The Role of the Medical Director and Consultant Pharmacists in Todays PA-LTC

David R. Gifford, MD, MPH, AHCA/NCAL 
Senior Vice President of Quality and Regulatory Affairs, American Health Care Association 

The world of post-acute medicine and the delivery of pharmacy services has become increasingly complex and increasingly intertwined. As acuity of residents increase and new payment models change how hospitals utilize SNFs, the role of the physician and pharmacist has increased. The new Medicare and Medicaid regulations also increase the involvement of both the physician and pharmacist in a number of areas. Adverse events in the post-acute care setting have been increasing with medications a leading cause. This session will discuss the increasing role physician and pharmacist play in medication prescribing in LTC with a focus on antibiotic stewardship and the use of medications that increase the risk of adverse events in the elderly. This session will help medical practitioners and consultant pharmacists understand their roles in today’s long term and post-acute environment that is demanded by regulators and third-party payors alike.

• Identify the most recent revisions to the Requirements of Participation in relation to the roles of Medical Directors and Consultant Pharmacists.
• Review the CDC guidance on antibiotic stewardship and monitoring antibiotic prescribing.
• Describe the regulations regarding unnecessary drug use and the need to prevent rehospitalizations in rehab patients.
• Discuss the Beer’s criteria for medications increasing the risk of adverse events in elderly and how the new regulations expect monitoring and limiting their use.

Successful Non-Pharmaceutical Approaches in Dementia Care 

Marianne Smith, PhD, RN
Associate Professor at the University of Iowa College of Nursing; Director of the Csomay Center of Gerontological Excellence at the CON; Co-Director of the UI Center on Aging 

Challenging behaviors in dementia often result from unmet needs that the person can no longer communicate in spoken language. This program reviews a stepwise approach to problem-solving that focuses on underlying causes and contributing factors to dementia behaviors, evidence-based interventions to reduce distressed behaviors, and the importance of team approaches to change the culture of using medication interventions vs. spending time on person-centered approaches.

• Describe how the two domains of the Need-driven Dementia-compromised Behavior (NDB) model interact.
• Identify factors in the personal, social, and physical environment that may cause or contribute to behavioral symptoms.
• Describe the importance of matching interventions to the person’s needs, preferences and abilities.
• Discuss the importance of team approaches to change the culture of using medication interventions in dementia care.  

Role of Palliative Care in Person-Centered Care

Ann Broderick, MD, MS
Director of Hospice and Palliative Care, VA Medical Center, Iowa City, IA 

What palliative care principles do you use every day with patients in the care center? How can you hone those skills to provide health care that meets the goals of your patients and their families? In this interactive session, attendees will learn some techniques that attend to the complex emotions of patients and families and that align a treatment plan with the goals and values of the patient. In addition, we will address how palliative care addresses the symptoms of the patients without necessarily adding to pill burden. Finally, we will address how deprescribing can be achieved based on evidence and alignment with the patients and families. 

• Recognize the palliative care principles that are utilized in care centers every day.
• Demonstrate the ability to recognize grief and emotion in patients and families and respond.
• Describe methods for establishing the goals of care and aligning the treatment plan to the goals.
• Identify a systematic method of addressing symptoms in patients to fully recognize the symptom burden of your patients.
• Provide evidence, prognostication, and patient goals to appropriately counsel on deprescribing of medications.  

Managing Chronic Mental Illness in Older Adults 

Colleen S. Brems, ARNP, PMHCNS-BC
Psychiatric Nurse Practitioner at University of Iowa Hospitals and Clinics 

Mental and emotional distress is a common problem among older adults who live in long-term care settings. Late-life mental illness and threats to mental health too often trigger a downward spiral of disability. This presentation will review signs and symptoms of mental distress and illness, which is the first step in resolving problems. Discussion will focus on the role of interdisciplinary team to assess common disorders and adapt care approaches to help enhance comfort, function, and wellness.

• Distinguish between threats to mental health and mental illness in later life.
• Describe common mental disorders that occur in later life.
• Discuss interdisciplinary care approaches that promote comfort and function and wellness.
• Identify common medications and significant side effects used to treat older adults with mental illness.
• Identify markers for Delirium, Dementia, and Depression.    

Reducing Re-Hospitalizations through Pharmacist-Physician Collaboration 

Diane Reist, PharmD, RPh
Clinical Pharmacy Specialist in Transitional Care, University of Iowa Hospitals & Clinics, Iowa City, IA 

The implementation of HRRP & SNFRM for SNF VBP has many of us asking WITW (what in the world?) As we deal with newly implemented rules and the threat of financial penalties for our patients making return trips to acute care how do we address these readmission issues? What are the issues? Who, what, and where are the stumbling blocks to a smooth transition across the post-acute care continuum and how can we improve this journey for our patients without adding time and work to an already overflowing workload? What is Transitional Care – another buzz word? This presentation will discuss local studies and projects that have looked at what the issues are and some methods for dealing with them.

• Discuss typical roadblocks to smooth patient transitions as patient’s journey from one healthcare environment or provider to the next.
• List strategies that can be used to prevent bad transitions.
• Develop a plan to identify transitional roadblocks that exist in the participants own practice setting.
• Identify the benefits of an Integrated Discipline Transition Team.
• Develop at least one actionable plan to implement on return to practice.