Deborah Lekan

Barriers to and Facilitators of Clinical Practice Guideline Use in Nursing Homes

OBJECTIVES: To identify barriers to and facilitators of the diffusion of clinical practice guidelines (CPGs) and clinical protocols in nursing homes (NHs).

A Quality Improvement Program to Enhance After-Hours Telephone Communication Between Nurses and Physicians in a Long-Term Care Facility

OBJECTIVES: To determine whether satisfaction of on‐site nurses with after‐hours telephone communication with off‐site physicians improved in one long‐term care (LTC) facility after a nurse‐oriented intervention.

Diffusion of innovations in long-term care measurement battery.

Poor understanding of factors influencing integration of new practices into long-term care (LTC) hinders timely implementation of evidence-based practices (EBPs). Using the Diffusion of Innovations (DOI) framework, a new instrument measuring staff perceptions of an EBP was developed as part of a DOI-LTC measurement battery and tested in a cross-sectional survey of North Carolina LTC nursing personnel. Valid questionnaires were received from 95 licensed nurses and 102 certified nursing assistants (CNAs). Internal consistency reliability for five of seven subscales was acceptable (Cronbachs alpha coefficient = 0.77 to 0.95). Perception of innovation attributes was associated with intention to adopt the new practice (Spearman rho correlation: licensed nurses = 0.41 to 0.68, p < 0.0001; CNAs = 0.26 to 0.54, p = 0.05 to <0.0001). The DOI-LTC measurement battery represents a promising new approach to studying implementation of EBPs in LTC. Future work should examine its responsiveness to interventions that facilitate implementation of EBPs in LTC.

After‐Hours Calls from Long‐Term Care Facilities in a Geriatric Medicine Training Program

OBJECTIVES: To describe after‐hours telephone calls from nurses in long‐term care (LTC) facilities to doctors in a geriatric medicine training program.

Frailty Assessment in Hospitalized Older Adults Using the Electronic Health Record

Introduction: Frailty, a clinical syndrome of decreased physiologic reserve and dysregulation in multiple physiologic systems, is associated with increased risk for adverse outcomes. Purpose: The aim of this retrospective, cross-sectional, correlational study was to characterize frailty in older adults admitted to a tertiary-care hospital using a biopsychosocial frailty assessment and to determine associations between frailty and time to in-hospital mortality and 30-day rehospitalization. Methods: The sample included 278 patients ≥55 years old admitted to medicine units. Frailty was determined using clinical data from the electronic health record (EHR) for symptoms, syndromes, and conditions and laboratory data for four serum biomarkers. A frailty risk score (FRS) was created from 16 risk factors, and relationships between the FRS and outcomes were examined. Results: The mean age of the sample was 70.2 years and mean FRS was 9.4 (SD, 2.2). Increased FRS was significantly associated with increased risk of death (hazard ratio = 1.77−2.27 for 3 days ≤ length of stay (LOS) ≤7 days), but depended upon LOS (p < .001). Frailty was marginally associated with rehospitalization for those who did not die in hospital (adjusted odds ratio = 1.18, p = .086, area under the curve [AUC] = 0.66, 95% confidence interval for AUC = [0.57, 0.76]). Discussion: Clinical data in the EHR can be used for frailty assessment. Informatics may facilitate data aggregation and decision support. Because frailty is potentially preventable and treatable, early detection is crucial to delivery of tailored interventions and optimal patient outcomes.