Cedars-Sinai Medical Center

medical staff pulse newsletter

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FDA conducting ongoing safety review of Mirapex

Pharmacy focus

The U.S. Food and Drug Administration is alerting healthcare professionals about a possible increased risk of heart failure with Mirapex (pramipexole), which is used to treat the signs and symptoms of Parkinson’s disease.

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Meetings and events

Grand rounds

Click here to view upcoming grand rounds.

Upcoming CME conferences

Click below to view a complete list of all scheduled Continuing Medical Education conferences.

CME Newsletter - November 2012 (PDF)

Share Your News

Won any awards or had an article accepted for publication? Share your news about professional achievements and other items of interest.

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A strong approach to frailty

Remember the flower children and beatniks of the '50s and '60s? These symbols of youth are now candidates for hip and knee replacements, not to mention a host of other medical treatments. In fact, nearly a third of Cedars-Sinai patients are 65 or older now.

Unfortunately, older adults who are hospitalized commonly suffer complications such as falls and associated fractures, bedsores, undernourishment and delirium during their hospital stay and soon after discharge. Older adults identified as "frail" are most at risk of these complications.

To ensure these patients receive the best care possible, Cedars-Sinai Medicine's Frailty Task Force rolled out the Frailty Project in July 2012. Successfully pre-piloted on 7SE for a year and now being tested in five additional units, the project uses a team approach to identify older adults who are at risk of frailty within 24 hours of admission so they can receive targeted interventions.

"We are trying to augment patient care without interfering with routine management by the attending physician," says Jeff Borenstein, MD, MPH, medical director for Applied Health Services Research, Cedars-Sinai Medicine. "Highlighting those issues that are directed to a patient's underlying health state allows us to address them with interventions that may prevent adverse events in the hospital and possibly reduce readmissions."

Nurses use a SPICES assessment tool that looks at six risk factors for frailty: Sleep disorders, Problems with eating, Incontinence, Confusion, Evidence of falls and Skin breakdown. Patients ages 65 and older who meet one or more SPICES criteria undergo a detailed multidimensional assessment by a Frailty team that is comprised of a physician, a gerontology trained nurse, a clinical pharmacist, a case manager and a social worker. The assessment includes a cognitive screening, a delirium screening, a functional assessment and an evaluation of the presence of social isolation.

Team members huddle to develop a frailty plan that is communicated to the attending physicians, nurses and other members of the care team. Recommended interventions may include anything from sleep hygiene and frequent cognitive orientation to medication substitutions and speech-language pathology assessments. Many of the interventions that help frail patients can be implemented by nursing staff and do not require physician approval.

"Preventing delirium is one of the main goals of the Frailty Project," Borenstein says. "Once delirium gets going, it's hard to treat, so we want to catch it early. You can prevent it by doing simple things like letting people sleep at night and frequently orienting them to where they are. We also have to think twice before we use certain drugs on elderly people because some of them can contribute to delirium."

Education Program Coordinator Larry Santiago, MSN, RN-BC, says the Frailty Project has been successful largely because it uses a team approach that "allows members of the team to see things they might not have seen otherwise."

The evidence-based Frailty Project is one of several best practices developed by Cedars-Sinai Medicine, under the direction of Glenn D. Braunstein, MD, vice president for Clinical Innovation, and Linda Burnes Bolton, DrPH, RN, FAAN, vice president and chief nursing officer, to ensure Cedars-Sinai consistently helps patients by doing "the right thing for the right patient in the right setting at the right time with the right resources."