13 results on '"Brandt, Nicole"'
Search Results
2. Management of Chronic Pain in Nursing Homes: Navigating Challenges to Improve Person-Centered Care.
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Sheikh, Fatima, Brandt, Nicole, Vinh, Dominique, and Elon, Rebecca D.
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THERAPEUTIC use of narcotics , *CHRONIC pain treatment , *CHRONIC pain , *WELL-being , *NURSING home patients , *ANALGESICS , *PATIENT-centered care , *TREATMENT duration , *NURSING care facilities , *PSYCHOSOCIAL factors , *HEALTH care teams , *QUALITY assurance , *QUALITY of life , *DRUG prescribing , *PATIENT-professional relations , *PHYSICIAN practice patterns , *PAIN management , *COVID-19 pandemic - Abstract
Despite the dynamic demands in the nursing home (NH), a definitive approach to managing chronic pain in older adults has yet to be established. Due to concerns for potential adverse pharmacologic effects, balancing appropriate pain management is a challenge among NH residents. The challenges encompass but are not limited to medical complexities, functional disabilities, and physical frailty. Barriers to the successful implementation of a comprehensive chronic pain management at the NH may include ambiguous directions on specific therapeutic interventions, insufficient guidance on treatment duration, and limited available treatment options. The Centers for Medicare and Medicaid Services' reporting requirement of adequate pain control among NH residents coupled with widely variable clinician-prescribing habits highlights the difficulties in overcoming the preceding challenges and barriers. The Coronavirus Disease 2019 (COVID-19) pandemic has further complicated pain management due to its negative consequences on well-being of residents of NHs. Associated symptoms of psychosocial stress, anxiety and depression, and chronic pain symptoms can exacerbate during the COVID-19 pandemic, leading to increased requirement for pain medications including but not limited to opioids. Pain is a multidimensional symptom and requires a strategic multimodal approach for its management. Nonpharmacologic modalities are underutilized in the NH setting and are the preferred first steps for mild pain, and nonopioid pharmacological agents can be added as a second step for a synergistic effect for moderate to severe pain. Opioids should be used as a last resort. Short-acting opioids are preferred over extended-release/long-acting opioids for chronic pain. Clinicians are encouraged to engage residents in proactive strategies in managing their pain, and to set realistic expectations toward improving their quality of life, as complete elimination of pain is not feasible in most cases. This review article provides the interdisciplinary team with a contemporary perspective of the multitude of changes and challenges influencing the prescribing as well as deprescribing of various pain medications. [ABSTRACT FROM AUTHOR]
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- 2021
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3. Medications in Post-Acute and Long-Term Care: Challenges and Controversies.
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Sloane, Philip D., Brandt, Nicole J., Cherubini, Antonio, Dharmarajan, T.S., Dosa, David, Hanlon, Joseph T., Katz, Paul, Koopmans, Raymond T.C.M., Laird, Rosemary D., Petrovic, Mirko, Semla, Todd P., Tan, Edwin C.K., and Zimmerman, Sheryl
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ANTIBIOTICS , *CONFLICT (Psychology) , *DRUG prescribing , *LONG-term health care , *MEDICAL prescriptions , *MEDICAL practice , *NURSING care facilities , *PARASYMPATHOMIMETIC agents , *PSYCHIATRIC drugs , *QUALITY assurance , *SERIAL publications , *SUBACUTE care , *PROTON pump inhibitors , *PHYSICIAN practice patterns , *INDIVIDUALIZED medicine , *INAPPROPRIATE prescribing (Medicine) - Published
- 2021
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4. Pharmacotherapy Research Priorities in Older Adults With Cardiovascular Disease in Nursing Homes, Assisted Living, and Home Care: Report From a Satellite Symposium of the ACC, AGS, NIA Workshop.
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Nace, David A., Brandt, Nicole, Schwartz, Janice B., and Zarowitz, Barbara J.
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CARDIOVASCULAR diseases , *CONGREGATE housing , *HOME care services , *NURSING care facilities , *PATIENT safety , *PRIORITY (Philosophy) , *WIRELESS communications , *ADULT education workshops , *OLD age ,RESEARCH evaluation - Published
- 2019
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5. Comparison of Preparation Times and Cost for Compounded, Outsourced and Premixed Vancomycin Products in a Long-Term Care Pharmacy.
