newsletter spring 2012 · 2012-06-08 · the newsletter — 1 spring 2012 volume 31, number 1...
TRANSCRIPT
The Newsletter — www.gapna.org 1
Spring 2012
Volume 31, Number 1
Collaborative Efforts Are Key To Improving Care
I t is an exciting time to be a member of the GerontologicalAdvanced Practice Nurses Association (GAPNA)!
Regardless of our educational preparation and national cer-tification, as GAPNA members, we are united in our mis-sion to promote excellence in advanced practice nursingthat enhances the well-being of older adults. One way wecan achieve this mission is through collaboration and part-nerships. GAPNA’s advice and collaboration are increasing-ly valued in clinical practice, education, policy, andresearch. GAPNA’s expert opinion has been sought by othergerontologic professional organizations and federal agen-cies, such as the American Geriatrics Society and the Centers for Medicaid andMedicare, on clinical topics including the Beer’s List revisions, management of olderadults with multiple medical co-morbidities, and initiatives to improve behavioralhealth for nursing home residents. GAPNA also continues to have representationamong the Advancing Excellence Campaign which seeks to pursue quality of care andquality of life for nursing home residents.
From an educational perspective, we are collaborating with the NationalOrganization of Nurse Practitioner Faculty to provide validation panel members forthe updated population-focused competencies of Lifespan/Family, Women’s Health,and Psychiatric Mental Health. GAPNA validation panel members will help ensureadvanced practice nursing gerontologic content is integrated into the revised educa-tional competencies. In addition, many of our state and regional GAPNA chaptershave partnered with local chapters of the American Medical Directors Association toplan and host excellent continuing educational conferences. The collaborative spirit atthese joint conferences is apparent.
continued on page 5
President’sMessage
NewsletterThe Official Newsletter of the Gerontological Advanced Practice Nurses Association — Founded in 1981
Be a Leader:Board of Directors Nominations Open
Nominations for the nationalGAPNA Board of Directors electionsare being accepted through April 1,
2012. The GAPNA Board of Directorsand the Nominating Committee areinstrumental in shaping the future ofthe organization and gerontologicaladvance practice nursing. The openoffices are President-Elect, Secretary,Board Member at Large, andNominating Committee. Don’t missthis opportunity to be a leader in thepremier organization for gerontologicaladvance practice nurses! Applicationsare available at www.gapna.org.
Elizabeth M. Galik
Activity Approval. Applications are due at least 8 weeks prior tothe CNE program.
Take advantage of this member benefit to provide ANCC-approved programs for your chapter. These courses may fulfillrequirements for continuing education for ANCC board certifi-cations.
The Approver Unit is always in need of nurse peer review-ers too. If you have questions about the application process orvolunteering, please feel free to contact me.
Liz Macera, PhD, RN, NP-C
Co-Nurse Peer Review [email protected]
IN THIS ISSUE
Health Affairs News . . . . . . . . . . . 2
Award Nominations Sought . . . . 2
Chapter News . . . . . . . . . . . . . . . . 3
Online Library . . . . . . . . . . . . . . . . 4
Nausea Management . . . . . . . . . . 6
Clinical Research Corner . . . . . . . 7
Conference Highlights. . . . . . . . 8-9
The GAPNA Approver Unit reviews and approves continu-ing nursing education (CNE) programs for American Nurses
Credentialing Center (ANCC) credit. Each GAPNA chapter canobtain ANCC credit for one CNE program of up to 8 credits peryear. In addition, the Approver Unit can award ANCC approvalfor CNE provided by any organization outside of GAPNA.
For example, the Northern California GAPNA Chapterobtains credit for their annual update and the DelawareChapter recently submitted and application for their programon “Medication Management for Older Patients with HeartFailure.”
The application forms, instructions, and fees are availableon the GAPNA web site. Go to Education, then choose CE
Another Benefit of Belonging to GAPNA — ANCC Credit
2 The Newsletter — www.gapna.org • Spring 2012, Volume 31, Number 1
Health Affairs News: A Scholarship Winner and More
The Health Affairs Com mittee ispleased to announce the selec-
tion of Meghan M. Routt, MSN,ANP/GNP-BC, AOCNP, as the 2011-2012 recipient of the Health AffairsScholar ship. Meghan works as a nursepractitioner both in an acute care hos-pital and a skilled nursing facility. Shehas been a member of GAPNA for 5years and been active on the PracticeCommittee. She has been active in theOhio Chapter and provided experttestimony to both the House andSenate of Ohio in favor of advancedpractice nurses’ ability to prescribe schedule II narcotics. She hasan in-depth understanding of the state legislative process and isnow interested in expanding that understanding to the nationallevel. She will attend the annual health policy meeting convenedby the American College of Nurse Practitioners in February andwill be an active part of the Health Affairs Committee.
