August 2023 Newsletter
The Center of Excellence for Behavioral Health in Nursing Facilities (COE-NF) provides mental health and substance use evidence-based training, customized technical assistance, and resources to certified Medicare and Medicaid nursing facilities who care for residents with a variety of behavioral health conditions at absolutely no cost. To submit a request for assistance, complete the online request form by clicking HERE.
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In This Issue
In this month’s newsletter, we will recognize International Overdose Awareness Day and explore overdose prevention measures that can be taken to support residents who are prescribed an opioid.
Nursing facilities play a pivotal role in safeguarding residents from the potentially devastating impact of adverse drug effects and overdoses. While nursing facilities serve as a haven for resident well-being and recovery, they may also face challenges in preventing substances from entering their premises.
Nursing facilities also cannot always control what substances are brought in by residents or visitors, educating and training staff to recognize signs of use and overdose can ensure a safer environment.
In This Issue:
Nursing facilities play a pivotal role in safeguarding residents from the potentially devastating impact of adverse drug effects and overdoses. While nursing facilities serve as a haven for resident well-being and recovery, they may also face challenges in preventing substances from entering their premises.
Nursing facilities also cannot always control what substances are brought in by residents or visitors, educating and training staff to recognize signs of use and overdose can ensure a safer environment.
In This Issue:
- International Overdose Awareness Day
- What Drugs Can Cause an Overdose?
- What Are Opioids?
- How Does an Overdose Occur?
- How to Recognize an Opioid Overdose
- Resources for Overdose Prevention and Stigma Reduction
- Medication Risk Alert
- Language Matters
- Substance Abuse and Mental Health Service Administration (SAMHSA): Opioid Overdose Toolkit
- Nursing Facility Guidance Updates: Overdose Prevention and Response
- Did You Know?
- New Cohort Learning Opportunity: Join the Behavioral Health Action Network
- Register for the August COE-NF Training Sessions
- You Matter-Mental Health Screening Tools
- We Want Your Feedback
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International Overdose Awareness Day
International Overdose Awareness Day, observed on August 31, is the world’s largest annual campaign to end overdose, remember those who have died of an overdose, and acknowledge the grief of the family and friends. It is also an opportunity to prevent and reduce drug-related harm and understand the impact stigma can have on recovery.
In recognition of overdose awareness day, nursing facilities can:
In recognition of overdose awareness day, nursing facilities can:
- Implement a naloxone awareness campaign by CLICKING HERE to share this resource with your team.
- Ensure your nursing facility team has access to naloxone. Naloxone can reverse an overdose from opioids including heroin and fentanyl.
- Coordinate a training event on naloxone administration.
- Implement a stigma reduction campaign.
- Learn more about what treatment options are available and how to support residents on their recovery journey.
- Share a social media post to acknowledge community partners that support recovery using #weseeyou.
What Drugs Can Cause An Overdose?
While a wide range of drugs can cause an overdose to occur (including alcohol, benzodiazepines, opioids, and stimulants), let's take a closer look at opioid overdoses.
Nursing facilities that implement opioid stewardship strategies and provide substance use education to their entire team can significantly reduce the chances of adverse side effects and overdose among their residents.
Nursing facilities that implement opioid stewardship strategies and provide substance use education to their entire team can significantly reduce the chances of adverse side effects and overdose among their residents.
What are Opioids?
Opioids are a class of drugs used to reduce pain by changing the way the brain and body feel pain.
Prescription opioids include morphine, codeine, oxycodone, and hydrocodone, among others.
Fentanyl is a powerful synthetic opioid that is 50x more potent than heroin and 100x more potent than morphine.
Knowing a resident’s substance use history will inform the staff on how to provide person-centered care, assist with the coordination of substance use treatment, resources, and support.
Source:https://www.cdc.gov/opioids/basics/index.html
Opioids are a class of drugs used to reduce pain by changing the way the brain and body feel pain.
