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MLA Bulletin 6 referenced November/December 2008
Citizen Watch Continuing Care in Alberta and the Seniors' Action and Liaison Team www.continuingcarewatch.com
November 30, 2008 From: Citizen Watch on Continuing Care in Alberta and SALT Subject: MLA Bulletin 6: Keeping Seniors Safe in Long Term Care According to the Research and Prevention Unit at UBC, unintentional injuries reported by acute care hospitals are a major cause of death and ill health among seniors, and nearly 40% of seniors' deaths. In Alberta, there has been a 44% increase in the number of seniors seen in an emergency department due to a fall from 1998 to 2006, while the number of Alberta seniors has increased 32% since 1996. The 12,500 Alberta seniors in continuing care centres, 3,000 in Designated Assisted Living facilities and another 20,000 in assisted living facilities are those most at risk for unintentional harm. These Albertans (and their families, friends and communities) rely on facility operators to provide safe and appropriate quality care. How safe are these very vulnerable seniors? Every now and then, a story about an accidental injury or death in a long term care facility is reported by the media. Disturbing headlines tell us a woman died after being scalded in a bath; an Alzheimer's patient killed another resident; a man's leg was amputated because of an uncontrolled pressure sore; a woman was raped; a man died after drinking a toxic cleaning product. Are these just isolated accidents or an indication of preventable systemic problems in care facilities that make accidents possible? The Task Force appointed after the Auditor General's 2005 report heard concerns about the health and safety of these patients (renamed "residents" in the early 1990s), their social and mental well-being, and the safety of the staff who care for them. In 2005, the Health Quality Council of Alberta (HQCA) initiated a Long Term Care Resident and Family Experience Survey as a priority issue, and we expect to see that report this year. Although the survey doesn't address the specific issues of safety and quality of care, it may reveal cause for concerns. In 2007, the Canadian Patient Safety Institute expanded their agenda to include long term care, identifying falls, medication issues, infections, pressure ulcers and resident aggression as common concerns in care facility environments. This Bulletin is about those major safety risks in long term care, most of which are preventable. Patient safety in long term care is a complex issue urgently needing leadership and action. Failure to provide timely and quality care, and the care we do provide, should not harm seniors. Sincerely, Carol Wodak, on behalf of the Seniors' Action and Liaison Team, and Citizen Watch (780) 417-1705; email to contributions@continuingcarewatch.com
MLA Bulletin 6 referenced November/December 2008
MLA Bulletin 6, November/December 2008 from Citizen Watch on Continuing Care and SALT www.continuingcarewatch.com Keeping Seniors Safe in Long Term Care
The shift from traditional models of long term care to assisted/supportive living and Designated Assisted Living appears to be a positive response for less de-personalizing and controlling "institutional" care and more opportunities for privacy. In the absence of resources and appropriate care practices, a "home" or "community" setting can be as problematic as any traditional institution. Finding the right balance between independence and safety for those who are reliant on others to meet their needs is a challenge, but failing to recognize the potential for harm in any setting will not make these problems go away. 1 Seniors in residential care facilities (continuing care centres, assisted living facilities, and lodges) tend to be older, with a high level of frailty, multiple illnesses and multiple medications, a high rate of dementia impairments, and reduced ability to care for themselves or to communicate care needs. 2 As seniors with more complex care needs are placed in these "alternative" care facilities and as they age, the "risk exposures" (including falls, medication errors, and decubitus ulcers) are increasing to the same level as more traditional care facilities. 3
What do we know about safety risks in long term care?
