Conclusion/Discussion: The protocol was safe with beneficial outcomes: in-

creased rate of HbA1c monitoring; decreased under- and over-utilization of

FSs; and, standardizing FSGM schedules. Concurrently, potential negative

outcomes were avoided: worsened glycemic control; increased hospital trans-

fers; increased hyper- or hypo- glycemic episodes; and, less attention to med-

ication management. The trend toward a higher number of FSs at one-year

emphasizes the difficulty of sustaining change in everyday practice. Resident

satisfaction, self-perceived health status, staff satisfaction, cost savings, and

decreased risk of transmission of Hepatitis B virus are noteworthy potential

benefits attributable to an approximate 50% reduction in FSs that must be

considered.

Disclosures: All authors have stated there are no disclosures to be made that

are pertinent to this abstract.

Staging of Chronic Kidney Disease [National Kidney Foundation (NKF)Guidelines]: Do the Cockcroft-Gault (C-G) and Modification of Diet inRenal Disease (MDRD) Equations Concur in Older Adults?

T. S. Dharmarajan, MD, Montefiore Medical Center North Division

Author(s): T. S. Dharmarajan, MD; Edward P. Norkus, PhD;

David Widjaja, MD

Introduction/Objective: CKD is a worldwide concern; in U.S. adults, 11%

have CKD, another 11% have increased risk. NKF guidelines identify 5

CKD stages for monitoring and treatment that require creatinine clearance

(CrCl) or glomerular filtration rate (GFR) estimates. Two equations are com-

monly used; the C-G equation (1976) uses age, sex, body weight and (spot)

serum creatinine to calculate CrCl and the MDRD equation (1999) uses

age, sex, race and serum creatinine to calculate GFR. This study compared

the derived CKD stages using both equations in older adults.

Design/Methodology: Retrospective data collected from 1,535 older hospi-

talized patients (2000 – 08) [age 791/-10(sd) years; 60% female; 45% nursing

home residents (NH)]. Demographics, labs [serum creatinine (sCr), hemoglo-

bin (Hb), chemistry profiles] and comorbidity recorded. NKF guidelines for

CKD (stage 1 . 90, stage 2 5 60-89, stage 3 5 30-59, stage 4 5 15-29, &

stage 5 \ 15) using CrCl (cc/min) and GFR (mL/min/1.73 m2) derived.

Results: CKD stages differed significantly between the two equations (using

C-G 5 10%, 25%, 44%, 16%, 5% vs. using MDRD 5 23%, 38%, 28%, 6%,

5%; stages 1, 2, 3, 4, & 5 respectively, P\.0005). Our sample included 562

(39%) whose records indicated ‘‘renal insufficiency’’ and stage 2, 3 and 4 es-

timates using both formulae again differed (using C-G 5 19%, 52% & 29%

vs. using MDRD 5 9%, 39% & 52%; stages 4, 3, & 2 respectively, P\.0005).

Finally, the observed disconnect between C-G and MDRD estimates became

even greater with each 10-year increase in age (P\.0005).

Conclusion/Discussion:1) Based on the formula used (C-G or MDRD), these results suggest a signif-

icant disconnect in the NKF recommended clinical guidelines to monitor

and treat CKD, differing even more with age.

2) Approximately 50% of patients with CKD may be misclassified or poorly

monitored depending on the formula used.

3) Since the NKF staging recommends monitoring and treatment (see Ta-

ble) based on a staging classification, CKD may be under or over-treated

based on formula utilized for staging.

4) Additional studies should evaluate the validity of these formulae to iden-

tify and stage renal function to better serve CKD patients.

Disclosures: T. S. Dharmarajan, MD has no disclosures to be made that are

pertinent to this abstract. As of submission, Edward Norkus, PhD and David

Widjaja, MD have not provided disclosures.

Stocking the Nursing Home Medication ‘‘Stat Box:’’ A ConsensusStatement

Sonal Brizendine, MD, Palmetto Health Richland, University of South Carolina

Author(s): Sonal Brizendine, MD; Monica Rawlinson, MD;

Rachelle Gajadhar, MD

Introduction/Objective: Develop a consensus statement on what the con-

tents should be in a nursing home emergency medication box. There are mul-

tiple reasons for minimizing hospital admissions of nursing home patients.

