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Be sure bookmark us and to keep an eye on our website. We are looking forward to expanding the site in order to more fully address and support the Assisted Living Facility industry needs.

Spring has sprung - Be water wise

With warm days and nights either here or just around the corner, now is the time to check the integrity of your pool enclosures and heighten outdoor supervision. Is your enclosure secure, are the locks in proper operation, don’t forget to check after the ‘pool guy’ leaves! And, be even more diligent with outside supervision of your residents than ever before.
Let’s keep summer fun.

CPR Guidelines - Coming soon, a new protocol

The American Heart Association (AHA) recently announced its revised international guidelines, which are geared toward both lay rescuers and healthcare providers. This will be the first revision to the CPR guidelines since 1992 and although change can be difficult to deal with the changes are meant to be simpler and ‘more user-friendly.’ “The International CPR and ECC Guidelines 2000” changes were developed by an international panel of experts and will go into effect after certified instructors have been trained. This change is anticipated by the fall of 2001. Some of the changes for lay rescuers

• The pulse check is no longer recommended when checking for signs of circulation, now instruction will be given to check for signs such as coughing or movement in response to stimulation when determining if they should administer chest compressions.
  
• Chest compression rate for adults (age 8 and older) has been changed to a specific rate of 100/min (up from 80/min). This should simplify things as children aged 1-8 has been and remains at 100/min.
  
• Recommendations for chest compression to breaths will now be 15 to 2 regardless of whether there are one or two responders.
  
• Added to CPR is the treatment of an unconscious adult choking victim. Lay rescuers will begin standard CPR including chest compressions and will not conduct abdominal thrusts or blind finger sweeps of the mouth. Notice that this is for an unconscious adult. If the victim is conscious the Heimlich Maneuver is still recommended.
  

The new guidelines also recommends instruction in and use of Automated External Defibrillator (AED) electric shock devices for lay responders. They set out timing guidelines for the use of the AED outside a hospital setting, recommends that AEDs be placed where there is a reasonable probability of one sudden cardiac arrest occurring every five years and identifies specific lay responders who should be trained in CPR and the use of an AED.

Other changes for the lay responder also includes changes to infant and pediatric care.

The American Heart Association expects the new CPR materials to be available by this summer and recommends anyone who has trained in CPR be re-trained when their current certification expires.

For a review of the full recommendations (lay and medical, adult and infant) go to http://www.cpr-ecc.org/Whats_new/whats_menu.htm#anchor10874

Alzheimer’s disease - New vaccine now being tested on humans

After encouraging and ‘remarkable’ results in mice, human studies are now underway for the new Alzheimer’s vaccine (AN-1792). Last July Elan Pharmaceuticals’ reported preliminary results of Phase I trials (the safety phase) of the human study group were going well stating “There’s no question the vaccine was well-tollerated.” The safety trial phase will continue in the United Kingdom. The next step, which Elan hopes to begin in 2001, is evaluating the effectiveness of the trials.

For more information visit http://www.alz.org; http://www.newsandevents.utoronto.ca/bin1/001220a2.asp

In the news

Mercury Thermometers - Have you gone digital

The September/October 2000 issue of “The American Nurse, reported ”In 1998, poison control centers fielded 18,000 calls from people who had broken a mercury thermometer in their home. Some of those incidents caused serious health effects in those exposed. Mercury attacks the central nervous system and can cause tremors, impaired vision and hearing, and developmental deficits during fetal development, among other serious health problems, according to Health Care Without Harm (HCWH).”

In 1998, the same year as cited above, the Environmental Protection Agency (EPA) and the American Hospital Association (AHA) signed a memorandum of understanding with the goal of eliminating mercury from health care. Since that time many cities have passed ordinances banning retail sale of mercury fever or basal thermometers, major medical associations (including the AMA) have signed resolutions on preventing human mercury exposure and mercury waste disposal, and many major retailers and distributors of thermometers -among them Albertson’s, CVS, Kmart Corporation, Rite Aid, Safeway, Target, Toys ‘R Us/Babies ‘R Us, Wal Mart, and Walgreens) - have pledged to stop selling mercury thermometers.

District of Columbia residents received free digital thermometers at DC fire stations during October 2000, and 10 DC hospitals pledged to go mercury-free with all their equipment in the next several years.

