Southeast Texas Medical Associates, LLP James L. Holly, M.D. Southeast Texas Medical Associates, LLP

Transforming Your Practice - Nursing Home
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    The Nursing Home is a unique place to practice medicine. The special needs of patients in the nursing home provide an opportunity for electron patient management to raise the standard and the level of that care. SETMA's nursing home service team provides an excellent level of care in that all patient management is done through the EMR.  SETMA has design a special suite of templates for the nursing home. These templates address the five most difficult problems faced in long-term residential patient care. SETMA has designed special templates for each of these concerns and these templates are used in many other places in SETMA's electronic patient management. This is one of the great strengths of EPM - a solution to a problem in one setting, can be used in all other settings where that same problem occurs. With the use of the EMR and with the continuity of care provided with EPM, SETMA has reduced nursing home patients' admission from a national standard of 7-10% to below 3.5%. This shows the power of EPM not only for quality of care but also for reducing the cost of that care.

    For many reasons, the long-term residential-care setting presents serious and unique challenges to excellence of care for patients who require such placement.  SETMA’s commitment to dignified, personal and excellent care for all who require long-term-residential care, whether due to advanced age and infirmity, disability and infirmity, or other reasons, has resulted in the forming of a team of healthcare professionals to coordinate and deliver that care.  This team is supported by a reference laboratory, mobile x-ray service and hospital-care team which provide a continuity of care between the outpatient, inpatient, and residential-care settings.  With this commitment SETMA has expanded the use of electronic patient records, and, electronic patient management, into the long-term residential-care setting.  The Nursing Home Suite of Templates is the foundation of that expansion.

    The full name of this template is Guidelines for Care of Nursing Home Patients.  It consists of 28 sets of guides for treatment of specific problems which are common in many clinical settings particularly in long-term residential care.

    Tutorial for SETMA’s Deployment of the Texas Department of Aging and Disability Services' Reduction of Antipsychotic Medications Toolkit. In an effort to decrease the inappropriate use of antipsychotic medications in Texas Nursing Homes, The Texas Medical Foundation and the Texas Department of Aging and Disability provided this toolkit.  Because SETMA provides care to over 90% of the long-term care residents in Southeast Texas, which comprises a five county area, and because SETMA documents the care of those patients in our electronic patient record (EMR), we have taken this tool kit and created a Clinical Decision Support tool to improve the care of the patients for whom we have responsibility.

    One of the most neglected areas of acute and critical care is nutrition. Also, one of the most litigated areas in long-term residential and/or nursing home care is malnutrition.  SETMA’s Nutrition Assessment Template makes it possible to objectively document a patient’s nutritional status in regard to:   Risk Factors for Malnutrition; Physical Signs and Symptoms of Malnutrition; Chemical and Metabolic Indications of Malnutrition.

    The next template which is unique to the Nursing Home Suite of Templates is Skin Lesions.  The full name of the template is “Clinically Unavoidable Skin Lesions.” Skin lesions are common in long-term care facilities, and often are unavoidable.  This template helps identify the patients who are at risk of unavoidable skin lesions.  Risk Factors - 22 conditions are listed which contribute to the patient’s being at risk for “Clinically Unavoidable Skin Lesions.”  These should be reviewed and any risk factors which apply to the patient should be documented by checking the box next to it.  These are in demographic fields, which means that once they are checked, they remain checked in subsequent visits until they are unchecked...

    It is often relatively easy to demonstrate that a patient is currently dehydrated or hydrated. However, it is often difficult to declare with objective evidence that while the patient is dehydrated today, he/she was not dehydrated at their last healthcare encounter. The Hydration Assessment tool is designed to enable you to objectively establish the patient’s state of hydration and to document that in an objective, supportable way. This tool is particularly important to use in the Nursing Home setting as the patient’s state of hydration is an important aspect of long-term residential care and is often the focus of malpractice actions.

    This is one of the greatest health threats to all elderly patients but particularly to those who are in long-term residential care.  Through the review of seven categories, a score is developed which indicates whether the patient is at high risk or low risk of falls.

    Depression is a serious and often life-threatening problem in the elderly and particularly in the elderly in long-term residential care facilities.  In addition, the complexity of mediation treatment of the elderly is greater because they are often on multiple drugs which have serious interactions.  While this template is mostly educational, it is key to the successful treatment of residents of long-term care facilities