RN Demand and FundingOn a national note, there are two items of interest from the
nursing community. First was an article published in December2011 in the journal Health Affairs titled “Registered Nurse SupplyGrows Faster than Projected Amid Surge in New Entrants Ages23-26.” Some have read this article and interpreted the news asthe RN shortage crisis is over. The concern is that Congress mightthink funding is less imperative in 2013. How ever, this was notthe conclusion of the authors. The authors note that given thegrowing demand for nursing care by older adults, new opportu-nities for nurses through health care reform, and the need formore highly educated nurses, the demand for RNs will increase.Even with some growth in new entrants, it may not meet thisdemand.
In mid-December, the House FY2012 appropriations billwas released that included significant funding below that of theFY2011. That funding already did not meet needs related tonursing. This bill impacts funding for Labor/Health and HumanServices/ Education including nursing education, research, andcommunity health centers. This bill requires tracking andwatching. Given the increasing need for health care, it is not thetime to support appropriations below last year’s inadequatefunding and requests.
Pat Kappas-Larson, MPH, APN-C, FAAN
Co-Chair, Health Affairs [email protected]
Meghan M. Routt
GAPNA Recognizes Excellence: Award Nominations Sought
GAPNA is an organization that strives to promote excel-lence in the care of older adults. This is achieved through abody of individuals working on improving clinical excellencethrough education, research, leadership, and community serv-ice. Members of GAPNA all play an important role in the careof older adults and each year the organization recognizes thoseindividuals who have gone above and beyond supporting themission and vision of the organization.
GAPNA will host an Awards Dinner Friday, September 21,2012, at the Red Rock Hotel & Casino, Las Vegas, NV, duringGAPNA’s 31st Annual Conference to recognize the outstandingcontributions of GAPNA members. Individuals will be recog-nized for the following awards:
Excellence in Clinical PracticeExcellence in Community ServiceExcellence in EducationExcellence in LeadershipExcellence in Research
GAPNA invites you to submit a nomination by June 1,
2012. For a more detailed description of each award and anomination form, visit www.gapna.org
Susan Mullaney, MS, APN, GNP-BC
Awards Committee [email protected]
P erhaps you know of a friend who is looking to changecareers? Maybe you are contemplating changing posi-
tions or employers? Do you have to move to a new area andcan’t transfer within your current company? Maybe your com-pany has an opening and wants to find a qualified individualto fill the vacancy?
If any of the above questions apply to you, it may be timefor you to visit GAPNA’s Career Center. Simply log onto theGAPNA web site and click the “Career” tab to view currentemployment opportunities. If you would like to post an oppor-tunity, please contact the National Office at 866-355-1392 orsend your advertisement to [email protected] for a quick pricequote!
Action Urged to Fight Health CareWorker Fatigue
The link between health care worker fatigue and adverseevents is well documented, prompting The Joint
Commission to issue a new Sentinel Event Alert: Health CareWorker Fatigue and Patient Safety. The Alert, issued inDecember 2011, urges greater attention to preventing fatigueamong health care workers and suggests specific actions forhealth care organizations to mitigate the risks.
An article in the November 2007 issue of The JointCommission Journal on Quality and Patient Safety reported thatnurses who work more than 12-hour shifts and residents work-ing recurrent 24-hour shifts were involved in three times morefatigue-related preventable adverse events. In addition, healthcare professionals who work long hours are at greater risk ofinjuring themselves on the job.
continued on page 10
GAPNA’s Career Center: Your Opportunity Awaits
The Newsletter — www.gapna.org • Spring 2012, Volume 31, Number 1 3
Chapter Elections Must Be Held April through June
S everal years ago, GAPNA changed the National Bylaws tostate that all chapter elections should be held from April-
June, the second quarter of the year. State chapters were sup-posed to change their bylaws to accommodate this change, butit has not happened throughout all chapters.
Many GAPNA State Chapters are still holding their chapterelections throughout the year, which is a problem. It causesconfusion at the GAPNA National Office. They have no ideawhen each chapter is changing officers. The consequence ofthis confusion means that emails, phone calls, or even chapterdues reimbursement payments are sent to the wrong people.There are also many documents and computer files at theNational Office that need to be updated whenever an electiontakes place (officers listed on the web site, newsletter, databaseand email listservs, to name a few).
To help resolve this issue, we request that each chaptermodify its election schedule to coincide with the NationalBylaws. Again, the elections should occur between April andJune. If your chapter has any questions about this issue, pleasehave your chapter president contact me for assistance.