The campaign to rid mercury devices from health care facilities is led by Health Care Without Harm. For more information visit http://www.igc.org/psr/index.html or http://www.sustain.org/hcwh/hcwhmanual/hthconsensus.html

Medications

Newly approved medications

Canasa (mesalamine) Suppositories, approved January 5, 2001. Pharmaceutical company, Axcan Scandipharm Inc., http://www.axcan.com/axcan/english/indexa.html

Canasa (mesalamine) Suppositories have been approved for the treatment of active ulcerative proctitis, at a dose of 500 mg twice daily. The dose may be increased to 500 mg 3 times daily if here is an inadequate response after two weeks of therapy. Pediatric studies have not yet been completed.

Final package labeling and package inserts are not available at this time. Be sure to obtain either package insert, or see physician or pharmacist for full information. See also FDA site http://www.fda.gov/cder/approval/index.htm

FDA warning letters

The FDA has issued a warning letter February 1, 2001 to Pharmacia Corporation with regard to its advertising of Celebrex. They were warned to cease their advertisement stating that concomitant use of Celebrex and Coumadin was safe especially in light of post marketing bleeding events. Pharmacia Corp. was also directed to correct all misleading advertising and to issue statements to all who may have been effected by the mis-information.

Since it is uncertain who was exposed to that mis-information, caregivers need to be watchful for this combination. Notify the physician for clarification if you see the combination of Celebrex and an anti-coagulant prescribed.

For further information visit the FDA site at http://www.fda.gov/cder/warn/2001/DD8432.pdf

Zydis, What’s that

Zydis is an exiting new vehicle for drug delivery. Developed by RP Scherer Ltd, in partnership with pharmaceutical companies worldwide to develop and manufacture novel dosage forms. Zydis is a convenient, fast-disolving freeze-dried wafer that dissolves on the tongue. The Zydis form of dosing would be particularly useful in:

• patients with swallowing difficulties (studies currently underway with Selegiline for Parkinson’s disease at Beth Isreal Medical Center),
  

• as an alternate fast delivery system to injectables (Apomorphine currently used in Europe for Parkinson’s disease), and
  

• as an alternative to tablets for a rapid response (research is currently underway with Viagra in an attempt to reduce the 1 hour wait to only a few minutes for effect).
  

• Using dry hands, open the sachet and peel back foil on blister. Do not push tablet through foil.
  

• Immediately upon opening the blister, remove the tablet and place it in the mouth.
  

• Tablet disintegration occurs rapidly in saliva so it can be easily swallowed with or without liquid.
  

For more information go to http://onhealth.webmd.com/conditions/resource/pharmacy/multum4/item,75705.asp

Herbal Review

Ephedra or Ma Haung - Let the taker beware

Ephedrine alkaloids; Ephedra; Ephedra sinica; Ma Haung, is a common ingredient used for over-the-counter asthma relief and found in diet supplements, weight loss preparations, and energy boosters.

The battle over ephedra has been going on for years. Critics say the product is dangerous stating such possible consequences as heart attacks, strokes, seizures and more. Supporters say it is safe and state millions of Americans take the herb without consequence. Manufacturers say 3 billion ‘servings’ were sold last year and estimate that anywhere from 15-44 million Americans take ephedra products.

In 2001, ephedra has once again made its way into the professional medical journals with warning of the possibility of dangerous side effects. Complicating the issue further, a University of Arkansas study tested 20 different ephedra-containing supplements and found half contained very different ephedra doses than the bottle promised - sometimes less, sometimes more.

AARP recently reported “in a second bulletin, the FDA raised red flags on ephedra (ma huang)... The agency had received reports of deaths, heart attacks, strokes and seizures...” they continued to report that researchers at the University of California at San Francisco who investigated the reports concluded that “our findings arouse concerns about the risks of these products.”

AJN (American Journal of Nursing), March 2001 reports cases of cardiovascular and central nervous system reactions associated to ephedra (ma huang). AJN cites an FDA commissioned review of the herb. The FDA review determined that about one-third of all events were definitely or probably linked consequently to ephedra, and another one-third were possibly related to its use. Cardiovascular events attributed to 47% of all adverse events with hypertension the most frequent adverse cardiovascular event. Stroke and seizures were the most common of the reported 18% grouped as central nervous system effects.

