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Previous Newsletters:
Vol.
1, No. 1, July-Sept 2000
Vol.
1, No. 2, Oct.-Dec. 2000
Vol. 2, No. 1, Jan-Mar.
2001
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Quarterly
Newsletter
Vol.1,
No. 2, Oct.-Dec. 2000
www.desert-t.com
© 2000 |
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Our
Website
Thank you all for your encouraging
and supportive comments about both our website and the
newsletter. Your comments and suggestions are much appreciated.
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.
Help us help you. Please take a few minutes to complete
and return the attached survey form.
Be Prepared
U.S. Department of Labor, Wage
and Hour Division Representatives plan to visit
all of Arizona’s licensed Assisted Living Facilities.
Be prepared! Is your payroll paper work complete and on
site? Do your schedules, time cards and payroll sheets
agree? Do you have W-4s or W-9s and I-9s on all employees?
Do you have the Federal Minimum Wage rates posted? Fines
as high as $10,000 per violation may assessed.
If you do not have current W-4s, W-9s, I-9s, A-4s or the
Minimum Wage Poster, they may be obtained at the following
websites:
I-9 http://www.ins.usdoj.gov
W-4 http://www.fedword.gov
W-9 http://www.irs.ustreas.gov
A-4 http://www.revenue.state.as.us
Minimum Wage Posters http://www.dol.gov./dol/esa/public/regs/compliance/posters/flsa.htm
In the News
Medication Errors
Have you noticed that it is almost impossible to read
a medically oriented publication or visit a medical website
without reading about medication errors and their, all
too often fatal, effects?
The Washington Post, Monday, July 3, 2000, Page A01 (by
Maria Glod) “Prescription Deaths Bring Call for Checks”
cites specific cases of death due to medication errors,
and reports the fact that in the Untied States there are
no standard reporting methods to accurately compile statistics
of medication errors and adverse reactions.
The Washington Post goes on to cite “Last year, pharmacists
nationwide filled about 3 billion prescriptions, and that
number is expected to hit 4 billion by 2004, said Carmen
Catizone, executive director of the Illinois-based National
Association of Board of Pharmacy. Although the number
of prescriptions has grown rapidly, the number of pharmacists
has risen only about 10 percent over the past five years.
State pharmacy boards estimate that between 2 percent
and 5 percent of the prescriptions filled in 1999 included
some sort of error, from simple misspellings to more serious
dispensing or instruction mistakes.”
WebMD Medical News (http://my.webmd.com) has several related
articles posted, “RX Errors on the Rise; As the number
of prescriptions soars, so too does the number of mistakes.
For patients, the consequences can be serious,” “Medical
Mistakes; As a result of a medication error, the writer
suffered a stroke. Could this happen to you?,” and
“Precarious Prescriptions; Can your doctor’s
handwriting kill you?,” all of which speak to the
rising incidence of medication error caused death and
injury which seems prevalent in the US today.
The FDA (www.fda.gov) and the CDC (www.cdc.gov) both have
numerous articles about the rising problem and possible
solutions to curb the errors.
The FDA hopes to reduce drug errors by working harder
to prevent mix-ups caused by similar sounding drug names,
by highlighting interactions and potential dosing errors
on drug labels, by putting the most important information
at the start of package inserts, and by hosting a national
summit on ways to reduce drug errors. (The Pink Sheet,
Vol. 62, No. 9), www.fdcreports.com.
“War on Drug Errors; Judging by budget requests from
the Food and Drug (FDA), the war on drug errors has begun.
As part of its nearly $16 million proposal, the FDA would
focus on these areas: developing new standards for drug
naming, packaging, and labeling--reportedly the source
of about half of drug errors hiring more staff members
to create or upgrade reporting systems and to interpret
the resulting reports identifying drug errors more quickly
by creating links to other government and private databases
expanding the FDA's current drug safety program for consumers
devoting added resources to policing Internet drug sales.
The Pharmaceutical Research & Manufacturers of America
also plans to fight in the war on drug errors. The organization
has convened a task force whose mission is to identify
methods by which drug makers can help to reduce drug errors.
Thus far, the task force is focusing on packaging, bar
codes, labels, and confusion over drug names.” (The
Pink Sheet, Vol. 62, No. 11), www.fdcreports.com.
