Literature Review

Why so many patients are confused about CPR and do-not-resuscitate orders STAT; by Lindsey Ulin; 9/11/24 Inherently difficult conversations are made more so by a lack of physician training. When a patient is admitted to the hospital in the U.S., there’s a standard question physicians like me are supposed to ask: “If your heart stops beating, do you want us to do CPR?” On the surface, this may seem like a mechanic asking a customer, “If your car stalls, do you want us to jumpstart the engine?” Who would say no to this, especially in a hospital? The problem is that this exchange, which we call asking about “code status” in medicine, centers around a closed-ended question. Talking to a patient about their preferences for cardiac resuscitation, intubation, and/or other life-sustaining treatments needs to be a complete, often lengthy discussion, not just a box to check. ...

Hugo man dies in house fire  [hospice patient] KXII 12 TV, Hugo, OK; by KXII Staff; 9/5/24 A fire at a home in Hugo claims the life of a former Choctaw County assistant district attorney. Officials said the fire happened Sunday afternoon. The Choctaw County Emergency Manager told News 12 that John Bounds, who was in hospice care, was unable to escape. All others in the house got out safely.Editor's note: What emergency discussions do your interdisciplinary team members have with home hospice patients and their caregivers? Regular fire safety training (and other forms of patient care safety, workplace safety, etc.) are required by OSHA and accreditation organizations. 

Rounds with Leadership: Focusing on the outcomes of NP practice American Association of Colleges of Nursing - The Voice of Academic Nursing; by American Colleges of Nursing (AACN); 8/28/24 ... In a synopsis of more than 50 research studies, the American Association of Nurse Practitioners found that patients under the care of NPs have fewer unnecessary hospital readmissions, higher patient satisfaction scores, and fewer unnecessary emergency room visits than patients under the care of physicians only. Recent studies have shown that ... NPs engaging in end-of-life care had fewer hospitalizations and higher hospice use; ... Despite such compelling evidence, challenges to NP education and practice continue. More than 20 states have yet to grant full scope of practice authority to NPs, denying these expert clinicians the opportunity to exercise the full range of their clinical expertise.

Sophisticated caregiver training remains an underutilized retention, ROI tool Home Health Care News; by Audrie Martin; 8/22/24 ... [Only] 43.8% of home-based care staff and 55% of home health and hospice staff feel prepared to care for new clients, according to the 2024 Activated Insights Benchmarking Report. As a possible result, the annual care staff turnover rate has climbed 14% in the last two years to almost 80%. Organizations demonstrating a commitment to continuing education improve employee satisfaction by allowing caregivers to hone their skills and grow in their careers. Investing in employees’ long-term success will impart a sense of purpose and possibility within a role known for turnover and burnout. “The average home-based care provider offers five hours of orientation and eight hours of ongoing training,” the report read. “Those who offer at least eight orientation hours and 12 hours of ongoing training see an increase of $1,103,291 in revenue. However, while establishing a clear path is one of the top strategies to retaining long-term employees, only 39% of providers have one.”

The importance of competencies in pain management and palliative care Greenwich Sentinel, Greenwich, CT; by Russell R. Barksdale, Jr.; 8/21/24 ... Competencies, ongoing pharmacological education, regular patient pain assessments, management, and medication adjustments are all crucial processes for healthcare providers in today’s complex medical environment. Regrettably, metabolic and behavioral issues related to pain medications, especially opioids, if not properly managed, poses risk of addiction. Beginning in the late 1990s, the consumption of medical opioids used to treat pain increased in many countries worldwide. Since that time, alarmingly the United States has outpaced every other country in per capita opioid consumption. ... [Click on the title's link to continue reading.]

TCN podcast: The need to know on the 2025 Hospice Wage Index Telios Collaborative Network (TCN); podcast hosted by Chris Comeaux; 8/21/24 In this episode of TCN Talks, Chris interviews Annette Kiser, Chief Compliance Officer with Teleios and Judi Lund Person, Principal with Lund Person & Associates LLC.  The conversation covers the need to know around the final published 2025 Wage Index for Hospices.  Some of the key points discussed are:

Staff education an anchor amid widespread hospice audits Hospice News; by Holly Vossel; 8/14/24 ... More than half of hospice providers reported having multiple types of audits within a six-month span in a survey earlier this year. ... Supplemental Medical Review Contractor (SMRC) and Targeted Probe and Educate (TPE) audits are among the most common types of audits that hospices undergo simultaneously alongside others. ... Staff need a firm understanding around the potential red flags on regulators’ radars and how to avoid common compliance errors in their roles, ... Compliance training should be focused on staff’s overall responsibilities alongside the larger bottom line of quality, she said. ... Notable mentions: Jason Bring, co-chair of post-acute and long-term care at the law firm Arnall Golden Gregory LLP (AGG)l; Megan Turby, vice president of quality and compliance at Gulfside Healthcare Services; Dr. Lisa Barker, chief medical officer at Gulfside Healthcare Services