The risk of falling for patients in all long term care settings is more than double the risk for seniors living in the community. 4 10% of falls result in serious injury 5 ; injuries sustained in a fall can undermine the individual's health so that other diseases and illnesses (such as pneumonia and infections) prove fatal. 6 Falls can be a consequence of medications. 7 Injuries from adverse drug events, including prescribing and monitoring errors, drug interactions, and failing to identify side effects, are more common in long term care than previously documented, and are largely preventable. The data indicate a rate of nearly 10 adverse drug events per month for every 100 residents. 8 Antidepressants, antipsychotics and benzodiazepines are the most common medication cause of increased falls. 9 These drugs have been marketed as "reducing the nursing burden" 10 of caring for patients with dementia, despite earlier and well-documented warnings about their safety, including the risk of increased falls. One-third of nursing home residents are given an antipsychotic drug. 11 The most frequent endemic infections in long term care facilities are respiratory tract, urinary tract, skin and soft tissue, and gastrointestinal. 12 The rate of infections in long term care facilities is 4 times the rate in the general population. 3 to 15% of long term care facility patients will acquire an MRSA infection each year, and these patients are more likely to die than younger persons. 13 Pressure ulcers are common among people with impaired mobility. In long term care, the prevalence is 30% - higher than in any other setting and increasing. Pressure ulcers are caused by pressure due to lack of mobility (in bed or a chair) and poor blood circulation, and can develop in a few hours. If left untreated, a pressure sore may lead to chronic infection, and can cause or contribute to death. 14 Resident aggression can be the result of many factors, including loss of control, physical and emotional discomfort arising from lack of toileting/basic hygiene, thirst, hunger and an inability to communicate (poor hearing, unable to speak, etc.). Fear, unmanaged pain, medication induced confusion or side-effects or drug interactions, unrecognized injury or illness, changing health status,
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MLA Bulletin 6 referenced November/December 2008
loneliness and boredom, inactivity, perceived lack of respect from caregivers and constantly changing caregivers are other underlying causes of aggression. 15 "Too often, illness in older people is misdiagnosed, overlooked, or dismissed as the normal process of aging, simply because health professionals are not trained to recognize how diseases and drugs affect older people." 16
Injuries are predictable and preventable, and not the result of chance occurrence. 17
"The majority of medical errors do not result from individual recklessness or the actions of a particular group this is not a "bad apple" problem. More commonly, errors are caused by faulty systems, processes, and conditions that lead people to make mistakes or fail to prevent them." 18 According to the Canadian Patient Safety Institute, staff skills to meet the increasing clinical complexity of care needs and the recruitment and retention of staff are priorities for safety in long term care. 19 "All provinces report that since 2000 they have experienced an increased prevalence of the following factors that contribute to increased risk of injury: complexity of care, major healthcare restructuring and amalgamations, reduction in the number of patients/resident care beds, and increased workload in an aging workforce . . . while there has been an increased focus on prevention and safety programs, their impact has been undermined by general changes within the healthcare sector." 20 Limited funding has resulted in fewer professional care staff, impacting the clinical care of patients, supervision of the personal care aide staff, monitoring of services, and updating and implementing care plans. 21
Is funding for seniors' care being rationed, to accommodate other priorities? 22
A culture of patient safety is lacking and victims are nameless and faceless. Other barriers to safety include difficulty recognizing errors; lack of information systems to identify errors; and fragmentation of care delivery. 23 The current CPSI long term care safety initiatives are the Medication Reconciliation and Falls Prevention programs. Neither addresses the basic safety issues which would be resolved by attention to individual toileting needs and hygiene, regular oral care and foot care, supervised daily physical activity and exercise 24 , attention to pain management, careful investigation of changes of behaviour, response to symptoms of illness and possible adverse drug reactions, or prompt response to need for assistance, however communicated. The InterRAI MDS system itself (on which $36.4 million has been spent to date) does nothing to measure care actually provided, assess the reasons for an adverse incident, or improve the adverse incident rates. 25 To some extent, the system has added to the problems by diverting nursing staff from patient care to administrative duties. 26
