Care Quality Across Health Care Settings

As older individuals typically have multiple comorbidities and are in various stages of mental and physical decline, geriatricians and long-term care (LTC) professionals are faced with complex medical decisions regarding their care. Prescribing medications, recommending procedures, assessing physical and mental symptoms, and recommending palliative care—to name a few—are all decisions that must be carefully weighed in light of individuals’ advancing age and living situation. 

The challenges of providing geriatric care are compounded when one also considers the frequent care transitions that older adults experience as they age. LTC professionals find themselves in a unique position as they care for older adults who move across the care continuum, passing through various care settings. Multiple provider coordination, communication, and consistent monitoring are essential in order to maintain quality standards and avoid potential errors or gaps in care.

Amy Haver, PharmD, BCPS, and colleagues are part of a research team dedicated to maintaining care quality for older adults across multiple health care settings through their work on a grant-funded project called the Pharmacist-led Intervention on Transitions of Seniors (PIVOTS). The PIVOTS project’s overall aim is to integrate and evaluate pharmacists on geriatric care teams to enhance communication among providers and management of care related to medication issues. Dr Haver and coauthors conducted a study using focus groups of physicians, nurses, and other professionals involved in these pharmacist-enhanced teams to gain feedback on how the pharmacists impact care delivery and how further improvements may be effected with this team model. After the focus group discussions, Dr Haver and coauthors were able to identify specific themes related to the benefits of a pharmacist’s presence on the geriatric care team and suggestions for future improvement of the model.

Monitoring the care of older adults consistently across care settings is not only important when it comes to reducing medication errors and adverse events but also in trying to avoid the use of drugs in general, and thus reduce the risk for polypharmacy. Medications are often used by LTC professionals to reduce these behaviors, but increased observation of residents’ environment and behaviors may remove or lessen the need for drugs. Dorothy M Grillo, MSN, RN, CDONA, and colleagues provide a review of practical, evidence-based, nonpharmacologic strategies for care teams to utilize in these situations with the aim of improving residents’ quality of life and reducing polypharmacy risk.

Learning from previous mistakes or adverse events is another strategy for maintaining high-quality care and for preventing future clinical errors. For example, falls are common in older adults living in LTC, and many screening tools and preventative measures exist. But much can be done to prevent future falls by studying and learning from the fall event itself. Shanthi Johnson, PhD, RD, FDC, FACSM, FGSA, and Swati Madan, PhD, share their quality improvement project that interviewed professionals from LTC facilities in Nova Scotia, Canada, concerning their individual post-fall assessment (PFA) reporting methods. Their results showed that PFA reports may benefit from adding more details on the risk factors surrounding fall incidents as part of the required report information. 

Keeping the continuity of care consistent and individualized across health care settings is a huge challenge and requires input and coordination from all team members involved. The articles presented in this issue discuss cases and methods to help providers in this task.