Jennifer Serafin, GNP
Member Services Committee [email protected]
Georgia
Georgia GAPNA wrapped up 2011 by supporting member-ship, sharing time and expertise with colleagues, and gearingup for our third annual local conference. Our second annualmembers-only dinner — a new Georgia GAPNA tradition —was held at The Colonnade (also a new tradition for our chap-ter) on November 3. Miles Hurley, JD, of Hurley Elder Law, pre-sented the topic of “Navigating Legal and VA Benefits” and con-tinuing education credit was available. In December, we host-ed a dinner for members and other colleagues at the BuckheadRuth’s Chris steakhouse. Our speaker was Steve Aldridge, con-sultant pharmacist, and his puppet Luther, the nursing homeresident. Prior to the puppetry, attendees learned quite a bitabout pseudobulbar affect disorder and its treatment. The din-ner and speaker were sponsored by Avanir Pharmaceuticals.
continued on page 4
Looking for a CHAPTER NEAR YOU?
ARIZONA (SONORAN)Jean [email protected]
CHICAGOLANDJill [email protected]
NORTHERN CALIFORNIAJulie [email protected]
DELAWARE/PENNSYLVANIAStacy [email protected]
FLORIDA GAPNAJo Ann [email protected]@oslermedical.com
FLORIDA GULF COASTPeggy [email protected]
GEORGIA (ATLANTA)Carolyne [email protected]
LOUISIANA/MISSISSIPPI (MAGNOLIA)Dr. Lisa [email protected]
MARYLANDSusan [email protected]
NEW ENGLANDSusan [email protected]
MICHIGAN (GREAT LAKES)Debra [email protected]
NORTH CAROLINA (TRIAD)Marigold (Margo) [email protected]@aol.com
OHIOBeth [email protected]
TENNESSEE (MIDDLE)Amber [email protected]
TENNESSEE (MIDSOUTH)Regina [email protected]
TEXAS (GULF COAST) - HOUSTONRhonda [email protected]
WISCONSIN (SOUTHEAST)Nancy [email protected]
Interested in Starting a Chapter?
Contact the GAPNA National Office
[email protected] • (866) 355-1392 • Fax (856) 589-7463
ChapterNews
l to r: Katherine Evans, Luther, Steve Aldridge, and Nikki Davis at theGeorge Chapter’s December dinner meeting.
4 The Newsletter — www.gapna.org • Spring 2012, Volume 31, Number 1
Chapter Newscontinued from page 3
Our Third Annual CNE Conference, “Caring for an AgingPopulation: An Interdisciplinary Perspective,” is just around thecorner on February 24-25, 2012. It will be held at the NellHodgson Woodruff School of Nursing, Emory University.Beginning this year, we are partnering with the Atlanta RegionalGeriatric Education Center to provide an outstanding geriatriceducation event. As we strive to become the primary source forgeriatrics in our area, we are expanding our conference this yearto include other nursing disciplines, social workers, physicians,and physician assistants — highlighting the importance of aninterdisciplinary approach to care. The keynote speaker for thisyear’s conference is the esteemed Joseph Ouslander, MD, profes-sor of nursing and medicine at Florida Atlantic University andexecutive editor of the Journal of the American Geriatric Society.We are looking forward to hearing his keynote address on caretransitions from nursing home to hospital – and those in between.
In addition to Dr. Ouslander, we are offering an incrediblyaccomplished faculty of speakers. Topics include “Innovations inCare Transitions,” “Late Life Depression,” “Evaluation of the OlderDriver,” “Chronic Heart Failure for Geriatric Patients in the LongTerm Setting,” “Navigating Community Services,” “PalliativeMedicine,” and a “Geriatric Literature Update.” Our Pre-Conference Workshops include “Suturing,” “X-Ray Interpre -tation,” and “ECG Interpretation.” We are looking forward to ahighly successful event and welcome all GAPNA members tojoin us in Georgia in February! Registration is available via linkfrom www.georgiagapna.org
Carolyn K. Clevenger
Chapter [email protected]
Amy Imes
Conference Planning Chair
Preserving the Evolution of the GNPThe Historical Committee remains hard at work to preserve
the evolution of the gerontological nurse practitioner as the lasttransformation and loss of the specialty title is occurring. Thearchival of the collection of information from 1980 is under waywith the committee researching the appropriate nursing library,developing and evaluating proposals to pay for the service, anddetermining what will be included in the collection. Also, an arti-cle series is being written about the change of the GNP role overthe decades for the GAPNA section of Geriatric Nursing. The lastgrand undertaking of the committee is publishing the history ofgerontological nursing and gerontological advanced practicenursing in book format within the next year. Documentation is animportant part of your job and the Historical Committee is keep-ing the documentation of the GNP for future nurses.
Colleen Wojciechowski
Poster Education at Your FingertipsA selection of professional posters from the 2011 GAPNA
Conference are available for members to view online. Theposters include evidence-based practice, research studies, andmany other topics of importance to gerontological nursing.They are identified as Clinical Project, Research, and ClinicalTopic. Take advantage of this member benefit by visiting the vir-tual posters on the GAPNA web site.
