Managing Warfarin Dosing In the Post-Acute Facility

by Flora Bessey, Pharm.D., BCGP

Those of us who have been in long-term care for a while have noticed the trend toward ever-higher levels of acuity being “pushed down” towards our facilities. Conditions that were nearly always the purview of acute care hospitals are now being routinely managed within our buildings, especially those with post-acute units. Complex medical conditions necessitate complex medication regimes, and often warfarin is a part of the equation.

EOLOA Webinar

The End of Life Option Act (EOLOA) has been in effect in California since June 2016, and the California Department of Public Health released information for the first six months, that included just fewer than 200 patients who were qualified for physician aid-in-dying, with about 175 doctors participating and 111 known deaths from ingestion of the prescribed medications. Of the patients who qualified, 90% were white and 96% had insurance. To our knowledge, none of these ingestions occurred in skilled nursing facilities.  Clearly in 2017, many more patients have participated.

In the News: Nephrologist Calls for ‘Age-Attuned Approach’ to Chronic Kidney Disease

We are grateful to Caring for Ages allowing us to reprint this article on CKD.  This is a balanced article that informs us on the need to help our patients make informed decisions about starting and continuing dialysis, as well as address common causes of distress appropriately.

Shared with permission from AMDA/Elsevier/Caring for the Ages

Nephrologist Calls for ‘Age-Attuned Approach’ to Chronic Kidney Disease

Christine Kilgore
PHOENIX — Conservative management and supportive care may offer elderly patients with end-stage renal disease (ESRD) the same survival as dialysis, as well as less functional decline, fewer hospitalizations, and better satisfaction with life, said Fahad Saeed, MD, at AMDA – the Society for Post-Acute and Long-Term Care Medicine’s Annual Conference.
CALTCM Gets A Facelift: Updated Board Of Directors & Advisory Council Bring New Life To Organization!

by Deb Bakerjian PhD, APRN, FAAN, FAANP, FGSA

In the last few years as President, I led the small Executive Board through a restructuring process to update and bring new energy to the leadership of the organization. This was a 2-year long effort that sought to answer the question, “How can CALTCM become a more effective force in improving the quality of older adults receiving any type of long term care in California?”

This effort was started with a strategic planning meeting in November 2015, led by physician, Alfredo Czerwinski, during which board members met for a brainstorming session at UC Davis in Sacramento.  During that 3-hour long meeting, board members grappled with CALTCM’s mission, growth, our position within the state, and the future of the organization. From the work completed by the board that night came a recognition that CALTCM had begun to stall, without growing or innovating in the previous few years.  Through the facilitated and often lively discussion, the board realized that all organizations must evolve to survive, and the board made a commitment to make changes so that CALTCM could grow.

Online Patient Education Resources for your Facility

by Tim Gieseke MD, CMD 

I am the Medical Director of a CCRC that has a superb wellness program as well as community outreach.  We are sponsoring a Health Fair in the near future that is open to our residents, staff, and the outer community.  As a part of that fair, I was tasked with creating a handout on the subject of patient education for our “The Doctor is In” booth.

I am a strong proponent of patient health education driven by interests and learning style that focuses on improving health and minimizing potential future harms.  In a brief survey of available and reliable online resources, I was astounded by the availability of an amazing amount of high-quality resources well organized and designed for patients.  The one-page handout I developed will be posted on the CCRC resident website for their use, as well as a handout for the outer community and staff at the Health Fair.

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