In short, we already know many of the factors resulting in compromised patient safety and quality of life in long term care settings. Isn't it time we collectively rolled up our sleeves and got to work? Prepared by Carol Wodak for Citizen Watch and SALT, November 2008
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Selected Bibliography "Adverse Events are unintended injuries or complications that are caused by health care management, rather than by the patient's underlying disease, and that lead to death, disability at the time of discharge or prolonged hospital stays" (Johnson, 2005) For readers interested in general information resources on safety in long term care, we suggest the following:
Drugs seniors should avoid: The Beers criteria from http://www.cbc.ca/news/background/seniorsdrugs/beers_table_more.html Ethical choices in long-term care : what does justice require? World Health Organization 2002 http://www.who.int/mediacentre/news/notes/ethical_choices.pdf Governance for patient safety: lessons from non-health risk-critical high-reliability industries (Website and PDF) http://www.hc-sc.gc.ca/sr-sr/finance/hprp-prpms/results-resultats/2005-shepseng.php Medication and Falls in the Elderly Brooks http://www.oltca.com/Library/LTC/0308medication_falls.pdf Medication Management and Polypharmacy Beer's List http://www.txhca.org/BestPractices/MedMgmt/medBeer1.pdf Outcomes of enhanced physical and occupational therapy service in a nursing home setting Przybylski et al, Archives of Physical Medicine and Rehabilitation 1996 77(6) 554-561 http://www.crd.york.ac.uk/CRDWeb/ShowRecord.asp?View=Full&ID=21996000691 Patient safety law: from silos to systems (website and PDF) http://www.energyk.com/healthlaw/ Prevention of Falls and Injuries Among the Elderly A Special Report from the Office of the Provincial Health Officer, British Columbia 2004 http://www.health.gov.bc.ca/library/publications/year/2004/falls.pdf Prevention of Unintentional Injuries Among Seniors Public Health Agency of Canada 2001 http://www.phac-aspc.gc.ca/seniorsaines/pubs/workshop_healthyaging/pdf/injury_prevention_e.pdf Report of a Study to Review Levels of Service and Responses to Need in a Sample of Ontario Long Term Care Facilities and Selected Comparators PriceWaterhouseCoopers 2001 http://www.health.gov.on.ca/english/public/pub/ministry_reports/ltc_rep/ltc_rep_mn.html Report on Seniors Falls in Canada 2005 Public Health Agency of Canada http://www.phacaspc.gc.ca/seniors-aines/pubs/seniors_falls/pdf/seniors-falls_e.pdf Safety in Home Care: Broadening the Patient Safety Agenda to Include Home Care Services Lang and Edwards 2006 Canadian Patient Safety Institute http://www.patientsafetyinstitute.ca/uploadedFiles/Research/Safety%20in%20Home%20Care %20-%20Apr%202006.pdf Safety in Long Term Care Settings 2008 Wagner and Rust; Canadian Patient Safety Institute http://www.patientsafetyinstitute.ca/uploadedFiles/LTC_paper.pdf
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Endnotes
1
Evaluating Programs of Innovative Continuing care (EPICC), U of A, Department of Ecology, March 1998, http://www.hecol.ualberta.ca/RAPP Public Health Agency of Canada Report on Seniors Falls in Canada 2005 http://www.phacaspc.gc.ca/seniors-aines/pubs/seniors_falls/pdf/seniors-falls_e.pdf Prevention of Falls and Injuries Among the Elderly Office of the Provincial Health Officer, British Columbia 2004 http://www.health.gov.bc.ca/library/publications/year/2004/falls.pdf the institutionalized elderly fall three times more often than elderly in the community B.C. Injury Research and Prevention Unit, UBC Seniors Falls Can Be Prevented 2007 http://www.injuryresearch.bc.ca/admin/DocUpload/3_20070425_160715Senior's%20Falls%20 Can%20Be%20Prevented%20Pamphlet%20April%2024_07.pdf Nursing Care and Improving Safety in Nursing Homes Wagner University of Toronto 2006 http://www.aging.utoronto.ca/sites/aging.utoronto.ca/files/Wagner.pdf Exercise and Fall Reduction in Assisted Living September/October 2005 Assisted Living Consult http://www.assistedlivingconsult.com/issues/01-05/ALC1-5_Exercise.pdf A recent national survey of 233 long term care communities found a higher average injury rate due to falls in AL communities compared to skilled nursing care. . .The rates of fall-related injuries requiring medical care were equivalent in both AL and skilled care.
