ARTICLES

Posted November 17, 2017

UTI SILENT DANGER AMONG THE ELDERLY

Among the Elderly, symptoms of a Urinary Tract Infection are often missing. Beware!

A UTI is an infection of the urinary tract, most commonly the bladder. For most people, the need to urinate frequently and/or urgently are two key symptoms of a UTI. A burning sensation when you go, and a change in color and odor are other common signs. Sometimes, a small amount of blood in the urine is visible. But in older adults, those symptoms are often missing. Instead, older adults may suffer from unexplained incontinence, vague fatigue or significant changes in their behavior and mental status.

ALL OF A SUDDEN CHANGES

Beware! A sudden change in behavior for an Elder is a medical emergency. Our patients in the home present different sign and symptoms. All of a sudden, the elder becomes confused, combative, agitated, cannot sleep, sees bugs crawling, and shadows on the wall. The behavioural changes are often dismissed by the family as “a sign of aging”, or “it’s the dementia”. We call this Delirium. Even if the Elder has a current diagnosis of Dementia, a sudden change in mental status is considered to be Delirium. And a main cause of that sudden change is usually a UTI. Medical attention is required to diagnose a UTI and look out for other probable causes such changes in sodium and potassium levels, elevated urea, thyroid levels, dehydration and constipation or even medication levels in the blood stream.

RECOVERY FROM UTI

Home nurses can help recently discharged patients and their families at home following hospitalization. Prescribed antibiotics can cause short term inconvenient side effects such as loose stool, upset stomach, loss of appetite, dizziness and weakness in walking. Recovering from a UTI is challenging for the elder and if not managed well can cause feeling of sadness related to their loss of independence.

HOME NURSING AND PHYSIOTHERAPY

For the once independent elder, coping with the sudden unexplained incontinence and change in mental status is a major setback. With proper care at home, functional independence can be restored. Home physiotherapy is most recommended for elders being treated for a UTI to build muscle strength, balance and coordination and restore confidence to functionally manage bowel and urinary continence.

Home nurses from Accredited Organizations are trained to detect sudden changes in mental status and behaviours and can help rehabilitate the elder back to his or her routine and regain function and restore mental health, once the underlying medical condition is addressed.

Enayati Home Nursing is recognized by Accreditation Canada International for providing safe home nursing care. Nursing strategies to manage Delirium, Dementia and Depression in the elderly are integral to Enayati training program. Our teams are trained in Elderly Care, Parkinson ’s disease, Dementia, Alzheimer Stroke/CVA.

Posted October 27, 2016

MEDICATION SAFETY IN HOMECARE

Medication errors in the home registers as the one of the highest risk to patient safety in the UAE. According to recent admission data to Enayati Home Healthcare, approximately 50% of hospital discharges contain some form of discrepancy as defined by the Institute of Safety Medication Practices, ISMP Canada.

INCOMPLETE INFORMATION

Often the ordering physician is unaware of treatments and medication regimens treated by other physicians. Discharge orders on the final day at hospitals are often left for the medical house officer on duty. Families will choose to ignore the team of doctors who have just treated a major stroke, and defer to their long standing Cardiologist of choice at another private hospital. We have seen patients being discharged home on a blood thinning agent while family is insisting to continue a previous prescribed anticoagulant (also blood thinning). The nursing team searches and tries to draw out the information delicately from all members of the care team.

INADEQUATE TIME

The hospital discharge in all facilities at many times is rushed. Families have been given a tentative discharge date and time but all is dependent on the results of the morning blood draw. The ward or unit doctor reviews the lab results with the primary Consultant to get the final discharge clearance instructions. Within a 2 hour time frame the family will need to vacate the room, attend to the billing department, and wait for the medications from the pharmacy. There is little time spent on reviewing the medications, and if so, retention would be poor due to anxiety related to going home.

MEDICATION RECONCILIATION AT THE HOSPITAL

Reconciliation of medications prior to discharge from hospital will allow the opportunity for clarification with the hospital team. Common errors include discrepancy with the physician order and the pharmacy issue instruction; the physician order and what the verbal instructions given by the nurse, omitted instructions for medications taken prior to hospitalization. If asked, the homecare nurses will insist to visit the hospital on discharge day as part of its admission process at no extra cost. Spending 1 hour in the hospital can save numerous of hours spent on seeking clarification after hours.

FAMILY UNDERSTANDING

It is important to ask the family “and why are you taking this medication for ?” as part of the medication reconciliation. Families have a rich and long health history of the patient. Their understanding of the medication will give insight to any existing gaps and or discrepancies which will require clarification. Sometimes all that is required is one phone call or visit to the doctor. The homecare nurse can gather the information and work to resolve discrepancies within the first 24 hours. Our homecare team will converse with the family drivers and cooks and other domestic staff that have a daily account of the medication routine. Remove the clock from the wall and ask the family cook to point to the time that the medication is normally given.

HOMECARE CHALLENGES

Medications at home is a high priority program for Enayati. Standardization of discharge medication procedures is urgently needed for all hospitals to follow to minimize variations in practice settings. Patients returning abroad from treatment bring a different medication regiment which families are insisting to follow. The reconciliation of these medications has proven to be difficult and a new challenge that falls outside the normal medication safety guidelines. Identifying for medication discrepancies include drug-drug interactions requires a systematic approach to program management.

Enayati Home Healthcare Center follows the Institute of Safety Medicine Practices ISMP Canada for medication safety. Being Accredited to Canadian Standards requires a diligent review of medications upon hospital discharges as well as on admission to the homecare service.

