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The Consultant pharmacist, 2015
Behavioral cues to expand a pain model of the cognitively impaired elderly in long-term care
open access to scientific and medical research
The Consultant Pharmacist, 2007
To determine if there were any differences in fall risk and actual falls between those who were p... more To determine if there were any differences in fall risk and actual falls between those who were prescribed and those who were not prescribed psychotropic and psychoactive medications in a skilled nursing facility. An observational, retrospective cohort study of prospective patient data in a skilled nursing facility. A public skilled nursing facility of more than 100 beds. Patient charts and consultant pharmacists' drug regimen review monthly report records for 177 patients who were residents for 30 or more days over a 19-month period during 1996-1997 were tabulated. A fall risk using an assessment method that incorporated patient fall history, conditions, diseases, and medications associated with falls was performed on each resident. Patient demographics, medication usage, fall risk, and fall occurrences. Falls occurred in 107 of 177 (60.5%) residents over the study period. There were 428 documented falls. Fall rates appeared to be directly related to the number of psychotropic drugs, but not other psychoactive medications, until two or more were used concurrently. Preliminary evidence suggests multiple psychotropic and psychoactive drugs may increase the risk of falls in a skilled nursing facility in proportion to the total load of these agents. Minimization of inappropriate prescribing of psychotropic and psychoactive medications in elderly nursing facility residents, as mandated by current federal guidelines, may affect the risk of falls in nursing facility patients.
Pharmacy Practice (Internet), 2007
The purpose of this study was to determine if there were any differences in hospitalization rates... more The purpose of this study was to determine if there were any differences in hospitalization rates due to total psychoactive drug "load" between those using and not or formerly using psychotropic and psychoactive medications in a skilled nursing facility; to determine if the diagnosis of dementia and the change in use and load of psychotropic and psychoactive drugs influenced hospitalization rates. Methods: An observational retrospective cohort study was conducted of patient chart, facility disposition changes and consultant pharmacist reports data from a skilled nursing facility of more than 100 beds. Some177 patients resident for 30 or more days over a 19 month period of 2978 patientmonths data were tabulated. A monthly repeatedmeasures assessment method that incorporated all conditions, diseases and medication changes was done on each resident to determine patient demographics, medication usage, and hospitalizations. Results: The rates of hospitalization ranged from 0.04 to 0.07 per patient/month for any psychoactive usage in those with and without dementia as a diagnosis. The rate of hospitalization during the study period for those with no current psychotropic nor regular psychoactive usage was 0.02 and 0.03/pt./month for those respectively with and without the diagnosis of dementia, yet 86% of this sample had used psychotropics or other psychoactive drugs before the period of observation. Conclusion: Preliminary evidence is offered that suggests psychotropics and psychoactive drugs and the total "load" of these drugs may be associated with an increase in the rate and risk of all hospitalizations within a single skilled nursing facility.
Journal of the American Pharmacists Association, 2009
continuing pharmacy education (cPE) credits: See learning objectives below and assessment questio... more continuing pharmacy education (cPE) credits: See learning objectives below and assessment questions at the end of this article, which is ACPE universal activity number 202-000-09-122-H01-P in APhA's educational program. To take the CPE test for this article, go to www.pharmacist. com/education, and follow the links to the APhA CPE center. disclosure: Other than continuing education programs developed by the authors or APhA and mentioned as resources for more information, the authors and APhA's editorial staff declare no conflicts of interest or financial interests in any products or services mentioned in this article, including grants, employment, gifts, stock holdings, or honoraria.
The Consultant pharmacist : the journal of the American Society of Consultant Pharmacists, 2015
Don't let a fear of falling keep you from being active. The good news is that there are simpl... more Don't let a fear of falling keep you from being active. The good news is that there are simple ways you can prevent most falls. Stay physically active. Regular exercise makes you stronger. Weight-bearing activities, such as walking or climbing stairs, may slow bone loss from osteoporosis. Lower-body strength exercises and balance exercises can help you prevent falls and avoid the disability that may result from falling. Here are some fall prevention tips from Go4Life: l Have your eyes and hearing tested often. Always wear your glasses when you need them. If you have a hearing aid, be sure it fits well, and wear it. l Find out about the side effects of any medicine you take. If a drug makes you sleepy or dizzy, tell your doctor or pharmacist.
The Consultant Pharmacist the Journal of the American Society of Consultant Pharmacists, May 1, 2013
An integral concern across care settings is the prompt intervention for patients suffering with p... more An integral concern across care settings is the prompt intervention for patients suffering with pain. Long-term care (LTC) settings present with unique challenges to assess and manage pain in resident populations. Pain assessment is especially challenging, because residents have varying degrees of cognition to communicate their pain, and clinician/staff knowledge of pain symptoms may be lacking. The purpose of this research was to improve the measurement of pain and outcomes of care for the elderly residing in skilled nursing care, especially those with cognitive-impairment. The specific aims of this study were to: 1) Determine the magnitude of the relationship between pain behaviors and a measurement model hypothesized for pain; 2) Test the construct validity of a pain measurement model; 3) Examine the concomitance of pain and cognition in a three-year longitudinal analysis. The research questions answered: 1) Is there a difference in the prevalence of pain in cognitively intact ve...