3 2
Assisted Living A Risky Business American Society of Consultant. Pharmacists, www.providermagazine.com/pdf/mgmt-08-2002.pdf Accreditation Issues for Risk Managers By JCR Staff, Jcaho, Joint Commission http://books.google.ca/books?id=sUk_KzaRwvEC&pg=PA5&lpg=PA5&dq=Assisted+living+%2B+fall s&source=web&ots=zhSWfj9Fo4&sig=fJ7A_Ej288xeEjt0xp5NYd3Z6c&hl=en&sa=X&oi=book_result&resnum=2&ct=result Public Health Agency of Canada Report on Seniors Falls in Canada 2005 http://www.phacaspc.gc.ca/seniors-aines/pubs/seniors_falls/pdf/seniors-falls_e.pdf Falls and Injurious Falls in Nursing Home Elderly http://enhs.umn.edu/2004injuryprevent/falls/falls.html "The fall incidence in nursing home elderly is three times time rate for non-nursing home elderly." Centers for Disease Control and Prevention Falls in Nursing Homes http://www.cdc.gov/ncipc/factsheets/nursing.htm
5 4
Prevention of falls and injuries among the elderly: A special report from the Office of the Provincial Health Officer. B.C. Ministry of Health Planning, 2004 Public Health Agency of Canada Report on Seniors Falls in Canada 2005 http://www.phacaspc.gc.ca/seniors-aines/pubs/seniors_falls/chapter2-2_e.htm Public Health Agency of Canada Report on Seniors Falls in Canada 2005 http://www.phacaspc.gc.ca/seniors-aines/pubs/seniors_falls/chapter2-2_e.htm
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Medication and Falls in the Elderly Brooks http://www.oltca.com/Library/LTC/0308medication_falls.pdf
8
The Incidence of Adverse Drug Events in Two Large Academic Long-term Care Facilities Rochon, Gurwitz et al, The American Journal of Medicine, Volume 118, Number 3 (March 2005) http://seniorjournal.com/NEWS/Eldercare/5-02-25DrugEvents.htm For background and references/links to studies, CBC Investigation Reports: Antipsychotics often prescribed in nursing homes 2004 http://www.cbc.ca/health/story/2004/05/03/antipsychotic040503.html Seniors and Drugs 2007 http://www.cbc.ca/news/background/seniorsdrugs/index.html Off Limits 2008 http://www.cbc.ca/news/background/seniorsdrugs/off-limits.html
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Dangerous Drugs http://www.cbc.ca/health/story/2007/12/17/dangerous-drugs.html Preventing Adverse Drug Events in Long Term Care http://www.cmaj.ca/cgi/reprint/174/1/52 Medication Management and Polypharmacy Beer's List http://www.txhca.org/BestPractices/MedMgmt/medBeer1.pdf
9
Medication and Falls in the Elderly http://www.oltca.com/Library/LTC/0308medication_falls.pdf Prevention of Unintentional Injuries Among Seniors Public Health Agency of Canada 2001 http://www.phac-aspc.gc.ca/seniorsaines/pubs/workshop_healthyaging/pdf/injury_prevention_e.pdf ICES Report: Exploring the Variation in Ontario Nursing Home Prescribing Rates for Antipsychotics Paula A. Rochon Healthcare Quarterly, 10(4) 2007: 20-22 The Effect of Risperidone on Nursing Burden Associated with Caring for Patients with Dementia, Frank et al, Journal of the American Geriatrics Society, JAGS 52:1449 1455, 2004 See FDA Warning re: Risperdal/Risperdone from http://www.fda.gov/MedWatch/ http://www.fda.gov/medwaTCH/SAFETY/2003/risperdal.htm "Increased Mortality in Elderly Patients with Dementia Related Psychosis Elderly patients with dementia-related psychosis treated with atypical antipsychotic drugs are at an increased risk of death compared to placebo. Analyses of seventeen placebo controlled trials (modal duration of 10 weeks) in these patients revealed a risk of death in the drug-treated patients of between 1.6 to 1.7 times that seen in placebo-treated patients. Over the course of a typical 10 week controlled trial, the rate of death in drug-treated patients was about 4.5%, compared to a rate of about 2.6% in the placebo group. Although the causes of death were varied, most of the deaths appeared to be either cardiovascular (e.g., heart failure, sudden death) or infectious (e.g., pneumonia) in nature. RISPERDAL (risperidone) is not approved for the treatment of patients with Dementia-Related Psychosis." Seniors drugged to cover staff shortages Edmonton Journal Feb 3, 2005 Prevention of Falls and Injuries Among the Elderly A Special Report from the Office of the Provincial Health Officer, British Columbia 2004 http://www.health.gov.bc.ca/library/publications/year/2004/falls.pdf
