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Aging Q3 2011 Fall Faculty Retreat. Kiawah Island Golf Resort Charleston, SC. Welcome to Kiawah Island!. Aging Q 3 Update . Completed 9 ACOVEs to date In the middle of Pain Management (ends Jan 20) 5 remain (Pressure Ulcers and Malnutrition are combined in 1 ACOVE).

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aging q3 2011 fall faculty retreat

Aging Q3 2011 Fall Faculty Retreat

Kiawah Island Golf Resort

Charleston, SC

aging q 3 update
Aging Q3 Update
  • Completed 9 ACOVEs to date
  • In the middle of Pain Management

(ends Jan 20)

  • 5 remain
    • (Pressure Ulcers and Malnutrition are combined in 1 ACOVE)
end of life care working group
End of Life Care Working Group

Chair:Paul Rousseau, MDWorking Group Members:

Leigh Vaughan MD

Rog Kyle MD

Elisha Brownfield MD

William P. Moran MD

Cara Litvin MD

Mary Adler RN

Lisa Roberge PA-C

Leah Clanton MD (Resident)

Amanada Overstreet MD (Resident)

objectives
Objectives
  • How to estimate life expectancy
  • How to communicate about Advanced Care Directives
  • How to lead a family meeting to discuss EOL issues and/or deliver bad news
interesting results
Interesting Results
  • 57% (568/998) of patients seen were asked if they have an ACD
  • 23% of patients asked (131/568), DO have an ACD
    • 51% (67/131) Resident knows their wishes
    • 20% (26/131) Copy in the chart
  • 77 % (437/568)of patients asked, don’t have ACD
    • 49% (214/437) want to discuss ACD today
    • 25% (111/437) want to discuss ACD at a follow up visit
slide12
More!
  • In 18% (99/537) of those patients for whom the resident estimated life expectancy using the Covinsky scale, the resident documented the results did have an influence on the clinical decision making.
osteoporosis acove working group
Osteoporosis ACOVE Working Group

Working Group Chair:Jay Brzezinski, MD

Working Group Members:

Pamela Pride MD

Leonard Lichtenstein MD

Amy Thompson PharmD

Brad Keith MD

Lara Hourani (Resident)

Tamela Sill, RN

learning objectives
Learning Objectives
  • Who to refer for a DXA scan
  • How/when to use a FRAX
  • Treatment options for Osteoporosis
slide19
A 70 year old female patient has a symptomatic compression fracture of her thoracic spine. Which of the following is true?
the of treated patients that are needed to cause osteonecrosis of the jaw nnh is rouhgly
The # of treated patients that are needed to cause osteonecrosis of the jaw (NNH) is rouhgly:
the of treated osteoporosis patients that are needed to prevent any fracture nnt is roughly
The # of treated osteoporosis patients that are needed to prevent any fracture (NNT) is roughly:
slide23

On a scale of 1-5 with 1 being no confidence and 5 being very confident, rate your confidence in your ability to decide ho to treat Osteoporosis in elderly females:

slide24

220/613=35.9% of patients seen (females 65+) had a DEXA scan documented it was done or referred

N=116 (done ‘yes’) + 104 (order ‘yes’)=220

D=613

slide26

158/170=92.9% of those patients who had a frax calculated and documented, the resident reported the results had influence on clinical decision

pain management acove working group
Pain Management ACOVE Working Group

Chair: Rogers Kyle, MD

Working Group Members:

Deborah Dewaay MD

Amy Thompson PharmD

Jayne Quinn, RN

objectives29
Objectives
  • All patients 65+ presenting in the clinic will be assessed for chronic and persistent pain.
  • All hospitalized adult patients on Gen Med will be assessed for uncontrolled pain, including the use of PCA management for pain.
  • All hospitalized adult patients on Gen Med on opioid therapy for pain will be assessed for efficacy and side effects.
skills
Skills
  • Manage PCA’s
  • Conversion
  • Pain assessment
key detailing messages
Key Detailing Messages
  • Opioid Use for Control of Pain
  • Opioid Side Effects
  • Non-Opioid Treatment Options
  • Conversion
pain acove participation progress
Pain ACOVE Participation Progress
  • 6/24 = 25% of residents on IP rotation have demonstrated how to properly read a PCA
  • 27/94 = 29% of residents in OP have been detailed
  • 20/94 = 21.3% of residents in OP have demonstrated pain assessment
slide34

