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SIGN Vol 20, Issue 1 Jan/Feb 2013

President's Message
By Amy Cotton MSN, GNP-BC, FNP-BC, FNGNA

Greetings,
 
I love the changing of seasons in Maine and spring is no exception.  For any of you in areas of the country where things are coming back to life, you know what a boost it is for us all.  It is a fitting time to share with you some exciting news as well.        
 
I am thrilled to share with you a major national collaboration for NGNA and significant new member benefit.  The Hartford Institute for Geriatric Nursing (HIGN) has joined with us to launch a new webinar series to improve nursing care for older adults.  NGNA will provide expert faculty for six webinars each year and present clinical topics relevant to improving the delivery of healthcare to older adults.  Members of NGNA will be able to access these webinars and other resources developed by the Hartford Institute, including the Gerontological Nursing Certification Review Course and other online learning modules, at heavily discounted rates. The webinars will also produce revenue for the organization.  This is a win-win and I hope all of you will take advantage of this new member benefit.
 
For those of you with sharp eyes, did you notice anything new about the NGNA logo?  Notice the new tagline: Where Compassion meets purpose.  Your board leaders thoughtfully crafted a short description to describe to the world who NGNA is.   I know you have all had experiences where people have asked “gero what?” when we tell them about NGNA.  We felt it was important to differentiate our nursing organization from others.  Our mission is clear – to improve nursing care for older adults.  We now have a tagline that truly shares member passion and purpose.        
 
Thank you all for your commitment to NGNA, the only inclusive nursing organization for gerontological nursing in the country! 
 
Warm regards,

 
     

 Pack your Sandals!
2013 NGNA Convention Update


Submitted by Marilyn Daly Newton, RN, BC, CRRN, FNGNA, Co-Chair Convention Planning Committee
 
The Planning Committee has been busy planning a great convention featuring  inspiring lectures, panel discussions, networking opportunities and “Fun in the Sun!”
 
The Call for Abstracts was extended and a wide variety of topics have been submitted making it difficult for the committee to make choices to suit everyone.
 
Speakers for six general sessions and the Opening Session are being reviewed with a wide variety of topics. All general session speakers will be university-based. Different formats have been proposed to allow variety and choice for everyone in attendance, from lectures to panel discussion to open discussion.
 
Our annual highlight and “relaxed feature” of Convention, the Consumer Session, will again be chaired by Marcia Shad. This session never fails to leave us with some inspiration, hope and a good feeling about our older adult population and the endless horizons impacting our lives day by day, one nurse at a time.
 
The committee members are working hard to provide varied unduplicated poster presentations and research topics. We have received a variety of abstract submissions, and several committees are currently reviewing these abstracts to provide the most valuable program possible for you. For the second year in a row, Jane Marks and Inez Wendel are chairing this sub-committee.
 
Deb Conley will again present her popular two-day  Pre-Convention  Certification  Workshop. Attendance increases every year and lasting friendships have been formed while attending the course.
 
By the time you receive the next newsletter, the speakers, panels and activities will be determined.  This year’s Convention Planning Committee members are very excited to have our board members actively participate as liaisons  to the committee so that together, we may provide you the best  education and networking opportunities that we all look forward to every year.  Many of our speakers will be from the local Tampa Bay area (Clearwater, St. Petersburg and Tampa) and the state of Florida.
 
Remember, the convention is about a large group of professionals and one goal: Improving the lives of our older population one conference at a time!
 
Clearwater offers beautiful beaches, culture, shopping and - best of all – a chance to reunite with fellow NGNA members! See you in Clearwater this October.
 


NGNA Awards and Scholarships Program: An Opportunity for Recognition
 
“It takes each of us to make a difference for all of us.” 
Jackie Mutcheson – Teacher
 
How many times have you encountered a person in your practice/teaching/research who is truly making or striving to make a difference in the quality care provided to older adults?  Most of you probably encounter somebody who fits this description daily. In fact, when you look in the mirror, you might see that person!
 
NGNA’s Awards and Scholarships Program offers many possibilities for recognizing those persons who influence the quality of nursing care provided to older adults.  The awards include:
  • Outstanding Chapter Award,
  • Distinguished Service Award (to NGNA),
  • Excellence in Gerontological Nursing Award (one for each of the following: advanced practice registered nurse, registered nurse, licensed practical/vocational nurse, and certified nursing assistant/unlicensed assistive direct care provider), AND
  • the NEW Distinguished Nurse Educator Award.
Scholarships include:
  • Cindy Shemansky Travel Scholarship (to help pay for travel to the NGNA annual convention),
  • Gerontological Nursing Student Leadership Awards (sponsored by NGNA Fellows to support students’ travel to the annual convention), and
  • Mary Opal Wolanin Scholarships (one for an undergraduate nursing student and one for a graduate nursing student - at any level of graduate education, MSN, DNP, PhD).
The award materials are available on the NGNA website – click here for details –and nominations are due on May 15, 2013.  Most of the awards and scholarships allow for self-nomination in addition to nomination of other worthy candidates.  Please consider nominating one of your fellow members for these awards/scholarships.
 
