Journal of the American Medical Directors Association
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To describe the impact of a Tennessee Department of Health regulation amendment requiring that all nursing home residents 65 years of age or older demonstrate documentation of pneumococcal vaccination, or documented medical contraindication, or patient refusal. ⋯ Pneumococcal immunization rates of at least 75% were associated with facility size, location, and record-keeping practices. Pneumococcal vaccination rates improved only modestly between 1998 and 1999, coincident with the health department amendment. Those who found the policy useful had the greatest improvement in rates.
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Practice Guideline Guideline
Ethics and research in long-term care: a position statement from the American Medical Directors Association.
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Residents of long-term care facilities are at risk of serious medical illnesses and being unable to express choices when difficult treatment decisions must be made. Advance care planning (ACP) allows residents to consider, make, and communicate their preferences for how medical decisions should be made if they are unable to participate in the decision-making process. This article reviews the three steps in ACP: consideration of options and expression of values, communication of decisions, and documentation of the choices. The article defines and describes the particular value of ACP in long-term care facilities, reviews the literature on successful ACP programs in long-term care, and concludes with practical suggestions on how to develop and implement ACP programs.