“Ways and Means to Curtail Medical Errors; Alarmed
by recent reports citing high rates of medical errors
in the American health care system, government officials
are discussing several ways to reduce them. Indeed, the
Institute of Medicine has set a goal to reduce medical
errors by 50% over the next 5 years. How to do it? Here
are some of the proposals: President Clinton's budget
for fiscal year 2001 would give $20 million to the Agency
for Healthcare Research and Quality to research the best
ways to reduce errors. California Congressman Pete Stark
proposed a Medicare-sponsored prescription drug benefit
in which computers could detect and prevent inappropriate
or dangerous drug prescriptions. Stark also proposed beefing
up Medicare's existing Peer Review Organization as a reporting
system. California Congressman Bill Thomas proposed an
amendment to the patient's bill of rights that encourages
voluntary reporting of errors. Pennsylvania Senator Arlen
Specter introduced the Medical Error Reduction Act (S
2038) that proposes to test error-reducing strategies
through demonstration projects involving 15 hospitals.
The projects would test the effects of hand-held electronic
prescription pads, bar codes on prescription drugs, and
bar codes on patient ID bracelets. The projects would
also compare differences among three reporting protocols:
Five participating hospitals would voluntarily report
errors to the Department of Health and Human Services
(DHHS), five would be required to report errors to DHHS,
and five would be required to report errors not only to
DHHS but also to patients and their families.” (The
Pink Sheet, Vol. 62, No. 7), www.fdcreports.com.
As caregivers what can you do? What is your part in
the war on drug errors? You are the bottom line, the final
filter, if you will, between errors and your residents.
As caregivers we are tasked with knowing our residents,
their needs and the medications they take. If you assist
with or administer medications you must be aware of the
drug which is being prescribed and make sure that the
medication received is the medication that was prescribed.
It is up to you to know the medication and the indication
of use. If the medication does not seem to couple with
your resident’s diagnoses, or if the medication received
is not the one you anticipated, check with the physician’s
office for verification or clarification. Please, go to
the source, not to the pharmacist who filled the prescription.
I have seen medication errors by physicians, by pharmacists,
and by caregivers alike. We are all human. However, in
light of the current volume of mistakes, we must all be
more vigilant. I have seen pharmacies fill prescriptions
for one person and have them delivered to a person with
a similar name at an entirely different address. I have
seen pharmacies fill the wrong drug and the right drug
filled at the wrong dose. I have known of physicians being
interrupted while writing a prescription for one person
then writing the wrong drug on the prescription pad. And,
I have seen caregivers give the wrong medication to the
wrong resident. Unfortunately many of these mistakes were
not noticed immediately and the resident received the
medication as delivered. I also have had caregivers ask
me what a particular medication is and what it is used
for. I do not mind the questions but am very concerned
that the questions were not posed to the physician. By
the time I am asked the resident has been receiving the
medication for days or even weeks.
Always know your residents and their medical status. Know
the medications they are taking, check for drug-drug or
drug-food interactions, (even when you think you know,
check) know why the medications are prescribed, and what
the expected outcome of taking the medication is. And,
have this knowledge before giving the medication.
In this regard the old adage ‘when in doubt ask’
is definitely sage. The only stupid or foolish questions
are the unasked questions. Be your residents final safety
net. If you do not know, ask, ask, ask.
And remember, chronic illnesses or the physiologic effects
of aging may alter a drug’s action. Dosages for geriatric
patients must be adjusted individually. Because of the
individual nature of aging and unique medical history
of each patient, assess each geriatric patient’s
response to drugs individually.
Medications
Newly Approved Medications
Rivastigmine tartrate (Exelon),
approved April 2000. Pharmacologic classification, cholinesterase
inhibitor; therapeutic classification, cholinergic enhancer;
pregnancy risk, category B. Pharmaceutical company, Novartis
Pharmaceuticals Corp., www.novartis.com.
Exelon indicated for symptomatic treatment of patients
with mild to moderate Alzheimer’s disease.
Exelon is contraindicated in patients with hypersensitivity
to drug or its components or to other carbamate derivatives.
Use cautiously in patients with history of ulcers or GI
bleed, sick sinus syndrome or other supraventricular cardiac
conditions, asthma or obstructive pulmonary disease (COPD),
or seizures and in those taking nonsteroidal anti-inflammatory
drugs.
Interactions: Multiple, see package insert.
Common adverse reactions, dizziness, headache, nausea,
vomiting, diarrhea, anorexia, abdominal pain and accidental
trauma.
Be sure to review drug information on web site, from physician
or package inserts for full information.
Meloxicam (Mobic), approved April 14, 2000. Pharmacologic
classification, enolic acid nonsteroidal anti-inflammatory
(NSAID); therapeutic classification, anti-inflammatory,
analgesic; pregnancy risk, category C. Pharmaceutical
company, Boehringer Ingelheim Pharmaceuticals, Inc. www.boehringer-ingelheim.com.
