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1Judy Borcherdt, BSN, RN, CWCMS NASVH 2014Sleep Disorders in State Vet Homes How Interventions Drive Quality and Optimize Resident WellnessMelissa Napier, MS, BSNJudy Borcherdt, BSN, RN, CWCMSNASVHCharleston, SCJuly 29th, 2014
2NASVH 2014So…Why are we here??To learn the SIMPLE tools necessary for your State Veteran Home to develop a program for better sleep to improve your veteran’s lives.Introduction before bullets for objectives.Unravel and explain the changes to current diagnostic criteria; ho9w that looks now and how it will look 10 years from nowGood sleep, bad sleep, sleep changes in dementiaWhat can we do? What a SVH in Fayetteville Arkansas didAll about outcomes right? Lets talk quality, surveys, outcomes
3NASVH 2014ObjectivesUnderstand current Clinical Practice Guidelines and Standards of Care for the evaluation, treatment, intervention and documentation of sleep disorders in LTC settings.Describe restful sleep physiology and the pathophysiology related to sleep deprivation on acute and chronic disease states, cognitive function and quality of life measuresDescribe non-pharmacologic treatment strategies and their positive effects on Patient Centered Care and caregiver and resident satisfactionEvaluate how treatment interventions for disrupted sleep can drive quality outcomes for facilities; and physical, cognitive, and wellness outcomes for residentsIntroduction before bullets for objectives.Unravel and explain the changes to current diagnostic criteria; ho9w that looks now and how it will look 10 years from nowGood sleep, bad sleep, sleep changes in dementiaWhat can we do? What a SVH in Fayetteville Arkansas didAll about outcomes right? Lets talk quality, surveys, outcomes
4NASVH 2014IntroductionMost sleep disorders in the Long Term Care setting are secondary to medical conditions or environmental issues.We will NOT be discussing primary sleep disorders including obstructive sleep apnea, restless-leg-syndrome or periodic limb movement but will discuss when to refer for evaluation.
5Presented by Melissa Napier, MS. BSN. NASVH 2014ObjectiveUnderstand current Clinical Practice Guidelines and Standards of Care for the evaluation, treatment, intervention and documentation of sleep disorders in LTC settings.Presented by Melissa Napier, MS. BSN.
6NASVH 2014National GuidelinesAMDA The Society for Post-Acute and Long-Term Care Medicine, affiliated with the American Medical Association and the American Society of Internal Medicine.Last updated 2005Available from
7Sleep Disorders Definition NASVH 2014Sleep Disorders DefinitionDifficulty in maintaining wakefulness during the day OR abnormal behavior associated with sleep all of which are subjectively or objectively distressing or harmful to the patient or the patient’s roommate or sleep partner.Most sleep disorders in LTC are secondaryto chronic disease states or environmentalfactors and will be the focus of this presentation.
8Classifications: Dyssomnias NASVH 2014Classifications: DyssomniasInsomnia:Difficulty falling or staying asleep or early awakeningNon-restorative sleep resulting in impaired function: cognitive, physical or socialOften result of mood disorders or health issueObstructive sleep apnea, restless leg syndrome, periodic limb movementsHypersomnia:Increased sleepiness, usually during the day that causes impairment of functionPrimary hypersomnia is rare in this populationSleep too much or sleep too little
9Classifications Parasomnias Circadian Rhythm Sleep Disorders NASVH 2014ClassificationsParasomniasDisorders characterized by abnormal sleep-related behaviors including: nightmares, sleep-terrors, sleepwalkingCircadian Rhythm Sleep DisordersTwilight Psychosis or “Sundowning” is NOT a sleep disorder but still requires identification and interventionWont be discussing Parasomnias
10Risk Factors: A Brief Overview Dementia, elderlyDepression, bipolar disorder, other mental illnessesInadequateExposure to sunlightFamily or social supportPhysical activityMultiple comorbidities especially COPD, CHF, arthritisNeurological diseaseNew admit to LTC facilityMedications
11Signs and Symptoms that could indicate a sleep disorder NASVH 2014Signs and Symptoms that could indicate a sleep disorderNighttime Signs and SymptomsNoticeable snoringApneic episodes and “arousal snort”Frequent awakeningsPeriodic, jerking limb movementsTalking during sleepWanderingFun word of the day: somniloquy = sleep talkingLimb movements while asleep or in bed awakeSleep talking: formerly known as somniloquy: maybe sign of stress, depression, fever, sleep-deprivation and can occur with other sleep disorders like REM disorders, or night terrors. Also can be benign.
