Whether a parent or loved one requires extra assistance with daily activities, such as bathing, dressing, medication management due to natural aging, or having undergone a major medical procedure, it may be time to consider looking into a skilled nursing facility or post-acute care center.
One type of skilled nursing facility that has become increasingly popular in recent years is the resort-style facility. The concept behind a resort-style facility is to create an environment that feels more like a vacation than a hospital. These facilities are designed to be comfortable, welcoming, and aesthetically pleasing. They typically have spacious, well-appointed rooms, beautiful outdoor areas, and a variety of amenities and services to help residents feel at home.
These facilities offer post-acute care for individuals who are recovering from an illness or surgery and require temporary rehabilitation services. They also provide long-term care for the aging population who need ongoing assistance with daily activities.
One of the main benefits of a resort-style facility is that they provide a higher level of personalized care than a traditional nursing home. Because they are often smaller in size, staff members can get to know residents on a more personal level and provide tailored care.
In addition to the higher level of care, resort-style facilities offer a wide range of amenities and services that are designed to improve residents’ quality of life. These may include chef-prepared meals, on-site beauty and spa services, fitness programs, and social activities. All these services can help residents feel more comfortable, which can lead to faster recovery and an overall better quality of life.
Unlocking the Power of Posture and Stress: Understanding Impact on Blood Indices and Anemia Management
Pseudoanemia
As a service provider catering to the geriatric population, dealing with anemia among your residents is common. However, there is a perplexing condition known as pseudoanemia that can create confusion. Despite having a normal or even increased red blood cell mass, the patient’s hemoglobin levels appear low. This condition arises due to postural fluid shift resulting in a diluted concentration of red blood cells in the blood and alterations in plasma volume when patients have been at rest for some time, such as when in bed at night, or if they have limited mobility. Fortunately, one simple solution exists to resolve this issue: changing the patient’s posture to an upright position at least 30 minutes before their draw.
The Problem
A patient’s blood is drawn early in the morning and the Complete Blood Count (CBC) shows a “critical value” for Hemoglobin and/or Hematocrit. The patient is admitted to the hospital for a potential blood transfusion. However, when the hospital reevaluates the CBC, the Hemoglobin and/or Hematocrit levels are found to be higher and not critical, leading to no need for a transfusion. A worse situation can arise if a pseudoanemic patient is kept reclined and the Hgb/Hct has not had time to correct, resulting in an unnecessary transfusion.
Study Conclusions
Results confirm that changes in posture affect blood indices. Posture alters hydrostatic pressure, which influences fluid movement between interstitial and intravascular spaces, leading to physiological fluctuations in blood volume.
Postural changes can significantly impact Hgb/Hct levels, which may be wrongly interpreted as blood loss or acute anemia, leading to unnecessary diagnostic and therapeutic procedures. However, these changes actually reflect postural pseudoanemia, a natural physiological response to shifts between standing and lying positions. Such changes can be exaggerated in patients with low albumins.
Medical Director Recommendation
To avoid pseudoanemic critical values and unnecessary treatments, ensure the patient remains upright, ideally engaging in light walking, or sitting upright for 30 minutes before blood collection. This will typically help reverse fluid shifts, leading to a more accurate Hgb/Hct measurement.
Stress Reactions
Stress reactions represent a phenomenon somewhat contrary to pseudoanemia, often occurring when a patient undergoes physiological or psychological stress, such as during unforeseen transportation to a hospital or another transfusion center. It is widely recognized that an adrenaline-fueled stress reaction can lead to a temporary increase in Hgb/Hct levels, a response commonly associated with the “fight or flight” reaction. In cases where a patient is genuinely anemic, this stress-induced surge in Hgb/Hct can push these values into the normal range by the time the patient arrives at the transfusion center. Consequently, these seemingly normal values might lead the transfusion center to decline the patient’s transfusion request, resulting in their return to the facility without the required treatment.
Additionally, it’s important to consider another factor in this scenario. Transfusion center phlebotomists may encounter challenges when drawing blood from chronic care patients, often due to limited venous access. In such cases, they may resort to the overuse of a tourniquet, a practice that can also falsely elevate Hgb/Hct levels into the normal range, further complicating the assessment of the patient’s true transfusion needs.
The Problem
These patients are often drawn at the facility and have been upright for hours, so this is not the same as pseudoanemia. They actually are anemic and do need a transfusion but after transport are showing falsely as being normal, possibly due to stress or phlebotomy technique. As a clue, they often have a recent history of multiple anemia-range Hgb/Hct values.
