ABSTRACT
OBJECTIVES: Nursing homes became epicenters of COVID-19 in the spring of 2020. Due to the substantial case fatality rates within congregate settings, federal agencies recommended restrictions to family visits. Six months into the COVID-19 pandemic, these largely remain in place. The objective of this study was to generate consensus guidance statements focusing on essential family caregivers and visitors. DESIGN: A modified 2-step Delphi process was used to generate consensus statements. SETTING AND PARTICIPANTS: The Delphi panel consisted of 21 US and Canadian post-acute and long-term care experts in clinical medicine, administration, and patient care advocacy. METHODS: State and federal reopening statements were collected in June 2020 and the panel voted on these using a 3-point Likert scale with consensus defined as ≥80% of panel members voting "Agree." The consensus statements then informed development of the visitor guidance statements. RESULTS: The Delphi process yielded 77 consensus statements. Regarding visitor guidance, the panel made 5 strong recommendations: (1) maintain strong infection prevention and control precautions, (2) facilitate indoor and outdoor visits, (3) allow limited physical contact with appropriate precautions, (4) assess individual residents' care preferences and level of risk tolerance, and (5) dedicate an essential caregiver and extend the definition of compassionate care visits to include care that promotes psychosocial well-being of residents. CONCLUSIONS AND IMPLICATIONS: The COVID-19 pandemic has seen substantial regulatory changes without strong consideration of the impact on residents. In the absence of timely and rigorous research, the involvement of clinicians and patient care advocates is important to help create the balance between individual resident preferences and the health of the collective. The results of this evidence-based Delphi process will help guide policy decisions as well as inform future research.
Subject(s)
COVID-19 , Consensus , Nursing Homes , Visitors to Patients , Canada , Delphi Technique , Female , Humans , Male , Middle Aged , Organizational Policy , Pandemics , SARS-CoV-2 , United StatesSubject(s)
Geriatrics , Patient Care Team , Rare Diseases/diagnosis , Aged , Assisted Living Facilities , Humans , Nursing Staff , Rare Diseases/therapySubject(s)
Aging , Long-Term Care , Pulmonary Disease, Chronic Obstructive/diagnosis , Adrenergic beta-2 Receptor Agonists/therapeutic use , Geriatric Nursing , Humans , Patient Readmission , Pulmonary Disease, Chronic Obstructive/drug therapy , Pulmonary Disease, Chronic Obstructive/prevention & control , Surveys and QuestionnairesSubject(s)
Assisted Living Facilities , Geriatric Nursing , Medicare , Obesity , Body Mass Index , Female , Humans , Male , Medicaid , United States , Suicide PreventionSubject(s)
Early Detection of Cancer , Geriatric Assessment , Patient-Centered Care , Aged , Aged, 80 and over , Humans , Middle AgedSubject(s)
Communicable Diseases, Emerging/epidemiology , Disease Outbreaks , Ebolavirus/isolation & purification , Hemorrhagic Fever, Ebola/epidemiology , Communicable Disease Control/organization & administration , Communicable Diseases, Emerging/prevention & control , Female , Hemorrhagic Fever, Ebola/prevention & control , Humans , Incidence , Male , Risk Assessment , United States/epidemiologyABSTRACT
OBJECTIVE: The objective of this work is to improve the management of disruptive behavior in the nursing facility setting through an interdisciplinary team (IDT) approach to reduce the use of antipsychotic medications in accordance with the Centers for Medicare & Medicaid Services initiative. DATA SOURCES, EXTRACTION, AND SYNTHESIS: The process began with a search and review of more than 100 peer-reviewed articles, government, and association resources that focused on the management of disruptive behavior in older adults. While data were limited to the past 10 years, the vast majority of data reviewed were within the past 5 years. This information was reviewed and discussed by all of the coauthors who meet in person at the American Society of Consultant Pharmacists as a work group. This group was tasked with identifying strategies through an IDT to improve the management of disruptive behavior and reduce the use of antipsychotic medications in nursing facility residents. In addition, significant follow-up work was accomplished following the live working session. CONCLUSION: Through an IDT, strategies can be implemented for long-term care residents to prevent and better manage disruptive behavior. These strategies can result in the reduction of the use of antipsychotic medications. The field of long-term care would benefit from further research to identify additional nonpharmacologic and pharmacologic treatments for managing disruptive behavior.