The Consultant pharmacist: the journal of the American Society of Consultant Pharmacists
This paper describes a 200-hour senior care clerkship for pharmacy students over a five-year peri... more This paper describes a 200-hour senior care clerkship for pharmacy students over a five-year period from 1998-2003. This clerkship used community long-term resources of a 160+ bed skilled nursing facility, adult day care, and senior citizen centers involving medicine, pharmacy, and nursing preceptors. The facility consultant pharmacist was the primary preceptor of students. He conducted pharmacy rounds and daily patient case reviews three times per week. He provided monthly drug regimen review (DRR) and quarterly drug utilization review (DUR) to the skilled nursing facility and, as needed, consultation and therapeutic recommendations to the adult day care center and the senior citizen center. A 200-hour clerkship was developed with multidisciplinary preceptor experiences to orient internal and external PharmD students to long-term care adult consultation with the attending physicians and nurses in the three sites. Each student prepared for physician rounds by performing an intensive...
The Consultant pharmacist: the journal of the American Society of Consultant Pharmacists
Hospital Pharmacy, 2007
Purpose To document and compare the outcomes from monthly drug regimen review recommendation acce... more Purpose To document and compare the outcomes from monthly drug regimen review recommendation acceptance and rejection in one skilled nursing facility by one consultant pharmacist (CP) in the fourth year of evaluation with the prior 3 years' data. Method A non-randomized, observational, prospective cohort study with all patients being residents for at least 30 days over the 12-month period (October 1, 1997 to September 30, 1998) in a skilled nursing facility with more than 100 beds. The admission problem-oriented records of all patients and their respective CP reports were screened for pharmacotherapy recommendations and subsequent acceptance and rejection on a monthly, repeated-measures basis for 12 months. There were 2,004 monthly drug regimen review (DRR) reports. The percentage of DRR reports that made recommendations was tabulated. Written recommendations made to attending physicians that were either accepted or rejected within 3 months were analyzed. The charges for adverse...
The Journal of nursing education, 2013
The Consultant pharmacist, 2015
Behavioral cues to expand a pain model of the cognitively impaired elderly in long-term care
open access to scientific and medical research
The Consultant Pharmacist, 2007
To determine if there were any differences in fall risk and actual falls between those who were p... more To determine if there were any differences in fall risk and actual falls between those who were prescribed and those who were not prescribed psychotropic and psychoactive medications in a skilled nursing facility. An observational, retrospective cohort study of prospective patient data in a skilled nursing facility. A public skilled nursing facility of more than 100 beds. Patient charts and consultant pharmacists' drug regimen review monthly report records for 177 patients who were residents for 30 or more days over a 19-month period during 1996-1997 were tabulated. A fall risk using an assessment method that incorporated patient fall history, conditions, diseases, and medications associated with falls was performed on each resident. Patient demographics, medication usage, fall risk, and fall occurrences. Falls occurred in 107 of 177 (60.5%) residents over the study period. There were 428 documented falls. Fall rates appeared to be directly related to the number of psychotropic drugs, but not other psychoactive medications, until two or more were used concurrently. Preliminary evidence suggests multiple psychotropic and psychoactive drugs may increase the risk of falls in a skilled nursing facility in proportion to the total load of these agents. Minimization of inappropriate prescribing of psychotropic and psychoactive medications in elderly nursing facility residents, as mandated by current federal guidelines, may affect the risk of falls in nursing facility patients.
Pharmacy Practice (Internet), 2007
The purpose of this study was to determine if there were any differences in hospitalization rates... more The purpose of this study was to determine if there were any differences in hospitalization rates due to total psychoactive drug "load" between those using and not or formerly using psychotropic and psychoactive medications in a skilled nursing facility; to determine if the diagnosis of dementia and the change in use and load of psychotropic and psychoactive drugs influenced hospitalization rates. Methods: An observational retrospective cohort study was conducted of patient chart, facility disposition changes and consultant pharmacist reports data from a skilled nursing facility of more than 100 beds. Some177 patients resident for 30 or more days over a 19 month period of 2978 patientmonths data were tabulated. A monthly repeatedmeasures assessment method that incorporated all conditions, diseases and medication changes was done on each resident to determine patient demographics, medication usage, and hospitalizations. Results: The rates of hospitalization ranged from 0.04 to 0.07 per patient/month for any psychoactive usage in those with and without dementia as a diagnosis. The rate of hospitalization during the study period for those with no current psychotropic nor regular psychoactive usage was 0.02 and 0.03/pt./month for those respectively with and without the diagnosis of dementia, yet 86% of this sample had used psychotropics or other psychoactive drugs before the period of observation. Conclusion: Preliminary evidence is offered that suggests psychotropics and psychoactive drugs and the total "load" of these drugs may be associated with an increase in the rate and risk of all hospitalizations within a single skilled nursing facility.
