Addressing Barriers to Advance Care Planning (ACP)

Conclusion/Discussion: Only half of NH patients who are ideally eligible foraspirin and beta-blockers received these medications yet 30-day and 1-yearmortality was significantly lower in patients who were treated with thesemedications when clinically indicated. These results demonstrate the effect ofapplying AMI guidelines for aspirin and beta-blockers to NH patients whilealso raising the question of what factors guided decisions not to provide thesemedications.Disclosures: Cari R. Levy, MD has no disclosures to be made that arepertinent to this abstract.

Addressing barriers to advance care planning (ACP)

Presenting Author(s): Laurie Jean Pung, DNP, NP, University of MinnesotaAuthor(s): Laurie J. Pung, DNP, NP

Introduction/Objective: This Doctorate of Nursing Practice(DNP) leader-ship project complements the Evercare corporate rollout of a training pro-gram on an advanced illness model that gives structure to the process of ACP.This project involves a values clarification/needs assessment survey and a 90day follow up survey. Objectives: Identify the top three barriers to advancecare planning facing NPs at Evercare. Evaluate the perceived self-efficacy ofNPs before and after Evercare’s Advanced Illness Training. Identify the threemost helpful tools to assist Evercare NPs with ACP. Identify the top 3 thingsthat most influence Evercare NPs own personal medical decisions.Design/Methodology: A one group pre and post-test design will be uti-lized.The Tailored Design Method was used in the development and distri-bution of the survey (Dillman, 2007).Results: 379/463 surveys have been returned; an 82% response rate. The topthree barriers: patient/family failure to recognize treatment futility; familydiscordance; and, cultural differences. The three things that would mostinfluence the NPs personal medical decisions: quality of life at the time; theextent to which they would depend on others; and ability to still makedecisions. The three most useful tools in ACP identified by the NPs: familyconferences; literature to assist families in the process of ACP; and, Evercare’straining modules on end of life (EOL). The areas the NPs felt most proficient:ability to build therapeutic relationships with the enrollee, the family, andthe nursing facility staff; ability to explain the disease progression and ex-pected medical outcomes; and ability to separate their own values and beliefsfrom enrollee/family beliefs. The follow up survey that is distributed 90 dayspost training has just been sent to the first group to participate in the trainingprogram. Results are not yet available.Conclusion/Discussion: ACP is relevant to the quality of the dying experi-ence. Healthcare institutions and healthcare providers share responsibility forquality care at EOL. Most providers agree that their educational preparationdid not prepare them to discuss ACP with their patients and families (Buss,Marx, and Sulmasy, 1998; Ryan et al., 2001; Sullivan, Lakoma, and Block,2003). The results of this project will help to evaluate Evercare’s trainingprogram on advanced illness care.Disclosures: Laurie Jean Pung, DNP, NP is a salaried employee of Evercare.Product(s) made by this company related to this topic: Advanced IllnessModel.

Agreement of diabetes mellitus diagnosis indicators in skilled nursingfacility elderly residents

Presenting Author(s): Sandra Molotsky, BSN, Omnicare Senior Health Out-comesAuthor(s): Sandra Molotsky, BSN; Mark J. Haumschild, MS, PharmD, CGP;Sharon Dybicz, PharmD; James Harper, PhD; Larry Helbers, MA; W. GaryErwin, PharmD; Bruce Stuart, PhD

Introduction/Objective: Previous studies in the literature report diabetesmellitus (DM) prevalence of 18% to 26% based on Minimum Data Set(MDS) assessments. However, it is generally believed that DM is underdiag-nosed within the elderly population. The purpose of this study was toexamine the agreement of multiple sources in estimating the proportion ofskilled nursing facility (SNF) elderly residents with DM in a 1-year period.Design/Methodology: This is a multicenter, retrospective, medical utilizationevaluation using data abstracted from active medical charts with endpoints

