Educating to Protect

Although healthcare providers serving the long-term care (LTC) community know they have a duty to protect residents, an integral component to ensuring the safety and well being of patients is often overlooked in the hustle and bustle of meeting residents’ daily needs: Education. Before an individual can take the necessary steps to ensure better outcomes, he or she needs to know what those steps are and why they are important. While educating providers and residents on a multitude of patient care and facility concerns can be time-consuming, such efforts quickly bear fruit, as staff and patients would become motivated and equipped to resolve issues before they reach a critical level.

This issue of Annals of Long-Term Care: Clinical Care and Aging (ALTC) features two articles that highlight the importance of education in different areas of care. In the first article, “Medication Reconciliation for Older Adults Transitioning from Long-Term Care to Home,” (page 25), the authors provide an overview of the medication reconciliation process for patients who are being discharged from LTC to home. When executed properly, medication reconciliation helps prevent medication errors, which can be life-threatening and costly. In LTC settings, it is generally nurses—not pharmacists—who perform medication reconciliation services. LTC discharge nurses should receive instruction on best practices for medication reconciliation and must be equipped with the information needed to thoroughly educate patients and their at-home caregivers about the patient’s medications before discharge. The authors recommend and explain the “teach-back” method for communicating medication instructions to patients and caregivers. After the LTC discharge nurse finishes presenting the information, the patient or caregiver “teaches” it back to the nurse. This provides the discharge nurse with an opportunity to clear up any confusion, helping to ensure that the instructions have been understood.

The second article, “Elder Mistreatment in the Long-Term Care Setting” (page 30), addresses a problem that is all too common, yet not often discussed: abuse of the elderly, whether physical, emotional, exploitative, or sexual. A frequent misperception is that staff are generally to blame for incidents of elder mistreatment in the LTC setting, but aggression between residents is far more common. Even severe cases of elder abuse sometimes go unreported, for a variety of reasons, including the victim’s fear of the perpetrator. All healthcare providers, however, are required to report suspected elder abuse and must be educated about their obligations. Although reporting mistreatment is an essential step in protecting elders, preventing the abuse is even more important. As the authors note, certain resident and staff factors increase the risk of elder mistreatment. Staff who are properly educated about abuse “triggers” will be able to take proactive steps to head off potential abuse. For example, behavioral disturbances, such as hollering and calling out, are common in LTC and might trigger another resident to lash out at the vocal resident. Staff who are aware of the potential for this scenario to escalate into something explosive might be prone to watch the situation more closely and take steps to diffuse it, which might require temporarily moving the vocal resident to another part of the facility or engaging him or her in another activity.

This month we also include a Case Report, “Angioedema Following Angiotensin-Converting Enzyme [ACE] Inhibitor Therapy” (page 22), which features two reports of angioedema, one that occurred immediately after the patient started taking an ACE-inhibitor and another that arose in a patient who had been using an ACE-inhibitor for several years. These cases demonstrate the need for clinicians to investigate ACE inhibitors as a possible cause of angioedema in a patient who is taking this type of medication.

ALTC is always happy to accept your article submissions on topics relevant to LTC healthcare providers, and our author guidelines are available on page 36. We also welcome letters to the editor regarding any article published in the journal or concerning an LTC topic about which you feel readers should be informed. Be sure to also visit our Website and take our monthly poll at www.annalsoflongtermcare.com.

Thank you for reading!