Medical Director Recommendation
These patients should not be sent back to the facility immediately but should be held at quiet rest at the transfusion site and retested at some reasonable interval to confirm they do or don’t actually need a transfusion. In the event that they are sent back to the client facility without undergoing a transfusion, it is imperative for the facility to promptly order a stat Hgb/Hct test to provide confirmation.
Messaging Approved by Laboratory Directors: Dr. John Morgan Brown, Dr. Russell Kerschmann, and Dr. Peter Patterson
Department of Laboratory, Aculabs, Inc., East Brunswick, New Jersey
Department of Medicine, New Jersey Infectious Diseases Associates, Edison
(2011) Abstracts and Case Studies From the College of American Pathologists 2011 Annual Meeting (CAP ’11). Archives of Pathology & Laboratory Medicine: September 2011, Vol. 135, No. 9, pp. 1102-1230
Introducing Premier Pharmacy Solutions, a chain of closed-door Long-Term Care (LTC) pharmacies dedicated to providing pharmacy services for hospices, skilled nursing and assisted living facilities to best care for their patients.
With an efficient new turn-key solution to patient care, utilizing multiple cutting edge machines, systems, and processes, facilities and patient care administrators can now quickly and easily provide custom medication care. This all-in-one solution to an ever-changing industry makes compliance tracking and accountability easier than ever. By reducing the burden of machine supervision and patient medication tracking, facilities are more available to focus on what they do best: patient care.
Some of the highlights of Premier Pharmacy Solutions:
Automated Compliance Packaging. Our machines can create all three compliance packaging options (single-dose bubble, multi-dose bubble, and pouches) for faster, more accurate dispensing and administering of patient medications.
Improved Prescription Accuracy. Our Perl machine scans and photo categorizes every prescription prior to a pharmacist review. This combination of accountability produces extra accurate results.
New Storage Locker System. Patients are assigned their very own medication locker with strict security measures to ensure safeguarding. These measures prevent theft and ensure proper dosage and accountability.
We pride ourselves on our advanced technology and efficient processes that empower facilities and administrators to deliver tailored medication care effortlessly. Experience seamless compliance tracking and enhanced accountability with our all-in-one solution.
For more information on Premier Pharmacy Solutions, contact us. Our expert pharmacists are standing by ready to assist.
Premier Lab Solutions has been featured in an article from Cronkite News regarding the efforts of the Arizona Department of Health Services (ADHS) in providing vaccines and COVID-19 tests to underserved communities. Premier Lab Solutions, a prominent healthcare provider, has played a crucial role in this initiative by partnering with ADHS to facilitate mobile vaccination and testing services and has been instrumental in ensuring the availability of testing supplies, conducting tests efficiently, and delivering vaccines and timely results to those marginalized communities.
The aim of Employee Spotlight is to highlight the exceptional talent and brilliance of our employees. Meet Lindsay Hubsmith, the Director of Wound Management for Premier Wound Solutions. Lindsay has been at Premier Wound Solutions since November 2022, leveraging her extensive knowledge and experience from years running her own Wound practice. Beyond her professional achievements, Lindsay finds joy in her time away from the clinic as a devoted mother to two boys. She enjoys the outdoors as well, spending time fly fishing and skiing.
PLS: What initially sparked your interest in the field of medicine?
Lindsay: When I was in high school, I had a PA in my hometown who provided excellent healthcare to our whole community, and I knew at that point that I wanted to have a similar career and a similar impact on my own community.
PLS: Tell us about running your own Wound Care practice.
Lindsay: In 2016 I left my Cardiology position and was now responsible for the actual wound and the treatment…I realized very quickly that there were limitations to our local outpatient clinic, especially for those of my patients that were in skilled nursing facilities, and it really inspired me to the idea that we could be doing it better.
PLS: How do your providers operate in concert with the facility medical directors?
Lindsay: We assist in alleviating administrative and nursing burdens by providing our own orders before we leave any facility. So, we will see the patient, provide all of the documentation, and then provide accurate orders that the nurses can then follow before we’ve even left the building.
PLS: Cool, sounds very efficient.
Lindsay: Yes. We work hard to write the orders and ensure they are being followed week to week and adjust them as clinically appropriate.
PLS: Can you tell us about a key milestone that has shaped your career or that you’re proud of?
Lindsay: I had a patient who was in his mid-40s. He was a type 1 diabetic and had had bilateral wounds on his legs for seven years. He spent seven years of his life going three times a week [to get his legs wrapped]. We were able to use graft him in the clinic using an amniotic membrane and within six weeks we had all of his wounds closed. He came to me and was just absolutely in tears because he said, “I could shower!” and you don’t think about what a blessing that is until you can’t do it. That made his life better and that makes you feel at least like you’re making a difference and you’re having an impact.