routinely collected electronically from selected SNF MDS and prescriptionclaims records. Data for SNF elderly residents �65 years of age on the chartreview date were abstracted to estimate the point prevalence of DM and levelof agreement between various indicators of the condition for the SNF elderlypopulation. Residents in a persistent vegetative state (ie, comatose) or re-ceiving hospice care were excluded. Indicators of DM include those based onlaboratory data, documented physician diagnosis, and prescription claims forDM therapy. The presence of these indicators within the previous 12-monthperiod from the chart abstraction date was determined. DM status based onlaboratory value indicators, medical chart diagnosis, MDS diagnosis, andprescription indicators was then compared to assess agreement between thesedata sources.Results: A total of 2828 residents were sampled from 23 SNFs across thecountry. Of these residents, 2317 were eligible (female: 73%, white: 84%,mean age: 83 years, length of residence: 2.8 years, body mass index: 25.8kg/m2). 32.8% (N�761) of SNF elderly residents had evidence of at least 1DM indicator. Among individual indicators, 30.3% (646/2131) of residentshad an MDS DM diagnosis, 29.7% (687/2317) had a chart DM diagnosis, and27.1% (419/1545) were prescribed DM medications. Agreement of DM statusbetween chart diagnosis and MDS diagnosis, chart diagnosis and prescriptionindicators, and MDS diagnosis and prescription indicators were highly cor-related (Kappa statistic: 0.9253; 0.8542; 0.8455, respectively): 28.5% (608/2131) of residents had DM by chart and MDS diagnosis, 26% (402/1545) hadDM by chart diagnosis and prescription indicators, and 26.4% (380/1440)had DM by MDS diagnosis and prescription indicators. Agreement betweenDM status based on fasting plasma glucose value and chart diagnosis, MDSdiagnosis, and prescription indicators was weakly correlated (Kappa statistic:0.2665; 0.252; 0.3026, respectively).Conclusion/Discussion: Approximately 30% of SNF elderly residents hadDM, and agreement between chart diagnosis, MDS diagnosis, and prescrip-tion medication claims was high, implying that these indicators can providea good estimate of prevalence of DM in SNFs.Disclosures: Lawrence Helbers, MA and James Harper, PhD have no dis-closures to be made that are pertinent to this abstract. Bruce Stuart, PhDreceived a consultant honorarium from Sanofi Aventis. Sandra Molotsky,BSN, Sharon Dybicz, PharmD, and W. Gary Erwin, PharmD received grant/research support from Sanofi Aventis. Mark J. Haumschild, MS, PharmD,CGP is a salaried employee of Sanofi Aventis.

An interdisciplinary team approach to reduce psychotropic medicationsin a community based nursing home: Implementation of F-Tag 329

Presenting Author(s): Veronica Escobar, DO, STVHCS, UTHSCSAAuthor(s): Veronica Escobar, DO; S. Liliana Oakes, MD; Cindy Alford, PhD;M. Rosina Finley, MD; David Espino, MD

Introduction/Objective: Normal aging, along with the inappropriate use ofmedications, can lead to significant adverse consequences. Drugs with thegreatest potential to be problematic are psychotropics. F-Tag 329 mandatesthat ”each resident’s drug regimen must be free from unnecessary drugs.” Thisregulation prohibits excessive doses, excessive duration, inadequate monitor-ing and adverse consequences. AMDA’s policy states that only an interdis-ciplinary team can make decisions to reduce inappropriate medication, suchas psychotropics. The purpose of this study was to evaluate the effectivenessof an interdisciplinary team formed to implement F-Tag 329.Design/Methodology: The site is a 230 bed community based long-term care(LTC) facility in San Antonio, TX. The facility has contracted with anindependent psychiatry group to provide mental health services. This psy-chiatry consulting team and medical director, a geriatrician, are responsiblefor all psychotropic prescriptions. An interdisciplinary team was created inMarch 2007 and was comprised of the medical director, consultant pharma-cist, director of nursing, MDS coordinator, and two social service represen-tatives. The psychiatry group’s nurse practitioner and nurse manager alsojoined the team. The team began by establishing clear guidelines for appro-priate uses of psychotropic medications. Guidelines required that a diagnosisbe linked to each medication. The committee then reviewed all psychotropicmedications prescribed within the preceding month. The team discussedconcerns about each patient, and made recommendations for reduction ordiscontinuation of medications. Each month a report was generated docu-

POSTER ABSTRACTS B5