Blood poisoning

Blood poisoning: What does it mean? - MayoClinic.com

Sepsis

Definition By Mayo Clinic

Sepsis is a potentially life-threatening condition, in which your immune system's reaction to an infection may injure body tissues far from the original infection.

As sepsis progresses, it begins to affect organ function and eventually can lead to septic shock — a sometimes fatal drop in blood pressure.

People who are most at risk of developing sepsis include:

■The very young and the very old
■Individuals with compromised immune systems
■Very sick people in the hospital
■Those who have invasive devices, such as urinary catheters or breathing tubes
Early treatment, usually with large amounts of intravenous fluids and antibiotics, improves chances for survival.

Sepsis - MayoClinic.com

Septic Shock:

Multiorgan Dysfunction Syndrome
Sepsis is described as an autodestructive process that permits the extension of normal pathophysiologic response to infection (involving otherwise normal tissues), resulting in multiple organ dysfunction syndrome. Organ dysfunction or organ failure may be the first clinical sign of sepsis, and no organ system is immune to the consequences of the inflammatory excesses of sepsis.

Circulation


Central circulation


Regional circulation


Hypotension

Pulmonary dysfunction

Endothelial injury in the pulmonary vasculature leads to disturbed capillary blood flow. As many as 40% of patients with severe sepsis develop acute lung injury.

Acute lung injuryThe acute lung injury may be reversible at an early stage, but, in many cases, the host response is uncontrolled, and the acute lung injury progresses to ARDS.
Gastrointestinal dysfunction and nutrition

The gastrointestinal tract may help to propagate the injury of sepsis. Overgrowth of bacteria in the upper gastrointestinal tract may aspirate into the lungs and produce nosocomial pneumonia. The gut's normal barrier function may be affected, thereby allowing translocation of bacteria and endotoxin into the systemic circulation and extending the septic response. Septic shock usually causes ileus, and the use of narcotics and sedatives delays the institution of enteral feeding. The optimal level of nutritional intake is interfered with in the face of high protein and energy requirements.

Liver dysfunction

Renal dysfunction

Central nervous system dysfunction


Mechanisms of Organ Dysfunction and Injury

Hypoxic hypoxia

Direct cytotoxicity

Apoptosis (programmed cell death)

Immunosuppression


Coagulopathy


Characteristics of Sepsis that Influence Outcomes
Clinical characteristics that relate to the severity of sepsis include the following:
•An abnormal host response to infection
•Site and type of infection
•Timing and type of antimicrobial therapy
•Offending organism
•Development of shock
•Any underlying disease
•Patient's long-term health condition
•Location of the patient at the time of septic shock

Frequency
United States
Since the 1930s, studies have shown an increasing incidence of sepsis. In 1 study, the incidence of bacteremic sepsis (both gram-positive and gram-negative sepsis) increased from 3.8 cases per 1000 admissions in 1970 to 8.7 cases per 1000 admissions in 1987. The incidences of nosocomial blood stream infection in 1 institution from 1980-1992 increased from 6.7 to 18.4 cases per 1000 discharges. The increase in the number of patients who are immunocompromised and an increasing use of invasive diagnostic and therapeutic devices predisposing to infection are major reasons for the increase in incidences of sepsis.

The incidence of sepsis syndrome and septic shock in patients admitted to a university hospital was reportedly 13.6 and 4.6 cases per 1000 persons, respectively. In the United States, 200,000 cases of septic shock and 100,000 deaths per year occur from this disease.

A recently published article reported the incidence, cost, and outcome of severe sepsis in the United States. Analysis of a large sample from the major centers reported the incidence of severe sepsis as 3 cases per 1000 population, and 2.26 cases per 100 hospital discharges. Out of these cases, 51.1% received intensive care admission, an additional 17.3% were cared for in intermediate care or coronary care unit. Incidence ranged from 0.2 cases per 1000 admissions in children to 26.2 cases per 1000 admissions in individuals older than 85 years. The mortality rate was 28.6% and ranged from 10% in children to 38.4% in elderly people. Severe sepsis resulted in an average cost of $ 2200 per case, with an annual total cost of $16.7 billion nationally.5

Mortality/Morbidity
The mortality rate in patients with sepsis varies in the reported series from 21.6-50.8%. Over the last decade, mortality rates seem to have decreased. In some studies, the mortality rate specifically caused by the septic episode itself is specified and is 14.3-20%.