These range from disruption of continuity, increased cost, iatrogenic compli-

POSTER ABSTRACTS

cations, greater risk for functional decline, delirium, and pressure ulcer forma-

tion. The emergency medication box, or ‘‘stat box’’ is an instrumental tool

that can be used in the care of nursing home patients. The medication

‘‘stat box’’ is used on call for urgent medical issues in the nursing home that

do not require ER evaluation or hospitalization but do need immediate treat-

ment. An evidenced based literature search regarding the most appropriate

medications that should be included in a nursing home stat box showed

that no research in this area has been published. Thus, we conducted a survey

to develop a consensus statement on what the contents of a nursing home stat

box should be.

Design/Methodology: The nursing home stat box medication survey list was

composed after obtaining a copy of three NH stat kits in the Columbia area.

These stat kit lists were compiled into a preliminary list which was distributed

to focus groups targeting local physicians in the community involved in long-

term care for review. The final version of the stat box medication list was in-

cluded in the survey, which was then distributed by electronic mail to the No-

vember 2007 AMDA Core Curriculum participants, and North/South Carolina

members. Survey participants were asked to identify which medications on the

list they felt should be included in a nursing home medication ‘‘stat box’’ with

a ‘‘yes’’ or ‘‘no’’ response. Inclusion category for medications to include in the

nursing home ‘‘stat box’’ to be determined by 80% or higher ‘‘yes’’ response

rate for the medication. Possible inclusion category for medications to include

in the ‘‘stat box’’ to be determined by a ‘‘yes’’ response rate of 66-79%.

Results: Stat box inclusion medications (.80% ‘‘yes’’ response rate):

Levaquin (PO), Rocephin (IM/IV), Lasix (PO), Nitroglycerin (SL), Albu-

terol nebulizer, Vitamin K (PO), Glucagon (IM/IV), Insta-glucose (PO), In-

sulin (SC), Phenergan (PO), and Ativan (PO/IM/IV).

Stat box possible inclusion meds (66-79% ‘‘yes’’ response rate): Ciprofloxacin

(PO), Keflex (PO), Bactrim (PO), Clonidine (PO), Kayexalate (PO), Pred-

nisone (PO), Dextrose 50%, Fleets enema (PR), Phenergan (IM/IV), Perco-

cet/Tylox (PO), Haldol (IM/IV).

Conclusion/Discussion: This pilot study serves as a basis for stimulating dis-

cussion and further research as to the optimal stat box contents. There ap-

pears to be a trend away from intravenous routes of administration in favor

of oral and intramuscular medications in semi-urgent situations. This may

be related to lack of adequate staff vs. patients with difficult venous access.

The low response rate was a study limitation which may have been related

to the short response time of 2 weeks.

Disclosures: All authors have stated there are no disclosures to be made that

are pertinent to this abstract.

Televisions in Residential Care Facilities for People with Dementia:Environmental Changes based on Pilot Data on Viewing and Behaviors

Stephen Vozzella, BA, Copper Ridge, The Coppe Ridge Institute

Author(s): Stephen Vozzella, ACC, BA

Introduction/Objective: Televisions are common in long-term care settings.

However, little is known about how televisions affect the overall living envi-

ronment of people with dementia in residential long-term care. We therefore

first conducted a pilot study to observe residents’ behaviors based on several

types of programs and subsequently made policy changes toward television

use.

Design/Methodology: We conducted a systematic review of data from 22 res-

idents with dementia in a long-term care facility who were observed watching

a series of taped programs commonly shown in long-term care settings as part

of a pilot study.

Results: Dozing was the most common activity for residents during program

viewing. In addition, most residents remained in the TV viewing area for at

least 30 minutes following the conclusion of the television programs, still

looking at the screen and appearing to watch TV, even though the sets

had been turned off. Based on these findings, televisions were moved to

less prominent areas within the facility and staff-lead activities were in-

creased.

Conclusion/Discussion: Three positive and important changes emerged

from the pilot study data. First, televisions were moved from main socializing

areas to smaller alcoves. Second, educational tools for family and staff regard-

ing television viewing were developed and disseminated. Third, passive tele-

vision viewing has been replaced with active participation in staff-lead

programs.

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