12Signs and Symptoms……. Daytime signs and symptoms Abnormal behavior in dementia patients such as agitation, hostility, combativenessComplaints by roommateEarly morning confusion, agitation, headacheFalls, accidents, functional declineImpaired cognitionUncontrolled hypertensionDecreased participation, food and fluid intake
13Sleep problems in LTC settings VERY CommonMore time in bed-AWAKE: less time in REM sleep with increased fragmentationComorbidities and/or medications can increase sensitivity to environmental distractionsIncreased interruptions, especially through the nightIncreased risk for falling ( self toileting?)Elevated mortality risk
14Evaluation, Assessment NASVH 2014Evaluation, AssessmentObtain sleep history through the interview process, utilize a sleep logDetermine the characteristics of sleep including routines, quality, history that could indicate issuesRule out external factors like diet, caffeine, exercise, stressAssess impact and physical evaluationSleep observationReview relevant medical conditionsIf a primary sleep disorder is suspected: REFERExternal factors include activity, diet, stress, meds, caffeine
15Treatment of Sleep Disorders NASVH 2014Treatment of Sleep DisordersIMPLEMENT non-pharmacologic interventions firstReconsider the need for medications that may be interfering with sleep……….INITIATE facility wide sleep program!!Treat the medical conditions that may be an underlying causeMONITOR interventions and re-evaluate as necessaryDOCUMENT per quality and survey standards
16When to refer to a specialist: NASVH 2014When to refer to a specialist:When Obstructive Sleep Apnea is suspectedDaytime SymptomsFrequent accidentsMorning headachesExcessive sleepinessRestless leg syndromePeriodic limb movementsUse clinical judgment and observation to determine if diagnostic testing by a specialist is warranted.RLS:
17Presented by: Judy Borcherdt, BSN, RN, CWCMS NASVH 2014ObjectiveTo describe the physiology of restful sleep and the pathophysiology related to sleep deprivation on acute and chronic disease states, cognitive function and quality of life measures.Presented by: Judy Borcherdt, BSN, RN, CWCMS
18Sleep and Dementia Leading Age 2014 Session D5 Sleep defined…The natural state of rest during which your eyes are closed and you become unconscious. (Merriam Dictionary)Sleep is a state that creates a heightened anabolic state, accentuating growth and rejuvenation of all physiologic systems. It is observed in all species of living creatures.A uniform block of time when we’re not awakeHow many of you slept for at least 7 hour last night? If not….Think about how you would define sleep???We may all define sleep differently—I like the 2nd description as it’s very simpleLast—scientific—one that most of us would have come up with
19Sleep Defined… wonderful! Sleep and Dementia Leading Age 2014 Session D5Sleep Defined… wonderful!Like a babyTake a look at these pictures that may best describe sleep for you.!!
20Sleep and Dementia Leading Age 2014 Session D5 …never enough!
