 20,28-31 use of some of these guidelines and tools has been associated with reduced hospitalizations in the NH population. [32][33][34][35] A CMS pilot study demonstrated a 50% reduction in hospitalizations in 3 NHs in Georgia with high hospitalization rates associated with a set of clinical practice tools that includes many of those mentioned previously (Interventions to Reduce Acute Care Transfers or ''INTERACT'').…”

Section: Discussionmentioning

confidence: 99%

Frequency and Diagnoses Associated With 7- and 30-Day Readmission of Skilled Nursing Facility Patients to a Nonteaching Community Hospital

Ouslander

Díaz

Hain

et al. 2011

Journal of the American Medical Directors Association

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

Frequency and Diagnoses Associated With 7- and 30-Day Readmission of Skilled Nursing Facility Patients to a Nonteaching Community Hospital

Ouslander

Díaz

Hain

et al. 2011

Journal of the American Medical Directors Association

View full text Add to dashboard Cite

“…An additional strategy for reducing avoidable hospitalizations is the use of practice guidelines, care paths, communication, and other tools that assist NH health professionals in recognizing, reporting, and managing conditions, which may be helpful in bolstering NHs' ability to manage sicker residents. [30][31][32][33][34][35][36] For example, in a randomized trial conducted in several Canadian NHs, implementation of a care path for pneumonia with the support of a trained nurse was shown to be effective in reducing hospitalizations and related costs without greater mortality. 36 Similar tools were created as part of the larger CMS project at the Georgia QIO and are available on-line.…”

mentioning

confidence: 99%

Potentially Avoidable Hospitalizations of Nursing Home Residents: Frequency, Causes, and Costs

Ouslander

Lamb

Perloe

et al. 2010

J American Geriatrics Society

419

387

View full text Add to dashboard Cite

OBJECTIVES:To examine the frequency and reasons for potentially avoidable hospitalizations of nursing home (NH) residents. DESIGN: Medical records were reviewed as a component of a project designed to develop and pilot test clinical practice tools for reducing potentially avoidable hospitalization. SETTING: NHs in Georgia. PARTICIPANTS: In 10 NHs with high and 10 with low hospitalization rates, 10 hospitalizations were randomly selected, including long-and short-stay residents. MEASUREMENTS: Ratings using a structured review by expert NH clinicians. RESULTS: Of the 200 hospitalizations, 134 (67.0%) were rated as potentially avoidable. Panel members cited lack of on-site availability of primary care clinicians, inability to obtain timely laboratory tests and intravenous fluids, problems with quality of care in assessing acute changes, and uncertain benefits of hospitalization as causes of these potentially avoidable hospitalizations. CONCLUSION: In this sample of NH residents, experienced long-term care clinicians commonly rated hospitalizations as potentially avoidable. Support for NH infrastructure, clinical practice and communication tools for health professionals, increased attention to reducing the frequency of medically futile care, and financial and other incentives for NHs and their affiliated hospitals are needed to improve care, reduce avoidable hospitalizations, and avoid unnecessary healthcare expenditures in this population. J Am Geriatr Soc 58:627-635, 2010.Key words: nursing homes; avoidable hospitalizations; transfers; quality H ospitalization of nursing home (NH) residents can cause discomfort for residents, anxiety for their loved ones, morbidity due to iatrogenic events, and excess healthcare costs. Many of these hospitalizations may be preventable through better care in the NH or inappropriate, because the transfer exposes NH residents to additional risks associated with hospitalization, 1 without substantial potential benefit for the residents' clinical course or quality of life. Previous in-depth research on the overall frequency and costs of potentially avoidable hospitalizations of nursing home residents is limited. One study found that, in 2004, 23% of the $972 million spent on hospitalizations of long-stay NH residents in the state of New York were for ambulatory care-sensitive diagnoses (ACSDs), a proxy measure for potentially unnecessary hospitalizations. 2ACSDs include diagnoses such as angina pectoris, heart failure, chronic obstructive pulmonary disease, pneumonia, urinary tract infection, cellulitis, diabetes mellitus, and dehydration. 3 This is an underestimate of the overall costs of these hospitalizations, because short-stay residents, in whom hospitalizations are more common than long-stay residents, were excluded from this analysis. A study of hospital admissions from Canadian long-term care facilities found 55% to be due to a modified list of ACSD. 4 In an analysis of hospital transfers from eight Los Angeles NHs, experienced physicians using a structured implicit record re...