Nurses Tops Honesty List AgainThe latest Gallup Poll asking Americans to rate the hon-
esty and ethical standards of 21 professions shows nurseswith the top positive rating followed by medical doctors, andpharmacists. Nurses have topped the list every year sincethey were included in 1999, with the exception of 2001when firefighters ranked first. At the bottom of the honestyand ethics poll: members of Congress, lobbyists, car sales-people, and telemarketers.
Call for GAPNA Foundation GrantsApplications are due May 16, 2012.
Grants are announced in September.
General Eligibility Requirements• Applicants must be a current GAPNA member. If you are
not a current member, please include a GAPNA member-ship application and fee with the grant application.
• Members may apply for more than one grant. • Awards are limited to one per person per year.
Applications are available at the Foundation AwardsLink on the GAPNA web site.
Three Reasons to Visit GAPNA’s Online Library
1. Free CNE Opportunity!Available now in the Online Library, “Chronic Heart
Failure Management for Geriatric Patients in the Long-TermCare Setting” (1 contact hour, 20 pharmacology minutes).This session is free to everyone!
Fragility, multiple co-morbid disease processes,polypharmacy, prevalence of geriatric syndromes, andfunctional de cline prevent universal application of clinicalpractice guidelines to geriatric residents in long-term care.This presentation is intended to provide guidance for appli-cation of guidelines necessary to improve heart failuremanagement and outcomes in this population.
2. Annual Conference Content Available Content from GAPNA’s Annual Conference is now
available for sale in the new Online Library. Conference attendees: Access content at no cost (andpurchase CNE for a minimal fee).
Couldn’t make it to the conference, GAPNA mem-ber? $30 for regular sessions (CNE included).
Not a GAPNA member? Only $35 for regular ses-sions.
Visit www.prolibraries.com/gapna for more information.
3. Presidential MinuteGAPNA President, Elizabeth Galik, provides a brief
update on the new Online Library and its benefits.
The Newsletter — www.gapna.org • Spring 2012, Volume 31, Number 1 5
President’s Messagecontinued from page 1
GAPNA members continue to be active in policy issuesrelated to advanced practice nursing and gerontologic healthpolicy issues through our Health Affairs Committee, representa-tion at the Nurse Practitioner Roundtable, and our partnershipwith the Coalition of Geriatric Nursing Organizations. TheResearch Committee continues to partner with clinicians andgraduate students who seek to understand and improve the careof older adults.
As we look toward the future of health care for older adultsthat must address quality, cost, and access, these collaborativerelationships and partnerships become even more important.Please let fellow advanced practice nurses and our other inter-disciplinary colleagues know you are a member of GAPNA,describe our mission, and think of ways that we can all worktogether. As Henry Ford said, “If everyone is moving forwardtogether, then success takes care of itself.” GAPNA’s collabora-tive efforts will require an active membership who is willing toshare its expertise and partner with others. On behalf of theBoard of Directors, I would like to thank so many of our mem-bers and committees who work tirelessly and are always agree-able to serve as expert reviewers, representatives, and partnerswith numerous projects. In the next few months, we will beworking to revise some of our demographic and practice ques-tions that we ask at the time you join GAPNA or renew yourmembership. Our hope is to fully tap into the expertise of ourmembers as we continue to grow as an organization.
May all of our GAPNA members have a happy, healthy,and professionally successful 2012. I look forward to meetingnew members and reconnecting and collaborating with ourcurrent members and professional colleagues and supporters atGAPNA’s Annual Conference, September 19-22, 2012, in LasVegas, Nevada.
Elizabeth M. Galik, PhD, CRNP
James Lawrence Receives State NursePractitioner Award
James F. Lawrence, Jr., PhD,APRN BC, FAANP, CPS, has beenawarded the 2012 State NursePractitioner Excellence Award by theAmerican Academy of NursePractitioners. This prestigious awardis given annually to a dedicatednurse practitioner in each state whodemonstrates excellence as a leader,advocate, role model, and clinicianin his or her area of practice.
Dr. Lawrence is an adult andgerontological nurse practitioner atthe Veterans Administration MedicalCenter in Decatur, GA, specializing in physical medicine andrehabilitation. He also works as a part-time nurse practitionerwith Guardian Hospice and is a part-time undergraduate andgraduate faculty member at Georgia State University andGeorgetown University. In addition, Dr. Lawrence is founderand president of Aging Successfully, LLC, a consulting firmdedicated to addressing the various changing health careneeds of the aging population. This company has allowed himto work with small businesses; the Chinese, Canadian, andIrish ministries of health; and academic institutions throughoutthis country in developing effective programs of healthy agingfor its members.
Dr. Lawrence received his doctorate in research and theo-ry development in nursing from the Medical University ofSouth Carolina, his master’s of science in nursing from EmoryUniversity, educational specialist and master’s of educationdegrees in administration and education from the University ofSouth Carolina, his bachelor of arts degree in teaching fromWofford College, and his bachelor of science in nursing degreefrom Seton Hall University.