PLS: Can you discuss any groundbreaking techniques or practices that your team has implemented to address complex wound care challenges? Lindsay: We have worked hard to streamline our process to ensure the timely treatment of wounds because time equals tissue. So, the faster that we can implement an accurate and targeted treatment plan, we lower the risk of further complications like infection or amputation.
PLS: In what ways do you envision further contributing to the advancement of your Advanced Wound Care practice in the future? Lindsay: We hope to continue to create lasting relationships/partnerships with facilities and the patients they care for by providing cutting-edge wound care.
PLS: What advice would you give to individuals seeking to pursue a career in wound management or medicine? Lindsay: Community involvement. Consider working in a facility in any capacity that they can. Whether it’s volunteering or working as a DNA. Get exposure and serve those facilities in your community.
Premier Wound Solutions, a leading provider of advanced wound care at the bedside, recently significantly impacted the highly acclaimed IHCA Spring Workshop held in the picturesque setting of Sun Valley, Idaho. The workshop, renowned for its focus on healthcare advancements and innovative solutions, brought together prominent industry experts, healthcare professionals, and researchers to explore ideas about leading-edge wound care and addressing critical challenges in the evolving healthcare landscape.
Esteemed Premier Wound Solutions directors Lindsay Hubsmith (B.Sc., PA-C) and James Grey sat on a panel of experts as special guest speakers to discuss topics regarding assisted living nursing and skin breakdown during end-of-life care. Lindsay Hubsmith presented a comprehensive medical case study on Kennedy ulcers. Her presentation focused on effective management strategies, highlighted the importance of multidisciplinary care in improving patient outcomes, and the importance of Hospice provider partnerships. James Grey delivered an insightful presentation emphasizing the significance of leveraging vendor partnerships to access the latest best practices, technology, tools, and education to improve clinical programs. His talk highlighted the potential benefits of collaboration between facilities and vendors, including improved patient outcomes and clinician competency.
In summary, Premier Wound Solutions demonstrated its commitment to advancing wound care through its participation at the IHCA Spring Workshop. Lindsay Hubsmith and James Grey’s expert insights provided valuable information for healthcare professionals seeking innovative solutions to address challenges in wound care. To learn more about Premier Wound Solutions’ advanced wound care services, contact Lindsay or James to see how they can assist with your wound management needs. Premierwoundsolutions.com
Our new Employee Spotlight aims to showcase our brightest and most talented employees working here at Premier Lab Solutions. Meet Jaime Anderson, Director of Laboratory Services, of the Phoenix Molecular, Toxicology, and Core laboratories. Jaime has been a team member at Premier Lab Solutions since 2020 and brings her valuable knowledge and skills from years of experience as a laboratorian and manager.
After receiving her Bachelor of Science degree in Chemistry with an emphasis in Forensics, Jaime’s education goals were to land an exciting job working at a crime lab performing forensic toxicology. She swiftly attained her goal and just after a couple of short years, found the crime lab to be a bit tedious and transitioned to a sales position at an instrumentation manufacturer. From there she exponentially grew her skills as a scientist by learning about a variety of analytical testing applications and instrumentation including chromatography and mass spectrometry. After a while, Jaime missed the laboratory atmosphere, so transitioned back to the lab working for a local forensic toxicology lab where she spent twelve years as a certifying scientist, technical supervisor, and laboratory manager. During that time, she also pursued a Master of Science degree in Chemistry, which she obtained in 2019.
When Jaime came aboard Premier Lab Solutions as a technical supervisor and lab manager, she focused on quality and improvement across the toxicology, core, and molecular labs. She spends her days overseeing all aspects of the laboratories and continues developing a good team of highly-skilled, cross-functional technologists. When asked what she enjoys most about her role, she replies, “My team.” Jaime has an excellent working relationship with the technical staff and really enjoys expanding the core lab alongside them.
One of the highlights of Premier Lab Solutions that Jaime prizes is the comparison of bigger labs and their often slow-moving, lumbering processes versus our small, swift, and nimble operations with an emphasis on our ability to offer more customized services to clients. “This really sets us apart,” she explains.
Jaime enjoys her time at Premier Lab Solutions and plans to continue adding new testing services and expanding the core lab. Due to her great work, Premier Lab Solutions continues to be innovative and on the front line for all laboratory services.
