Attendees at the 2019 McKnight’s Online Expo will learn from Kimberly Gordy, BakerHostetler associate, about the “3 B’s” of mobile technology: Basic Capabilities, Business Associates and Bombshells. Gordy’s presentation will start at 3 p.m. ET on Wednesday, March 27. 

The Expo, now in its 13th year, offers five CE-approved webinars and an exhibit hall. The first session on payment, featuring Leah Klusch, will start at 11 a.m. ET on March 27. Additional details, and free registration, are available at www.mcknights.com/expo2019.

They noted that soil samples came from grasslands in Northern Ireland contained a previously unfound strain of bacteria, which has “remarkable” medicinal properties. Investigations revealed that this strain stopped the growth of MRSA and three other superbugs, researchers noted in Frontiers in Microbiology.

Ancient healers in Ireland would often use soil from the site to treat everything from toothaches to throat infections.

A:Last year at the JP Morgan conference, we had a really great panel focused on innovation in Medicaid. From that event, people said, ‘Why aren’t we doing something more about making sure there’s a pathway for entrepreneurs in the Medicaid space?’ Ten months later it came to be.

Q: What should nursing providers be thinking about innovation?

A:[They] serve a huge population of dual-eligibles, so innovation in Medicaid is really important. It impacts staff — if you have better technology and innovation, it helps manage diseases and ailments that can come from long-term nursing care.

Q: What about providers who feel like Medicaid is underpaying them?

A:I was a hospital administrator for 15 years, so I know that struggle intimately. But the Medicaid ecosystem has potential for business development. It’s a fallacy to think there is not a business case to be made.

Q: What about those who balk at installing new technology?

A:If you have staff with technology that can work with your patients, that staff is more likely to stay. Ultimately, there is a cost savings that trickles down.

There is a whole open can of worms concerning photos, with some corporations wanting photos of everything, and some forbidding photos. 

The most important thing is to be sure you follow the policies of your facility or corporation. Do not go against these policies, and if you have questions or concerns, please be sure to check with your boss.

Many corporations and facilities take pictures of bruises if they are significant and appear on the face, neck or breast, or the bruises are large, have particular shapes or fingerprints, or no one knows how they occurred. Any bruise that looks unusual or needs to be investigated to rule out abuse should be photographed.

There are also programs out there that many facilities use that require assessments, with or without photos. You need to pay attention to what is required with these programs, too.

You also must be consistent. If day shift is taking pictures of all wounds and bruises and that is the policy, then all three shifts need to be doing the same thing. The easiest way to send inspectors on a hunt is inconsistency. 

Some quick audits will help you check for pictures and notes to ensure everyone is documenting the same. Be sure that any wounds or bruises are also discussed at your stand-up meetings. Don’t let these fall between the cracks, as I can assure you the first day you don’t discuss such an issue, there will be a significant change with no follow up note or proper documentation.

I repeat: be consistent and follow your formal policies.

Please send your resident care-related questions to Sherrie Dornberger at ltcnews@mcknights.com.

The Hebrew Home at Riverdale first launched its “innovative” new cannabis program in 2016. With it, the facility provides educational sessions on the often-misunderstood drug to both residents and their family members. About 10 have participated so far, reporting that cannabis has helped to lessen the severity of chronic pain and reduce opioid dosages, among other benefits, investigators wrote in January’s Journal of Post-Acute and Long-Term Care Medicine.

“There’s a tremendous amount of stigma associated with marijuana in general,” said Zachary Palace, M.D., medical director of Hebrew Home. “But we need to be looking at medical cannabis objectively and recognizing it not from the lens of recreational use. We have to be open-minded.”

Residents reported a lessening in the severity of chronic pain when using cannabis, resulting in lower opioid use. Those with Parkinson’s also reported mild improvement with rigidity, while one patient experienced a “marked reduction” in seizures. 

Authors noted their program is compliant with state and federal rules, including residents purchasing cannabis directly from certified dispensaries.

The United Hospital Fund in New York released its analyses in January, based on interviews with patients and providers. Authors from the New York nonprofit noted that individuals often felt they were rushed, with little say in which facility they ended up. Patients and their families want to know more upfront about what to expect during their SNF stay, but it’s rare that they get that info,  said Kristina Ramos-Callan, a UHF program manager and co-author of one analysis.

“Families typically report that the transition is rushed, and that there are pieces of information missing,” she said. “There’ a serious knowledge gap in what families are told and what they’re able to find out on their own. ”

Authors noted that hospitals’ efforts to smooth transitions are often hampered by pressures to increase efficiency, constraints from insurance providers, authorization delays, and regulations that limit assistance they can provide to patients. Location and access to transportation were often critical factors in choosing a nursing facility.