He has a strong primary care clinical background in geri-atrics with over 15 years of practice in rural and urban settingsand also in private, group, and institutional practices.
Dr. Lawrence has published nationally and internationallyon geriatric nursing, advance directives, palliative care, andissues related to vulnerable populations. He has received threestate awards and six national awards for his achievements innursing, currently holds four consulting contracts with nation-al pharmaceutical companies, and formerly served as healthcare adviser under Georgia Governor Sonny Purdue’s adminis-tration and President George W. Bush’s administration.
He has served on numerous state and national boards ofdirectors ranging from the American Nurses CredentialingCenter, American Academy of Nurse Practi tioners, SouthCarolina and Georgia Nurses Associations, and Geron tologicalAdvanced Practice Nurses Association, to name a few.
In 2009, Dr. Lawrence was inducted as a Fellow into theAmerican Academy of Nurse Practitioners. In 2010 he was rec-ognized as one of the top 100 health care professionals work-ing in geriatrics by the Marquis’ Who’s Who in Medicine andHealth.
Upcoming Educational Events
2012 Georgia GAPNA Local Conference
“Caring for an Aging Population: An Interdisciplinary
Perspective on Geriatric Care”
February 24-25, 2012Emory University, Atlanta, GA
CNE, CME, and Social Work CEU Credits Offeredwww.georgiagapna.org
2012 Florida GAPNA Symposium
“Leading the Way in Care for the Older Adult”
May 4-5, 2012Crowne Plaza Airport, Orlando, FL
6.0 CNE Credits OfferedEarly Bird Rates Available through April 1, 2012
www.flgapna.org
James F. Lawrence, Jr.
6 The Newsletter — www.gapna.org • Spring 2012, Volume 31, Number 1
C ommon side effects ofcancer treatment in the
older adult include nausea,vomiting, and pain. Theseeffects do not cease oncetreatment has stopped, butoften last long into survivor-ship and can become im -portant end-of-life issues. Infact, in a recent study oflong-term survivors ofbreast, prostate, and col-orectal cancer, 40% report-ed at least one symptomrelated to cancer or treatment(Deimling, Bowman, Sterns, Wagner, &Kahana, 2006) and concluded adultsreported pain most commonly with21% of those reporting pain relating it tocancer.
The body has four major triggers fornausea and vomiting: (1) chemoreceptorzone (CTZ), detecting blood toxins out-side of the blood brain barrier; (2) thecortex, responding to changes inintracranial pressure, anxiety, or othersensory triggers; (3) peripheral pathways,including the gastrointestinal tract recep-tors and nerves; and (4) the vestibularsystem, reacting to motion (Wood,Shega, Lynch, & Von Roenn, 2007).
The most common causes of nauseaand vomiting in the geriatric oncologypatient include chemotherapy-inducednausea and vomiting (CINV), opioid-induced, poor gastrointestinal tractmotility, and malignant bowel obstruc-tion. The mechanism behind CINV ismultifactorial; however, it is generallythought the chemotherapy itself activatesthe CTZ (Wood et al., 2007). Opioid-induced nausea and vomiting is linkedto dopamine receptor stimulation. Thesedopamine receptors are most oftenfound in the gastrointestinal tract and inthe periphery. Poor gastrointestinalmotility also activates peripheral path-ways. Bowel obstruction not only acti-vates peripheral pathways but also stim-ulates the CTZ with inflammatory medi-ators. Individuals who have undergonesurgery to the GI tract may have delayedgastric emptying as well.
Once the mechanism behind thenausea and vomiting is understood, med-ications can be chosen. Typically medica-tions targeting the D2 receptor (metoclo-pramide, prochlorperazine, halo peridol)are good starting points as they workwithin the CTZ and in the gastrointesti-nal tract (Wood et al., 2007). If nausea is
not relieved, it is more ben-eficial to add a second med-ication rather than switch-ing to another medication(Wood et al., 2007). Insomeone who is sufferingfrom delayed gastric empty-ing, adding metoclopro-mide or erythromycin/azith-romycin has shown to behelpful. It is important tocommunicate to the phar-macy the reasoning behindplacing a patient on erythro-
mycin/azithromycin, otherwise the pa -tient may not receive it.
Adverse drug effects and individualco-morbidities should be evaluatedwhen choosing additional medications.Ondansetron and palonosetron are ben-eficial with CTZ activation, but cancause constipation and prolonged QTinterval. Promethazine can successfullytreat nausea and vomiting associatedwith the CTZ; however, urinary retentionand extrapyramidal side effects (tremor,slurred speech, sedation, and anxiety)make this a suboptimal choice in theolder adult (Fick et al., 2003; Wood etal., 2007). Patient compliance with med-ication is paramount. Older adults aremore prone to medication side effectsand may be taking multiple medications,so care should be taken when prescrib-
ing nausea medications. These medica-tions should be scheduled and notordered as needed. Targeted therapy hasresulted in successful treatment of nau-sea and vomiting in up to 80%-90% ofpatients (Wood et al., 2007).
