Enhancing Care Delivery in LTC Facilities

Long-term care (LTC) settings that have high numbers of older adults with multicomorbidities means that routine conditions or infections can develop quickly into facility-wide problems. Rapid response or specialized teams are important to have on-hand in order to address large crises that arise; however, enhancing daily procedures of care delivery proactively is a more effective strategy, significantly decreasing the potential harm to residents and staff.

Preventing infections in LTC settings is a constant battle, and with the growing population of aging adults who will soon be in LTC, more effective strategies are needed. In a previous article, Barbara I Braun, PhD, and colleagues performed a literature review to investigate the prevalence of high reliability concepts in literature and in current infection prevention initiatives. As the concepts of organizing for high reliability have been applied in advanced industries such as nuclear power systems and air traffic control, the authors thought these system-enhancing concepts may be evident within the LTC industry as well. Findings from that article demonstrated the existence of these concepts already at work in the literature and in national initiatives, but Dr Braun and her team also wanted to identify successful infection control practices in the field as well. In the second part of their project, provided in this issue, the team distributed a call for practices to LTC settings, convened an expert panel to assess responses, and then compiled practice examples from responses that demonstrated high reliability concepts in order to integrate them into online education materials, which LTC professionals can then apply to their own facilities.

Another ongoing problem that LTC settings must constantly address, as well as many other sectors of health care, is the overprescription of medicines, particularly antibiotics. Suspected urinary tract infections (UTIs) are common scenarios that contribute to unnecessary antibiotic prescription, but, oftentimes, patients merely have asymptomatic bacteriuria with insufficient signs and symptoms of UTI and do not require treatment. In an effort to improve provider knowledge and assessments of UTI signs and symptoms in LTC residents, Denise L Cooper, DNP, RN, ANP-BC, and colleagues implemented a multifaceted, evidence-based program that included a newly developed algorithm, to be used as a clinical tool by nurses daily, along with staff education and the assignment of change champions. Authors found the quality improvement intervention to be successful for improving the appropriateness of UTI diagnoses, thereby reducing unnecessary antibiotic prescriptions.

Specialized care and mindful strategies for the management of patients whose conditions present unique challenges to LTC providers are also needed to enhance care, as the rising numbers in LTC residents will also mean more patients with specialized needs. Residents with multiple sclerosis (MS) is one such subgroup of older adults who will require providers that are cognizant of their comorbid conditions. Indeed, reportedly 20% to 25% of people with MS will require some form of LTC in the future. Aysha Khan, MD, and colleagues present a case of advanced MS in an older woman from a LTC facility with concurrent health problems who was admitted to the hospital with medical complications. LTC providers play a major role in the management of patients with MS and should be well versed in identifying typical concurrent conditions of MS, such as depression and fatigue, that can be difficult to take special note of and as these are common conditions in LTC settings. 

Ideally, facility providers and administrators who focus on optimizing the daily care provided to residents will contribute to better quality of life for residents and more effective care delivery procedures for staff.