The FDA has cited approximately 1,000 reports of side effects, including 44 deaths. Use of epherda has been associated with hyperactivity, diarrhea, dizziness, disorientation, numbness, anxiety, chest pains, breathing difficulties. heart palpitations, irregular heartbeat, hypertension, depression, headaches (migraines), insomnia, seizures, stroke, heart attacks, and death.

And, in September 2000 the American Medical Association submitted a letter to the FDA requesting that it remove from the market all products containing ephedrine (ephedra) alkaloids because they pose “significant or unreasonable risks of illness or injury” when used as recommended on the label. The FDA has not issued a final ruling as of this date.

At the very least, people with heart disease or high blood pressure are at risk from stimulants, including ephedra. Other risks are kidney disease, thyroid disease, a history of seizure disorders and/or diabetes. And, ephedra should not be given to a person who is taking an MAOI. Some antidepressants in the MAOI family are, among others, Furoxone, Marplan, Nardil and Parnate.

For more information see http://www.tnp.com, http://www.abcnews.go.com/sections/living/Daily News/ephedra001106.html, or http://www.civilrights.com/mt_foodsups.html

Clinical Reminders

Anaphylactic reaction - Who is most at risk

Life-threatening allergies to food, insect stings, drugs, and latex could affect up to 15% of the American population. As many as 1,000 people each year die from anaphylactic reactions, and researchers believe the incidence of anaphylaxis is grossly underreported because of the lack of standard definition and confusion with other conditions.

People with severe allergies are advised to carry epinephrine with them in an auto-injectable “pen.” And, it is a good idea to keep diphenhydramine liquid (this is over-the-counter) on hand in case one of your residents experiences a severe allergic reaction. Of course, you would need an order. But in an emergency there is no time to run to the store.

Those most likely to develop a severe allergic reaction to a drug or food are those who have multiple allergies, especially if they've had severe reactions before. The patient has usually been exposed to the same antigen or something very similar to it before. Sometimes only one exposure is needed to produce an allergic response the next time.

Dirty little secrets - Do you have one

The continuing emergence of superbugs, pathogens and multidrug-resistant organism and considering the fact that infectious diseases remain the leading cause of death and disease worldwide as well as the third leading cause of death in the United States it is important to look at what we, as one person, can do to help control the problem.

Dr. Julie Gerberdin, M.D. of the Center for Disease Control and Prevention (CDC) says that “handwashing is the simplest, most effective thing people can do to reduce the spread of infectious diseases,” and, adds that “it is the first line of defense for infectious diseases” - including respiratory infections and gastrointestinal disorders, among others. In addition to preventing widespread public health epidemics, handwashing can reduce the spread of antibiotic-resistant bacteria.

So, how are we doing in the handwashing department? Not so good, it would seem!

A recent national survey conducted by Wirthlin Worldwide found that 95% of respondents say they always wash their hands after going to the bathroom. However, observations in public restrooms indicate that only 67% of American adults do so. Several studies show that most physicians and nurses believe they wash their hands correctly; however, researchers have observed that even the handwashing technique of healthcare professionals can be inadequate as they wash their hands only 30% of the required time between patient contact and procedures, if they wash their hands at all (CDC). And, a study conducted at the University of California, San Diego, Medical Center reported in AJN’s (American Journal of Nursing) March 2001 issue states that “physicians cleansed their hands less often (29.3% of the required time) than nursing personnel (41.2% of the required time), who in turn cleansed their hands less often than did ancillary personnel (51.2% of the required time).

Bearing the above in mind, here are some of the things I have seen or not seen. I have seen caregivers assisting residents to the bathroom and with peri care (and with incontinent pad changes and peri care) without washing their hands. Yes, they put gloves on, but all too often do not wash their hands after taking the gloves off. That’s a no-no. I have seen (or heard) caregivers got to the bathroom, flush the toilet but not heard the tap water go on or off. I have observed caregivers preparing meals who stop in the preparation to assist resident then return to their preparations without washing their hands. And, here’s one I know we’ve all seen, the person who turns on the water, wets their hands, shakes off the excess water then stands there looking for a nice clean cloth or paper towel to dry their hands on. No soap. And just as bad is the ‘little quickie,’ water, soap, rub, rub, rinse and dry.