References
Deimling, G.T., Bowman, K.F., Sterns, S.,Wagner, L.J., & Kahana, B. (2006).Cancer-related health worries and psy-chological distress among older adult,long-term cancer survivors. Psycho -oncology, 15(4), 306-320.
Fick, D.M., Cooper, J.W., Wade, W.E., Waller,J.L., Maclean, J.R., & Beers, M.H.(2003). Updating the Beers criteria forpotentially inappropriate medicationuse in older adults: Results of a US con-sensus panel of experts. Archives ofInternal Medicine, 163(22), 2716-2724.
Wood, G.J., Shega, J.W., Lynch, B., & VonRoenn, J.H. (2007). Management ofintractable nausea and vomiting inpatients at the end of life: “I was feelingnauseous all of the time…nothing wasworking.” JAMA, 298(10), 1196-1207.
Meghan Routt, MSN GNP- BC,
ANP-BC
Arthur G. James and Richard M.Solove Cancer Hospital
The Ohio State UniversityMedical Center
Geriatric Oncology: Nausea Management
Meghan M. Routt
The Newsletter — www.gapna.org • Spring 2012, Volume 31, Number 1 7
State Regulation of CareQuality Is Costly to NursingHomes
Nursing homes are a highly regulat-ed industry in the United States. Theymust comply with federal Medicare andMedicaid standards, as well as thoseimposed by individual states. Main -taining compliance with all of these reg-ulations imposes costs on nursinghomes, concludes a new study.
William D. Spector, PhD, a res earcher at the Agency for HealthcareResearch and Quality, and Dana B. Mukamel, PhD, and CharleneHarrington, PhD, RN, of the Universityof California, and other co-investigatorsfound the more stringent the regulatoryrequirements, the higher the costs nurs-ing homes face. They collected data on11,168 freestanding U.S. nursing homesbetween 2004 and 2006. Medicare costreports yielded information on totalexpenditures and wages. The researchersalso conducted a survey of each state’scertification and licensing office for infor-mation on nursing home quality deficien-cies and the associated financial penal-ties. From these and other data, they cal-culated for each state a regulatory strin-gency index. Higher index values indi-cate stricter state regulation of quality.
The researchers found that nursinghomes located in states with more strin-gent regulation of quality had highercosts. The incremental costs of one stan-dard deviation increase in regulationstringency resulted in $78,467 in costs(in 2006 dollars). This translates into1.1% of the yearly expenditures for anaverage nursing home. The researcherscaution the findings should not detercontinuing attempts to regulate qualityand note that research underway isaimed at estimating the impact of stateregulation on quality. Estimates of boththe costs and benefits of regulation areneeded to assess the value of regulation.
More details are in Mukamel et al.(2011). Does state regulation of qualityimpose costs on nursing homes? MedicalCare, 49(6), 529-534.
Knee Replacements UpDramatically among Adults45 to 64 Years Old
Women and men ages 45 to 64were 2.5 times more likely to be hospi-talized for knee replacement surgery in2009 than in 1997, according to the lat-est News and Numbers from the Agencyfor Healthcare Research and Quality(AHRQ).
AHRQ’s analysis of hospital stays forknee replacement surgery from 1997 to2009 found:• The rate for women ages 45 to 64
jumped from 16 to 42 stays per10,000 people, while for men thesame age, the rate climbed from 11to 28 stays per 10,000 people.
• The rates for women and men 65 to84 rose by 69% and 55%, respective-ly — from 72 to 122 stays and from58 to 90 stays per 10,000 people.
• Among those age 85 years andolder, rates increased by 23% forwomen (from about 27 to 33 staysper 10,000 people) and 36% formen (from about 27 to 36 stays per10,000 people).This AHRQ News and Numbers
summary is based on data from HCUPFacts and Figures: Statistics on Hospital-Based Care in the United States, 2009,which provides highlights of the latestdata from the 2009 Nationwide InpatientSample, a part of AHRQ’s HealthcareCost and Utilization Project. The reportcan be accessed at http://www.hcup-us.ahrq.gov/
Clinical InformaticsMonitoring Tool Helps ReduceAdverse Drug Events inNursing Home Settings
In nursing homes, 40% of residentsuse at least nine different medications,and adverse drug events (ADEs) are com-mon. Yet many ADEs are preventable ifadequate medication monitoring is per-formed. The use of the Geriatric RiskAssessment MedGuide (GRAM), a clini-cal informatics tool that implementsprospective monitoring plans, markedlyreduced the risk of potential delirium innewly admitted and long-stay nursinghome residents, according to a newstudy. Potential hospitalizations and
deaths due to ADEs and mortality werealso reduced, but the effect was weakerin longer-stay residents. There was noeffect of the monitoring system on theincidence of falls.
