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Studying Patient Profiles and Streamlining Care Protocols


Gregg Warshaw, MD, Medical Editor

Continuous study of the clinical and functional characteristics of the patient population that we care for is integral in providing high-quality, patient-centered care. Constant reevaluation of care protocols and processes is also a key practice for care improvement. The articles in this issue focus on increasing provider knowledge of nursing facility residents with Parkinson disease (PD) and residents at high risk for severe hypoglycemia, with an emphasis on how nurses and nurse practitioners can contribute to more effective care protocols.

PD is a neurodegenerative disease estimated to afflict approximately 1 million Americans and 10 million people worldwide, with about 60,000 new cases diagnosed every year in the United States. PD psychosis is estimated to occur in up to 60% of patients with PD over the course of their disease. Psychotic symptoms associated with PD are linked to increased dementia, caregiver burden, and mortality, and uncontrolled PD psychosis is a risk factor for premature nursing facility placement and mortality. Barbara Zarowitz, PharmD, BCPS, BCGP, FCCP, FASCP, and colleagues conducted a retrospective database analysis to evaluate the demographic, functional, and clinical characteristics of nursing facility residents with PD compared with those with PD psychosis. Their aim was to better understand the characteristics of nursing facility residents with PD psychosis to develop a profile to better inform care.

Hypoglycemic events can have catastrophic outcomes, including seizure, coma, long-term disability, and, if left untreated, death. The Joint Commission recognizes the value of nurse-driven standing orders in promoting patient outcomes. In their quality improvement project, Carol L Delville, PhD, APRN, ACNS-BC, and colleagues sought to determine whether a protocol with a standing order for injectable glucagon and appropriate aftercare to treat severe hypoglycemia in residents at a central Texas long-term care facility could reduce the utilization of external health care resources over a 3-month period compared with a 3-month baseline. 

Finally, the LTC GPS column in this issue elaborates on the growing role of advanced practice registered nurses (APRN) in health care. With the current projections for physician shortages, APRNs may be a solution to help fill the gap. In their column that first appeared online in the June 2019 digital issue, Matthew Pakizegee, PharmD, MS, and Richard G Stefanacci, DO, MGH, MBA, AGSF, CMD, discuss how APRNs can bring much value to care processes in LTC.

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