What is the recommended method for handwashing?

• Wet hands and wrists with warm (not hot) running water,
  
• apply soap - preferably liquid - and lather thoroughly.
  
• Using plenty of lather and friction, wash your hands for 10 - 15 seconds.
  
• Vigorously washing the palms and backs of hands, each finger, between the fingers and your knuckles, wrists and forearms.
  
• Wash at least 1 inch above any area of contamination. If your hands aren’t visibly soiled, wash to 1 inch above the wrists.
  
• Use an orangewood stick to clean under your fingernails as needed.
  
• Rinse thoroughly from hands to wrists.
  
• Using a clean paper towel, blot dry your hands then using the same towel turn off the water.
  

• Apply enough (about 2-3 ml) gel to entirely cover all services of hands and fingers.
  
• Rub the solution vigorously into hands until dry (approximately 20 seconds), allowing the alcohol to evaporate.
  

• prepare or eat food,
  
• treat a cut or wound,
  
• tend to someone who is sick,
  
• put in or take out contact lenses,
  
• do any kind of activity that involves putting your fingers in or near your mouth, eyes, etc.
  

• go to the bathroom,
  
• handle uncooked foods, especially raw meat,
  
• eat,
  
• blow your nose,
  
• cough or sneeze,
  
• handle garbage,
  
• tend to someone who is sick,
  
• change a diaper,
  
• play with or touch a pet, especially reptiles and exotic animals,
  
• and the State of Arizona adds after smoking.
  

And always offer your resident the opportunity to wash their hands. Another thing I don’t see often enough.

For more information visit http://www.washup.org/index.html

Providing For Your Educational Needs

DeserTortoise is proud to be able to provide for all of your continuing education needs. All courses are self-paced correspondence courses. Our courses will also satisfy CNA continuing education requirements by the Arizona State Board of Nursing. Courses are available with credit card payments at our website (www.desert-t.com) or by mail with check or money order (call, write or fax us for brochure and order form).


Courses Available:

Required Subjects

“Breach of Confidentiality, Invasion of Privacy and Resident Rights,” a review of the pitfalls encountered when dealing with resident privacy and sensitive information - 1 hr

“Implications of Medication (Drug) Therapy and the Elderly,” incorporates how medications effect the elderly and includes medication administration and assistance - 2 hrs

“Elder Abuse, Neglect and Exploitation,” covering cause, prevention and reporting requirements - 2 hrs

“Community Based Infection Control,” a review of pathogens and protection to prevent contamination
and cross contamination of germs in a home environment - 1 hr

“Community Based Fire and Safety,” a review of general home safety, fire safety and being prepared for Nature’s disasters - 1 hr

Or, obtain all five required subjects (above) in one volume, “Subjects required annually by the State of Arizona Department of Health Services For Assisted Living Facility Personnel,” take one test and satisfy all mandatory subjects for the year at one time, and at a special low price - 6 hs

Subjects which satisfy requirements for Personal Care

“Care and Treatment of the Elderly Person with Diabetes Mellitus,” an in depth study into diabetes, a must for any facility who has diabetic clients. Includes comprehensive glossary - 3 hrs

“Providing Personal Care of the Elderly,” a review of the aging process and the subsequent care needs of the elderly - 2 hrs - Available in English and Spanish

“Medical Abbreviations and Acronyms, What do all those ABCs, XYZs and letters in between mean? (Or, reading and understanding prescriptions, diagnoses and medical reports),” includes a compre-hensive alphabetical listing for quick reference - 2 hrs

Subjects which satisfy requirements for Directed Care

“Care and Monitoring of the Confused Patient with Diabetes Mellitus,” an excellent guide for the care-giver with diabetic patients who are confused - 2 hrs

“Care and Monitoring of the Confused Patient with Alzheimer’s Disease and other Dementias,” a study guide into the cause and effect of Alzheimer’s disease and other dementias and how to monitor and care for the resident with dementia - 2 hrs

Watch our website for more courses.

Contact Us With Your Comments And Suggestions

Website www.desert-t.com

Email trudy@desert-t.com

Voice Mail (520) 733-6191

Fax (520) 733-6191 (remember to hang up the handset on your phone before faxing)

Desert Tortoise
1440 N. Sonoita Ave.
Tucson, AZ 85712

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