Other Education and Quality Improvement Initiatives
Fall Prevention in LTC facilities
We first Addressed a Key Myth About Frequent Falls
Frequent falls are not the main focus of fall prevention because they will always fall.
We are working with Durgin Pines in Kittery to change the general approach to fall prevention and interventions by focusing on residents with frequent falls because they need our help the most.
Call us if you would like to know more about our fall prevention work.
Antibiotic Stewardship and reducing unnecessary use of antibiotics in geriatrics
There is one issue not addressed enough in most antibiotic stewardship efforts, and that is the availability of dipstick urine testing in nursing homes. Dr Fazeli had recognized that as an issue 19 years ago and removed urine dipsticks from all the facilities he worked at. The result is that our nurses have to go through the process of calling the medical doctor or the NP to make the case for testing the urine, and that by itself reduces testing and unnecessary antibiotic use in asymptomatic bacturia.
We teach our nurses to do an in depth analysis of reasons for testing, for example, chronic confusion is not a reason for urine testing unless it is a sudden and new change. Sun-downing is not a reason for testing, but in case of suspected delirium it is and imperative to test and treat infections.
We teach our nurses and families that if all the residents in a facility were to be tested with dipstick urine tests, almost half of the residents will have positive results, so liberal testing will always result in liberal antibiotic use. As a result of frequent antibiotic use, residents are exposed to the potential emergence of antibiotic resistance followed by deadly infections or the development of C.Diff colitis.
Ultimately, doing the right thing in geriatrics is rarely easy and we have to contend with the need for frequent reeducation of staff and caregivers about the scientific rational for this approach.
Please feel free to call or email us if you need more details about this work and the other elements of our antibiotic stewardship initiative.