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Jay Luxenberg, MD CALTCM Wave Editor-in-Chief, Chief Medical Officer On Lok Lifeways
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POLST & Drug Shortage
When is a poorly executed POLST worse than no POLST at all? Timothy Gieseke MD, CMD provides us with a thought provoking article showing how the POLST, which should be physician orders reflecting a thoughtful discussion, can lead to unacceptable consequences when not properly produced.
In recent years we have been confronted with shortages of medical items like IV fluids, vaccines and critical drugs. In this issue Flora Bessey, Pharm.D., BCGP discusses managing the challenge of shortages in tuberculosis testing supplies.
Keeping up with changes can be a challenge, and the WAVE is here to help!
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Should You Be Concerned About the "Integrity" of Your Facility's POLST Forms?
by Timothy Gieseke MD, CMD
In 2008, I attended the UCLA LMG (Leadership and Management in Geriatrics) course that has continued under the leadership of CALTCM. I was paired with a nursing professor at Sacramento State who was quite helpful as a mentor for my project which was the implementation of the new POLST Form in Sonoma County. I teamed with Susan Keller, who energetically partnered with many people and provided detailed trainings in many settings of care. Sadly, despite our efforts, I still find POLST forms initiated by frontline SNF admitting nurses that don't have choices congruent with the ones I find on my assessments. In addition, many of the forms fail to record basic information like care contacts, presence of AHCDs/DPOAs, and who assisted with completion of the form.
This summer, as a part of vacation coverage for another physician, I discovered a systemic problem I had not seen before. In this facility, key physicians have a binder where nurses place return lab, POLST forms they've initiated, and change of condition notification SBARs, which are then reviewed by that physician on a daily basis M-F. In the folder I saw a POLST Form for my review and signature that only checked Attempt CPR (ACPR) in a 95 y/o woman and had no other information on the form apart from the patient's signature.
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The Shortage Of Tuberculin Antigens; Can Anything Be Done?
by Flora Bessey, Pharm.D., BCGP
For as long as most of us can remember, we have been subject to regulatory oversight regarding testing for tuberculosis in our residents. For most of us, this equates to a "mandatory" skin test upon admission (as well as mandatory tests for our employees!) to check for possible "exposure" to TB. The efficacy of these tests, or even the accuracy of chest x-rays, in diagnosis of the disease is tenuous at best, but we still must comply with the regulation.
There has been recent news about a nationwide shortage of Aplisol, one of two purified-protein derivatives (PPD) used in performing tuberculin skin tests (TST). Since it is recommended on the CDC website that Tubersol be used as a possible substitute, I recently checked with one of the pharmacy providers who serves my facilities; turns out that Tubersol is on national back-order status as well! Another possible "solution"promulgated by CDC is the substitution of interferon-gamma release assay (IGRA) blood tests. These tests are subject to the same limitations of the TST, i.e. they are not sufficient for diagnosis. And, they are more expensive for our facilities as well.
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Leadership and Management in Geriatrics (LMG)
Friday & Saturday August 2 & 3, Carlsbad, CA
Starts tomorrow! On-site registration not recommended
Become a sought-after candidate for leadership positions by participating in the 17th annual Leadership & Management in Geriatrics (LMG) course.
This course offers practitioners the chance to spend time in an intensive and highly interactive setting with leaders in the field of geriatric medical management.
- Work in small collaborative groups with a faculty mentor to develop and implement an action plan to create change in your organizational setting.
- Work with your post-course faculty mentor to complete the implementation of your practice improvement project.
LMG offers up to 16 live continuing education credits (CME, CMD, BRN, and NHAP) and is approved for ABIM MOC credits. You also can complete a post-course project for up to 8 additional credits. Complete accreditation details available online:
Visit the LMG webpage.
Location: Omni La Costa Resort & Spa, Carlsbad, CA |
2019 Fall Summit
The Best of the 2019 CALTCM Summit for Excellence
Saturday October 19, Sacramento, CA
CALTCM is pleased to announce our Fall Summit, this event
has been designed to engage and benefit direct care practitioners - all members of the interdisciplinary team and administrative leadership. This event will help you stay current on best practices to be the driver of quality, patient safety and person-centered care, featuring hot topics in PALTC and two "In The Trenches" sessions, giving you the opportunity to individualize your experience, choose from a variety of sessions to fit your education needs. Earn up to 4.5 hours of CME/CEU's.
We hope to see you and your leadership team, click here to
see schedule.
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CALTCM EXCLUSIVE FAMILY PERKS
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We hope you enjoyed this edition of The CALTCM WAVE. We are constantly looking for newsworthy articles, upcoming events, resources, and tools. If you have something that may be of interest to the PALTC community, please feel to contact us at info@caltcm.org.
CALTCM Members: Are you interested in becoming more involved in CALTCM? Join one of our committees,
click here for details.
California Association of Long Term Care Medicine (CALTCM)
Phone (888) 332-3299
Email: info@caltcm.org
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