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Neuroleptic and benzodiazepine use in long-term care in urban and rural Alberta Hagen et al, International Psychogeriatrics (2005), 17:4, 631-652 2005 Variation in Nursing Home Antipsychotic Prescribing Rates Rochon et al Archives of Internal Medicine Vol. 167 No. 7, April 9, 2007 http://www.ices.on.ca/webpage.cfm?site_id=1&org_id=31&morg_id=0&gsec_id=0&item_id=41 42 Drugs seniors should avoid: The Beers criteria from http://www.cbc.ca/news/background/seniorsdrugs/beers_table_more.html Preventing Infections in Non-Hospital Settings: Long-Term Care Lindsay E. Nicolle University of Manitoba, 2001 http://www.cdc.gov/ncidod/eid/vol7no2/pdfs/nicolle.pdf
12
Extraordinarily High MRSA Rates in Nursing Homes 2005 American Society for Microbiology Beekmann, University of Iowa http://www.asm.org/Media/index.asp?bid=39311 Infections are a serious problem in nursing homes http://www.ahrq.gov/research/jul03/0703RA22.htm
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Prevalence of pressure ulcers in Canadian health-care settings Woodbury MG, Houghton PE. Ostomy/Wound Management. 2004;50(10):22-38 http://www.preventpressureulcers.ca/library/woodbury.pdf TMF Health Quality Institute http://nursinghomes.tmf.org/PressureUlcers/tabid/544/Default.aspx
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Alzheimer Society Ontario Position Paper on the Casa Verde Jury Recommendations 2005 http://alzheimerontario.org/local/files/Web%20site/Public%20Policy/Position-Paper-Casa-VerdeJury-Sept05.pdf Letter to Provincial and Territorial Ministers of Health 24/10/2007 from the Long Term Care Medical Directors Association of Canada http://www.cmda.ca/ Advocacy. See also http://www.cbc.ca/marketplace/2007/10/17/reports_to_the_coroner/ for a list of the 1993 to 2006 recommendations regarding care for long term care patients with behavioural concerns from the reports of the Chief Coroner of Ontario's Geriatric and Long Term Care Review Committee http://www.mcscs.jus.gov.on.ca/English/home/pubs.html
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Senate Special Committee on Aging, Murphy J. quoted in The Washington Post, May 30, 1999. Health Administrator Vol XIX Number 1:76-82 http://medind.nic.in/haa/t06/i1/haat07i1p76.pdf Hidden problem pain in older people 2007 http://www.pickereurope.org/Filestore/Publications/paincarehomes_final.pdf
17
BC Injury Research and Prevention Unit, UBC Injury Facts http://www.injuryresearch.bc.ca/categorypages.aspx?catid=1&subcatid=44 Insurance Bureau of Canada Incident and Accident Reporting "It is becoming an accepted belief in safety and risk management that all accidents are preventable. This means that for every accident or incident there is something that could have been done to avoid it." http://www.ibc.ca/en/business_insurance/documents/incident-accident.pdf Alberta Injury Control Strategy 2003http://www.acicr.ualberta.ca/ Alberta Injury Control Strategy Public Health Agency of Canada Prevention of Unintentional Injuries Among Seniors http://www.phac-aspc.gc.ca/seniors-aines/pubs/workshop_healthyaging/injury/injury1_e.htm Canadian Institute of Health Information Health Care in Canada 2004 "Errors are like symptoms of diseases--they can be caused by multiple conditions, and treatment of the error or symptom does not correct the underlying malfunction. In both errors and symptoms, `cure' requires attacking the underlying causes."
