Premier Health Care

Abstract Communication challenges in long-term care organizations can strain relationships, curtail workers’ engagement and contributions, and impact care delivery and outcomes. PHI, a national organization focused on the direct care workforce in long-term care, developed the Coach Approach organizational change model to enhance communication skills among all members of the care team in long-term care settings toward a goal of building strong, respectful relationships that foster collaboration and collective problem-solving. The Coach Approach model comprises three components: executive coaching, supervisory training (“Coaching Supervision”), and frontline worker training (“Coaching Communication”). For this evaluation study, PHI contracted with a large national home care provider to adapt and deliver the Coach Approach intervention in a hybrid format to their full staff between January and August 2024. Findings from the evaluation revealed high levels of satisfaction with the training, and 100% of supervisors and 97% of frontline staff reported that they have used the skills they acquired. Findings also indicated that the Coach Approach helps care team members appreciate one another’s perspectives and work together more effectively. The evaluation results demonstrate the value of implementing communication training across all staffing levels within a large, multi-site long-term care organization with implications for improving job quality and care quality for older adults and people with disabilities being served.

Background: The beauty and wellness industries are undergoing a profound paradigm shift, moving from a purely aesthetic focus to a holistic model that addresses the intricate interplay between physical and mental well-being. This evolution is underpin

BackgroundDirect-acting oral anticoagulants (DOACs) are recommended to reduce risk of stroke and systemic embolism in patients with non-valvular atrial fibrillation (NVAF). However, DOAC dosing inconsistent with FDA-approved product labels is common and associated with poor clinical outcomes.ObjectivesIdentify DOAC dosing inconsistent with FDA-approved product labels in ambulatory care patients with NVAF; identify variables associated with dosing lower and higher than label.DesignRetrospective analysis using electronic health records from nine US healthcare systems.PatientsAdults with NVAF receiving DOAC therapy in 2022.Main MeasuresRates of label-inconsistent dosing; multivariable regression analysis to identify demographic and clinical variables associated with dosing lower and higher than label.Key ResultsAmong 51,128 NVAF patients (56.1% male, 94.3% White, mean [SD] age 73.5 [10.5] years), 5008 (9.8%) were prescribed label-inconsistent doses of DOACs (6.8% lower and 3.0% higher than label). Age ≥ 75 years, renal impairment, and hypertension were significantly associated with inconsistent dosing both higher and lower than label. Female sex and higher weight were significantly associated with dosing lower than label, as were heart failure, vascular or liver disease, and bleeding history. Dosing higher than label was significantly associated with male sex, race (African American/Black), weight < 60 kg, and use of drugs with potential drug-drug interactions. When prescribed by primary care physicians, DOAC doses were 37% (95% CI, 27–49%) more likely to be lower than label and 30% (95% CI, 16–46%) more likely to be higher than label than when prescribed by cardiologists or electrophysiologists. Label-inconsistent dosing varied (6.7 to 15.8%) across participating systems.ConclusionsDOAC dosing inconsistent with label varied by demographics, clinical characteristics, prescriber specialty, and healthcare system, suggesting a need to monitor and assess dosing decisions in NVAF. Identification of variables associated with dosing inconsistencies may enable targeted interventions to ensure label-consistent dosing in vulnerable populations.

Chronic nitrous oxide inhalant use produces a myeloneuropathy syndrome resembling subacute combined degeneration of the spinal cord with features of peripheral nerve disease despite normal-appearing vitamin B12 levels. We present a case, where a patient presented with chronic nitrous oxide (whippet) use along with oral B12 supplementation and how the diagnosis was made despite patient denying any drug use.

Occasionally, blood samples may be required from thyroid cancer patients after they have been given the therapy dose of (131)I, as part of necessary medical management of comorbidities. Thus, in the days after (131)I administration, medical health professionals may be involved in the withdrawal, handling, and manipulation of radioactive blood samples. The purpose of this study was to quantify the amount of radioactivity in blood samples taken from thyroidectomized thyroid carcinoma patients after the administration of therapeutic activities of (131)I. For dosimetry purposes, serial blood sampling is performed on thyroidectomized thyroid carcinoma patients prior to therapy with (131)I. The quantities of radioactive material present in these blood samples were expressed as a percentage of the administered activity and then extrapolated to the high levels of (131)I used in therapy for 377 patients in this study. The corresponding radiation exposure rate from the blood samples was then calculated to determine what radiation protection methods were required for staff handling these samples. The average amount of radioactivity in a 1 mL blood sample at 1 hour postadministration of 5.5 GBq (150 mCi) of (131)I was 0.2 ± 0.15 MBq (5.4 ± 4.0 μCi). This corresponds to an exposure rate of 1.23 μSv/h (0.123 mrem/h) at 10 cm from the sample. For samples obtained beyond 24 hours after a therapeutic administration of 5.55 GBq (150 mCi), the exposure levels are approximately equal to background radiation. The data in this study indicate that the radiation exposure from blood samples withdrawn from thyroidectomized thyroid cancer patients is low. However, to ensure that staff members are exposed to minimal levels of radiation, it is imperative that staff members who are involved in withdrawing, handling, or manipulating radioactive blood samples adhere to the recommended radiation safety practices.

Implementing health information technology (IT) is a major strategic objective for providers. To pinpoint considerations that tie to success, the Premier health care alliance surveyed hospitals to develop an electronic health record best-practices library. Compiled from diverse health care organizations, the library outlines considerations to support "meaningful use" in the areas of computerized physician order entry, medication management, clinical documentation, reporting of measures, privacy, information exchange, management of populations' health, and personal health records. Best practices also uncovered strategies for securing executive leadership, culture change, communication, and support for clinicians. This paper summarizes lessons from the library, providing recommendations to speed up health IT implementation.

A culture that provides for safe patient environments demands that health care risk managers address all barriers to safe care, sometimes in extraordinary ways. For example, the operating room is one environment that has gained attention with policies on performing "time outs" before beginning a case and strong emphasis on correct site, correct patient and correct procedure surgery. However, a common hospital practice that has been generally accepted is to invite, allow and encourage sales representatives, or vendors, into the operating room to help surgeons use new equipment or devices. This article will describe how risk managers - partnering with their facility's sourcing and materials management departments - were able to influence a network-wide shift in vendor interactions in the operating room to create safer places for patient care.