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OBJECTIVE: To adapt a diabetes survival skills education (DSSE) program for delivery on inpatient behavioral health units (BHUs) and to evaluate implementation feasibility within nursing unit workflow. METHODS: We employed mixed methods to codesign, implement, and evaluate a DSSE program for inpatient BHUs. The Diabetes to Go core program incorporates linking knowledge deficits to video education content, a companion book on diabetes survival skills, and education for nurses on delivery processes and teaching content. The Diabetes to Go adaptation for BHUs was codesigned in partnership with BHU staff and patients. Implementation evaluation included patient surveys and nursing staff feedback obtained during field observations. RESULTS: A total of 89 patients participated in nine group education sessions among whom 17 (20%) had diabetes. Nursing unit staff and patients expressed willingness to engage in program design. Barriers to implementation were encountered in both groups including lack of standardization of education content by nurse facilitators and difficulty engaging patients for the time required for completion of surveys plus group education. Preferred education media for both nurses and patients was a book. Diabetes knowledge deficits were identified among over two thirds of participants with diabetes. CONCLUSIONS: Group class may not be the optimal delivery model for specialized DSSE on BHUs. It remains to be determined if individual diabetes education alone or a model which combines individual and group sessions is preferable. Translation of standardized approaches for diabetes education on inpatient BHUs will require further redesign to meet the unique needs of this population. [ABSTRACT FROM AUTHOR]

Background Many patients are reluctant to speak up about breakdowns in care, resulting in missed opportunities to respond to individual patients and improve the system. Effective approaches to encouraging patients to speak up and responding when they do are needed. Objective To identify factors which influence speaking up, and to examine the impact of apology when problems occur. Design Randomised experiment using a vignette-based questionnaire describing 3 care breakdowns (slow response to call bell, rude aide, unanswered questions). The role of the person inquiring about concerns (doctor, nurse, patient care specialist), extent of the prompt (invitation to patient to share concerns) and level of apology were varied. Setting National online survey. Participants 1188 adults aged ≥35 years were sampled from an online panel representative of the entire US population, created and maintained by GfK, an international survey research organisation; 65.5% response rate. Main outcomes and measures Affective responses to care breakdowns, intent to speak up, willingness to recommend the hospital. Results Twice as many participants receiving an in-depth prompt about care breakdowns would (probably/definitely) recommend the hospital compared with those receiving no prompt (18.4% vs 8.8% respectively (p=0.0067)). Almost three times as many participants receiving a full apology would (probably/definitely) recommend the hospital compared with those receiving no apology (34.1% vs 13.6% respectively ((p<0.0001)). Feeling upset was a strong determinant of greater intent to speak up, but a substantial number of upset participants would not 'definitely' speak up. A more extensive prompt did not result in greater likelihood of speaking up. The inquirer's role influenced speaking up for two of the three breakdowns (rudeness and slow response). Conclusions Asking about possible care breakdowns in detail, and offering a full apology when breakdowns are reported substantially increases patients' willingness to recommend the hospital. [ABSTRACT FROM AUTHOR]

Quality of care in nursing homes has been evaluated from varying perspectives, but few studies analyze complaints made to surveyors. This study analyzed complaints, investigations, and citations for nursing homes nationwide. Using the complaint and survey data sets, analyses match nursing home complaints with findings of investigations conducted. Results showed the average complaint rate was 13.3 complaints per 100 residents and that 43.2% of complaint allegations were substantiated, with complaints about care and services provided being the most prevalent. Variability was noted among the Centers for Medicare and Medicaid Services regions and, on average, 47.5% of facilities had five or more complaints in a given year. While additional research could evaluate the effect of complaint investigations on nursing home quality, results indicated that complaints and subsequent investigations provide further information regarding quality for residents. Results also suggest improvements in the training for surveyors and more consistency across Centers for Medicare and Medicaid Services survey regions. [ABSTRACT FROM AUTHOR]