Septic Shock: eMedicine Critical Care

Sepsis - Danger to Nursing Patients

Sepsis is a serious medical condition that is characterized by a whole-body inflammatory state (called a systemic inflammatory response syndrome or SIRS) and the presence of a known or suspected infection. The body may develop this inflammatory response by the immune system to microbes in the blood, urine, lungs, skin, or other tissues. A lay term for sepsis is blood poisoning, more aptly applied to septicemia, below.

Septicemia (also septicaemia or septicæmia [sep⋅ti⋅cæ⋅mi⋅a], or erroneously septasemia and septisema) is a related but sometimes deprecated medical term referring to the presence of pathogenic organisms in the bloodstream, leading to sepsis. The term has not been sharply defined. It has been inconsistently used in the past by medical professionals, for example as a synonym of bacteremia, causing some confusion. International medical consensus, since 1992, is that the term "septicemia" is problematic and should be avoided.

Sepsis is usually treated in the intensive care unit with intravenous fluids and antibiotics. If fluid replacement is insufficient to maintain blood pressure, specific vasopressor medications can be used. Mechanical ventilation and dialysis may be needed to support the function of the lungs and kidneys, respectively. To guide therapy, a central venous catheter and an arterial catheter may be placed. Sepsis patients require preventive measures for deep vein thrombosis, stress ulcers and pressure ulcers, unless other conditions prevent this. Some patients might benefit from tight control of blood sugar levels with insulin (targeting stress hyperglycemia), low-dose corticosteroids or activated drotrecogin alfa (recombinant protein

Prognosis can be estimated with the MEDS score. Approximately 20–35% of patients with severe sepsis and 40–60% of patients with septic shock die within 30 days. Others die within the ensuing 6 months. Late deaths often result from poorly controlled infection, immunosuppression, complications of intensive care, failure of multiple organs, or the patient's underlying disease.

Prognostic stratification systems such as APACHE II indicate that factoring in the patient's age, underlying condition, and various physiologic variables can yield estimates of the risk of dying of severe sepsis. Of the individual covariates, the severity of underlying disease most strongly influences the risk of dying. Septic shock is also a strong predictor of short- and long-term mortality. Case-fatality rates are similar for culture-positive and culture-negative severe sepsis.

Some patients may experience severe long term cognitive decline following an episode of severe sepsis, but the absence of baseline neuropsychological data in most sepsis patients makes the incidence of this difficult to quantify or to study. A preliminary study of nine patients with septic shock showed abnormalities in seven patients by MRI.

http://en.wikipedia.org/wiki/Sepsis

Sepsis in elderly individuals can have lasting impact

Sepsis is a medical emergency in which an infection overwhelms the body. Unless antibiotics and life support are delivered quickly, the condition can lead to organ failure and death. Most of those who recover do so gratefully and move on with their lives. However, elderly people who survive a bout of sepsis may not be so lucky.

Research published Tuesday suggests, for the first time, that sepsis can leave some elderly individuals with long-term physical or cognitive problems. Researchers analyzed data from 1,194 elderly patients who were hospitalized with severe sepsis and compared them with 4,517 elderly people who experienced a hospitalization but did not have sepsis. Examining data from up to eight years after the hospitalization, the researchers found sepsis patients had a threefold higher risk for developing cognitive problems, such as forgetfulness, compared with the people who were hospitalized for other reasons. Moreover, the sepsis patients were more likely to have at least one new physical limitation, such as walking, dressing or bathing, after the hospitalization.

"[A]n episode of severe sepsis, even when survived, may represent a sentinel event in the lives of patients and their families, resulting in new and often persistent disability, in some cases even resembling dementia," the authors wrote.