Death is inevitable. It's time we learned to talk about it. MedPageToday; by Nidhi Bhaskar; 8/13/24 By fostering honest and compassionate discussions, we can provide patients with more dignity. Years ago, in a busy emergency department, I found myself joining my mentor at the bedside of an elderly man experiencing chest pain. After completing the physical exam, the doctor unceremoniously changed gears to abruptly ask our patient, "If your heart were to stop beating, do you want us to do everything?" Between the stress of the situation and the vague and awkward delivery of the question, our patient seemed (understandably) overwhelmed. So was I. ... End-of-life conversations can feel like a "word soup" of sorts ... it is easy for patients and providers alike to feel lost. ... Providers must also consider the nuances of cultural attitudes towards death; the location and family arrangements surrounding a person at the end of life; and the varying emotional responses and feelings of decision paralysis surrounding how one dies and how one feels about dying.Editor's Note: For a related article in our newsletter today, read "Examining the relationship between rural and urban clinicians’ familiarity with patients and families and their comfort with palliative and end-of-life care communication."

Education curricula need to incorporate whole-person care beyond electives Pharmacy Times; by Ashely Gallaher; 7/21/24“[Whole-person care is] simply caring for a person and not just their pills. It's making sure that we're focusing on medications as tools to help people live better, healthier lives, and not as the focus of their lives,” Kashelle Lockman, PharmD, MA, clinical assistant professor and clinical pharmacy specialist at the University of Iowa. ... 3 Key Takeaways:

Homecare Homebase opens nominations for 2024 Home Care Aide Scholarship Program PRNewswire-PRWeb; 7/23/24 Homecare Homebase (HCHB) ... and the National Association for Home Care & Hospice (NAHC) are proud to announce the opening of nominations for the 2024 Home Care Aide Scholarship Program. This annual program awards $1,000 scholarships to 15 deserving home care aides across the country, recognizing their dedication to providing exceptional care and supporting their professional development. The scholarship program helps address the growing need for aides in the home care workforce, enabling these essential workers to pursue further education and advance their careers. ... Nominations for the 2024 Home Care Aide Scholarship Program are now open and will be accepted through September 30th, 2024.

Pain management in the wake of the opioid crisis Forbes; by Web Golinkin; 7/15/24 Pain is the single most frequent reason for patient visits in the United States. An estimated 20 percent of adults experience chronic pain, and nearly seven percent experience a level of chronic pain that limits their daily activities. However, most doctors and other healthcare professionals have very little education in pain management, according to Scott Fishman, MD, an internationally recognized expert in pain management, ... This lack of education was one of the main causes of the Opioid Crisis, Fishman says ... of the part of the crisis that was caused by the over-prescribing of opioids, many clinicians have become so wary of the medical-legal issues surrounding pain management that they have gone from an overly liberal approach to a restrictive one in which some prescribers are effectively abandoning patients who need to have their symptoms treated. Both extremes are frequently fueled by lack of knowledge and training, according to Fishman. ... The solution is to close the education gap ...

Report shows substantial financial opportunity in prioritizing research, education on women’s heart health Pharmacy Times; by Alexandra Gerlach; 7/13/24 A report published by authors from the American Heart Association (AHA) and the McKinsey Health Institute showed that addressing the gender gaps prevalent in the treatment of cardiovascular disease (CVD) could boost the US economy by $28 billion annually by 2040 and potentially address the 1.6 million years of life lost due to barriers to care experienced by women. The paper identifies multiple pathways to addressing the lack of representation and access to care for women with CVD... CVD is the leading cause of death in women in the United States, affecting nearly 60 million individuals, and it makes up over a third of the health gap between men and women. 

The impact of clinical internship experience on nursing students' attitudes towards death and choices of end-of-life care: A self-control study Nursing Opens; Jingyuan Jiang, Jing Zhou, Xiaoli Chen, Xiaolin Zhu, Hao Zhang, Qin Zhang, Jianna Zhang; 6/28/24  Attitude towards death refers to an individual's evaluative and stable reactions to death events, reflecting their psychological tendencies and characteristics. ... Death is an inevitable part of life, and individuals must face the reality of death. ... The findings of this study suggest that real clinical experiences in the emergency department contribute to nursing students' development of a positive attitude towards death and a more positive view of providing end-of-life care in a hospital setting. Incorporating teachings on end-of-life care in a hospital setting into death education courses can further enhance nursing students' understanding and acceptance of end-of-life care.