Prescription opioids include morphine, codeine, oxycodone, and hydrocodone, among others.
Fentanyl is a powerful synthetic opioid that is 50x more potent than heroin and 100x more potent than morphine.
- Pharmaceutical Fentanyl is a synthetic opioid, typically used to treat advanced cancer pain.
- Illegally manufactured Fentanyl is often made to look like prescription medications and is illegally distributed. It has contributed to an increase in deaths across the country.
Knowing a resident’s substance use history will inform the staff on how to provide person-centered care, assist with the coordination of substance use treatment, resources, and support.
Source:https://www.cdc.gov/opioids/basics/index.html
How Does an Overdose Occur?
An overdose occurs when a toxic amount of a drug or multiple drugs are taken, and the effects of the drug(s) interfere with the brain and body’s ability to function. An overdose is a medical emergency that requires immediate attention.
Nursing facilities with access to the lifesaving medication Naloxone are prepared to save a life. F tag 697 (p.413) indicates that nursing facilities should have a written policy to address opioid overdoses. F tag 689 (p. 338) indicates that facility staff be prepared to administer opioid reversal medications. State Operations Manual Appendix PP
Source:https://harmreduction.org/issues/overdose-prevention/overview/overdose-basics/what-is-an-overdose/
How to Recognize an Opioid Overdose
An overdose can happen to anyone taking an opioid.
Sometimes it is hard to tell if an overdose is occurring. Signs of an overdose include:
Source:https://www.cdc.gov/drugoverdose/pdf/patients/preventing-an-opioid-overdose-tip-card-a.pdf
An overdose occurs when a toxic amount of a drug or multiple drugs are taken, and the effects of the drug(s) interfere with the brain and body’s ability to function. An overdose is a medical emergency that requires immediate attention.
Nursing facilities with access to the lifesaving medication Naloxone are prepared to save a life. F tag 697 (p.413) indicates that nursing facilities should have a written policy to address opioid overdoses. F tag 689 (p. 338) indicates that facility staff be prepared to administer opioid reversal medications. State Operations Manual Appendix PP
Source:https://harmreduction.org/issues/overdose-prevention/overview/overdose-basics/what-is-an-overdose/
How to Recognize an Opioid Overdose
An overdose can happen to anyone taking an opioid.
Sometimes it is hard to tell if an overdose is occurring. Signs of an overdose include:
- Small, constricted “pinpoint pupils”
- Pale, blue, or clammy skin
- Loss of consciousness or falling asleep
- Vomiting or making gurgling noises
- Slow, shallow breathing
- Breathing or heartbeat slows or stops
- Limp body
Source:https://www.cdc.gov/drugoverdose/pdf/patients/preventing-an-opioid-overdose-tip-card-a.pdf
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Resources for Overdose Prevention and Stigma Reduction
The COE-NF developed the following resources related to overdose prevention and substance use stigma reduction. Nursing facilities can use these resources to educate the team about opioids. A link to the SAMHSA Opioid Overdose Toolkit is also included below.
Medication Risk Alert: Opioids and Benzodiazepines
This COE-NF flyer provides awareness on the dangers of combining opioids and benzodiazepines. Both types of drugs can cause sedation and suppress breathing—the cause of overdose fatality.
CLICK HERE to download.
This COE-NF flyer provides awareness on the dangers of combining opioids and benzodiazepines. Both types of drugs can cause sedation and suppress breathing—the cause of overdose fatality.
CLICK HERE to download.
Language Matters
This COE-NF one pager promotes the use of non-stigmatizing language as it relates to substance use. Non-stigmatizing language can lead to understanding, demonstrates compassion, and restores dignity.
CLICK HERE to download.
This COE-NF one pager promotes the use of non-stigmatizing language as it relates to substance use. Non-stigmatizing language can lead to understanding, demonstrates compassion, and restores dignity.
CLICK HERE to download.
