Long-Term Care Patients: A Case Study

One of the critical core components of Skilled Nursing Facility is medication administration. As cited by Tenhunen, Tanner, and Dahlen (2014), they stated that 88% of the residents living in the nursing homes are aged 65 years old and older. They discussed that every five of administered medications in nursing home has one probability of error. This means that about half of the residents have the possibility of two or more medication errors daily. This applies to the Pasadena Care Center (PCC) because its residents are mostly older adults who require medications on a daily basis. Moreover, residents are prescribed with multiple medications, which make them vulnerable to medication errors. The staff at PCC is trying their best to ensure safe medication administration, however, it still in need of a major change. The goal of the proposed change is to decrease the medication errors in this organization to ensure patient safety.

The medication reconciliation process compares the medications taken by a patient prior to admission to a facility with medication orders at the facility. The Joint Commission (TJC), the accrediting body for health care organizations, stipulates that the medication reconciliation process must be completed within 24 hours of admission (Sentinel Event Alert, Issue 35, 2006). This process begins with compiling an accurate list of the patient's home medications which are also referred to as prior to admission (PTA) medications. At Poudre Valley Hospital, it is the job of the Pharmacy Admission Specialist (PAS) to compile and verify this list. The PAS must collect, record and communicate to the provider an accurate list of the patient's

Medication reconciliation is defined as “ the formal process of obtaining, verifying, and documenting an accurate list of a patient’s current medicines on admission and comparing this list to the admission, transfer, and discharge orders, to identify and resolve discrepancies (Duguid, 2012). This is very important process for all parties involved. If we think about the admission process (let us assume that this patient is able to talk), there are many stressors that our patient is exposed at that time and sometimes that person is not able to verbalize and give us the list of all medications that he/she is taking. We also cannot rely on their family members as a source of such important information.

Upon arriving at the long-term care facility and noticing that the toe tag on the decedent did not match the removal authorization, I would immediately inform; the decedents doctors, the decedents nurse, or whoever was in charge of the care of the decedents body at the facility. I would also call the funeral home and get instructions on what I should do next. Most likely, I would tell the facility to call the funeral home back after the body had been properly tagged. After the facility called me back, I would come back and transfer the body to the funeral home. I would follow the same procedures for transferring a body, but I would do everything I could to make sure that I was taking the correct body. It would be helpful in identifying the

            As electronic health records, have been a former nursing present transition, medication list equally compare in a transition as medication reconciliation is addressing preexisting medications that are no longer being taken by the patient, removed from the patient's medication list. The development of medication reconciliation is becoming the up and coming push to obtaining patient medication list accurately, precisely, and safely beginning in outpatient settings.  Similarly, nursing presences theory supports direct nursing practice to improve direct patient care, safety among medication treatment, as well as engagement to providers with patients (Presence in nursing practice: a concept analysis,

The National Patient Safety Goals are intended to assess the safety and quality of care provided to patients/residents. Of the programs created to provide quality patient care, two are in relation to this particular case, Nursing Care Center and Home Care.1

Long Term Care (LTC) is an area where change is needed. According to the CDC, by 2030, older adults will account for roughly 72 million of the U.S. population. In 2030, when the last baby boomers turn 65, one in every five Americans will be over the age of 65, and will account for roughly 20% of the population. As the growing population of baby boomers continued to aged they will become more reliant on long term care services. Nurses will be at the forefront of providing care to this demographic of the population. Leadership and accountability are needed in long term care to provide efficient care to the aging population.

Mediation reconciliation is the process of gathering all the medications, including over the counter meds, herbal supplements, and multivitamins a patient is taking regarding their care. Within the parameters of mediation reconciliation, dosage, frequently, name,and route are the prime factors of developing a medication regimen. The goal of knowing all medications of a patient before continuing with care or being admitted to specialized settings like hospitals or clinics will avoid over-medicated adverse effects and possibly death. According to the article, Medication Reconciliation to Facilitate Transition of Care after Hospitalization states that, “ It is estimated that 20% of patients experience adverse effects during the two weeks after hospital discharge (2015). With that in mind, image ho many patients experience this disparity throughout their lives with the advised medications given at the hospital. The nurse, as well as the patient and their families should be encouraged to be more involved in their care to avoid inadvertent inconsistencies across the transition of care between admission, transfer, and discharge from and to specialized settings. Aside from preventing medication errors, we as nurses, can support the patient 's safety as the first line of defense in battles against unsanitary and explosive adverse effects that results from inadequate nursing skills.