Posted October 21, 2016

HOMECARE PEG FEEDING

Aspiration risk is the same for all patients with or without a Nasogastric or Percutaneous Endoscopic Gastrostomy Tube (PEG or NG) when in a state of bedrest. Imagine yourself eating a full meal and lying down flat. In quick time you will feel your stomach contents rising and teasing your esophageal sphincter. Acid burning, and sometimes, regurgitation (GERD). For the immunocompromised, Elderly and or Stroke CVA patients who have weakened swallowing muscles, the risk of aspirate into the lungs is high.

GASTRIC EMPTYING TIME

Gastric emptying time is around 2 ½ hours for liquefied meals and 4 hours after a solid meal. Factors which alter gastric emptying include Medication e.g., prokinetic agents can increase gastric motility and help to empty the stomach (Cisapride, Phenergren). Other medications slow down the emptying as a side effect (e.g., narcotic analgesics, anticholinergics). Hyperglycemia also slows down gastric emptying. Stroke patients who commonly have diabetes need special attention and should be on aspiration risk watch when their Blood Sugars are high.

POSITIONING

For patients at home on long term feeding, we recommend a hospital bed to be used that can be elevated for patient safety during meal/feeding times. During any feeding, it is ideal that the patient is placed in a high fowler position, 45-90 degrees to assist in the breathing and digestion of food contents. After 30 minutes of meal time, the bed can be lowered to 30 degrees NOT LOWER. Turning to the right side after the meal will further aid in gastric emptying and minimizing aspiration risk.

Keeping the bed at 45 degrees for long periods can increase the risk of pressure sores and thus careful attention to turning and positioning and planning meal times is important. We advise families to plan ahead and create a schedule. Any activity that requires the patient to be flat in the bed be conducted BEFORE meals, such as bathing, shampooing and or changing of the sheets etc.

Most beds have a diagram on the frame below the mattress and you can see the 30 degree mark.

HOME NURSING

Home nurses can help recently discharged patients and their families at home maintain safe positioning whilst PEG feedings and NG. Home nurses from Accredited Organizations are trained to conduct medication reconciliation and are aware of the medications that can delay the gastric emptying. Enayati provides medical equipment and bed rentals are available for those families looking for a temporary solution while maintaining Safe Care.

Enayati Home Nursing is recognized by Accreditation Canada International for providing safe home nursing care.  Our teams are trained in Elderly Care, Parkinson’s disease, Dementia, Alzheimer Stroke/CVA.

Posted June 21, 2015

Falling: Dangerous,but a preventable, threat:

From a flashlight to Tai Chi to homecare nurses, strategies that prevents from falling or reducing the aftermath of a fall.

Falling is a dangerous — and very expensive — problem. Its direct medical costs are in the thousand Dirhams yearly.

It’s well-known that the risk of falling and being hurt increases with age. About 20 percent of the elderly who have a major fall are likely to die within a year, according to national studies.

Falling injuries, including slips, trips, and falls among elderly are prevalent and serious — but more importantly they are preventable.

A lot of work on fall prevention is being done in the UAE,” said “Shiella”, program coordinator for injury prevention at the Enayati homecare. “It’s very important that we let the public know what’s available to help our seniors.” for this reason there will be a conference in October that covers falls preventions among other patient safety topics.

Among the activities that can reduce falls for elderly at home are:

Tai chi has been researched using randomized control trials,” Head said. “Studies have found tai chi can reduce falls by as much as 30 percent.”

Tai chi is an ancient Chinese martial art with low-stress training techniques beneficial for physical fitness and mental focus. In the past several decades, it has spread worldwide, and many programs, especially those geared to seniors, concentrate on exercise and health improvement rather than self-defense.

Shiella says a major problem with falls is “as we age, no one thinks a fall can happen to them.” And the surprise is what happens when they do fall: fractures, hospital bills and an increased chance that they will fall a second or third time, according to hospital reports.

Another way are Flashlights. Seniors may not want to wake a spouse during the night but need to get out of bed for one reason or another. A simple item like a handy flashlight can make a big difference.

Yet a private nurse at home can be excellent proactive activity. “Our plan was straightforward,” says Shiella, a registered nurse at your home that doesn’t just prevent elderly from risks of falling, but also assist in organized daily exercise and physiotherapy.

This group is just sitting down all day, which changes their muscle composition of the body rendering them non-responsive to balance themselves during any rapid action or reaction and they fall.

“Our geriatric management tool looks at how to address patients on a personal level,” Shiella said. “Vision, medications and the environment are all items to be considered in the assessment.”

“Nurses at home are there for care or possibly rehabilitation,” said Shiella and they make sure elderly participates in exercise that helps preserve their muscles and prevents falling.

Posted April 30, 2015

Technology meets Homecare in Dubai

Etisalat, the UAE’s leading Telecommunication Company and Enayati; signed a memorandum of understanding today for the pilot launch of an innovative patient home monitoring system. The system, developed and manufactured by British health Technology Company – Equivital, includes body worn sensors which measure multiple physiological parameters in real time.

The development of wearable and mobile healthcare technologies is reducing the burden of healthcare cost and frequent, inconvenient visits to the clinic, thereby enriching people’s quality of life. Etisalat’s nationwide 3G, 4G mobile and fibre-optic broadband networks are opening doors to many such innovative solutions in the field of e-health and mobile health, helping healthcare systems in the UAE evolve.

During the pilot, Enayati will be able to efficiently manage high volumes of variable, real time and retrospective data for its patients while they are in the comfort of their homes. We have positioned ourselves as a leader in homecare, with a focus on Patient Safety. Using the Equivital platform, including the body worn LifeMonitor sensor, Enayati’s nurses will be able to monitor changes in patient condition and alert Enayati’s clinical team and the most responsible physician instantly, therefore allowing for any adjustments in the care plan to occur with no delays. The new system will also provide family members with a dedicated portal to monitor the health status of their loved ones while they are away.

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