Why should you, as a NGNA member, nominate persons for these awards (or encourage them to submit their own application)?  Members of the 2013 Awards Committee articulated the following reasons.  Jackie Close stated, “It is our professional responsibility when nominations are announced to really think of a deserving person…that we could take the time to nominate. If we do not toot the horns of our colleagues and peers, we are doing our organization and nursing a disservice.”  Carol Amann added that members might think about “a great nurse from your memory that often went unnoticed.”  These are the persons who deserve recognition.
 
Please consider taking a few moments of your time to make a difference not only in the lives of older adults but also to recognize those who contribute to the quality of older adults’ lives.  Nominate at least one person for an award/scholarship this year!
 


Rethink, Reconnect, Restore and Reduce Antipsychotic Medications to Improve Care for Persons with Dementia in the Nursing Home

Submitted by Pam Seale, MSN, RN, GCNS-BC
Reviewed by Melodee Harris, PhD, APN, GNP-BC and Wanda Spurlock, DNS, RN-BC, CNE, FNGNA

 
The Food and Drug Administration (FDA) has determined that antipsychotics that are used for the management of behavioral symptoms in persons with dementia are at an increased risk for cardiovascular mortality.1 According to data from The Center for Medicare and Medicaid Services (CMS), more than 17 per cent of nursing home residents received inappropriate doses of antipsychotic medications.2 A medical record review for one 6 month interval revealed off-label use for 83 per cent of claims for atypical antipsychotic medications.2 Patrick Conway, the CMS Chief Medical Officer and Director of Clinical Standards and Quality reported that 40 per cent of persons with dementia in the nursing home received antipsychotic medications without a diagnosis of psychosis.3   In response to these findings, CMS issued The Initiative to Improve Behavioral Health and Reduce the Use of Antipsychotic Medications in Nursing Homes.4  In May 2012, CMS announced the Partnership to Improve Dementia Care.  The Partnership to Improve Dementia Care is a national effort lead by federal and state partners, nursing homes, and other organizations to reduce off-label antipsychotic use in nursing homes by 15 per cent.5
 
The reactions of nurses, DONs, and administrators fall across a continuum. They don’t understand our population. Do they know what will happen if we stop his Seroquel? Others look quickly for the loophole. How can the paper work look right yet our practices not really change? What kind of documentation will we need? Drug companies are promoting alternative drugs that promise behavioral management outside of the antipsychotic category. Alternative drug therapy may satisfy the surveyors who are looking at the letter of the law, but does it reach the spirit of the law? The cynic will say the driving force for the change is financial.  I say the driving force is increasing person centered care with the most vulnerable population we have in long-term care (LTC).
 
Yes, we are working in a broken system that needs financial fixing fast. According to CMS, in 2007 US citizens and Medicare spent $13 billion for antipsychotic drugs. That is nearly 5% of the total drug expenditures.Woven deep in the tapestry of the healthcare industry however, including CMS, there are nurses and other professionals who are looking for strategies to improve individuals’ quality of life. Nurses know the heart of the matter is quality of life. Nurses know that off-label antipsychotic medications cause a sedative effect leaving the patient less alert and often somnolent.  Increasing somnolence is equivalent to increasing immobility. Immobility decreases independence. As activities of daily living decline, other poor outcomes increase such as a falls, incontinence, and skin breakdown.

Nursing home residents with dementia are even more vulnerable to geriatric syndromes due to adverse side effects of antipsychotic medications.  Nonpharmacological alternatives can be used to manage dementia associated behaviors and improve quality of life.7
           
We at NGNA advocate for older adults to receive the highest quality of care available.  Evidence-based research in non-pharmacological interventions is developing all across the nation.  Take the opportunity to move dementia care forward to a new level for the sake of the each individual’s quality of life.  
 
The CMS National Partnership to Improve Dementia Care in Nursing Homes promotes “the three R’s” - Rethink, Reconnect, and Restore!
Rethink the approach to managing behaviors in persons with dementia.
Reconnect using person centered care.
Restore good health and quality of life.3
 