Mobic is indicated for relief of signs and symptoms of
osteoarthritis.
Mobic is contraindicated in patients with hypersensitivity
to drug and in those with history of asthma, uticaria,
or allergic-type reactions after taking aspirin or other
NSAIDs. Avoid use in late pregnancy. Use with extreme
caution in patients with history of ulcers or GI bleeding,
in patients with dehydration, anemia, hepatic disease,
renal disease, hypertension, fluid retention, heart failure
or preexisting asthma. Also use cautiously in elderly
and debilitated patients because of increased risk of
fatal GI bleeding.
Interactions: Multiple, see package insert.
Life-threatening adverse reactions: arrhythmias,
myocardial infarction, hemorrhage, pancreatitis, renal
failure, leukopenia, thrombocytopenia, hepatitis, bronchospasms
or angioedema.
Be sure to review drug information on web site, from physician
or package inserts for full information.
Linezolid (Zyvox), approved April 18, 2000. Pharmacologic
classification, oxazolidinone; therapeutic classification,
antibiotic; pregnancy risk, category C. Pharmaceutical
company, Pharmacia & Upjohn Co., www.pnu.com/home.asp.
Zyvox is indicated for vancomycin-resistant Enterococcus
faecium infections, including cases with concurrent bacteremia.
Contraindicated in patients with hypersensitivity to drug
or other components of formulation.
Interactions: Multiple, see package insert.
Life-threatening adverse reactions: leukopenia, neutropenia,
thrombocytopenia.
Be sure to review drug information on web site, from physician
or package inserts for full information.
Insulin glargine (rDNA) injection (Lantus), approved
April 24, 1000. Pharmacologic classification, pancreatic
hormone; therapeutic classification, antidiabetic; pregnancy
risk, category C. Pharmaceutical company, Aventis Pharmaceuticals,
Inc., www.aventis.com.
Lantus is indicated for management of type I diabetes
mellitus in patients who need basal (long-acting) insulin
for control of hyperglycemia.
Contraindicated in patients with hypersensitivity to insulin
glarine or its components. Do not use during episodes
of hypoglycemia and use cautiously in patients with renal
or hepatic impairment.
Interactions: Multiple, see package insert.
Be sure to review drug information on web site, from physician
or package inserts for full information.
Insulin aspart (rDNA) injection (NovoLog), approved
June 7, 2000. Pharmacologic classification, hormone and
synthetic substitute; therapeutic classification, antidiabetic;
pregnancy risk, category C. Pharmaceutical company, Novo
Nordisk Pharmaceuticals, www.nova-nordisk.com.
NovoLog is indicated for the control of hyperglycemia
in patients with diabetes mellitus.
Contraindicated during episodes of hypoglycemia and in
patients hypersensitive to NovoLog or one of its excipients.
Use cautiously in patients who are prone to hypoglycemia
and hypokalemia, such as patients who are fasting, have
autonomic neuropathy, or who are using potassium-lowering
drugs or drugs sensitive to serum potassium levels.
Warning: NovoLog may be incompatible with crystalline
zinc insulin preparations. Do not mix together.
Interactions: Multiple, see package insert.
Be sure to review drug information on web site, from physician
or package inserts for full information.
Name
Change
Amrinone (Inocor), issued July
1, 2000, pharmaceutical company, Sanofi Pharmaceuticals,
www.sanofi-synthelabous.com.
Sanofi Pharmaceuticals announced that amrinone has been
renamed as of July 1, 2000. The company has renamed the
product because of confusion with amiodarone. The new
name for amrinone is inamrinone.
New Warnings
Thioridazine Hydrochloride (Mellaril), issued
July 2000, pharmaceutical company, Novartis Pharmaceuticals
Corp., www.novartis.com.
Novartis Pharmaceuticals has issued a statement that important
changes have been made to the labeling of Mellaril. A
warning has been added to the label advising clinicians
that Mellaril may prolong the QTc interval in a dose-related
manner, and may be associated with torsades de pointes
and sudden death.
In addition, the package labeling has been updated to
reflect a change in the indication for use of Mellaril.
Be sure to review drug information on web site, from physician
or package inserts for full information.
Zanamivir (Relenza), issued July, 2000, pharmaceutical
company, Glaxo Wellcome, Inc., www.glaxowellcome.com.
Glaxo Wellcome, Inc., has issued a warning that Relenza
may cause serious respiratory adverse reactions in patients
with our without known underlying respiratory disease.
The package labeling has been revised to state that Relenza
is not recommended for patients with underlying airway
diseases, such as asthma or chronic obstructive pulmonary
disease (COPD) because of reports of bronchospasm and
decline in lung function in some patients.