Many aging Americans often struggle to pay for home care, assisted living and other forms of long term care. When choosing the right type of care much consideration and research should be given. In determining whether one must self-fund their care can be a process which can leave the door open for many unanswered questions. Questions like, what is the expected cost, will Medicare help to cover any cost, or can one use their property to pay the cost for long term care. Since elder care and senior care can be in a variety of forms, the biggest concern is who takes on the brunt of payments. According to Benjamin (2015), “99% of our services are a private pay product with some assistance for veterans; long-term care insurance does account for part of the remaining 1%, along with some waivers provided by Medicare. “Private Pay can be funded by savings and investments, long term care insurance or annuities, social security or other retirement benefits, Veterans’ benefits, and through the conversion of a life insurance policy into a Life Care Benefit Plan or Long Term Care Benefit Plan” (Orestis, 2013, para 1). Most anyone can pay or arrange their care cost, however cost is usually determined by ones need and where they live.

Borrayo, Salmon, Polivka, and Dunlop (2002) assert that fostering a closer connection with eldercare services and providers and the needs of the community will demonstrate the importance for policymakers regarding long-term care now and in the future as the aging population continues to increase. Byrd, Fletcher and Menifield (2007) state evidence supports that health disparities regarding minority older adults are a problem that can no longer be overlooked. The authors offer that individual healthcare providers must acknowledge that the problem exists and assess their practices concerning combating issues of disparities (Byrd et al., 2007). They posit that older adults in minority communities incur a higher percentage for missed diagnoses,

Woten (2016) attributes, National Patient Safety Goals (The Joint Commission, 2016): Medication Reconciliation – an Overview acknowledges effective communication is a driven force to accurate medication reconciling. Communication to patients, families, professional to professional provides honesty along with direction in role responsibilities. Poor communication was recognized from a study at Mayo Health system, reporting, “medical information at transition points was responsible for as many as 50% of all medication errors in the hospital and up to 20% of ADEs”(Vogenberg & DiLascia, 2013). The evidence in transitions throughout care directly connects to communication validating how medication lists, if not updated or accurate cause harm to

(Heatlh Promotion by Design in Long-Term Care Settings, n.d.). For example, insomnia or disturbed sleep is common in older individuals and ensuring the environment is comfortable is a big contribution to improving sleep. There are many other environmental aspects that can be changed to achieve quality of life for residents.

According to the Institute for Healthcare Improvement, “Medication reconciliation is the process of creating the most accurate list possible of all medications a patient is taking — including drug name, dosage, frequency, and route — and comparing that list against the physician’s admission, transfer, and/or discharge orders” (Institute For Healthcare Improvement, n.d). This process includes three steps: collecting the medication history, ensuring that the medications and dosages are appropriate for the patient, and documenting the changes in the orders. This occurs when the patient is admitted, transferred and discharged from the hospital (Institute for Healthcare Improvement, 2011). The purpose is to avoid any duplications, incorrect

The elderly population (above 65 years old) constitutes more than 60% of the world population. Most of them are polypharmacy patients, that is, they take more than 5 medications regularly. This increases the chance of adverse reaction, sensitivity to drug effect and overdose of medications. Ageing is a strong factor on the pharmacokinetics and pharmacodynamics, comorbidities, and patterns of medication that may contribute to an increased risk of adverse events. According to Ahmed, Nanji, Mujeeb, and Patel (2014), previous studies have provided evidence that the probability of ADRs among geriatric patients is estimated at 6% when two drugs are taken, 50% when five drugs are taken, and 100% when eight or more drugs are taken simultaneously (p.

In Nursing homes, quality of care has undergone many changes since the early 1980’s to now. Quality of care is measured by four components: “consistency, holistic well-being, desirable clinical outcomes and prevention of undesirable consequences” (Singh, pg. 442). In the early 1980s, there were so many problems with nursing homes such as inadequate patient to nurse ratio, no on call registered nurses and poorly trained staff. A nurse not able to attend patients when needed is not reaching consistency. Holistic well-being was also not met as shown in YouTube video “Nursing Home Reform Then and Now” by patients looking very lifeless and unhappy. Desirable clinical outcomes have not been desirable. Nursing homes are experiencing negative quality