24Sleep and Dementia Leading Age 2014 Session D5 Decrease in REM as we ageAs you can see in this graph—The % of REM sleep decreases as we age.Infants spend most of their sleep cycle in REM and elderly only about 12-15%
25Sleep and Dementia Leading Age 2014 Session D5 Circadian RhythmCircadian Rhythm:. Latin word- “circa- meaning around AND diem meaning day!IS A NATURAL 24 hour CLOCK OF SIGNALING WHEN OUR BODY SHOULD BE AWAKE AND WHEN WE SHOULD BE ASLEEP. IT NATURALLY KICKS INTO RYTHYM.It’s influenced by the amount of light entering the eyes, which triggers cells in the brain to produce more or less melatonin (causes drowsiness)-Circadian Rhythms can influence sleep wake cycles, hormone release, body temp and other important bodily functions.As we age-DISTURBANCES IN CYCLE WITH NORMAL AGING AND THE PHYSIOLOGICAL EFFECTS OF THE DISEASE.There is a progressive deterioration of circadian rhythms with aging.changes in the sleep wake cycle manifested by reductions in sleep quality and impairment in cognitive performance [1, 2].exaggeration of age-related changes is seen in Alzheimer’s Disease (AD) affecting as many as a quarter of patients during some stage of their illness.As we’ll review in later in the presentation: In LTC facilities-•sleep disturbances accompanied by sleepiness during the daytime hours.•Sleep disturbances related to negative health outcomes, including risk for falling, and elevated mortality risk•Residents are commonly asleep intermittently at all hours of the day, even during mealtime periods•Sleep fragmentation both nighttime and daytimeincontinence and other personal care, lights etc…
26Sleep and Dementia Leading Age 2014 Session D5 Here’s what we know…Sleep patterns began to drastically change during the Industrial Revolution and the invention of the light bulbMost everything we know about sleep, we’ve learned in the past 25 yearsTiny luminous rays from digital alarm clocks can be enough to disrupt the sleep cycle even if you do not fully awaken. The light turns off a “neural switch” in the brain, causing levels of a key sleep chemical to decline rapidly.FYI- A well known Sleep expert, Dr. Mahowald suggests that anyone who needs an alarm clock is by definition sleep deprived because “if the brain had received the amount of sleep it wanted, you would have woken up before the alarm went off.”Bullet #1- we know that in the 1800’s, people actually used to sleep in 2 phases (they would go to bed for a couple hours then awake for a few hours, then back to sleep)33% of those who drink 4 or more caffeinated beverages daily are designated at risk for sleep apnea
27Sleep and Dementia Leading Age 2014 Session D5 Do we really know…Just what is the impact of chronic sleep deprivation?OH MY!!We’ve learned that sleep plays a significant role in our health, but do we really understand the impact?? Let’s take a look
28Sleep is a serious matter Sleep and Dementia Leading Age 2014 Session D5Sleep is a serious matterSleep deprivation can have a disastrous effect, ultimately leading to death.Seventeen hours of sustained wakefulness leads to a decrease in performance equivalent to a blood alcohol level of 0.05%.Major disasters attributed to human errors in which sleep-deprivation played a role including the 1989 Exxon Oil Spill off AlaskaThe Challenger space shuttle disasterThe Chernobyl nuclear accident1999, American Airlines Flight 1420 overshot the runway at Little Rock National Airport, killing 11
29Sleep: a serious matter Sleep and Dementia Leading Age 2014 Session D5Sleep: a serious matterWell over 100,000 car accidents in North America occur every year due to sleep deprivation—leading to 6000 deaths.Research conducted in 2012 showed:adults who regularly slept less than six hours each night were four times more likely to suffer a stroke than were those who got plenty of sleep.A recent study of orthopedic surgical residents found that residents were fatigued 48% of the time.Negatively effected performance 27% of the timeIncreased potential risk for medical errors by 22% (Arch. Surg. 2012;147)I WANT YOU TO REALLY THINK ABOUT THESE STATS THE NEXT TIME YOU ARE BEHIND THE WHEEL WITH LITTLE SLEEPREAD after 1st bullet---32 million people (17%), said they have fallen asleep at the wheelRESEARCH—ADULTS WHO REGULARLY GET LESS THAN 6HRS OF SLEEP-MORE LIKELY TO SUFFER STROKEORTHO STUDY—INCREASES POTENTIAL RISK FOR MEDICAL ERROR-BY 22% WOW!Recent book_ Essentialism by Greg McKeown- chapter on sleep: Protecting the Asset—yourself!! If protecting or asset is so essential- why do we give up sleep so easily???Sleep continues to be a serious matter –more so as we age!MYTH- we don’t need as much sleep
30Just what happens when we sleep? Biochemical:Hormone secretionMetabolic rate falls during REM sleepEnergy is conservedBody temperature dropsProtein synthesis and production of complex molecules in the body increase
31Sleep and Dementia Leading Age 2014 Session D5 Cont.Physiological:Restorative OR recovery phaseCell division more rapid during NREMIncrease immune functionNeurological:Development of brain cells and formation of new neuronsConnections between brain cells during developmentPhysiological:Restorative OR recovery phase-40 per cent of the usual blood flow to the brain is diverted to the muscles to restore energyOVER 100,000 BILLION OF CELLS RESTORE THEMSELVES IN THEIR 7 YEAR CYCLES. WOUNDS HEAL- WHITE CORPUSCLES SURROUND BACTERIACELL DIVISION MORE RAPID DURING NREMIncrease immune function- CORTICOSTEROIDS BUILD UP OUR RESISTANCE TO INFECTIONS AND TIREDNESSimmune system's increased production of certain proteins during sleep, as the levels of certain agents which fight disease rise during sleep and drop when we are awake.