It's not uncommon for elderly people to experience some long-term effects from a hospitalization. But the much higher rate of subsequent functional problems in sepsis patients suggests there is something about the illness that takes a particular toll on an older person. It's likely that the effect of the infection can degrade muscle fibers to the extent that the patient's physical strength declines. How sepsis contributes to dementia is less clear. It could be that the massive inflammation that occurs with sepsis causes some brain damage, the authors wrote. Delirium is common in severe sepsis, and delirium has been linked with an increase in cognitive decline in people with Alzheimer's disease.


Sepsis in elderly individuals can have lasting impact - chicagotribune.com

Severe Sepsis Associated With Development of Cognitive, Functional Disability in Older Patients

Severe Sepsis Associated With Development of Cognitive, Functional Disability in Older Patients
CHICAGO -- October 26, 2010 -- Older adults who survived severe sepsis were more likely to develop substantial cognitive impairment and functional disability, according to a study published in the October 27 issue of JAMA.

"Although severe sepsis is the most common non-cardiac cause of critical illness, the long-term impact of severe sepsis on cognitive and physical functioning is unknown," the authors wrote.

Theodore J. Iwashyna, MD, University of Michigan Medical School, Ann Arbor, Michigan, and colleagues examined whether an episode of severe sepsis increased the odds of subsequent worsened cognitive impairment and functional disability among survivors.

The study involved 1,194 patients with 1,520 hospitalisations for severe sepsis from the Health and Retirement Study -- a nationally representative survey of US residents (1998-2006). A total of 9,223 respondents had a cognitive and functional assessment at the beginning of the study and also had linked Medicare claims; 516 survived severe sepsis and 4,517 survived a non-sepsis hospitalisation to at least 1 follow-up survey and were included in the analysis. The presence of cognitive impairment was assessed, as was the number of activities of daily living (ADLs) and instrumental ADLs (IADLs) for which patients needed assistance. The mean age of survivors at hospitalisation was 76.9 years.

The researchers found that the prevalence of moderate to severe cognitive impairment increased 10.6 percentage points among patients who survived severe sepsis, and their odds of acquiring moderate to severe cognitive impairment were 3.3 times higher. Also, a high rate of new functional limitations was seen following sepsis, with an additional average increase of 1.5 new functional limitations per person among those with no or mild to moderate pre-existing functional limitations.

Nonsepsis general hospitalisations were associated with no change in moderate to severe cognitive impairment and with the development of fewer new limitations.

"Cognitive and functional declines of the magnitude seen after severe sepsis are associated with significant increases in caregiver time, nursing home admission, depression, and mortality," the authors wrote. "These data argue that the burden of sepsis survivorship is a substantial, underrecognised public health problem with major implications for patients, families, and the healthcare system."

The authors added that given published dementia and sepsis incidence rates for those aged 65 years or older in the United Slates, their results suggest that nearly 20,000 new cases per year of moderate to severe cognitive impairment in the elderly may be attributable to sepsis. "Thus, an episode of severe sepsis, even when survived, may represent a sentinel event in the lives of patients and their families, resulting in new and often persistent disability, in some cases even resembling dementia."

"Future research to identify mechanisms leading from sepsis to cognitive impairment and functional disability -- and interventions to prevent or slow these accelerated declines -- is especially important now given the aging of the population," the authors concluded.

Derek C. Angus, MD, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, wrote in an accompanying editorial that there are several important implications of this study: "First, the information in this study can help physicians when assessing care options and discussing outcomes with patients and families. Even if clinicians do not know why patients who develop sepsis experience a decline in function, it is clear that many patients do. Second, the development of pre-clinical models could help establish a better understanding of causality, potential mechanisms, and therapeutic targets. Current models of sepsis only crudely mimic sepsis in the modern ICU and rarely afford an assessment of long-term outcomes among survivors. Third, a number of relatively simple strategies used in other areas of medicine to promote physical rehabilitation and minimise the effects of neurocognitive dysfunction might be adaptable to the ICU and post-ICU setting and ought to be evaluated in clinical trials. Fourth, the traditional end point of day 28 all-cause mortality used in the evaluation of any therapy for sepsis should be replaced by longer-term survival data and functional outcomes. Assessing detailed physical and cognitive function is challenging and costly in the multicenter trial environment. However, the larger cost may be from failure to measure these outcomes and miss important benefits or harms of therapies on the lingering consequences of sepsis."


