I was at the national AMDA meetings in Florida when the new guidelines for opiod use in non-cancer pain were released by the CDC (available JAMA online March 15, 2016).  I groaned as I thought of my increasing load of patients with complex persistent pain who come to me from the hospital on > 90 MME (morphine mg equivalents) along with their pneumonia, hip fracture, back surgery, SBE, or other acute illness.  Some of them will report a 10 as their current level of pain which will generate the call from their nurse for me to “do something”.  When I receive those calls, I hope that the nurse has done a comprehensive assessment, but frequently find that the front line busy nurse has relied on the self-reported pain # as their assessment rather than using available free comprehensive assessment tools available at www.geriatricpain.org for the cognitively intact or the cognitively impaired patient.

Finally, we see that CMS is showing it really cares about the whole system. So far, NHs were encouraged to improve care and reduce readmissions. Both very noble goals. However we have mainly contributed to the bottom line of hospitals by helping them to avoid penalties for 30 day readmissions. The article published recently in Modern Health announces a pilot with 250 participating SNFs that are hoping to be rewarded for reducing hospital admissions for conditions that are commonly called Ambulatory Care Sensitive Conditions (ACSC),such as urinary tract infection, pneumonia to name a few. The message to the post acute community is: improve care, pay attention to what you can treat in the SNF and you will be rewarded.

At last year’s annual CALTCM meeting, Dr. Peter Patterson gave an excellent presentation on antibiotic stewardship challenging the commonly held view that the bladder is almost always sterile in women in nursing homes.  In fact the literature shows that 20-50% of women have asymptomatic bacteriuria, which will not benefit from antibiotics, but in fact may result in significant harm from their use. Since that time, he has developed a detailed evidenced based implementation strategy for facilities with amazing improvement in meaningful metrics. He is one of the 5 presenters for CALTCM’s Best Practice Session at this year’s annual meeting.  Since working with Dr. Patterson on this project and presentation, I am convinced that his presentation will be one of the practical highlights of this year’s meeting.

by Flora Bessey, PharmD, CGP

There has been much discussion lately regarding the use, or overuse, of proton pump inhibitors (PPI) in our patient population, especially given the recent article in the Journal of the American Medical Association (JAMA February 15th, 2016 issue, “Association of Proton Pump Inhibitors with Dementia; a Pharmacoepidemiological Claims Data Analysis”). This article seems to point to at least a correlation between the use of PPI and dementia. But as we all know, “correlation” is not the same as “causation.” So, given this new data, as well as everything we have learned about this class of medicines, what do we need to focus upon as we attempt to provide the best care for our very vulnerable residents?