For more info, see Lapane et al.(2011). Effect of a pharmacist-led multi-component intervention focusing on themedication monitoring phase to preventpotential adverse drug events in nursinghomes. Journal of the American GeriatricSociety, 59, 1238-1245.
Heart Disease, Cancer, andTrauma-Related Disordersamong the Most CostlyConditions for Men
The cost of treating men for heart dis-ease topped $47 billion in 2008, leadinga list of the 10 most expensive conditionsfor men age 18 and older, according tothe latest News and Numbers from theAgency for Healthcare Research andQuality (AHRQ). The federal agency alsofound that among the top 10 costliestconditions for men in 2008:• Cancer was the second most costly
disease to treat ($34 billion), fol-lowed by trauma-related disorders($33 billion) and osteoarthritis ($23billion).
• Among these conditions, overallcosts were lowest for back problems($14 billion), followed by chronicobstructive pulmonary disease andasthma ($18 billion).On a per-patient basis, the average
annual treatment cost ranged from $4,873 for cancer to $838 for high bloodpressure.
The data in this AHRQ News andNumbers summary are taken from theMedical Expenditure Panel Survey(MEPS), a detailed source of informationon the health services used by Americans,the frequency with which they are used,the cost of those services, and how theyare paid. For details, go to Statistical Brief#331: Top 10 Most Costly ConditionsAmong Men and Women, 2008:Estimates for the U.S. Civilian Non -institutionalized Adult Population, Age 18and Older, on the MEPS Web site.
continued on page 10
Clinical ResearchCorner
Published an Article Recently?We are looking for GAPNA members who have recently published clinical or research arti-
cles. Let us know the title, publication, volume, and issue number of your article, along with abrief abstract/summary, and we’ll share it with your fellow members in the GAPNA Newsletter.Keep us updated at [email protected]
More Photo Highlights from GAPNA’s 30th Annual Conference
September 14-17, 2011 • Washington, DC
Photos by Reflections Event Photography, Washington, DC. To view and order photos from GAPNA’s 30th Annual Conference, visit www.Reflections-Photo.com
More Photo Highlights from GAPNA’s 30th Annual Conference
“Improving Lives Of Older Adults: Practice and Policy”
10 The Newsletter — www.gapna.org • Spring 2012, Volume 31, Number 1
Clinical Research Cornercontinued from page 7
More Seniors GettingPneumonia Shots, But SomeLag Behind
The overall proportion of Americansage 65 and older who have ever beenvaccinated against pneumonia, a leadingkiller of seniors, increased from 53% to60% between 2000 and 2008, accord-ing to the latest News and Numbers fromthe Agency for Healthcare Research andQuality (AHRQ). Specifically, AHRQfound that in 2008:• Almost two-thirds (65%) of high-
income seniors reported ever beingvaccinated against pneumonia com-pared with less than half (46%) ofpoor seniors.
• Only 52% of seniors who live in alarge inner-city area, where resi-dents tend to be low-income andminority, reported ever being vacci-nated against pneumonia compared
with 64% of seniors who live inmedium-size cities.
• Just 37% of Hispanic seniors report-ed ever being vaccinated againstpneumonia compared with 65% ofWhite seniors. The proportion ofAsian and Black seniors who haveever been vaccinated against pneu-monia fell in between — 46% and45%, respectively.This AHRQ News and Numbers is
based on information in Chapter 2 of the2010 National Healthcare Quality Report.(http://www.ahrq.gov/qual/nhqr10/Chap2c.htm). The report examinesAmericans’ access to and quality ofhealth care.
Lower Educational LevelIncreases the Likelihood ofPreclinical Changes inMobility in Older Women
If you have less than 9 years ofschooling, you are more likely thansomeone with 12 or more years of edu-
cation to report changing the way orhow often you do at least one of fourmobility tasks: walking 0.5 miles, climb-ing up steps, doing heavy housework,and getting in/out of a bed or chair, eventhough you don’t report difficulty withthe task, according to a new study. Sucha change, made before difficulty withthe task arises, is termed preclinicalmobility disability (PCD), and has previ-ously been identified as an independentpredictor of functional decline in theelderly.
The study authors suggest PCD is amarker for early attempts to preservefunction by compensating for impair-ments at an early stage, when interven-tion may be beneficial.
More details are in Gregory et al.(2011). Education predicts incidence ofpreclinical mobility disability in initiallyhigh-functioning older women: TheWomen’s Health and Aging Study II.Journal of Gerontology: MedicalSciences, 66A(5), 577-581.