Objective: To examine the relationship between dietary service staff and dietary deficiency citations in nursing homes (NHs). Method: 2007-2011 Online Survey and Certification and Reporting data for 14,881 freestanding NHs were used to examine the relationship between dietary service staff and the probability of receiving a dietary service–related deficiency citation. An unconditional logit model with random effects was employed. Results: Findings suggest that higher staffing levels for dietitians (odds ratio [OR] =.955; p <.01), dietary service personnel (OR =.996; p <.01), and certified nursing assistants (CNAs; OR =.981; p <.05) decrease the likelihood of receiving a dietary service deficiency citation. Conclusion: Higher levels of dietary service and CNA staffing levels have the potential to improve the quality of nutritional care in NHs. Findings help substantiate the Centers for Medicare and Medicaid Services' proposed rules for more stringent Food and Nutrition Services in the NH setting and signify the need for further research relative to the impact of dietary service staff on nutritional and clinical outcomes. [ABSTRACT FROM AUTHOR]

Background: Communication and resolution programs have emerged as central to organizational responses to serious patient harm events, with demonstrated evidence of patient safety and medicolegal outcome improvements within a handful of healthcare systems. Hospitals, including those with open medical staffs, have struggled implementing communication and resolution programs, particularly around the components supporting resolution. Here, we describe our lessons learned early after implementing the resolution ("R") component of Communication and Optimal Resolution, a comprehensive contemporary communication and resolution program at MedStar Health, a large community health system in the United States. Context: MedStar Health is a regional healthcare system with 10 hospitals, 250 ambulatory care delivery sites, and 20 diversified businesses in the mid-Atlantic region of the United States. MedStar Health initiated Communication and Optimal Resolution implementation in 2015. Approach: Our approach to resolution following patient harm yielded seven strategies supporting our resolution process. These included infrastructure and processes to (i) provide immediate support to patients and families, (ii) hold and waive bills, (iii) activate event review processes early to inform resolution, (iv) embrace a paradigm shift in legally defensible cases, (v) develop a communication and resolution program legal community, (vi) accept sacrifices with a principled resolution, and (vii) commit to address challenges with open medical staffs. Summary: The resolution process in response to serious patient harm is complex. Our early experience in implementing the "R" of Communication and Optimal Resolution required enhanced infrastructure, embracing the clinician, legal, and insurance communities and instructing them in the principles of communication and resolution program, and a strong organizational commitment to "doing the right thing" for patients and families. [ABSTRACT FROM AUTHOR]

The article presents the inaugural address of incoming American Society of Health System Pharmacists (ASHP) president Kelly M. Smith delivered at the ASHP Summer Meetings held in Denver, Colorado on June 5, 2018. Topics of the speech included the value of connectivity, the idea of being all in the profession, and collaborating, sharing, working together, and supporting one another in caring for a diverse population.

Gabapentin (GBP) is widely used to treat epilepsy and neuropathic pain. There is evidence that GBP can act on hyperpolarization-activated cation (HCN) channelmediated Ih in brain slice experiments. However, evidence showing that GBP directly modulates HCN channels is lacking. The effect of GBP was tested using two-electrode voltage clamp recordings from human HCN1, HCN2, and HCN4 channels expressed in Xenopus oocytes. Whole-cell recordings were also made from mouse spinal cord slices targeting either parvalbumin positive (PV+) or calretinin positive (CR+) inhibitory neurons. The effect of GBP on Ih was measured in each inhibitory neuron population. HCN4 expression was assessed in the spinal cord using immunohistochemistry. When applied to HCN4 channels, GBP (100 μM) caused a hyperpolarizing shift in the voltage of half activation (V1/2) thereby reducing the currents. Gabapentin had no impact on the V1/2 of HCN1 or HCN2 channels. There was a robust increase in the time to half activation for HCN4 channels with only a small increase noted for HCN1 channels. Gabapentin also caused a hyperpolarizing shift in the V1/2 of Ih measured from HCN4- expressing PV+ inhibitory neurons in the spinal dorsal horn. Gabapentin had minimal effect on Ih recorded from CR+ neurons. Consistent with this, immunohistochemical analysis revealed that the majority of CR+ inhibitory neurons do not express somatic HCN4 channels. In conclusion, GBP reduces HCN4 channel-mediated currents through a hyperpolarized shift in the V1/2. The HCN channel subtype selectivity of GBP provides a unique tool for investigating HCN4 channel function in the central nervous system. The HCN4 channel is a candidate molecular target for the acute analgesic and anticonvulsant actions of GBP. [ABSTRACT FROM AUTHOR]