Poster Abstracts / JAMDA 14 (2013) B3eB26 B23

discharge from the SNF using the Katz Index of Independence in Activitiesof Daily Living. Hospital readmission and reason for readmission wereobtained from medical record review.Results: Forty-eight patients were admitted to the two SNF in that timeperiod. Mean age was 84.7, with 75% female, and 96% white. Half of thepatients were living at home without assistance prior to the fracture,and majority (56%) had intertrochanteric fractures. Of the 48 patients, 23(48%) were eventually discharged back to home, 23 (48%) were read-mitted to the hospital, and 2 (4%) expired in the SNF. The two mostcommon reasons for readmission were infectious (22%) and neurologic(17%). About a third (30%) of the readmissions occurred within the firstweek, and 74% occurred within 3 weeks. The readmitted patients wereslightly older (85.5 + 5.0 vs. 83.9 + 7.2) and had more comorbidities(Charlson Comorbidity Index, 3.8 + 2.7 vs. 2.8 + 2.2). Seventy percent ofthe males compared to only 44% of the females were readmitted.Majority (71%) of those who stayed >7 days in the hospital werereadmitted. Almost three-fourths (71%) of those on around-the-clockanalgesics and 88% of those on supplemental oxygen at the time ofhospital discharge were readmitted. More than half (56%) of those whowere fully dependent (Katz Index 0-1) at the time of admission into theSNF were readmitted. There was no difference between the two groupson fracture type and pre-fracture living situation, as well as on weightbearing status, use of antibiotics or antipsychotics, and presence ofindwelling catheter at the time of discharge.Conclusion/Discussion: Patients discharged to SNF after hip fracturesurgeries have a high risk for readmission. These readmissions are largelydue to nonsurgical illness, and reflect the poor overall health condition,both physically and functionally, in this particular subset of patients.Author Disclosures: All authors have stated there are no financialdisclosures to be made that are pertinent to this abstract.

Impact of Quarterly Interdisciplinary Medication Reviews on ResidentCare in a Canadian Long Term Care Facility

Presenting Author: Denis J.P. O’Donnell; and Judith Vepy-Lebrun, MedicalPharmacies Group LimitedAuthor(s): Denis J.P. O’Donnell, Judith Vepy-Lebrun, Sid Feldman, MD,Paul R. Katz, MD, CMD; and Linda Zhao

Introduction/Objective: There are only a few long term care facilities inCanada where quarterly medication reviews are conducted as a regularly-scheduled face-to-face meeting involving the primary care physician, theclinical unit nurse and the clinical consultant pharmacist. Although the valueof the interdisciplinary medication review has been documented in otherpractice settings, there is little research evaluating this medicationmanagement strategy in the long termcare environment. Thepurposeof thisstudywas to evaluate the impact of quarterlymedication reviews conductedin a Canadian long term care facility using this integrated team approach.Design/Methodology: A retrospective review of all residents who receivedone or more medication reviews between January 1, 2011 and December 31,2011was completed at the Baycrest Apotex Centre, a 472-bed long term carefacility in Toronto. Types of drug-related problems were identified as well asthe pursuant interventions. Electronic medical records were accessed by anindependent reviewer in order to extract the information.Results: 1821medication reviews involving 536 residents were reviewed. Atotal of 1952 medication-related issues were identified during medicationreviews. The threemost common drug-related problemswere: unnecessarydrug therapy, too high of a dose, and the need for additional drug therapy.2452 documented interventions occurred during the medication reviewswith approximately 95% of residents having received at least one inter-vention. The three most frequent drug-related interventions were: discon-tinuation of a medication, decreasing of a dose, and initiation of a newmedication. Nearly 450 orders for therapeutic monitoring were generatedduring the medication reviews. Therapeutic drug categories commonlytargeted during the medication reviews included: proton-pump inhibitors,H2-antagonists as well as neuroleptics. Approximately 70% of proton-pumpinhibitor and H2-antagonist evaluations resulted in dose reduction ordiscontinuation of medication. The majority of neuroleptic evaluationsresulted in no change of therapy regimen, but 20% of evaluations resulted indiscontinuation or dose reduction of neuroleptic orders.

Conclusion/Discussion: The results of this study demonstrate that aninterdisciplinary medication review is an effective method to monitorresident’s health status, identify drug-related problems, and implementdrug and non-drug related interventions. The collaborative team approachmay enhance the assessment of residents’ therapeutic outcomes and coor-dination of monitoring activities. The interdisciplinary approach used by theApotex Centre ensures thatmedication concerns are addressed immediatelyduring a medication review without a communication delay. Due to thecollaborative nature of Baycrest’s model, therapeutic plans are developed asa team and implemented immediately. This study demonstrates the feasi-bility and acceptability of an interdisciplinary approach for medicationreviews in long term care facilities.Author Disclosures: All authors have stated there are no financial disclo-sures to be made that are pertinent to this abstract.

Implementation of an Evidence Based Protocol to Reduce Use ofIndwelling Urinary Catheters in the Long Term Care Environment

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

Introduction/Objective: The use of indwelling urinary catheters (IUC) hasbeen documented between 5-15% in long term care (LTC) even though theCMS requires a valid medical justification for use. A major complication ofIUCs is UTIs which contributes to the problems of urinary incontinence, fallsand delirium and are the primary cause of hospitalization of patients fromLTC facilities. IUCs are an added concern as they are one point restraints.Purpose of this project was to implement the evidence based FIRM (FoleyInsertion, Removal, and Maintenance) Protocol aimed at the reduction ofinfections and other complications by reduction of indwelling urinary cath-eter use in the LTC environment. The protocol was a revision of an acute careprotocol developed, implemented and evaluated by the authors. Larrabee’smodel of evidence-based practice change guided the implementation of thestudy along with Model of Technology, Nursing and Patient Safety.Design/Methodology: The FIRM Protocol incorporated an electronic ordersheet and a removal reminder system that was complimented with aneducation program for health care providers regarding use and care of IUC,and prevention of Catheter-associated urinary tract infections (CAUTIs). Theprotocol was implemented at 14 LTC settings with 17 comparison sites. Theon-line hour long educationprogramwas introduced via repeatedWebinars.Results: The knowledge scores of the staff of the intervention sites (N¼340)increased significantly following the education program from a mean of65.8% to 77.2% compared to no change for the comparison site staff (mean¼65.3%; N¼193)) who did not receive the program. Review of electronichealth records (EHRs) over 3 months following implementation revealed 81documented IUCs (13 at intervention sites; 68 at comparison sites). 100% ofthe IUCs at intervention sites had an order for use compared to only 70.6%having an order for use at the comparison sites.Conclusion/Discussion: Implementation of the FIRM Protocol was effectivein decreasing the inappropriate use of IUC in a LTC environment. Recom-mendations for revisions in the protocol to promote utility and efficacy inLTC settings will be presented.Author Disclosures: Murthy R. Gokula, MD, CMD received an AMDA/PfizerQI grant support for this project. All other authors have stated there are nofinancial disclosures to be made that are pertinent to this abstract.

Institutionalized Residents have Increased Risk of Death FollowingHospitalization with Clostridium Difficile Infection

Presenting Author: Laurie R. Archbald-Pannone, MD, University ofVirginia Internal MedicineAuthor(s): Laurie R. Archbald-Pannone, MD, MPH, Tim McMurry, PhD;and Richard Guerrant, MD

Introduction/Objective: Incidence and severity of Clostridium difficile (C.difficile) infection (CDI) have increased in the past decade and elderly,hospitalized patients aremost severely affected- with acutemortality rates