Daniel Davidson, MD, MBA, DBA, PHD
Introduction:
Facilities for chronic care are essential in helping people with long-term medical needs receive continuing assistance and care. Despite the fact that these facilities work to improve patients’ quality of life and wellbeing, a number of typical issues related to their diseases may arise for patients. In order to provide comprehensive care and enhance patient outcomes, healthcare providers must have a thorough understanding of these issues. We look at some of the most common issues that patients in chronic care institutions face in this article.
Pressure Ulcers (Bedsores):
Bedsores, also known as pressure ulcers, are a common and sometimes dangerous condition among patients in long-term care institutions. Prolonged pressure on the skin, usually over bony prominences like the sacrum, heels, hips, and elbows, causes these ulcers to form. The severity of pressure ulcers varies, ranging from superficial skin redness to deep, open sores that reveal underlying tissues and raise the possibility of infection.
One common explanation for the development of pressure ulcers is immobility or restricted movement, which can result in prolonged pressure on particular body parts. Shear and friction pressures, dampness, inadequate diet, and impaired blood flow are further contributing factors. Pressure ulcers are more common in patients who are bedridden, wheelchair-bound, or unable to move around on their own.
Falls and Fractures:
Falls and fractures are two of the most frequent problems that patients in long-term care facilities deal with, and they can have major repercussions. These events frequently occur as a result of conditions including decreased mobility, weakened muscles, and balance problems, which are common among people in these environments, particularly senior citizens.
A patient’s health and quality of life may be significantly impacted by fractures, head trauma, lacerations, and other injuries that can arise from falls. In example, fractures can result in functional limits, decreased mobility, and prolonged discomfort, which makes managing chronic health issues even more difficult.
In order to mitigate the risk of falls and fractures, long-term care facilities need to take preventative steps. To make patient living environments safer, this involves making changes to the surrounding environment, such as eliminating trip hazards and adding grab bars and handrails. Strength, balance, and mobility-focused exercise regimens can also aid to enhance physical function and lower the risk of falls.
In order to identify patients who are at risk of falling and to put the right measures in place to stop accidents, staff education and training are essential. Fall risk assessments, close patient monitoring, and the implementation of customized care plans based on each patient’s unique requirements and mobility constraints may all be part of this process.
Medication Errors:
Medication errors are mistakes made during the prescription, dispensing, administering, or monitoring of medications that cause the patient to suffer unintentional injury. These mistakes can happen at any point during the medicine process and can be caused by a number of things, such as equipment malfunctions, human error, and poor communication. An outline of the many kinds of pharmaceutical errors and their reasons is provided below:
Medication Error Types:
Errors in the prescription process:
Mistakes in the prescription process, such as giving the wrong medication, the incorrect quantity, or the wrong medication for the patient’s condition.
Errors committed by pharmacy technicians or pharmacists during the preparation of prescriptions, such as giving the incorrect drug or dosage amount.
Medication administration errors include giving the incorrect dosage, giving the medication to the incorrect patient, or giving the medication by the incorrect route (intravenous as opposed to oral).
Errors in the monitoring of a patient’s response to medication: Inadequate observation of side effects or drug interactions, for example.
Reasons for Medication Mistakes:
Human Factors:
Medication errors among healthcare providers can be caused by a variety of factors, including fatigue, distraction, inexperience, and a lack of knowledge or training.
Communication breakdowns:
Misunderstandings or incorrect interpretations of pharmaceutical instructions can result from poor communication amongst patients, caregivers, and healthcare professionals.
System Problems:
Inadequate medication reconciliation protocols, a lack of standard operating procedures, or technical malfunctions in electronic prescription systems are examples of medication-related process deficiencies that can lead to errors.
Prescription Complexity:
The risk of errors is increased by complicated prescription regimens, polypharmacy (using numerous medications), and pharmaceuticals with similar names or packaging.
Infections:
In healthcare settings, such as chronic care facilities, infections are a major issue since patients may be more susceptible because of weakened immune systems, underlying medical disorders, and close quarters. When pathogenic microorganisms, including bacteria, viruses, fungus, or parasites, enter the body and proliferate, they can lead to an infection and subsequent illness or disease.
Common infections found in long-term care institutions include:
Urinary Tract Infections (UTIs):
UTIs are caused by bacteria that enter the urinary tract, grow, and cause infection and inflammation. UTIs are more common in patients who have urinary catheters or underlying urinary tract disorders.
Respiratory Infections:
Patients in chronic care institutions are frequently afflicted with respiratory infections, including influenza and pneumonia. These infections are particularly common in older persons and those with long-term respiratory disorders. These infections can cause major difficulties, especially in susceptible individuals, and are frequently transmitted through respiratory droplets.