Journal of the American Pharmacists Association, 2009
continuing pharmacy education (cPE) credits: See learning objectives below and assessment questio... more continuing pharmacy education (cPE) credits: See learning objectives below and assessment questions at the end of this article, which is ACPE universal activity number 202-000-09-122-H01-P in APhA's educational program. To take the CPE test for this article, go to www.pharmacist. com/education, and follow the links to the APhA CPE center. disclosure: Other than continuing education programs developed by the authors or APhA and mentioned as resources for more information, the authors and APhA's editorial staff declare no conflicts of interest or financial interests in any products or services mentioned in this article, including grants, employment, gifts, stock holdings, or honoraria.
The Consultant pharmacist : the journal of the American Society of Consultant Pharmacists, 2015
Don't let a fear of falling keep you from being active. The good news is that there are simpl... more Don't let a fear of falling keep you from being active. The good news is that there are simple ways you can prevent most falls. Stay physically active. Regular exercise makes you stronger. Weight-bearing activities, such as walking or climbing stairs, may slow bone loss from osteoporosis. Lower-body strength exercises and balance exercises can help you prevent falls and avoid the disability that may result from falling. Here are some fall prevention tips from Go4Life: l Have your eyes and hearing tested often. Always wear your glasses when you need them. If you have a hearing aid, be sure it fits well, and wear it. l Find out about the side effects of any medicine you take. If a drug makes you sleepy or dizzy, tell your doctor or pharmacist.
The Consultant Pharmacist the Journal of the American Society of Consultant Pharmacists, May 1, 2013
An integral concern across care settings is the prompt intervention for patients suffering with p... more An integral concern across care settings is the prompt intervention for patients suffering with pain. Long-term care (LTC) settings present with unique challenges to assess and manage pain in resident populations. Pain assessment is especially challenging, because residents have varying degrees of cognition to communicate their pain, and clinician/staff knowledge of pain symptoms may be lacking. The purpose of this research was to improve the measurement of pain and outcomes of care for the elderly residing in skilled nursing care, especially those with cognitive-impairment. The specific aims of this study were to: 1) Determine the magnitude of the relationship between pain behaviors and a measurement model hypothesized for pain; 2) Test the construct validity of a pain measurement model; 3) Examine the concomitance of pain and cognition in a three-year longitudinal analysis. The research questions answered: 1) Is there a difference in the prevalence of pain in cognitively intact ve...
The Consultant pharmacist: the journal of the American Society of Consultant Pharmacists
This paper describes a 200-hour senior care clerkship for pharmacy students over a five-year peri... more This paper describes a 200-hour senior care clerkship for pharmacy students over a five-year period from 1998-2003. This clerkship used community long-term resources of a 160+ bed skilled nursing facility, adult day care, and senior citizen centers involving medicine, pharmacy, and nursing preceptors. The facility consultant pharmacist was the primary preceptor of students. He conducted pharmacy rounds and daily patient case reviews three times per week. He provided monthly drug regimen review (DRR) and quarterly drug utilization review (DUR) to the skilled nursing facility and, as needed, consultation and therapeutic recommendations to the adult day care center and the senior citizen center. A 200-hour clerkship was developed with multidisciplinary preceptor experiences to orient internal and external PharmD students to long-term care adult consultation with the attending physicians and nurses in the three sites. Each student prepared for physician rounds by performing an intensive...
The Consultant pharmacist: the journal of the American Society of Consultant Pharmacists
Hospital Pharmacy, 2007
Purpose To document and compare the outcomes from monthly drug regimen review recommendation acce... more Purpose To document and compare the outcomes from monthly drug regimen review recommendation acceptance and rejection in one skilled nursing facility by one consultant pharmacist (CP) in the fourth year of evaluation with the prior 3 years' data. Method A non-randomized, observational, prospective cohort study with all patients being residents for at least 30 days over the 12-month period (October 1, 1997 to September 30, 1998) in a skilled nursing facility with more than 100 beds. The admission problem-oriented records of all patients and their respective CP reports were screened for pharmacotherapy recommendations and subsequent acceptance and rejection on a monthly, repeated-measures basis for 12 months. There were 2,004 monthly drug regimen review (DRR) reports. The percentage of DRR reports that made recommendations was tabulated. Written recommendations made to attending physicians that were either accepted or rejected within 3 months were analyzed. The charges for adverse...
The Journal of nursing education, 2013