A 70 year old woman has been taking 20 mgs of oxycodone every 6 hours for two weeks for pain related to a pelvic fracture. A reasonable next step in her pain management would be to initiate a long acting opioid such as:

  • MSContin 60 mg BID
  • Fentanyl transdermal 75 mcg
  • Oxycontin 20 mg BID
  • Methadone 20 mg BID
slide35
Which of the following medications might be useful in the management of neuropathic pain in the elderly?
  • NSAIDS
  • Anticonvulsants
  • Topical anesthetics
  • Antidepressants
  • B,C, and D
  • All of the above
slide36
When prescribing pain medications, it is often useful to combine an opioid with either acetaminophen or an NSAID.
  • True
  • False
im fm residents minimum geriatric competencies
IM-FM ResidentsMinimum Geriatric Competencies
  • Medication Management
  • Cognitive, Affective, and Behavioral Health
  • Complex or Chronic Illness(es) in Older Adults
  • Palliative and End of Life Care
  • Hospital Patient Safety
  • Transitions of Care
  • Ambulatory Care
acgme competencies
ACGME Competencies
  • Patient Care
  • Medical Knowledge
  • Interpersonal and Communication Skills
  • Professionalism
  • Practice Based Learning
  • Systems Based Practice
let s play a game drs caton and thompson
Let’s Play a Game!

Drs. Caton and Thompson

m 2 m madness to methods amy thompson cathryn caton
M2M“Madness to Methods”Amy ThompsonCathryn Caton
  • Medical College of Wisconsin
  • Can be adapted to any learning task
  • Engages the learner and their “competitive” spirit
  • Encourages Creativity
  • Promotes transfer of behavior to real task
upcoming acoves
Upcoming ACOVEs
  • Osteoarthritis – Cathryn Caton, MD
  • Depression – Bill Moran, MD
  • Urinary Incontinence – Fletcher Penney, MD
  • Pressure Ulcers/Malnutrition – Keri Holmes-Maybank, MD
  • Hearing Loss – Brad Keith, MD
osteoarthritis acove 11
OsteoarthritisACOVE # 11

Chair: Cathryn Caton, MD

Working Group Members:

Theresa Cuoco, MD

Pam Charity, MD

Keri Holmes-Maybank, MD

Don Fox, MD

Cara Litvin, MD

Amy Thompson, PharmD

Kathy Wiley, MD

Lynn Manfred, MD

Cheryl Lynch, MD

Ashley Morris (Med Student)

objectives47
Objectives
  • Perform & Document functional assessment at the time of admission (H&P)
    • Found under ROS section of the H&P
  • Improve knowledge of treatment options
    • Medications
    • Physical Therapy
    • Joint Replacement
osteoarthritis
Osteoarthritis
  • Skill for outpatient?
    • Joint injection labs
    • Joint exams – knees, hips
    • Tools for evaluating patients with osteoarthritis
depression acove 12
DepressionACOVE # 12

Chair: Bill Moran, MD

Working Group Members:

Cara Litvin, MD

Delores Tetrault, MD

Cathryn Caton, MD

AmyThompson, PharmD

Brad Keith, MD

Temeia Martin, MD (Resident)

QI Residents

phq 2 screen for depression
PHQ-2 Screen for Depression

Over the past two weeks, how often have you been bothered by any of the following problems?

Little interest or pleasure in doing things.

0 = Not at all

1 = Several days

2 = More than half the days

3 = Nearly every day

Feeling down, depressed, or hopeless.

0 = Not at all

1 = Several days

2 = More than half the days

3 = Nearly every day

Thibault, JM, Prasaad Steiner, RW. (2004) “Efficient Identification of Adults with Depression and Dementia.” American Family Physician (70):6.

the next steps grant
The Next Steps Grant
  • Training of hospitalists and surgical and medical specialists.
  • Training physicians to learn to work optimally with other disciplines.
important areas of consideration
Important Areas of Consideration
  • Faculty recruitment and development
  • Development of new educational techniques and methodologies
    • Methods to assess learners’ competencies in these areas
  • Existence or creation of infrastructure to support proposed programs
evaluations
Evaluations
  • Survey in the envelope
  • Green card in the box