SOURCE: JAMA




News - Severe Sepsis Associated With Development of Cognitive, Functional Disability in Older Patients

Doctors order mandatory arbitration for patients

The argument against binding arbitration, now common in consumer agreements such as cell phone and credit card contracts, is that it denies access to courts. In health care disputes, the use of mandatory arbitration is not as widespread, but the stakes are much higher, consumer advocates say—in part because patients seeking treatment are likely to sign anything a medical provider puts in front of them.

Some individual doctors, health care facilities, HMOs, and doctors’ insurers routinely ask patients to sign predispute mandatory arbitration agreements. Although some can be revoked later, critics argue that these agreements have no place in medicine.

“Health care isn’t like other goods and services,” said Clark Newhall, a lawyer and physician in Utah, where predispute agreements in health care have been common for years. Consumers usually have access to information on the quality, effectiveness, price, and safety of a good or service they’re choosing, he explained, “but you have less information about your doctor than about a bar of soap.” With predispute mandatory arbitration agreements, Newhall said, “You go forth blindly out of necessity, and you are limited thereafter to one remedy in the event your choice is misguided. There is no appeal.”

Consumer groups fighting to eliminate mandatory arbitration across the board say there is nothing wrong with arbitration itself. But because consumers are asked to sign these agreements before a dispute arises, and the arbitration clause often is buried in a longer document, people don’t understand that they’re signing away their right to a jury trial. Other concerns are that arbitrators are biased and do not have to follow court precedent, some agreements cap damages, and the process lacks transparency and can cost more than a trial.

“In medical malpractice, this is a dangerous road to go down,” said Valkyrie Hanson, campaign organizer for Give Me Back My Rights, a Washington, D.C.-based coalition of public-interest groups fighting against mandatory arbitration.

“They say arbitration is faster, fairer, and cheaper, but it’s not,” said Todd Wahlquist, a Salt Lake City lawyer. Just paying the arbitrator for a simple two-day arbitration can cost $15,000, he said.

“People are handed a stack of papers about insurance, medical history, arbitration—nobody reads them. They trust their doctors,” Wahlquist said. “We assume they’re looking out for our best interests.”

The likelihood that a patient will encounter an arbitration agreement in a medical setting varies widely across the country. A Pennsylvania hospital recently made headlines when it started asking patients to sign these agreements, but patients in California and Utah have been dealing with them for years. Some states have passed laws governing the use of these agreements in health care.

In 1999, the Utah legislature passed a law allowing doctors to use arbitration agreements; it was amended in 2003 to let doctors turn away patients who refused to sign them, although it made an exception for emergency treatment. That law was repealed in 2004; now, health care providers can use these agreements, but they can’t deny treatment because the patient won’t sign. But providers may simply cite other reasons for denying care, Wahlquist said.

Newhall said that some of the people who signed these agreements during the period in which doctors could turn patients away have since filed malpractice suits, and some judges have allowed the arbitration agreements to stand.

Because the two companies that dominate Utah’s health care industry both use mandatory arbitration, patients in the state have a hard time finding doctors who do not use these agreements. When Wahlquist himself refused to sign one at a doctor’s office, he was essentially told that “only people who intend to file frivolous lawsuits don’t sign it,” he said.

In Pennsylvania, such agreements are less common. When attorney David Saba of Kingston discovered that Kindred Hospital, in Wyoming Valley, was asking patients to sign them, it was the first time in 30 years of practice that he had seen them used in health care. “It’s rife with all sorts of problems,” the biggest of which may be the potential for abuse, he said. “We don’t know what patients are being told, if anything.”

Saba noted that once a dispute arises and a client approaches him, he may advise the client to arbitrate, depending on the situation. “Alternative dispute resolution is appropriate if there’s equal status and sophistication” between the parties, but that’s not the case with a hospital and a patient who signs a predispute agreement, he said.

If a pregnant mother signs an arbitration agreement and her child is injured, is the child bound by the agreement? In a wrongful death case, is the heir bound? Can a minor consent to arbitration? Can someone who signs an agreement for a spouse be bound to arbitrate? Courts have gone in different directions on these issues.