32Sleep and Dementia Leading Age 2014 Session D5 -Mood swings-DepressionLet’s TAKE NOTICE TO COGNITIVE IMPAIRMENT/ CONCENTRATION/ MOOD SWINGS/ IRRITABILITY/ DEPRESSION/ ANDWhat about wounds that the elderly acquire while in a hospital or LTC facility…our bodies need to repair, new cells need to be generated etc…Dr. Michael Twery, sleep specialist at National Institute of Health says that “sleep affects almost every tissue in our bodies.”Risk of Cancer may also be elevated in people who fail to get enough sleep.In woman, low melatonin levels may be linked to breast cancer.Decrease production of cytokines, cellular hormones that help to fight infections
33Sleep should not decline as we age, however… Sleep patterns usually change as part of the normal aging processIncreased interruptions, especially through the nightMany times takes longer to fall asleepMost sleep disruptions are related to physical or psychological conditions and medicationsTo bed earlier-arise earlier// changes in activity and/or schedule
34Sleep and Dementia Leading Age 2014 Session D5 Let’s take a look at a “snap shot” of those areas that effect the sleep cycle as we age
35Sleep Duration and Cognition: Preliminary Results The Nurses’ Health StudyPopulation: 15,263 woman, at least 70 years of age-study sleep duration at mid-life/later life- free from stroke and depression at the start.Women with sleep durations less than 6 hours a day or more than 9 hours a day had worse average cognition at old age compared to those with sleep durations of 7 hours a day.(Presented by Dr.. Devore of the Harvard Nurse’s Health Study on 2013)
36Summary and duration and cognition: preliminary results Women with sleep durations that change by 2 hours a day or more had worse cognitive function than those with no changeThe findings support the following notion:Extreme sleep durations and changes in sleep duration over time may contribute to cognitive decline and early Alzheimer’s changes in older adults.Our findings suggest that getting an 'average' amount of sleep, seven hours per day, may help maintain memory in later life and that clinical interventions based on sleep therapy should be examined for the prevention of cognitive impairment."Elizabeth Devore, ScD –Brigham and Woman’s Hospital, Boston
37Sleep and Dementia are Bi-Directional Diseases such as Dementia/ Alzheimer’s can significantly impact the sleep cycle and trigger declines in mental abilitySLEEP“One of the unique challenges in researching sleep disturbance as a factor in cognitive decline is: Once patients have developed AD, we do not know if sleep disruption contributes to AD progression or if AD progression contributes to sleep disruption.” (Mander BA. Disturbed sleep in preclinical cognitive impairment: cause and effect? SLEEP 2013;36(9))
38Sleep and Dementia Leading Age 2014 Session D5 Sleep in dementiaAlmost ½ of all dementia patients have sleep disturbancesCompared to older adults with normal cognition, adults with dementia have:Shorter sleep cycle with greater sleep fragmentationLess deep and REM sleep with reduced sleep efficiencyMore frequent nighttime awakening, wandering, and increased daytime nappingMore difficulty falling asleep(Feinburg et al., 1967: Moe et al., 1995; Prinz et al., 1982a, 1982b; Vitiello et al., 1990: Mortimore et al., 1992)Increased severity of dementia is associated with greater sleep fragmentationGreater sleep disturbances may predict more rapid cognitive decline.Greater dementia severity is associated with greater sleep fragmentation
39Sleep and Dementia Leading Age 2014 Session D5 Sleep in dementiaSundowning: a state of confusion at the end of the day and into the night.Can cause a variety of behaviors, such as confusion, anxiety, aggression or ignoring directions.Sundowning can also lead to pacing or wandering.Wandering and incontinence are the top two causes of Institutionalization, because the family member has great difficultly taking care of a patient who displays one characteristic or the other (National Sleep Foundation)Sundowning refers to a state of confusion at the end of the day and into the night. Sundowning can cause a variety of behaviors, such as confusion, anxiety, aggression or ignoring directions. Sundowning can also lead to pacing or wandering.
