Journal of the American Medical Directors Association
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Multicenter Study
A standardized quality assessment system to evaluate pain detection and management in the nursing home.
Assessment and management of pain for nursing home residents is frequently reported to be inadequate, yet few studies have used objective criteria to measure the quality of care related to pain. ⋯ Infrequent or incomplete physician pain assessment and treatment and inaccurate documentation by licensed nurses limits evaluation of pain care quality based on medical record review alone. A brief resident interview identified participants reporting symptoms of chronic pain not documented in the medical record and those with a preference for medication. Initial targeting of residents with self-reported pain maximizes the efficiency of the standardized scoring system described in this study. Focusing on explicit process measures clearly identifies areas for improvement and represents an important step in assessing the quality of pain care in the NH.
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Multicenter Study
Nursing home resident barriers to effective pain management: why nursing home residents may not seek pain medication.
Multiple barriers to effective pain management are present in the nursing home setting. The purpose of this analysis was to determine the extent to which residents in pain declined to request pain medication from the staff, and the reasons provided by the residents to explain this behavior. ⋯ Interventions to reduce pain in nursing home residents need to be responsive to the concerns of the residents. It must be acknowledged that resident preferences and beliefs may lead to declined pain interventions regardless of the staff's motivation to make the resident more comfortable. Staff nurses also need to make a more concerted effort to systematically assess pain and offer pain medication to residents rather than rely on resident requests.
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Multicenter Study
Barriers to timely care of acute infections in nursing homes: a preliminary qualitative study.
During a large prospective study of lower respiratory infections in nursing home residents, project staff observed that in some facilities there was consistent difficulty in obtaining timely identification of potential subjects. Starting with this motivation, we conducted a preliminary qualitative study to investigate the process of illness identification and initiating management in episodes of acute infection. We sought factors promoting timely or delayed identification and treatment of acute infections among nursing home residents. ⋯ Effective identification and management of acute infections requires successful communication at multiple levels; however, breakdowns are common. Our model provides a framework for improving acute illness care in nursing homes, which offers important insights potentially useful in quality improvement activities in nursing homes and may facilitate further research.
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Multicenter Study
Preventing assaults by nursing home residents: nursing assistants' knowledge and confidence-a pilot study.
To describe the frequency and context of assaults against nursing assistants (NAs) from residents and to describe NAs' beliefs about their violence prevention knowledge and self-efficacy to prevent assaults from residents. ⋯ These findings provide useful information that supports the need for violence prevention education and for developing violence prevention programs in nursing homes.
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Multicenter Study
Antibiotic prescribing and outcomes following treatment of symptomatic urinary tract infections in older women.
To describe antibiotic prescribing patterns for the treatment of urinary tract infections (UTI) among older women female long-term care facility residents and evaluate factors associated with adverse outcomes. ⋯ Nursing home residents with UTI are treated for longer durations than community elderly. They experience a greater likelihood of receiving antibiotics in excessive dosage, a greater likelihood of adverse drug events, and a greater likelihood of retreatment compared with community subjects with UTI.