The Colorado Supreme Court held in 2003 that although a man’s arbitration agreement with his HMO extended to his surviving spouse and her wrongful death action, the agreement was unenforceable because it did not comply with the Colorado Health Care Availability Act. The court held that the McCarran-Ferguson Act prevented the Federal Arbitration Act from preempting that state law. (Allen v. Pacheco, 71 P.3d 375 (Colo. 2003).) A Texas appeals court relied on that decision in 2005 in denying a nursing home’s motion to compel arbitration. (In re Kepka, 178 S.W.3d 279 (Tex. App. 2005).)

In March, a California appeals court denied a nursing home’s petition to compel arbitration against a woman whose husband had signed an arbitration agreement as part of her admission. (Flores v. Evergreen, 55 Cal. Rptr. 3d 823 (Cal. App. 2007).) The court held, “Although the legislature has specifically conveyed authority over medical decision-making and enforcement of rights to family members, it has not conveyed authority over the arbitration decision to family members.”

Another problem with these agreements, Wahlquist said, is that nonsignatory defendants can sometimes join in the arbitration: “All providers in a dispute can join, even if only one doctor had an arbitration agreement.” Also, a plaintiff can end up in arbitration with one defendant and in court against another—leaving him or her basically “empty-chaired in both places,” with each defendant pointing a finger at the other, Wahlquist explained.

The arbitrators
Arbitrators are ostensibly neutral, but critics say the system is inherently unfair. “Individuals are not repeat users of arbitration—doctors are,” said John Bowman, associate director of legislation for AAJ Public Affairs. “If an arbitrator finds for the plaintiff every time, the doctors won’t hire him or her again,” he said, adding that arbitration providers advertise to health care providers.

In 1998, the American Arbitration Association (AAA), American Bar Association, and American Medical Association (AMA) jointly released a Health Care Due Process Protocol that recommended that “in disputes involving patients, binding forms of dispute resolution should be used only where the parties agree to do so after a dispute arises.”

According to a 2002 press release announcing the AAA’s policy not to arbitrate in cases involving individual patients without a postdispute agreement, the organization’s senior vice president, Robert Meade, said, “Although we support and administer predispute arbitration in other case areas, we thought it appropriate to change our policy in these cases since medical problems can be life-or-death situations and require special consideration.”

Now, the AAA follows those policies but does administer some arbitrations involving predispute agreements, in cases “where a court has ordered a dispute to arbitration, or where medical treatment is not conditioned upon a knowing and voluntary agreement to arbitrate any future disputes and the agreement to arbitrate is revocable by the individual,” according to Wayne Kessler, the association’s vice president of corporate communications. These cases include health care disputes with Duke University, he said.

“The AAA agreed not to administer medical cases with predispute agreements because they’re not fair, but they made an exception for Duke because the agreements are voluntary,” said Erin Jennings, a lawyer in Dunn, North Carolina. She added that from the information the AAA has made public, “everyone would think that they don’t administer these cases.”

Jennings represents Bennie Holland, who sued Duke and other defendents after having spinal surgery. He alleges he suffered a severe infection due to a well-publicized incident in which Duke hospital staff mistakenly washed surgical instruments in used hydraulic fluid. (Holland v. Automatic Elevator Co., No. 07CVS00306 (N.C., Durham Co. Super. amended complaint filed Feb. 9, 2007).) Because Holland had signed a predispute arbitration agreement, Duke moved to compel arbitration. In April, the court granted that motion.

“If they can lock patients in arbitration, they’re going to. It’s a growing trend, at least for Duke, because they know they can get away with it,” Jennings said. She added that after the hydraulic fluid incident, Duke started asking all patients to sign predispute arbitration agreements for all past and future claims.

Jennings pointed out that the incident was a case of blatant error; patients could not have anticipated hydraulic fluid contamination as one of the risks of surgery. About 3,800 patients were affected.

The medical community
Hanson of Give Me Back My Rights noted that insurance companies are pushing doctors to use mandatory arbitration. In response to rising malpractice insurance rates, doctors in some specialties have banded together to self-insure in so-called risk retention groups, and some of these groups require patients to sign predispute agreements.