40Causes of sleep changes in Dementia Sleep and Dementia Leading Age 2014 Session D5Causes of sleep changes in DementiaThe way that the brain controls sleep may be changed due to the physical changes in the brainThe person may have unmet needs or problems such as pain.It is also possible that their poor sleep may be linked to breathing or other sleep related problems such as Obstructive Sleep Apnea, Snoring or Periodic Limb Movements.Some medications may affect sleep (including pain relievers, drugs to treat Dementia, Parkinson’s disease and antidepressants.
41NASVH 2014ObjectiveTo "get back to the basics" and describe non-pharmacologic Patient Centered Care interventions and treatment strategies that caregivers can apply in their facilities to improve QAPI and resident wellness outcomes.Presented by Melissa Napier, MS, BSNBack to the basis. How does all of this affect PATIENTS/RESIDENTS THAT WE CARE FOR
43Facility Readiness Staff Education Environmental enhancements Develop a “cross-pollinated team to evaluate issues INCLUDING family and residents and caregivers to help tailor person-centered care approach for EVERY residentSleep disorders recognition and consequencesInterventions to change the current “culture” of sleep practices and routines in LTC facilities involve common sense.Environmental enhancementsIndividualized care planningStart with the sleep interviewInterdisciplinary care management: TEAM effort!
44Fayetteville, Arkansas SVH Uninterrupted Sleep Program NASVH 2014Fayetteville, Arkansas SVH Uninterrupted Sleep ProgramDeveloped to promote person-centered care and restorative sleep to all Veterans within the Home. “Change will help restore dignity, autonomy, privacy, choice, honor, trust and quality of life to those we serve.” (Fayetteville Veterans Home Policy)Introduce “the folks” in Arkansas and acknowledge them for this great programSleep interview: what are their preferences /previous routines related to nighttime sleep and nap periods, with preferences incorporated into care plan and re-evaluated as necessaryEvaluate Incontinence3 subgroups of residents related to incontinenceambulatory and can self-toilet during the nightincontinent and can reposition themselvesincontinent but unable to reposition without assistance.
45Uninterrupted Sleep Program NASVH 2014Uninterrupted Sleep ProgramProcessSleep interview preferences incorporated into care plan and re-evaluated as necessaryEvaluate IncontinenceFor incontinence management, switched to superabsorbent, longer wearing, brief/pull-on to keep skin dry, improve skin integrity andallow for longer periods of uninterrupted sleepEvaluate medical management where changes can occurIntroduce “the folks” in Arkansas and acknowledge them for this great programSleep interview: what are their preferences /previous routines related to nighttime sleep and nap periods, with preferences incorporated into care plan and re-evaluated as necessaryEvaluate Incontinence3 subgroups of residents related to incontinenceambulatory and can self-toilet during the nightincontinent and can reposition themselvesincontinent but unable to reposition without assistance.
