Staff & Caregiver Education                           





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Sometime we are lucky enough to care for an Artist like Joan Flanagan from York, Maine

Less can save lives 

In geriatrics!


Primum non nocere


"First do no harm" axiom is most relevant in geriatric medicine.


We spend a great deal of time with residents and caregivers explaining:

  • Why certain over the counter medications can result in medical issues like falls and delirium
  • How certain medications are interacting with their other medications
  • Why a certain drug recommended by their favorite specialist is now harmful

Antisychotics, Benzodiazepines, and Hypnotics can cause serious harm and lead to various complications like falls, fractures, swallowing difficulties, and increased confusions in the elderly

yet

They continue to be prescribed with high frequency

Dr. Fazeli explored the reasons why that is and developed the C.A.L.M. protocol to address the route causes in a multidisciplinary manner


C.A.L.M. Protocol 

Staff In-Services 

Clinical Approach to Antipsychotic Reduction

Non-Pharmaceutical Approach in Dementia Care

Antipsychotic Reduction Data From Three Nursing Homes Covered by Maine Geriatrics Provider Team

Lecture at New Hampshire Health Care Association Conference presented by Dr. Fazeli on September 25, 2013:

Antipsychotic Reduction in Dementia Care

A Pilot Study 09/2012 – 09/2013

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Antipsychotic Reduction in Dementia Care

A Pilot Study 09/2012 – 09/2013

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General Objectives and Intervention For the Antipsychotic Reduction QI

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Antipsychotic Goal 2012

Antipsychotic Presentation at Northeast Health Care Quality Foundation Conference, September 19, 2013:

Antipsychotic Reduction Presentation

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Antipsychotic Reduction Presentation

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Antipsychotic Reduction Presentation

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Antipsychotic Reduction Presentation

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June to August data is the period before the initiative. September to December is post-initiative data -2012.

Antipsychotic Flow Chart

Clinical Criteria For Use of Antipsychotic and Dose Reduction Protocol

Hospital Admission Due to Dementia With Behaviors During the QI: 0%

Data on Benzodiazepines and Hypnotic Use During the Antipsychotic Reduction QI

Other Education and Quality Improvement Initiatives


Fall Prevention in LTC facilities


We first Addressed a Key Myth About Frequent Falls


Frequent falls are not the main focus of fall prevention because they will always fall.

We are working with Durgin Pines in Kittery to change the general approach to fall prevention and interventions by focusing on residents with frequent falls because they need our help the most.

Call us if you would like to know more about our fall prevention work.


Antibiotic Stewardship and reducing unnecessary use of antibiotics in geriatrics

  • There is one issue not addressed enough in most antibiotic stewardship efforts, and that is the availability of dipstick urine testing in nursing homes. Dr Fazeli had recognized that as an issue 19 years ago and  removed urine  dipsticks from all the facilities he  worked at. The result is that our nurses have to go through the process of calling the medical doctor or the NP to make the case for testing the urine, and that by itself reduces testing and unnecessary antibiotic use in asymptomatic bacturia.
  • We teach our nurses to do an in depth analysis of reasons for testing, for example, chronic confusion is not a reason for urine testing unless it is a sudden and new change. Sun-downing is not a reason for testing, but in case of suspected delirium it is and imperative to test and treat infections.  
  • We teach our nurses and families that if all the residents in a facility were to be tested with dipstick urine tests, almost half of the residents will have positive results, so liberal testing will always result in liberal antibiotic use. As a result of frequent antibiotic use, residents are exposed to the  potential emergence of antibiotic resistance followed by deadly infections or the development of C.Diff colitis.
  • Ultimately, doing the right thing in geriatrics is rarely easy and we have to contend with the need for frequent reeducation of staff and caregivers about the scientific rational for this approach.
  • Please feel free to call or email us if you need more details about this work and the other elements of our antibiotic stewardship initiative.

Other Material on various topics 

will be added soon


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