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Brandt, Nicole, Lee, Merton, Worz, Chad, and Gaal, Dana
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DRUGSTORES , *VANCOMYCIN , *MEDICAL care costs , *CONFERENCES & conventions , *LONG-term health care , *DOSAGE forms of drugs - Published
- 2022
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6. Pharmacist-Mentored Implementation Collaborative: High-Risk Medications Stewardship Program.
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Accetta, Robert C., Zarowitz, Barbara J., Brandt, Nicole, David, Tosin, Hill, Valerie, Jones, Aminah, Kuzinski, Matthew E., Lubowski, Teresa, Myrka, Anne, Thomas, Avra, Worz, Chad, and Wu, Jing
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PATIENT safety , *INTERPROFESSIONAL relations , *RISK management in business , *EVALUATION of human services programs , *MENTORING , *MEDICATION therapy management , *DRUG utilization - Published
- 2024
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7. Deficiency Citations on Inappropriate Psychotropics Use Related to Care for Behavioral Symptoms of Dementia.
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Yoon, Jung Min, Trinkoff, Alison M., Galik, Elizabeth, Storr, Carla L., Lerner, Nancy B., Brandt, Nicole, and Zhu, Shijun
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PSYCHIATRIC drugs , *RESEARCH methodology , *INAPPROPRIATE prescribing (Medicine) , *BEHAVIOR disorders , *DEMENTIA patients , *SURVEYS , *QUESTIONNAIRES , *CHI-squared test , *QUALITY assurance , *CONTENT analysis , *ANTIPSYCHOTIC agents , *TRANQUILIZING drugs - Abstract
The Centers for Medicare and Medicaid (CMS) initiated the National Partnership to Improve Dementia Care in Nursing Homes in 2012, which helped decrease antipsychotics use. However, inappropriate use of antipsychotics and other psychotropic medications to control behavioral symptoms associated with dementia persists. Nursing homes (NHs) can be flagged for inappropriate psychotropics use as a deficiency of care citation (F-758 tag). The purpose of this study was to comprehensively explore inappropriate psychotropic medication use deficiency, F-758 citations, in caring for NH residents with dementia. A mixed-methods study was performed. During the first quarter of 2018 (January–March), 3526 NHs were surveyed, of which 642 received F-758 tags. Of the 642, the sample was confined to the 444 NHs that received the citation for the care of residents with dementia. Information on deficiencies was obtained from 2018 Certification and Survey Provider Enhanced Reporting data. Inspection reports for deficiencies were obtained from Centers for Medicare and Medicaid Nursing Home Compare and ProPublica. Quantitative analysis was used to examine the frequency of involved psychotropic medications, scope/severity of F-758 deficiency citations, and reasons for the citations. Reasons for F-758 citations by psychotropic medication categories and scope/severity of the citations were also examined using χ2 tests. Qualitative data analysis was conducted using content analysis with an inductive coding approach to summarize the inspection reports. Antipsychotics were the most involved drug category for F-758 tag citations. The 3 most common reasons for F-758 citations included failure to identify and/or monitor behavioral symptoms (178 NHs), attempt gradual drug reduction (131 NHs), and maintain 14-day limitations on Pro Re Nata (PRN) psychotropic orders (121 NHs). Compared with those with no involvement of antipsychotic drugs, facilities with antipsychotics-related F-758 tags had higher rates of failure to identify/monitor behavioral symptoms (P <.001), attempt gradual drug reduction (P <.001), and provide adequate indications for psychotropics use (P <.001). NHs with F-758 tags related to inappropriate antianxiety medication use had a higher prevalence of failure to maintain 14-day limitation on PRN orders (P <.001) and provide nonpharmacologic interventions (P <.001). This study suggests areas for improvement that could potentially reduce inappropriate psychotropics use. Supporting quality of dementia care workforce and improving cooperation within healthcare staff and professionals are recommended to ensure proper nonpharmacologic and pharmacologic interventions. [ABSTRACT FROM AUTHOR]
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- 2022
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8. Top 10 Signs and Symptoms of Psychotropic Adverse Drug Events to Monitor in Residents of Long-Term Care Facilities.