18
To Err is Human: Building a safer health system Quality of Health Care in America Committee of the Institute of Medicine of the National Academies, 1999 http://books.nap.edu/openbook.php?isbn=0309068371 Report Brief. To Err Is Human: Building a Safer Health System http://www.iom.edu/Object.File/Master/4/117/ToErr-8pager.pdf
19
Canadian Patient Safety Institute Safety in Long Term Care Settings 2008 Wagner and Rust http://www.patientsafetyinstitute.ca/uploadedFiles/LTC_paper.pdf "The majority of direct care staff have had little training, and that training may not be sufficient to consistently ensure a safe care environment. Barriers to adequate training include availability of adequate training programs for best practices, and the ability to cover staff when they are off the floor." Trends in Workplace Injuries, Illnesses, and Policies in Healthcare across Canada Health Canada 2004 http://www.ohsah.bc.ca/media/17-Trends-Workplace-Injuries-Canada-FinalReport.pdf
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Bethany Care Society Seniors' Care and Programs in Alberta: Themes for Action After Five Years of Study Response to The MLA Task Force on Continuing Care Health Service and Accommodation Standards 2005 "In contrast to the increasing functional needs, behavioral issues and complex care needs of residents, funding directions over the past five years have resulted in a continuing deprofessionalization of the workforce. This not only impacts the quality of clinical care provided, but also limits the availability of professional supervision for personal care aide staff. This move also directly impacts quality improvement initiatives, monitoring of services, updating of care plans and monitoring the implementation of care plans areas that all require skilled knowledge of professional nursing and management staff. Continued deprofessionalization of the workforce is an area of concern expressed by the Auditor General and one that will, in fact, inhibit the ability of
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operators to implement and manage many of the Draft Standards as proposed." http://www.bethanycare.com/news-events/documents/SeniorsCareinAB_ThemesforAction_000.pdf Achieving Excellence in Continuing Care Final Report of the MLA Task Force on Continuing Care Health Service and Accommodation Standards November 2005 "Long-term care and supportive living staff are struggling to care for residents with higher and more complex health care needs. Funding formulas, policies and legislation do not always reflect the changing needs of continuing care clients." http://www.health.alberta.ca/Key/lt_MLA05.pdf ALTCA (now the Alberta Continuing Care Association) Response to MLA Task Force September 2005 ". . .the trend has been to replace RNs with lesser-qualified and lower wage LPNs. The loss of RNs means a loss in skills, care planning and resident health status communication capabilities. In addition, the RN must spend more time training and supervising a larger staff of LPNs. These lead to poorer resident health outcomes and safety concerns regarding the monitoring of medications and patient response to medications." Provincial Health Ethics Network, Interrogating Scarcity: The Challenge for Health Ethics Ted Schrecker in Health Ethics Today, Volume 15, Number 1, 2005 " . . .when (for example) there are not enough ICU beds or there is not enough money for palliative care, it is important to ask why not, and to challenge decisions that have generated or worsened scarcity." http://www.phen.ab.ca/materials/het/Vol.%2015,%20No%201%20-%202005.pdf Ethical choices in long-term care : what does justice require? World Health Organization 2002 "A society invites a dialogue about how best to structure the ethical framework within which equitable, fair, rational, and transparent decisions about long-term care can be made when it asks: "What long-term care needs exist?" "What resources are available to provide them?" "What does justice require?". . . A starting place for change is to be explicit that long-term care institutions exist within a community and are not exempt from community ethics and prevailing standards." http://www.who.int/mediacentre/news/notes/ethical_choices.pdf Dr. Bruce Miller, Alberta Hansard, April 3, 2006 "Long-term care should embody everyday ethics, placing a high moral value on the routines which provide comfort, relief from suffering, and an enhanced quality of life. Those are three important phrases . That's the goal, I think, of our long-term care facilities and of nursing homes in Alberta: provide comfort, relief from suffering, and an enhanced quality of life."
