Impact of the Relocation of a Long-term Residential Care Facility on Staff.

This article describes the relocation of residents and staff of a long-term residential care facility into a new state-of-the-art building in a Canadian province. All staff were surveyed about their perceptions of the moving process 2 months after the move occurred using a newly created 51-item questionnaire containing both open-ended and closed questions (5-point Likert scale). The results were positive for the 3 subscales of the survey, with average scores for premove, midmove, and postmove items of 3.67, 3.94, and 3.66, respectively. There was no significant difference in the means when comparing staff position, years of employment, or assignment to 1 or more units. Staff were very positive about the move itself, the orientation provided and overall planning, and support from coworkers and management. Some concerns were raised about staffing shortages, involvement of residents, and preparedness of the units and building. In addition, it is evident that relocation is an ongoing process, with many supports required in the months after the move. This article describes a very well planned and executed relocation of a long-term residential care facility and can provide guidance and lessons learned to assist other administrators who are planning a similar endeavor.

Urinary tract infection diagnosis and response to therapy in long-term care: A prospective observational study.

BACKGROUND: The prevalence of asymptomatic bacteriuria among residents of long-term care (LTC) facilities is high, and is a source of inappropriate antibiotic prescription. OBJECTIVE: To establish symptoms and signs associated with a positive urine culture, and to determine whether antibiotic therapy is associated with functional improvement. METHODS: A total of 101 LTC patients were prospectively observed after submission of urine for culture. RESULTS: The culture positivity rate was consistent with the expected asymptomatic bacteriuria rate. Change in mental status and male sex were associated with culture positivity. Treatment decisions were not consistent with culture results. Treatment did not lead to improvement in activities of daily living scores at two days or seven days. DISCUSSION: Significant growth cannot be well predicted based on clinical variables; thus, the decision to submit urine is somewhat arbitrary. Because urine culture testing and treatment does not lead to functional improvement, restricting access to the test may be reasonable. CONCLUSION: Urine culture testing in LTC facilities does not lead to functional improvement.

HISTORIQUE: La prévalence de bactériuries asymptomatiques est élevée chez les résidents d'établissements de soins de longue durée (SLD). Elle suscite la prescription inappropriée d'antibiotiques. OBJECTIF: Déterminer les signes et symptômes associés à une culture d'urine positive et établir si l'antibiothérapie favorise une amélioration fonctionnelle. MÉTHODOLOGIE: Au total, 101 patients en SLD ont fait l'objet d'une observation prospective après l'envoi d'un prélèvement d'urine pour culture. RÉSULTATS: Le taux de cultures positives était conforme au taux prévu de bactériuries asymptomatiques. La détérioration de l'état mental et le sexe masculin s'associaient à des cultures positives. Les décisions thérapeutiques n'étaient pas en accord avec les résultats des cultures. Le traitement ne suscitait pas d'amélioration à l'indice d'activités de la vie quotidienne au bout de deux ou sept jours. EXPOSÉ: Les variables cliniques ne permettent pas de prévoir une croissance importante. Ainsi, la décision de faire une culture d'urine est quelque peu arbitraire. Puisque les cultures d'urine et le traitement n'assurent pas d'amélioration fonctionnelle, il est peut-être raisonnable de restreindre l'accès aux analyses. CONCLUSION: Dans les établissements de SLD, les analyses d'urine ne favorisent pas d'amélioration fonctionnelle.