Health Care Worker Fatiguecontinued from page 2
The Alert addresses the effects and risks of an extended workday and of cumulative days of extended work hours. The JointCommission Alert recommends that health care organizations:
Assess fatigue-related risks such as off-shift hours, con-secutive shift work, and staffing levels.Examine processes when patients are handed off or tran-sitioned from one caregiver to another, a time of risk thatis compounded by fatigue.Seek staff input on how to design work schedules thatminimize the potential for fatigue and provide opportu-nities for staff to express concerns about fatigue.Create and implement a fatigue management plan thatincludes scientific strategies for fighting fatigue such asengaging in conversation, physical activity, strategic caf-feine consumption, and short naps.Educate staff about good sleep habits and the effects offatigue on patient safety.
The Joint Commission also suggests health care organiza-tions encourage teamwork as a strategy to support staff who workextended work shifts or hours. For example, use a system of inde-pendent second checks for critical tasks or complex patients.Also, organizations should consider fatigue as a potentially con-tributing factor when reviewing all adverse events, and educateemployees on the importance of good sleep habits, includingensuring their rest environment is conducive to sleeping.
The warning about health care worker fatigue is part of aseries of Alerts issued by the Joint Commission. Previous Alertshave addressed diagnostic imaging risks, violence in health carefacilities, maternal deaths, health care technology, anticoagu-lants, wrong-site surgery, medication mix-ups, health care-associ-ated infections, and patient suicides, among others. The completelist and text of past issues of Sentinel Event Alert can be found onthe Joint Commission web site (www.jointcommission.org).
NewsletterThe Official Newsletter of the Gerontological Advanced Practice Nurses Association — Founded in 1981
PRESIDENTElizabeth Galik, PhD, CRNPUniversity of MarylandSchool of NursingBaltimore, [email protected]
PRESIDENT ELECTMarianne Shaughnessy, PhD, CRNPUniversity of Maryland, BaltimoreSchool of NursingBaltimore, [email protected]
IMMEDIATE PAST PRESIDENTEvelyn Duffy, DNP, GNP/ANP-BC, FAANPCWRU-FPB/School of NursingCleveland, [email protected]
SECRETARYBarbara (Nikki) Davis, MSN, FNP-C, GNP-BCOptum Health, Evercare-ISNPBraselton, [email protected]@gmail.com
TREASURERKathyrne Barnoski, MN, FNP, GNP, BCEvercare PhoenixPhoenix, [email protected]
DIRECTOR-AT-LARGEAlice Early, MSN, ANP-BCBeaumont HospitalDivision of GeriatricsRoyal Oak, [email protected]
DIRECTOR-AT-LARGEPatty Kang, MSN, RN, GNPPermanente Medical Group/Kaiser South SacramentoFairfield, [email protected]
NATIONAL OFFICEMichael Brennan, CMPExecutive [email protected]
Sherry DzurkoAssociation Services [email protected]
East Holly Avenue/Box 56Pitman, NJ 08071Phone: 856-355-1392Fax: [email protected]
Spring 2012 • Volume 31, Number 1
Volunteers NeededInterested in serving on a GAPNA Committee? Learn more by contacting the
GAPNA National Office at [email protected] or call 866-355-1392 and request a Call for Volunteers form.
2011-2012 Committee ChairsApprover UnitLiz Macera PhD, RN, [email protected] Mandler, [email protected] Mullaney, MS, APN, [email protected] PlanningPamela Cacchione PhD, RN, [email protected] Marie Baylis, [email protected] Kennedy-Malone, PhD, [email protected] Harrison, PhD, [email protected] AffairsAnna Treinkman, MSN, RN, [email protected] Kappas-Larson, MPH, APN-C, [email protected] Fletcher, MSN, RN, CS, GNP, [email protected] Keltz, RN, [email protected] ServicesJennifer Serafin, [email protected] Ann Fisher, MSN, [email protected] Abraham Evans, MSN, RN, [email protected] Harrington, DNP, A/[email protected] A. Roznowski-Olson, RN, GNP, [email protected] Routt, MSN, ANP/GNP-BC, [email protected] Sabol, ACNP-BC, [email protected] Hammersla, MS, [email protected]
Journal Section EditorsLisa Byrd, PhD, RN, [email protected] Bakerjian, PhD, MSN, RN, [email protected] EditorsDebra [email protected] Harrington, DNP, A/[email protected] Site EditorsGeorge Smith, MSN, APRN, [email protected] Clevenger, DNP, [email protected]
SPECIAL INTEREST GROUPSAssisted LivingKathy Carroll, MSN, RN, [email protected] [email protected]/Palliative CareCarla Tozer, MSN, ANP-BC, GNP-BC, [email protected] Mullaney, MS, APN, [email protected] CallsDeb Wolff-Baker, MSN, FNP-BC, [email protected] Brewer, [email protected] Kappas-Larson, MPH, APN-C, [email protected]/Nursing HomeSuzanne Ranselhousen, [email protected] [email protected] CareTherese Narzikul, [email protected] Wollman, [email protected]
Please send mail and email address changes to [email protected] Newsletter Deadline: April 4, 2012
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The Newsletter — www.gapna.org • Spring 2012, Volume 31, Number 1 11