23 22
Patient Safety: Barriers to Action http://www.nbhealthcare.com/conference/presentations/Phil_Hassan_English.ppt#756
24
Outcomes of enhanced physical and occupational therapy service in a nursing home setting Przybylski et al, Archives of Physical Medicine and Rehabilitation 1996 77(6) 554-561 http://www.crd.york.ac.uk/CRDWeb/ShowRecord.asp?View=Full&ID=21996000691
25
Stepping In: Falls in Long Term Care Gallagher & Scott 2005, Long Term Care Collaborative Falls Prevention Project http://web.uvic.ca/~senage/resources/publications/reports/Stepping_In_Falls_Long_Term_Care.pdf Report of a Study to Review Levels of Service and Responses to Need in a Sample of Ontario Long Term Care Facilities and Selected Comparators PriceWaterhouseCoopers 2001 http://www.health.gov.on.ca/english/public/pub/ministry_reports/ltc_rep/ltc_rep_mn.html ALTCA (now the Alberta Continuing Care Association) Response to MLA Task Force Seniors Report September 2005 (author's file) "With budgets eroded by inflation, the trend has been to replace RNs with lesser-qualified and lower wage LPNs. The loss of RNs means a loss in skills, care planning and resident health status communication capabilities. In addition, the RN must spend more time training and supervising a larger staff of LPNs. These lead to poorer resident health outcomes and safety concerns regarding the monitoring of medications and patient response to medications."
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Fall Prevention in Long-term Care: Practical Advice to Improve Care Mara Ferris, MS, RN, GCNSBC, CPHQ, FASCP Topics in Advanced Practice Nursing eJournal. 2008;8(3) 2008 Medscape http://www.mnnursinghomelaw.com/falls-prevented-situations.html
26
ALTCA (now the Alberta Continuing Care Association) Response to: MLA Task Force Seniors Report September 2005 "The role of RNs in adopting InterRAI/MDS is also a key factor that will reduce the time RNs can devote to patient care and LPN training. In addition, the decreasing number of RNs makes InterRAI/MDS implementation more difficult." ALTCA (now the Alberta Continuing Care Association) Information Update for Alberta MLAs April 2006, "The Minimum Data Set/Resident Assessment Instrument (MDS/RAI) is a data set used to assess a resident's state of health and create a care plan for the individual. Healthcare professionals can use this data to track patient treatments, medications, and monitor health outcomes. It has potential to aid in the delivery of more effective healthcare. . .Sustainability includes the ongoing need for training new-hires, software licensing, hardware costs, and data analysis and reporting. We are very concerned that operating and maintaining the MDS/RAI system will divert staff from care delivery at the bedside. Furthermore, the time and resources devoted to operating the system at less than optimal performance compromises the output of the system and the benefits it may hold for resident's health outcomes."
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