Last month, Premier Lab Solutions partnered with AALHA to host a Caregiver Continuing Education class on Fungal Infections in Assisted Living Facilities. A synergy of two new company divisions drove a symbiotic partnership between advanced wound care with Premier Wound Solutions and treatment options for common fungal infections with Premier Pharmacy Solutions. Presenting the class was the esteemed Director of Clinical Pharmacy Services for Premier Pharmacy Solutions, Darya Inocencio (PharmD, RPh), and Lindsay Hubsmith (B.Sc., PA-C), Director of Wound Management for Premier Wound Solutions.
In that class, attendees learned the following:
Why fungal infections are an important topic in assisted living facilities
Different types of fungal species
How to identify common fungal infections in patients
Different medications used to treat fungal infections
Common drug-drug interactions
Important counseling points when administering antifungals
How to identify an in-house treatment vs. an emergency
National Lab Week (April 24-28, 2023) is an annual celebration of medical and lab professionals who play an important role in healthcare. Premier Lab Solutions celebrates the appreciation of all staff by hosting a fun activities week with food, games, and activities.
Take a look at some of the fun events happening throughout the week:
Dress Up Days
Staff are encouraged to dress up according to the day’s theme, such as Pajama Day, Sports Day, and Crazy Hat Day. Each day offers a new theme challenge, and the best costumes are awarded prizes.
Phoenix staff having a blast from the past on Decade Day, a throwback to a favorite era.
Games with Prizes
Management spun a clever twist to some classic team games. A new take on the childhood favorite Candy Guess Game has staff trying to guess how many candies are in a urine cup or laboratory beaker, while Where’s Waldo gets a makeover with lab manager heads pasted onto Waldo bodies for staff to find. Another workplace favorite, Two Truths and a Lie, will have staff competing to learn which of their managers has the most interesting past.
Someone found the winning Lab Waldo in an unexpected place.
Contests
Two fun contests are running all week long, culminating in a competitive showdown at the end of the week. The Create-a-Mascot contest will have teams competing to build a unique lab mascot using everyday lab materials and the Create-a-Lab-Coat contest will have teams decorating a lab coat using only materials found in a lab setting. For extra credit, lab coats can be given a name and slogan.
Lab Mascot “Space Ventura” by “The Zookeepers” team in Phoenix.
Food, Food, Food!
Staff will be getting their grub on all week long as each day brings a new food adventure. From free lunch on Monday to Ice Cream Social Friday, each lab location will host their own Potluck throughout the mid-week.
Sacramento lab enjoying a pizza party on Pajama Day.Serving up Mexican food for the Potluck in the Phoenix lab courtyard.
Appreciation
We firmly believe that our employees are the backbone of the company and that management is lucky to have staff that are great employees and wonderful people. At its core, our company is about serving the community and we couldn’t do that without a community-first workforce. We are so appreciative of our hard-working and dedicated staff.
If you’d like to support our staff during Lab Week, consider sponsoring a meal. For more information, please contact HR at 877-211-4523.
Before 2009 you would have never heard of Candida auris (C. auris). This relatively new fungus is spreading primarily in healthcare facilities such as assisted living and hospital settings, causing deadly infections and illness in humans. It is especially dangerous to elderly and immunocompromised patients but can also affect healthy people. Per the CDC, C. auris is spreading at an “alarming rate” and is an “urgent threat”.
Who is at greatest risk?
C. auris poses the greatest threat to people with compromised immune systems such as nursing home patients and cancer patients. Patients in hospital settings with invasive medical devices or who are enduring extended stays are also at risk.
Why is it so dangerous?
Identification is often difficult, resulting in misidentification or mismanagement of treatment.
C. auris can be carried on a patient’s skin and is often asymptomatic. Patients sick with other diseases may not exhibit symptoms unique to C. auris and thus get overlooked.
C. auris has been found to be drug-resistant, which means once identified, patients have a more difficult time fighting the fungus.
C. auris spreads quickly and easily due to a coupling of the aforementioned reasons.
What can be done?
Proper laboratory screening is vital to detecting and mitigating the spread. Screening new patients to nursing and assisted living facilities and those who have transferred from a hospital will be especially important. Partnered laboratories should be able to provide fast turnaround times.
Deep cleaning hospital and nursing home settings regularly and especially in the presence of afflicted patients will be beneficial in reducing the spread. The fungus can live on surfaces for weeks, so wipe down surfaces and medical equipment thoroughly with proper disinfectants. Staff should practice frequent hand washing.
We can take bold measures and strategic steps to reduce the global impact of Candida Auris by better sanitation practices in medical facilities and screenings of new patients to detect the presence of the fungus. If your facility needs a lab with expertise in testing for C. auris, we provide quicker turnaround times with greater lab capacity than most local labs. Contact us to learn more. Our lab experts are standing by ready to assist.
References: The Washington Post, CDC, University of Mississippi Medical Center