One of them is the Obstetricians & Gynecologists Risk Retention Group of America, Inc. (OGRRGA). According to a letter telling patients that their doctor has joined the group, one of the group’s goals is “to protect you, as a reasonable patient, from the cost, problems, and mistrust caused by patients who want to ‘win the lottery’ off the doctor through a jury trial lawsuit.”

A document titled “The Top Twelve Reasons to Implement OGRRGA Binding Arbitration in Your Ob-Gyn Offices” touts knowledgeable arbitrators: “The list of arbitrators consists only of retired and semiretired ob-gyns. . . . This replaces a jury of driver’s license holders who know nothing about medicine.” Another OGRRGA document notes that “where state provisions could potentially create an issue,” the agreements include waivers “to abnegate state law.”

Eugene Rosov, who is president of OGRRGA, said that “what constitutes the notion of standard of care is quite specific to the [medical practice] area” and that “it’s not fair to expect jurors to really understand the conflicting views of experts.” He pointed to Kaiser Permanente as one company that has succeeded in using mandatory arbitration widely.

The AMA frowns on predispute arbitration agreements. Information on alternative dispute resolution from the AMA’s Office of General Counsel, posted on its Web site, says: “To be used to settle disputes between physicians and patients, arbitration must typically be voluntarily agreed to after a dispute arises, as opposed to being a mandatory prerequisite to treatment (i.e., predispute binding arbitration).”

Although mandatory arbitration agreements are still less pervasive in health care than in other areas, a high-profile judicial decision could trigger a change, Bowman said—or “the AMA could jump on board and encourage the use of mandatory arbitration.”

A bill is expected to be introduced in Congress to prohibit the use of mandatory arbitration agreements in all contracts or agreements involving health care.

“People have an understanding that there may be conflicts with a bank, for example, but when people go to a doctor, they don’t anticipate malpractice,” Wahlquist said. “They don’t consider how they’d resolve that.”



Doctors order mandatory arbitration for patients

Mass. aims to cut drug overuse for dementia

State regulators and the Massachusetts nursing home industry are launching a campaign today to reduce the inappropriate use of antipsychotic medications for residents with dementia — a practice that endangers lives and is more common here than in most other states.

During the next year, a team of specialists will identify nursing homes with successful methods for avoiding overuse of antipsychotics and determine which homes need help cutting back. Nursing home staff will be taught how to deal with aggressive and difficult behaviors, often displayed by dementia patients, without resorting to antipsychotics to sedate them.

In 2009, 22 percent of Massachusetts nursing home residents who received antipsychotic medications did not have a diagnosis for which the drugs were recommended — the 12th highest rate of inappropriate antipsychotic use in the nation, the Globe re ported earlier this year.

Twice in the past five years, federal regulators have issued nationwide alerts about troubling and sometimes fatal side effects when antipsychotics are taken by people with dementia, often Alzheimer’s patients.

Specialists say that understaffing sometimes prompts overuse of these medications to help control dementia patients’ behavior, but that inappropriate use can also be traced to lack of training in alternative approaches.

“There is a knowledge gap between the front-line workers — the nurses — and the black-box warnings on these medications,’’ said Laurie Herndon, a geriatric nurse practitioner who is leading the initiative for Massachusetts Senior Care, the trade group representing the state’s 430 nursing homes. A black-box warning is the most serious type of caution used in prescription drug labeling.

“We wanted to avoid talking at them, and instead provide educational material they can use,’’ Herndon said.

Campaign details will be unveiled at the association’s annual meeting today in Worcester, which is expected to draw about 900 people.

Alice Bonner, the state’s top nursing home regulator, said she appointed a task force to study the overuse of antipsychotics in nursing homes and develop alternative approaches after the Globe highlighted the problem in Massachusetts earlier this year. The task force includes nursing home physicians, nurses, social workers, and pharmacists, along with elder advocates, researchers, and state surveyors who monitor the quality of the facilities.