46Sample Sleep Interview Questions NASVH 2014Sample Sleep Interview QuestionsDo you have difficulties falling asleep or maintaining sleep?Do you feel sleepy, tired or fatigued during the day?What is your sleep schedule?How many hours do you sleep at night?How long does it take you to fall asleepHow many times do you wake up during a typical night?Do you feel refreshed when you wake up?Do you have loud snoring and do you stop breathing at night?Are your legs restlessness, crawling or aching when trying to fall asleep?Do you repeatedly kick your legs during sleep?Do you act out your dreams?Sleep in the Geriatric Patient Population p. 54 Table 1Many of these questions are directly related to physiological disorders that can be disrupting sleep
47Fayetteville: Standard of Care NASVH 2014Fayetteville: Standard of CareKeep lights to a minimum during checks.Use soft voicesDecrease loud noises from any source i.e. promptly answer call lights and alarmsDon’t interrupt unless condition warrants.Eliminate a “wake up list” altogether in an effort to support the Veteran’s natural sleep pattern .AM medications: shift medication schedule for meds that can be given anytime of dayAM Blood Sugar: time based on individual needsContinental Breakfast: for early risersEliminate universal, rigid morning routines. Assist each Veteran in a non-hurried fashion at the time of arising each morning
48Fayetteville, Arkansas SVH Uninterrupted Sleep Study NASVH 2014Fayetteville, Arkansas SVH Uninterrupted Sleep StudyDeveloped from observation of the following problemsAnger and acting out issuesNon-compliance with overall care and ADL’sIncrease in negative psychiatric behaviors…leading toThese behaviors caused an increase in:Anti-psychotic drug administrationTransfers to acute care and psychiatric treatment facilitiesNegative side effects from the medicationsIntroduce why we have this protocol to discuss and thank the folks in Arkansas for caring enough to develop it and put it into practice
49Study Results: All related to quality……………….. NASVH 2014Study Results: All related to quality………………..Decrease in anti-psychotic med useReduced admission rate to acute care and psychiatric facilitiesDecrease in anger issuesDecrease in illness related to lack of sleepIncrease in compliance with care including meals, ADL’s and PT/OTImprovement in overall wellness of residents(Jerry Poole, RN, Staff Development/Infection Prevention)
50Fayetteville SVH Outcomes NASVH 2014Fayetteville SVH OutcomesLonger periods of uninterrupted sleep.Staff have more time to do safety rounding during the night and other meaningful and personal care.Staff/Veteran and family satisfaction.When asked if they have observed a change in difficult behaviors……..Comment about behavior
51NASVH 2014ObjectiveTo evaluate how treatment interventions for disrupted sleep can drive QAPI (Quality Assurance and Performance Improvement) outcomes for facilities, and physical and cognitive wellness outcomes in veterans.Melissa Napier, MS, BSNAdd two rafting slides. Its all about outcomes………………………
52Quality Outcomes of Poor Sleep NASVH 2014Quality Outcomes of Poor SleepPatient dissatisfaction with sleep quality can significantly decrease overall quality of life and perceived quality of residential care.Older, fatigued patients are more likely to:Have difficulty with ADL’sExperience confusionBe more challenging for caregiversExperience falls and injuryHeal more slowly and have exacerbated acute and chronic illnessDaytime sleepiness can also be dangerous. In a large study of older women who self-reported the need for frequent napping during the day, poor sleep was associated with a 30-40% increase in falls (Stone, et al. 2006).Find remainder of citation and bullet info. Last bullets will be from trials.POOR SLEEP = INCREASE IN CHRONIC AND ACUTE DISEASES, HOSPITAL ADMISSIONS FOR HEART FAILUREPOOR HEALING, INCREASE IN PAIN, HYPERTENSION, DIABETES AND THE LIST GOES ON AND ONWhat does this mean? Decreased quality of life and increased healthcare $$$$$
53Partnership to improve dementia care NASVH 2014Partnership to improve dementia careIn 2012, CMS launched Partnership to Improve Dementia Care in NursingPartnership:Advancing Excellence in America’s Nursing Homes CampaignAHCA Quality Program and Quality Assurance Performance Improvement (QAPI).Focus on person-centered careThe reduction of unnecessary antipsychotic meds in nursing homes and other care settings.In 2012, CMS launched Partnership to Improve Dementia Care in Nursing Homes to promote comprehensive dementia care and therapeutic interventions for nursing home residents with dementia-related behaviors.AHCA Quality Program and Quality Assurance Performance Improvement (QAPI).Programs for un-interrupted sleep fall into place with a person-centered care approach.