Research has shown that exercise can help ease symptoms in residents with venous insufficiency. 

Chronic lower leg edema from venous insufficiency is what leads to the development of venous stasis ulcers. Therefore, the edema must be managed. Compression therapy and leg elevation are necessary to manage it. Exercise and physical activity can further help reduce edema in residents with venous insufficiency. 

Types of exercises to consider include the following: 

•  Performing ankle flexion (pointing the toes forward away from the body, then flexing, pulling the toes toward the shin) throughout the day will help reduce venous congestion and decrease venous reflux. Performing this in a standing position or with a resistance band will further enhance the effects. 

•  Walking briskly at frequent intervals during the day will help the calf muscle pump the blood up and out of the legs. 

•  If the resident is capable, have the resident walk at an incline on a treadmill, to further enhance the calf muscle pump action. Rocking in a rocking chair, using the feet to rock, will also promote the calf muscle pump action. 

Always ensure the resident is safe to perform the exercises and, if they are to be performed in a standing position, ensure appropriate footwear. 

The benefits of exercise for residents suffering from venous insufficiency are often overlooked. Encouraging appropriate exercise for these residents may improve the disease state, reduce the risk of ulcer development and enhance ulcer healing. 

As caregivers, we can use any advantage we, and our patients, can find, so look into the benefits of responsible exercise at every possibility.

Please send your wound treatment-related questions to “Ask the Expert” at ltcnews@mcknights.com.

Labeled traction force-activated payloads, or TrAPs, the method allows materials to communicate with tissues.

“This sort of intelligent, dynamic healing is useful during every phase of the healing process, has the potential to increase the body’s chance to recover, and has far-reaching uses on many different types of wounds,” said Ben Almquist, Ph.D., lecturer in the Department of Bioengineering at Imperial College London.

Almquist described a natural process that occurs post-injury, in which cells move through collagen structures found in wounds. TrAPs recreate that method by folding DNA segments into three-dimensional shapes, called aptamers, that cling to proteins. An attached handle gives cells a grip. 

Lab testing showed the technique unravels TrAPs like shoelaces to uncover and trigger healing proteins that then grow and multiply. By changing the cellular handle, researchers determined they could change which type of cells are grabbed. The manipulation allows scientists to interact with the correct type of cell at the correct time.

In Advanced Materials in January, the researchers posited the technique could be used for chronic wounds, including diabetic foot ulcers.

In a study published in Wounds online, a group of Canadian scientists explained their efforts to develop a stable, topical doxycycline hyclate. DOXY, a type of tetracycline, could be used to inhibit protein synthesis.

Persistently high concentrations of cytokines — small proteins that signal cells — within wounds are suspected of encouraging many patients’ inflammatory responses. Their presence can degrade growth factors, receptors and matrix proteins required for proper wound healing. The types most commonly over-expressed in diabetic foot ulcers are members of the matrix metalloproteinase, or MMP, family.

The research team, led by David Charles Baranowski, Ph.D., of biotech firm Delivra Corp. in Prince Edward Island, wanted to test DOXY’s ability to reduce MMP-9 specifically.

They found their 2% formulation netted a 30% decrease in MMP-9 when compared to a control. It also showed stability when stored for up to 70 days at 4o Celsius.

The new staff competency requirements may seem challenging at first. However, the Centers for Medicare & Medicaid Services has reinvested some of the funds collected from civil money penalties to develop tools and resources to guide facility leaders through a staff competencies assessment process.  

Three separate toolkits assess staff in different roles: (1) certified nursing assistants/certified medication technicians (CNA/CMT); (2) licensed practical/vocational nurses (LPN/LVN) and registered nurses (RN); and (3) assistant directors of nursing (ADON), directors of nursing (DON), and administrators. Each toolkit is a complete package, including videos, talking points, an email memo, a poster, an assessment completion tracker, a manager’s guide to meeting one-on-one with staff, and an assessment worksheet to compile and analyze results, designed to support your nursing home’s existing learning-and-development standards of practice.

The toolkit for the licensed nursing staff such as RNs and LPN/LVNs includes a competency assessment that covers behavioral, technical and resident-based skills — covering everything from ethics to infection control to detecting resident change in condition and pain management.

There is a separate, detailed assessment for CNA/CMTs that also covers CNA-level questions on ethics, problem-solving, documentation, resident falls, urinary incontinence and more.  

Staff competency requirements, which help reduce adverse events, needn’t be overwhelming. These toolkits are there to support nurse leaders. Download the toolkits and use them today!

Please send your nursing-related questions to Judi Kulus at ltcnews@mcknights.com.