SAMHSA: Opioid Overdose Toolkit
This toolkit provides strategies to prevent overdose deaths.
CLICK HERE to download.
This toolkit provides strategies to prevent overdose deaths.
CLICK HERE to download.
Interested in accessing additional COE-NF resources for your facility?
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Nursing Facility Regulatory Guidance:
Drug Overdose Prevention and Response
Drug Overdose Prevention and Response
Like other adverse events, overdoses are not always preventable. Regulatory guidance reminds surveyors that relapses of substance use and drug overdoses are a common occurrence in the Substance Use Disorder (SUD) disease process. The key compliance areas are whether a facility took appropriate steps to prevent an overdose and responded appropriately once the overdose occurred.
Regulatory guidance notes requirements related to preventing and responding to overdoses:
- Identification of risk:
- Staff should assess residents for risk of substance use.
- Have knowledge of warning signs, symptoms, and triggers for possible substance use
- Preventive Care Plan: Staff should develop preventative interventions to reduce the risk of substance use, such as treatment referrals and offering appropriate diversional activities such as meditation, music therapy, resident specific hobby/interest etc.
- Provision of supervision: If there is suspected substance use or a suspicion that a resident may have acquired substances, staff should provide additional supervision and checks on that resident.
- Response to an overdose: Staff should administer Naloxone in case of an opioid overdose.
- Ensure you have a routine substance use assessment process in place.
- What assessment tool are you using/documenting?
- When are you assessing? For example, are you assessing upon admission, quarterly, etc.?
- Ensure appropriate preventative interventions are identified, implemented, and documented for each resident at high risk of substance use.
- Ensure staff have knowledge of warning signs, symptoms, and triggers for possible substance use.
- What training do staff receive on the topic?
- Ensure you provide adequate supervision and checks on residents who are at high risk for substance use or who engaged in a high-risk activity (eg. a resident with a history of SUD returning from an offsite visit).
- Do you have a policy regarding steps to take for residents with high risk for substance use?
- Ensure appropriate response in case of an overdose.
- Is Naloxone available at the facility?
- Are staff trained in the use of Naloxone to reverse an overdose?
Interested in accessing additional COE-NF resources for your facility?
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Death from an opioid overdose happens when too much of the drug overwhelms the brain and interrupts the body's natural drive to breathe.
Source:https://www.cdc.gov/drugoverdose/pdf/patients/preventing-an-opioid-overdose-tip-card-a.pdf
Source:https://www.cdc.gov/drugoverdose/pdf/patients/preventing-an-opioid-overdose-tip-card-a.pdf
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New Cohort Learning Opportunity: Join the Behavioral Health Action Network
Beginning September 2023, the Center of Excellence for Behavioral Health in Nursing Facilities (COE-NF) will host six (6) one-hour monthly cohort sessions.
Join us for the opportunity to learn industry best practices from other nursing facilities and behavioral health subject matter experts. With the support of COE-NF behavioral health specialists, you will be able to implement the learnings in your facility.
The series is designed to meet the needs of leadership and interdisciplinary staff members. Topics include understanding behavioral health regulations, mental health basics, screening for behavioral health and substance use, effective communication skills, individualized assessment and resident centered care planning, and deescalating strategies.
Leadership will be provided with concrete direction surrounding facility assessment, and staff education. Participants will develop new assessment, care planning, and communication skills designed to enhance their ability to interact effectively with residents dealing with behavior health and substance use disorder needs.
This cohort series is ideal for nurses, CNAs, social workers, direct care staff, and
leadership who work in nursing facilities across the United States.
As a result of this series, participants will be able to:
Join us for the opportunity to learn industry best practices from other nursing facilities and behavioral health subject matter experts. With the support of COE-NF behavioral health specialists, you will be able to implement the learnings in your facility.
The series is designed to meet the needs of leadership and interdisciplinary staff members. Topics include understanding behavioral health regulations, mental health basics, screening for behavioral health and substance use, effective communication skills, individualized assessment and resident centered care planning, and deescalating strategies.