542012 QAPI Goal to Reduce Antipsychotic Med Use NASVH 20142012 QAPI Goal to Reduce Antipsychotic Med Use(QAPI) standards from the Centers for Medicare and Medicaid Services (CMS) to improve nursing home safety.Part of CMS Partnership to Improve Dementia Care in Nursing Homes.AHCA 2012 goal of 15% reduction in the off-label use of antipsychotic drugs in skilled nursing centersOften used in patients with dementia that become agitated or combativeSleep disturbance often a causative factorWhat is the clinical importance of sleep for mood, cognitive function, DEPRESSION,distressed behaviors, falls, appetite, healing?
55NASVH 2014QAPI 2012Ohio’s Long Term Care facilities, for example, have decreased the use of these medications by 8.1% between 2011 and 2013Well on the way to the goal of a 15% reduction by March 2015.Increasing restful sleep can reduce agitation and the need for sedatives.Bullet on QAPI actual title of initiative then bullet the remainder of the infoThis slide should go after Alzheimer's/dementia differentiation slides
56MDS and Sleep (MDS 3.0) Section J0500-A Section N0400-D NASVH 2014MDS and Sleep (MDS 3.0)Section D0200-ATrouble Falling or staying asleep or sleeping too muchSection J0500-AHow much of the time have you experienced pain or hurting over the last daySection N0400-DNumber of days during last 7 days that resident has received hypnotic medication
57Performance for facilities and consumers NASVH 2014Performance for facilities and consumersState Veteran Home commitment to customer service quality and a desire to improve performance:Consumer satisfactionMeeting state survey standardsParticipating in the Advancing Excellence in America’s Nursing Homes Campaign.Resident review complianceStandard and Compliance Surveys(Ohio LTC Quality Initiative ohio.gov)
58NASVH 2014SummaryGuidelines for the treatment of sleep disorders in LTC and numerous available resources can help your facility develop an effective program to improve veteran’s sleep.The relationship between sleep and aging is a bi-directional one and is a hot topic of current research.Simple, non-pharmacologic interventions can help reset circadian rhythms and optimize sleep efficiency.Improving sleep and establishing uninterrupted sleep programs contribute to quality indicators AND resident health and wellness.
59NASVH 2014Check the Back Table For:Available Resources
60Managing sleep disorders in the elderly NASVH 2014Managing sleep disorders in the elderlyThe Nurse PractitionerBy Judith Townsend-Roccichelli, PhD, et alExcellent physiologic overview of sleep disorders with pharmacological and non-pharmacologic interventions.
61Department of Veterans Affairs Evidence Based synthesis program NASVH 2014Department of Veterans Affairs Evidence Based synthesis programPublished 2011 for VA Veterans Health Admin. Health Services R&D ServicePractical, evidence-based intervention programs to improve behavioral outcomes in the dementia population
62Sleep and Dementia www.dementiaknowledgebroker.ca Published 2011 NASVH 2014Sleep and DementiaPublished 2011A report on the evidence-base for non-pharmacologic sleep interventions for persons with dementiaCary A. Brown, et. Al, University of Alberta
63Dementia and sleep www.sleephelthfoundation.org NASVH 2014Dementia and sleepInformative 2 page handout for patients and caregiversPresented by the Sleep Health Foundation
64NIH Public Access Article NASVH 2014NIH Public Access ArticleCurrent Treatments for Sleep Disturbances in Individuals With Dementia (Deschenes, C.L. MSN& McCurry, S. M., PhD (Curr Psychiatry Rep.2009)Target audience is medical professionals: evidence-based discussion.
65NASVH 2014Society of the American Medical Association for Post Acute and Long Term Care Medicine.Guidelines for the evaluation and treatment of sleep disorders.$35 from website
66Honoring our Veterans with providing Excellent Care
67NASVH 2014Thank you!To provide comments or ask further questions, please contact us anytime……..Melissa Napier, MS, BSNJudy Borcherdt, RN, BSN