Cath Lab Digest

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Newer facilities might have small neighborhoods of a few rooms with a central living area. In this situation, the same staff might prepare meals and snacks, bathe and feed residents, and launder their clothes, and in the process develop a personal relationship with their patients. When caregivers know a patient well, they often can provide important input regarding a patient’s habits and willingness to accept changes in routines or treatment that might be needed for wound healing.

Practice Points

  Ideally, LTC community staff members should know each resident well. The staff should develop a rapport and a history with the residents they care for and know their choices and habits over time, including what treatments and interventions have been ordered and refused in the past. Patients in LTC facilities should have regular access to a registered dietitian (RD) who can evaluate their wound(s), make nutritional recommendations, and monitor them periodically. Food and fluid intake is easily observed, and poor intake can and should be addressed quickly. The effects of new treatments can be observed on a daily basis. Routine care planning is best conducted by an interdisciplinary team, which provides a variety of perspectives and professional opinions on each patient’s plan of care. Medical specialists should take advantage of an insider’s perspective and consult with the LTC facility staff for input on a patient’s lifestyle, choices, and treatment goals. This type of communication and involvement is perhaps the best way to achieve goals and obtain the best medical outcomes.

  The attitude and environment of LTC is shifting. Many LTC residents now live in an environment where a patient’s rights and choices drive the care provided. Quality of life is important, and patients’ decisions to maintain their quality of life are respected. Providers who aren’t familiar with the current culture of change and the regulations in LTC may question a patient’s medical regimen for wound healing, which should be patient-centered. Although nutritional care and other interventions are important to promote wound healing, patients retain the right to refuse. Clinicians must respect these rights but also strive to educate, inform, and guide. All discussions and efforts should be fully documented in the medical record and communicated to other team members.

  Working together used to refer only to the staff; these days, it includes the patient, a win-win situation for all.

References

1. Pioneer Network. What is Culture Change? Available at www.pioneernetwork.net/CultureChange/. Accessed July 31, 2012.

2. American Dietetic Association. Individualized nutrition approaches for older adults in health care communities. JADA. 2010;110(10):1554–1563.

3. Pioneer Network Food and Dining Clinical Standards Task Force. New Dining Practice Standards, August, 2011. Available at: www.pioneernetwork.net/Data/Documents/NewDiningPracticeStandards.pdf. Accessed August 23, 2012.

4. Centers for Medicare and Medicaid Services. State Operations Manual, Appendix PP - Guidance to Surveyors for Long Term Care Facilities, Revision 70 (1-7-11). Available at www.cms.gov. Accessed July 31, 2012.

5. Butack OR, Weiner AS, Reinhart JP. The impact of culture change on elders’ behavioral symptoms: a longitudinal study. J Am Med Dir Assoc. 2012;13(6):522–558.

6. American Medical Directors Association. Diabetes Management in the Long-Term Care Setting Clinical Practice Guideline. Columbia MD:AMDA 2008. Available at: www.amda.com/tools/guidelines.cfm. Accessed August 23, 2012.

7. American Medical Directors Association. Pressure Ulcers in the Long-Term Care Setting Clinical Practice Guideline. Columbia, MD: AMDA 2008. Available at: www.amda.com/tools/guidelines.cfm.