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McInerney, Brigid E., Cross, Amanda J., Alderman, Christopher P., Bhat, Ravi, Boyd, Cynthia M., Brandt, Nicole, Cossette, Benoit, Desforges, Katherine, Dowd, Laura A., Frank, Chris, Hartikainen, Sirpa, Herrmann, Nathan, Hilmer, Sarah N., Jack, Leanne, Jordan, Sue, Kitamura, Christopher R., Koujiya, Eriko, Lampela, Pasi, Macfarlane, Stephen, and Manias, Elizabeth
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COGNITION disorder risk factors , *BENZODIAZEPINES , *CONSENSUS (Social sciences) , *SCALE analysis (Psychology) , *DRUG side effects , *PSYCHOMOTOR disorders , *LONG-term health care , *HOSPITAL nursing staff , *ANTIPSYCHOTIC agents , *TRANQUILIZING drugs , *DESCRIPTIVE statistics , *ANTIDEPRESSANTS , *CAREGIVERS , *SURVEYS , *QUALITY of life , *DROWSINESS , *PSYCHIATRIC drugs , *ACCIDENTAL falls , *POSTURAL balance , *HYPOTENSION , *DISEASE risk factors - Abstract
To produce a consensus list of the top 10 signs and symptoms suggestive of adverse drug events (ADEs) for monitoring in residents of long-term care facilities (LTCFs) who use antipsychotics, benzodiazepines, or antidepressants. A 3-round Delphi study. Geriatricians, psychiatrists, pharmacologists, general practitioners, pharmacists, nurses, and caregivers from 13 Asia Pacific, European, and North American countries. Three survey rounds were completed between April and June 2023. In Round 1, participants indicated their level of agreement on a 9-point Likert scale on whether 41 signs or symptoms identified in a systematic review should be routinely monitored. Participants considered signs and symptoms that reduce quality of life or cause significant harm, are observable or measurable by nurses or care workers, and can be assessed at a single time point. Round 1 statements were included in a list for prioritization in Round 3 if ≥ 70% of participants responded ≥7 on the Likert scale. Statements were excluded if ≤ 30% of participants responded ≥7. In Round 2, participants indicated their level of agreement with statements that did not reach initial consensus, plus amended statements based on Round 1 participant feedback. Round 2 statements were included in Round 3 if ≥ 50% of the participants responded ≥7 on the Likert scale. In Round 3, participants prioritized the signs and symptoms. Forty-four participants (93.6%) completed all 3 rounds. Four of 41 signs and symptoms reached consensus for inclusion after Round 1, and 9 after Round 2. The top 10 signs and symptoms prioritized in Round 3 were recent falls, daytime drowsiness or sleepiness, abnormal movements (eg, shaking or stiffness), confusion or disorientation, balance problems, dizziness, postural hypotension, reduced self-care, restlessness, and dry mouth. The top 10 signs and symptoms provide a basis for proactive monitoring for psychotropic ADEs. [ABSTRACT FROM AUTHOR]
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- 2024
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9. Pragmatic Trials in Long-Term Care: Research Challenges and Potential Solutions in Relation to Key Areas of Care.
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Resnick, Barbara, Zimmerman, Sheryl, Gaugler, Joseph, Ouslander, Joseph, Abrahamson, Kathleen, Brandt, Nicole, Colón-Emeric, Cathleen, Galik, Elizabeth, Gravenstein, Stefan, Mody, Lona, Sloane, Philip D., Unroe, Kathleen, and Verbeek, Hilde
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CLINICAL trials , *RESEARCH methodology , *FUNCTIONAL status , *HEALTH outcome assessment , *AGING , *QUALITY of life , *LONG-term health care , *OLD age - Abstract
As a method of research, pragmatic trials are recommended so as to generate results that are applicable to real-world care. This intent is especially important for the millions of older adults who receive long-term care in thousands of nursing homes and assisted living communities across the country—and many millions more around the globe. This article presents key points raised by experts participating in a conference funded by the National Institute of Aging held at the 2021 conference of the Society for Post-Acute and Long-term Care Medicine. The purpose of the conference was to convene leading clinicians, researchers, and industry partners to address special considerations of pragmatic trials in long-term care. Cross-cutting and unique challenges and solutions to conducting pragmatic trials were discussed focusing on 3 areas of clinical relevance to long-term care: (1) functional care and outcomes, (2) psychosocial care and quality of life, and (3) medical care and outcomes, with a special focus on persons with dementia. Challenges and innovative solutions were organized across the 9 domains of the revised Pragmatic-Explanatory Continuum Indicator Summary (PRECIS) Tool, and future research recommendations for pragmatic trials in long-term care were identified. [ABSTRACT FROM AUTHOR]
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- 2022
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10. Impact of Nursing Home Factors on Antipsychotic Use in Residents Before and After the Implementation of the Antipsychotic Reduction Initiative: A Facility-level Analysis.