The package labeling has also been revised to state that
allergic reactions may occur in patients receiving Relenza,
and that serious bacterial infections may occur with influenza-like
symptoms. The clinician is reminded that Relenza does
not prevent bacterial infections associated with influenza.
Be sure to review drug information on web site, from physician
or package inserts for full information.
New
Formulations
Also watch for:
A new patch in a controlled release
form from Novartis Pharmaceuticals Corp. “Vivelle”
for the prevention of postmenopausal osteoporosis which
was approved August 16, 2000. http://www.novartis.com/
“Depakote ER” tablets for the prophylaxis
of migraine headaches in adults, from Abbott Laboratories,
approved August 4, 2000. http://www.abbott.com/
“Rescula” eye drops from Ciba Vision
Corp Div Novartis Co. for the lowering of intraocular
pressure in patients with open-angle glaucoma or ocular
hypertension who are intolerant of other interocular pressure
lowering medications or insufficiently responsive to other
intraocular pressure lowering medications, approved August
3, 2000. http://www.novartis.com/
“Atacand HCT” tablets for the treatment
of hypertension from Astrazeneca LP, approved September
5, 2000. http://www.astrazeneca-us.com/products/pibs_tradename.asp
As always check pharmaceutical websites or with the physician
or pharmacist for package insert and full information.
Herbal
Review
“If the results of a small
Texas study hold true nationwide, abut 4 in 10 people
use herbal supplements, more than half as first-line treatments
for various ailments. But only about 1 in 10 of the people
who use herbal supplements discuss their choice with a
physician or pharmacist. Worse yet, of the 135 HMO members
who responded to the survey, at least 2 in 10 took both
herbal supplements and prescribed or over-the-counter
drugs at the same time.
As these figures make clear, the risk of mysterious adverse
effects and interactions may be substantial. The risk
may be compounded by the finding that about half of herbal
supplement users obtain information about herbs from their
friends or family. Another 1 in 5 rely on the media or
advertisements. Most users confess that they don’t
know how dependable herbal products are in strength or
quality. Even so, at least two-thirds of them say they’ll
bet that the supplements are safe,” from FDC (The
Green Sheet, Vol.49, No19), www.fdcreports.com.
Although Arizona’s Assisted Living Facilities are
required to obtain Primary Care Provider orders to assist
or administer any prescribed or over-the-counter preparation,
many caregivers are not familiar with herbal supplements
and they frequently are not listed in our drug reference
books. Therefor, the DeserTortoise Quarterly Newsletter
will review one or two herbs in each issue beginning with
a couple I have recently seen prescribed, Cats Claw and
Saw Palmetto.
Cat’s Claw (Scientific Name, Uncaria tomentosa):
Reported medical uses: Treatment
of systemic inflammatory diseases such as arthritis and
rheumatism and inflammatory diseases such as diverticulitis,
gastritis, Chron’s disease, dysentery, ulcerations
and for immune system stimulation.
As with most herbal supplements, information is as diverse
as it is sketchy. Be sure to know why the preparation
has been ordered and what the primary care provider would
like you to watch for.
Contraindications and precautions: Contraindicated in
patients undergoing skin grafts and organ transplants
and in those who have coagulation (bleeding) disorders
or who are receiving anticoagulants. Avoid use in pregnant
or breast-feeding patients as its effects are unknown.
Adverse reactions: Potential hypotension.
Interactions: Antihypertensives; may potentate effects,
avoid concomitant use.
Sources: Professional’s Handbook of Complementary
& Alternative Medicines, by C.W. Fetrow and J.R. Avila,
Springhouse Corporation, 1999; The A to Z Guide to Healing
Herbal Remedies, by Jason Elias, M.A., L.Ac., and Shelagh
Ryan Masline, Dell Publishing, 1995; Nurses Handbook of
Alternative & Complementary Therapies, Springhouse
Corporation, 1999; Herbal information Center, www.kcweb.com/herb/catsclaw.htm;
Tropical Plant Database, www.rain-tree.com/plants.htm;
Purdue University, www.hort.purdue.edu/newcrop/CropFactSheets/catsclaw.html;
Alternative Medicine Foundation HerbMed, www.herbmed.org/herbs/Uncaria_CatClaw.htm
Saw Palmetto (Scientific Name, Serenoa serrulata &
repens [arecaceae]):
Reported medical uses: Treatment
of conditions associated with benign prostatic hypertrophy
(BPH). It is chiefly used as a diuretic and to tone the
bladder by improving urinary flow and relieving strain.