Bonner, director of the Bureau of Health Care Safety and Quality in the Department of Public Health, said the state, given its budget problems, does not have new resources to devote to the campaign, but is working with legislators and the Patrick administration to get new funding in the next state budget. The trade association intends to apply for grants from nonprofit groups to fund the initiative.

“No one is going to plunk a whole lot of money in our laps,’’ Herndon said, “but that shouldn’t stop us.

Bonner said that the task force has already identified low-cost approaches used by some nursing homes. One approach involves more careful screening of patients when they are admitted, which includes gathering more detailed information from families about the patient’s personality before the onset of illness. This, Bonner said, helps staffers tailor care and activities to each patient.

“They get a good sense of who a person was before they began to suffer with dementia, what kinds of things they like to do, and what kinds of things their family can tell us makes them calm or gets them engaged,’’ Bonner said.

“When you see a nursing home with a low rate of antipsychotics, very often you will see these programs,’’ she said.

Bonner also said that nursing homes that give workers consistent schedules that allow them to work with the same patients have also been successful.

“That helps reduce difficult behaviors with patients with dementia because staff knows the patients so well, they pick up on early signs of trouble and prevent a catastrophic event, so they can intervene early,’’ she said. Consistent schedules have the side benefit of helping nursing homes retain their workers longer, Bonner said. “Once this is in place, it turns out it is less expensive because staff turnover is expensive,’’ she said.

The education campaign will draw on the work of Dr. Susan Wehry, a geriatric psychiatrist and associate professor of psychiatry at the University of Vermont College of Medicine. Wehry recently concluded an intensive, nine-month pilot project in four Vermont nursing homes that taught all staffers, from housekeepers to medical directors, alternative approaches, such as using music and massage, to manage difficult patient behaviors.

The program, she said, helped identify which alternatives work, which don’t, and how challenging the mission can be.

Wehry is still analyzing the results but said preliminary findings showed that in one of the homes where the administrator made all of the training sessions mandatory for staff, antipsychotic use was dramatically reduced. A third of the patients with dementia had been prescribed antipsychotics before the program, and not one was on them by the end, she said.

“They were much improved in terms of staff-resident interactions and level of alertness,’’ Wehry said. “And they looked happier.’’

Data from another home that did not make all of the training mandatory showed no change in the number of dementia patients given the medications. Wehry said a more troubling trend also emerged there — one of the physicians switched from giving antipsychotics to prescribing antianxiety medications.

“If all we do is shift the burden, then all we have done is create a different set of problems,’’ Wehry said. “Our goal is not to just reduce our reliance on antipsychotics, but to change [patient] behaviors.’’


Mass. aims to cut drug overuse for dementia - The Boston Globe

Albert Lea Nursing Home Abuse Lawsuit Grows

A seventh lawsuit is filed in federal court in South Dakota over alleged abuse of residents at an Albert Lea nursing home. The lawsuit claims the Sioux Falls based Evangelical Good Samaritan Society failed to properly oversee employees at the home in Albert Lea. A 2008 Minnesota Health Department investigation concluded that several nursing assistants mistreated dementia and Alzheimer's patients.

Reportedly, one woman has been sentenced to three months in jail in the case and another is scheduled for sentencing in December. The Good Samaritan Society is asking for the lawsuits to be dismissed.

Albert Lea Nursing Home Abuse Lawsuit Grows

Woman, 94 found in freezer at Calif. nursing home

California investigators are trying to determine how a 94-year-old woman ended up in a freezer at a retirement home.

The Los Angeles Times said Saturday that the California Department of Social Services is investigating the Oct. 28 incident, when the employees of Silverado Senior Living in Calabasas could not find one of their 60 residents.

State records say that after a search of the grounds, the woman was found standing in the home's walk-in freezer.

Senior vice president of Silverado Mark Mostow said the woman was hospitalized but back safe at the home. He would not give further details, citing privacy restrictions.

The home reported the incident to the state as required.

The same home had a former caregiver convicted of torture and elder abuse earlier this year.


Read more: http://www.sfgate.com/cgi-bin/article.cgi?f=/n/a/2010/11/13/state/n184747S02.DTL#ixzz15HxUWLBg

Woman, 94 found in freezer at Calif. nursing home