show abstract

“…These atypical signs are observed as absence of fever, weakness, falling, weight loss, physical dysfunction and cognitive decline [3,7,[12][13][14]. In addition, early signs of infection are very similar to, and also as diffuse as, signs of acute illness [12,15,16]. Changes, such as lethargy, weakness, decreased appetite, agitation, disorientation, dizziness, falls and delusions are reported to have high predictive values for acute illness in frail elderly [16].…”

mentioning

confidence: 91%

The Challenge of Infections in Frail Elderly: The Story of Mr. Nilsson

Sund‐Levander

Grodzinsky

2015

Clin Med Rev Case Rep

View full text Add to dashboard Cite

rectally. One morning nursing assistants (NA) observed that Mr. Nilsson was behaving differently, e.g. he did not feel well, expressed as "expression in the eyes", less appetite, lethargy and general signs of illness. They also observed respiratory symptoms. The NA continued to report about his changed condition for the next few days to the registered nurse (RN), who noted that he might have a cold but took no further action as he did not have a fever. His ear temperature was 37.6°C in the morning and 36.8°C in the afternoon the first day, and 37.2°C in the morning and 37.3°C in the evening the second day. Day six Mr. Nilsson's temperature is 38.1°C and hence the RN informs the general practitioner (GP), who takes no further action. There is no more RN documentation about his condition until day 16, when the RN order paracetamol due to increased body temperature (38.9°C). The next morning the nurse contacts the GP who prescribes antibiotics due to suspected pneumonia. The condition worsens and Mr. Nilsson dies on day 24. See flowchart over the 24 days in figure 1. DiscussionThis case illustrates the process from the first signs and symptoms of infection to diagnosis in an elderly person with severe cognitive decline and physical impairment. It is well known that nonspecific symptoms and lack of specific ones are common in NHR [9-11], contributing to a delayed diagnosis and treatment [10]. These atypical signs are observed as absence of fever, weakness, falling, weight loss, physical dysfunction and cognitive decline [3,7,[12][13][14]. In addition, early signs of infection are very similar to, and also as diffuse as, signs of acute illness [12,15,16]. Changes, such as lethargy, weakness, decreased appetite, agitation, disorientation, dizziness, falls and delusions are reported to have high predictive values for acute illness in frail elderly [16]. The complexity of detecting infections in NHR can be explained by difficulties in understanding and interpreting non-specific signs and symptoms and co-existing chronic diseases that blur the clinical picture. An individual that normally is confused, anxious and restless may become apathetic and infirm, or vice versa, when infection is suspected. On the other hand, an individual who normally is unrestrained could become more confused, aggressive, anxious and restless. As specific symptoms are often lacking [9][10][11] the presence of fever, in terms of > 38°C, is often evaluated as a significant symptom of illness and an important reason for taking further action. However, fever in frail NHR has been reported to be lower than traditionally stated [17][18][19]. In addition, the effects on body temperature from medication with paracetamol daily have to be considered. AbstractSigns and symptoms of infection in Nursing Home Residents (NHR) are often atypical with a lack of specific ones, causing a delay in diagnosis and treatment. The complexity of detecting infections in NHR can be explained by difficulties in understanding and interpreting non-specific signs and symptoms ...

show abstract

Nursing Assistants Detect Behavior Changes in Nursing Home Residents that Precede Acute Illness: Development and Validation of an Illness Warning Instrument

Cited by 65 publications

References 23 publications

Frequency and Diagnoses Associated With 7- and 30-Day Readmission of Skilled Nursing Facility Patients to a Nonteaching Community Hospital

Frequency and Diagnoses Associated With 7- and 30-Day Readmission of Skilled Nursing Facility Patients to a Nonteaching Community Hospital

Potentially Avoidable Hospitalizations of Nursing Home Residents: Frequency, Causes, and Costs

The Challenge of Infections in Frail Elderly: The Story of Mr. Nilsson

Contact Info

Product

Resources

About