Skin and Soft Tissue Infections:
Failure of the immune system or breaches in the skin barrier can result in skin and soft tissue infections, such as cellulitis, wound infections, and pressure ulcers. Individuals who have chronic wounds or restricted movement are more vulnerable to these diseases.
Illnesses of the Gastro intestines:
In chronic care institutions, contaminated food, water, or surfaces can quickly spread intestinal illnesses such gastroenteritis and Clostridium difficile (C. diff) infections. Symptoms of these illnesses include vomiting, diarrhea, and stomach pain.
Circulation Infections:
When bacteria or other pathogens enter the circulation and spread throughout the body, it can lead to bloodstream infections, also known as bacteremia or sepsis. Bloodstream infections are more common in patients with indwelling medical devices, such as intravenous lines or central venous catheters.
A multifaceted strategy is needed to prevent infections in long-term care institutions, including:
Hand Hygiene:
In order to stop the spread of infectious bacteria, healthcare personnel need to wash their hands with soap and water or use hand sanitizers that include alcohol.
Measures to Prevent Infection:
Putting infection control procedures into practice, such as using personal protective equipment (PPE), cleaning the environment, and isolating areas, can help stop infections from spreading throughout the facility.
Vaccination:
Vaccination campaigns against diseases like influenza and pneumococcal illness can stop the spread of these infections in patients and healthcare personnel.
Antibiotic Stewardship: Using antibiotics wisely and putting antimicrobial care plans in place can help stop the spread of bacteria resistant to antibiotics and lower the risk of infections linked to healthcare.
Malnutrition and Dehydration:
Patients at long-term care institutions frequently worry about malnourishment and dehydration. When the body does not get enough of the vital nutrients it needs to stay healthy and function correctly, malnutrition sets in. It may be caused by a number of things, including insufficient food intake, trouble swallowing, gastrointestinal problems, and poor appetite. Fatigue, loss of muscles, and a weakened immune system can all result from malnutrition.
Dehydration happens when the body loses more fluid than it gains, which throws off electrolyte balance and impairs physiological processes. In chronic care settings, dehydration can result from a lack of fluid intake, fluid losses from vomiting or diarrhea, drugs that make you urinate more, or illnesses like kidney or diabetes. In addition to symptoms like thirst, dry mouth, dark urine, exhaustion, and dizziness, dehydration can also cause electrolyte imbalances, organ failure, and in extreme situations, death. Healthcare providers in long-term care institutions have a duty to keep a careful eye out for symptoms of malnourishment and dehydration in their patients. This could entail performing routine evaluations of nutritional status, which would include weighing in, keeping track of food intake, and screening for risk factors. Providing nutrient-rich meals and snacks, offering assistance with eating and drinking, promoting appropriate fluid intake, and giving oral or intravenous fluids as needed are some interventions to address malnutrition and dehydration. Healthcare professionals may also work in conjunction with nutritionists or dietitians to create customized meal plans and inform patients and caregivers of the need of maintaining adequate nutrition and hydration for general health and wellbeing.
Mental Health Challenges:
A person’s emotional health and psychological functioning can be negatively impacted by a wide range of situations and experiences that fall under the category of mental health problems. Patients in chronic care facilities may have a range of mental health difficulties as a result of conditions like long-term sickness, diminished independence, and environment changes.
These difficulties may appear in a variety of ways, such as:
Depression:
Common signs of depression include feelings of melancholy, hopelessness, and apathy in once-enjoyed activities. Additionally, patients may have changes in appetite, difficulties concentrating, and sleep issues.
Anxiety:
Anxiety disorders are characterized by excessive worry, fear, and apprehension. Patients may suffer panic episodes, feel uneasy, and struggle to control their feelings and thoughts.
Social Isolation:
Feelings of loneliness and social isolation can result from physical disabilities and chronic illness. Individuals may become withdrawn from social situations, feel cut off from other people, and battle feelings of loneliness.
Stress:
Managing several medications, adjusting to living in a care facility, and coping with chronic health concerns can all lead to high levels of stress. Patients may experience emotional exhaustion, irritability, and overwhelm.
Grief and Loss:
Individuals receiving long-term care may feel sad and lost as a result of their health deteriorating, losing their freedom, and being away from their loved ones. Accepting these losses can be difficult and have an effect on one’s emotional health.
Conclusion:
Patients in long-term care institutions frequently face a variety of difficulties, such as pressure sores, prescription mistakes, and mental health issues. But by identifying and comprehending these typical side effects, medical practitioners can create all-encompassing treatment regimens that cater to the particular requirements of every patient. Reducing risks and enhancing results require proactive management techniques, preventive measures, and a patient-centered approach.
Prioritizing holistic care that takes into account a person’s physical, emotional, and social well-being is critical for chronic care facilities. Healthcare teams may empower patients to navigate their health journey with dignity and resilience by applying evidence-based practices and creating a supportive environment.
