Poster Abstracts / JAMDA 14 (2013) B3eB26B16

posted on each cart. The IT manager developed and maintained thenecessary technical aspects. Evaluation methods: Each episode of use wasdocumented in a log with staff feedback and informally received residentand family satisfaction. This data and other input were reviewed regularlyat the Palliative Care Committee meetings.Conclusion: Very encouraging, definitely worth-it. Essential are 1-2dedicated and enthusiastic “champions” who quarterback day to dayefforts and proactive staff members who initiate and facilitate PCencounters. Buy-in by activities leader also very important. Front-line staffusually too busy to participate much but have key role in prompting othersto initiate use. Plans: 1. Promote more; 2. Obtain more structured feedbackfrom family and staff; 3. Explore Skype with multiple locations eg ooVoo;and 4. Explore expansion to provider/nurse communication with familymembers regarding resident care updates and dialogue.Author Disclosures: All authors have stated there are no financialdisclosures to be made that are pertinent to this abstract.

Evaluation of Diabetes Management in 29 Long Term Care and RehabPatients: A Quality Improvement Project

Presenting Author: Elizabeth Muller Hames, DO, NSU-COM GeriatricsAuthor(s): Elizabeth Muller Hames, DO, Naushira Pandya, MD, CMD; andCheryl Atherley-Todd, MD

Background: In the long term care setting, several issues arise regardingthe management of residents with diabetes who require insulin. Theexclusive use of sliding scale insulin for a prolonged period of time for non-urgent situations is citable (F-tag 329), and is also listed on the revisedBeers Criteria (2012). With sliding scale usage, more glucose checks needto be performed, resulting in increased resident discomfort, higher costs,as well as nursing time. Hemoglobin A1C values of 7.5%-8.0% (from theADA Position Paper on DM in Older Adults) are currently recommended inelderly populations, with lower values linked to greater morbidity andmortality in some studies. These values need to be performed regularly inlong term care patients.Objective/Aim: To survey the study population in terms of diabetesmanagement, and to formulate strategies for medically optimal and cost-efficient care.Quality Improvement Methods: Twenty-nine patients, including thosereceiving long term care and short-term rehabilitation, were evaluated interms of diabetes management for the month of July 2012. Charts werereviewed for past medical history, diabetes medications including oralagents and insulin regimens, presence of hypoglycemia, HbA1C, 7 dayaverage fasting blood glucose, blood pressure, date of measurement oflipids, the last eye exam, foot exam, and number of daily glucose checks.Conclusion: This project highlighted areas for improvement in diabetesmanagement in our facility. Goals for improvement include decreasing theuse of sliding scale insulin, optimizing A1C results, and decreasing thenumber of daily blood glucose checks. Physicians in long term care facili-ties are perfectly positioned to manage their patients, with access to on-site data and the opportunity for close follow up, allowing therapeuticchanges as needed. Long term care physicians have a critical role in dia-betes management.Author Disclosures: All authors have stated there are no financialdisclosures to be made that are pertinent to this abstract.

Implementation of an Evidence-Based Quality Improvement Programtowards Nursing Home Care

Presenting Author: Linda G. Uhrig-Hitchcock, MD, CMD, Scott & WhiteClinicAuthor(s): Linda G. Uhrig-Hitchcock, MD, CMD, Alison Granato, MD,Vietnam Nguyen, MD, Ryan Holler, LNFA; and Angela Hochhalter, PhD

Background: Many transfers to EDs and hospitals from nursing facilitiesare potentially avoidable. Quality improvement efforts are needed toreduce rates of transfer because these transfers place residents and fami-lies at risk for unnecessary anxiety, iatrogenic injuries, and hospital costs.The Interventions to Reduce Acute Care Transfers (INTERACTII) program is

an evidence-based quality improvement that can reduce hospital transfersfrom nursing facilities, especially when fully implemented.Objective/Aim: The objective of this project was to evaluate the impact ofinitial INTERACTII implementation on hospital readmissions, falls, and newpressure ulcers at one nursing facility. We also explored opportunities toimprove implementation at the nursing facility.Quality Improvement Methods: The nursing facility chose to beginimplementing INTERACTII in January through March of 2012. The fullfacility was involved in the change, affecting all residents. Implementationstrategies included support and program knowledge among facility lead-ership and the Medical Director, at least two training sessions for staffmembers, and gradual introduction of specific INTERACTII communicationtools (e.g., forms for ED transfers, SBAR, care paths). Facility-level data onfalls, new pressure ulcers, and 30-day readmissions per resident days wereexamined using statistical process control charts to identify changes inthese measures during implementation and in the months after.Conclusion: Full Implementation of all INTERACTII tools and consistent useof those tools may be required to impact resident care in measurable ways.Author Disclosures: All authors have stated there are no financialdisclosures to be made that are pertinent to this abstract.

Implementation of the Rejuvenate Activity Program (RAP): A QualityImprovement Project for Improving Well Being of Nursing Home (NH)Residents

Presenting Author: Murthy R. Gokula, MD, CMD, University of ToledoDepartment of Family MedicineAuthor(s): Murthy R. Gokula, MD, CMD, Phyllis Gaspar, PhD, RN; andRamchandra Siram, MD

Background: The national goal of reducing use of antipsychotic drugs inNH residents by 15 percent by the end of 2012. Centers for Medicare &Medicaid (CMS) requires innovative non-pharmaceutical approaches toaddress behavior disorders in dementia. The RAP envisions integratedevidence based complementary therapies to restore the health ofdementia patients. Activities were developed based on individual lifehistory.Objective/Aim: The aim of this quality improvement project was todetermine the influence of RAP on well-being of participants.Quality Improvement Methods: The RAP was implemented at a NH 5days a week for two months. 12 (9 females) residents, ranging in age from77 to 98 years (functional ages 5.04-6.81 RCCT) were selected for theprogram. Each participant progressed through three stations in the RAProom spending 15 minutes at each station with a staff by their side.Stations included exposure to bright lights (10,000 lux), hydrationenhancement, video of interest, and relaxation on motion bed and indi-vidualized relaxation. Outcome data were obtained from the MDS 3.0,chart review and interviews with family and staff.Conclusion: This program serves as a model for the integration ofcomplementary therapies for NH residents with dementia as an alterna-tive to the use of antipsychotic drugs. A program that integrates thecomponents of the RAP along with individualized computer components isbeing implemented.Author Disclosures: Murthy R. Gokula, MD, CMD has stated there are nofinancial disclosures to be made that are pertinent to this abstract.

Initiating Call Center Protocols to Decrease Hospital Admissions

Presenting Author: Laurie Roatch, MSN, RN, ANP, Geriatric Associates ofAmerica, PAAuthor(s): Donna L. Hamby, MSN, RN, NP, Laurie Roatch, MSN, RN, ANP,Dawna Boudreaux, RN; and Keith Rapp, MD

Background: The problem area addressed was timely initiation of treat-ment for urinary tract infections (UTIs) and pneumonia to prevent furtherprogression of the illness and possible hospitalization. All calls handled bythe Immediate Response Call Center (IRCC) were based on assessmentprotocols and did not address treatment. The IRCC averages 5600 callsa month from 80 nursing facilities for providers. If the IRCC cannot handle