Here’s how to start: 
  1. Learn about the CMS initiative on their website. Staff and family education modules are available online. Go to http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNEdWebGuide/index.html and type “dementia education” in the search bar. There are many more good dementia care resources.  The NGNA website links you to Advancing Excellence in America’s Nursing Homes through “resources”. This national campaign will motivate and assure that you are not alone in your quest to improve dementia care, and can link you to multiple other initiatives. Research is happening. Take advantage of it.
  2. Once you are convinced the person with dementia can be cared for in a better way, educate others. Invite families into the nursing home so they can grow in their understanding of how to improve their loved ones’ quality of life. Every individual in the nursing home, not just nursing staff, can benefit from understanding behavioral problems and evidence-based approaches to them.
  3. Keep up to date and be the best you can be  by offering your knowledge and encouragement to others. If you aren’t certified in Gerontological Nursing, turn to the ANCC. You will feel more confident as a specialist. Encourage others to become certified and encourage nursing home administration to support and take advantage of the expert staff.
  4. Get involved in NGNA. Join the LTC Special Interest Group (LTC-SIG) and the Advancing for Nursing Home Excellence Special Interest Group where ideas are shared. Use the List Serve for help with care planning difficult behavioral problems. Behavioral management is challenging and we need each other!
NGNA continues to develop a cadre of nurse leaders who promote excellence in dementia care.  It is a challenging time and rewarding time. If you provide nursing care for persons with dementia, your contributions to this partnership make a difference.
 
Let’s do our best to care for older adults!
  1. FDA.  (2005).  Public Health Advisory:  Deaths with antipsychotics in elderly patients with behavioral disturbances. Retrieved from  http://www.fda.gov.
  2. Levinson, D.R.  (2011).  Medicare atypical drug claims for elderly nursing home residents.  Department of Health and Human Services. Retrieved from https://oig.hhs.gov/oei/reports/oei-07-08-00150.pdf
  3. CMS. (2011).  Press Releases:  CMS announces partnership to improve dementia care in nursing homes.  Retrieved from http://www.cms.gov.
  4. McMullen, T. (2012).  The initiative to improve behavioral health and reduce the use of antipsychotic medications in nursing homes (PowerPoint slides). Retrieved from http://www.ngna.org
  5. CMS.  (2012).  The CMS National Partnership to Improve Dementia Care in Nursing Homes.  Retrieved from http://www.cms.gov
  6. Bonner, A. (2013). Improving dementia care and reducing unnecessary use of antipsychotic medications in nursing homes (PowerPoint slides). www.cms.gov/Outreach-and-Education/Outreach/NPC/Downloads/2013-01-31-Dementia-Care-presentation.pdf
  7. Gitlin, L.N., Kales, H.C., & Lyketsos, G.  (2012).  Nonpharmacological management of behavioral symptoms in dementia (Abstract.).  JAMA,  308(19), 2020-2029.  doi: 10.1001/jama.2012.36918

 
Chapter Annual Reports Due April 8!

NGNA Chapter Presidents, please complete your chapter’s Annual Report online by April 8, in order to keep your chapter current for another year! Click here to access the online form.
 
Additionally, the chapter member roster and $50 fee must be submitted to NGNA Headquarters. You may send the roster and payment by check to:
 
NGNA Headquarters
ATTN: Courtney Devine
3493 Lansdowne Drive, Suite 2
Lexington, KY 40503
 
You may also pay by credit card by calling headquarters at 800-723-0560. Please contact Courtney Devine at cdevine@ngna.org with any questions.


NGNA/HIGN Webinar Series
April Webinar Topic: Advance Directives and Decision Making


Description: This webinar will inform the primary care provider on how to utilize various types of advanced directives to ensure patient care preferences are met. It discusses the advantages and limitations of each type of advanced directive, and how they are executed.

Presenter: Mathy Mezey, EdD, RN, FAAN

A pioneer promoting best nursing care practices for older adults nationally and internationally, Dr. Mezey's distinguished career has focused on elevating the competency of nurses caring for older adults and ensuring that people age in comfort and dignity. Her research and writing focus on geriatric nursing education, the quality of care for older people in hospitals and long-term care, and bioethical issues that affect decisions at the end of life. Dr. Mezey is the founder and Associate Director of the Hartford Institute for Geriatric Nursing.

NGNA Members: Login using your member access information to view a 50% discount code for NGNA members to use when registering for the webinar series.

Description: Many behaviors of older adults who have Alzheimer’s disease provide challenges for caregivers. Knowing what to expect and what to do to prevent or manage specific behaviors increases satisfaction of caregivers and care recipients. A framework for rethinking challenging behaviors will provide guidance for choosing effective interventions.

This webinar will award 1 contact hour.

REGISTER NOW!

Information can be found on the Hartford Institute website. http://hartford2staging.hartfordign.org/education/webinars/

The New York University College of Nursing is accredited as a provider of continuing education by the American Nurses Credentialing Center's Commission on Accreditation.


 
Save the Date!
2013 NGNA Annual Convention: October 3-5, 2013
A Clear Vision of Care for the Older Adult
Hilton Clearwater Beach
Clearwater, Florida
 
Mark your calendar for the NGNA 2013 Annual Convention in Clearwater, Florida! Click here for hotel information - reservations are available now! Watch your inbox for more details. Registration will open in May.