It also inhibits androgen and estrogen receptor activity
and may be beneficial for both sexes in balancing the
hormones thereby (possibly) increasing sperm production,
breast size and sexual vigor.
Contraindications and precautions: Contraindicated in
women of childbearing age because of the herb’s potential
hormonal effects. Should be used cautiously for conditions
other than BPH due to data regarding the herb’s effects
are sketchy at best.
Adverse reactions: abdominal pain, back pain, constipation,
decreased libido, diarrhea, dysuria, headache, hypertension,
impotence, nausea and urine retention.
Interactions: None reported.
Sources: Professional’s Handbook of Complementary
& Alternative Medicines, by C.W. Fetrow and J.R. Avila,
Springhouse Corporation, 1999; The A to Z Guide to Healing
Herbal Remedies, by Jason Elias, M.A., L.Ac., and Shelagh
Ryan Masline, Dell Publishing, 1995; Nurses Handbook of
Alternative & Complementary Therapies, Springhouse
Corporation, 1999; Alternative Medicine Foundation HerbMed,
www.herbmed.org/ herbs/serenoa.htm; Herbal Information
Center, www.kcweb.com/herb/sawpalm.htm; National Library
of Medicine, www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?form=4&db=m&term=saw+palmetto.
As with most herbal supplements, readily available information
on Cat’s Claw and Saw Palmetto is as diverse as it
is sketchy. Be sure to know why the preparation has been
ordered and what the Primary Care Provider hopes to achieve
by adding the herb to the resident’s medication profile,
also know what the Primary Care Provider would like you
to watch for.
The Aging Process And Cold
Weather
Just as a decrease in blood supply,
perspiration, skin thickness causes our older population
to become more sensitive in hot weather, age related changes
effect the way they respond to cold weather.
As we age our systems experiences a skin cell replacement
decline of about 50% of the epidermis and the dermis,
which combined with age related connective tissue loss
causes thinning of the skin. Blood supply to the skin
decreases and subcutaneous fat is lost, both with the
greatest decrease/loss occurring in the arms and legs.
Men loose more subcutaneous fat than women. The thinning
of the skin combined with the reduced blood supply and
loss of insulating subcutaneous fat tissue causes a reduced
ability to regulate body temperature.
Although The State of Arizona’s Department of Health
Services requires Assisted Living Facilities to maintain
an indoor temperature range of 68-85ºF (R9-10-718-A3),
we should be alert to the fact that what is comfortable
or warm for us may not be adequate for our residents.
Be sure your residents have warm shoes and socks on (don’t
forget warm socks when wearing slippers), that their arms
and legs are covered and be prepared to add warm sweaters
and serve warm drinks. Be careful, with the warm drinks,
their thin skin makes them more susceptible to burns and
at lower temperatures.
Our
Elderly Population, Depression And The Holidays
Depression is the most common psychological consequence
of disability and the frequency and intensity of depression
increases with age. And once joyous holidays become lonely
times to many of our older adults adding to the depression
risk. To understand our elderly population’s propensity
for depression we need to look at attitudes and beliefs.
Attitudes are learned through one’s culture. American
cultural attitudes are diverse yet we share many similarities.
We value performance, productivity, appearance, self-reliance,
independence and individuality. And we are youth-oriented
viewing older adults as obsolete and expendable, thus
leaving older adults with feelings of worthless.
Beliefs affect attitudes and feelings. Beliefs vary with
experience, culture and religious values causing many
people to fear changes associated with aging. Older adults
are the most stereotyped age group due to negative stereotyping
of older adults in literature, jokes and on television,
thus perpetuating the problem.
Physical, psychological and social losses combine with
loneliness due to actual loss of (or separation from)
family, friends and significant others sets our elderly
up for depression. And depression increases the risk of
suicide.
In the U.S. the suicide rate of older adult men is seven
times that of older adult women. Older adults account
for about 25% of suicides. Suicide among our older adults
is rarely an impulsive act. Our older adults have less
fear of death than younger people. Their greatest fears
are dependency, pain and loss of function and control.
And most older adult suicide attempts are not gestures
or threats, they are real.
To support our older population be watchful for loneliness
and depression and intervene to counter act it and increase
the older adult’s socialization. Recruit family members,
peer groups, community programs, pet therapy and crisis
intervention.
To determine if your resident has considered suicide or
has a plan for doing so, ask. Keep in mind that someone
with a well-planned method (especially a lethal one) is
at higher risk for suicide. Refer your resident with unresolved
grief, depression, or thoughts of suicide for counseling.
Support and encourage active participation in life (ie.,
suggest substitute for lost companionship, a pet or new
social connection), group activities, perhaps even reestablishing
contact with religious groups and activities.
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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