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Zarowitz, Barbara J., Jain, Paavani, Holmes, Sarah, Qato, Danya, Carabajal-Johnson, Aaron, Fleming, Sean, Lucas, Judith, Desai, Abhilash, Brandt, Nicole, and Wastila, Linda
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NURSING home patients , *NURSING care facilities , *GOVERNMENT programs , *PSYCHOSOCIAL factors , *ANTIPSYCHOTIC agents - Published
- 2022
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11. Deficiency of Care Reports on Inappropriate Psychotropic Medication Use Related to Care for Behavioral Symptoms of Dementia.
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Yoon, Jung Min, Trinkoff, Alison, Galik, Elizabeth, Storr, Carla, Lerner, Nancy, Brandt, Nicole, and Zhu, Shijun
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INAPPROPRIATE prescribing (Medicine) , *MEDICAL errors , *DEMENTIA , *ANTIPSYCHOTIC agents - Published
- 2022
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12. COVID-19 Pandemic and Management of Chronic Pain in Nursing Homes.
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Sheikh, Fatima, Elon, Rebecca D., Katz, Morgan J., and Brandt, Nicole
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CHRONIC pain treatment , *CHRONIC pain & psychology , *THERMOTHERAPY , *COLD therapy , *INDIVIDUALIZED medicine , *NURSING care facilities , *HEALTH care teams , *QUALITY of life , *COVID-19 pandemic , *PAIN management , *DISEASE exacerbation - Published
- 2021
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13. DEA Enforcement in Long-Term Care: Is a Collaborative Correction Feasible?
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Elon, Rebecca D., Schlosberg, Claudia, Levenson, Steven, and Brandt, Nicole
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DRUG administration laws , *DRUG laws , *DRUG control , *ELDER care , *DRUGS , *HEALTH services administration , *HOSPITAL pharmacies , *HOSPITALS , *LONG-term health care , *HEALTH policy , *MEDICAL protocols , *MEDICAL prescriptions , *NARCOTICS , *NURSES , *NURSING practice , *NURSING home patients , *NURSING care facilities , *PHARMACISTS , *PHYSICIANS , *THERAPEUTICS , *REGULATORY approval , *THEFT , *GOVERNMENT regulation , *OCCUPATIONAL roles - Abstract
The prescribing and dispensing of controlled substances within long-term care facilities is an important and complex issue from both the clinical and the public policy perspectives. This article reviews the regulatory background and clinical concerns regarding the enforcement of the Controlled Substances Act by the Drug Enforcement Administration within the institutional pharmacies serving long-term care facilities. The article argues that the processes implemented since 2009 in response to concerns about Drug Enforcement Administration enforcement are suboptimal at many levels. A robust solution that meets the needs of all parties involved will require multiple levels of collaboration and respect for several legitimate agendas pertinent to this issue. The comprehensive solution must address at least 4 concerns. It must ensure that (1) residents and patients of long-term care facilities receive appropriate and timely administration of controlled substances when they are part of their individualized plans of care; (2) long-term care facilities have rigorous processes in place to prevent diversion of controlled substances; (3) required processes for prescribing controlled substances are reasonable and not overly burdensome to the clinicians caring for this population; and (4) all parties are in compliance with statutory and regulatory requirements. The solution, however, will likely require legislative amendments to the Controlled Substances Act and regulatory revisions for optimal outcomes. The debate surrounding the enforcement of the Controlled Substances Act within long-term care facilities is ongoing and the parameters are in flux. This article provides a historical perspective and policy framework for understanding the topic, reviews various proposed solutions, and suggests a collaborative process for resolution. [Copyright &y& Elsevier]
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- 2011
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