Leadership will be provided with concrete direction surrounding facility assessment, and staff education. Participants will develop new assessment, care planning, and communication skills designed to enhance their ability to interact effectively with residents dealing with behavior health and substance use disorder needs.
This cohort series is ideal for nurses, CNAs, social workers, direct care staff, and
leadership who work in nursing facilities across the United States.
As a result of this series, participants will be able to:
- Develop an effective resident assessment, communication and care planning process in their facility.
- Design an implementation plan for each element of the best practices presented during the session.
- Implement and assess the effectiveness of best practices for assessing, communicating, and care planning with residents with mental health and substance use disorders.
Registration will open soon.
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Register for the August COE-NF Training Sessions
Wednesday, August 9, 2023
2-2:30 p.m. EST
There are many people around the world who suffer from depression, anxiety, and other mental illnesses. According to a study published by the National Institutes of Health (NIH), 65% to 90% of nursing home residents have a mental health disorder, ranging from common mental health conditions such as anxiety and depression to serious mental illnesses (SMI) like schizophrenia and bipolar disorder. This session will provide an introduction to SMI, increase the participants understanding of SMI, and demonstrate how a 5-step model for care is effective in assisting staff in supporting residents with a serious mental Illness diagnosis.
Learning Objectives:
1. Define serious mental illness and list the four major categories of SMI.
2. Describe the differences between SMI and dementia and note misperceptions about SMI.
3. Describe the recovery model and list the five steps in the CARES Approach for SMI care.
Learning Objectives:
1. Define serious mental illness and list the four major categories of SMI.
2. Describe the differences between SMI and dementia and note misperceptions about SMI.
3. Describe the recovery model and list the five steps in the CARES Approach for SMI care.
- THIS SESSION IS FULL -
Friday, August 11, 2023
11 – 4:30 p.m. EST
Mental Health First Aid (MHFA) gives you the skills to reach out and provide initial help and support to someone who may be developing a mental health or substance use challenge or experiencing a crisis.
This session provides a MHFA certification for three years.
Certification Details: This session provides a MHFA certification for three years.
Tuesday, August 15, 2023
2–3:30 p.m.
Culturally and Linguistically Appropriate Services (CLAS) Standards provide a blueprint toward improving health equity, patient safety, and patient satisfaction. This presentation is an introduction to CLAS standards and provides ideas for implementation in your organizations.
Learning Objectives:
1. Describe what CLAS is and why it is important for improving health equity.
2. Classify CLAS standards into operational objectives.
3. Learn your role in implementing CLAS standards in your organization.
Thursday, August 17, 2023
2-3 p.m. EST
In Part 2 of this series, we explored what happens when a person's nervous system is activated, and how they react with a fight-flight-freeze state. In this session, we'll discuss grounding techniques to support a person when they are emotionally stimulated and experiencing distress. By integrating grounding strategies that work for each resident, staff may also have more capacity to uphold trauma-informed principles including safety, trust, empowerment, and collaboration.
Learning Objectives
1. Define the concept of grounding and why this method of distraction supports a person with an activated nervous system.
2. Name three grounding strategies.
3. Consider collaborating with residents and their families to integrate these strategies into the care plan.
Register for the Trauma-Informed Care Training Series
Did you miss any COE-NF hosted trauma-informed care trainings?
CLICK HERE to register for the upcoming series.
Join us for the first session on Tuesday, August 15 at 10 a.m. EST!
CLICK HERE to register for the upcoming series.
Join us for the first session on Tuesday, August 15 at 10 a.m. EST!
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You Matter! Mental Health Screening Tools
In the journey to care for others, it is crucial to prioritize one’s own mental health. Taking care of yourself ensures that you will have the emotional and psychological well-being necessary to provide effective support and care to residents.
Consistently caring for others without attending to your own mental health can lead to burnout and decreased effectiveness in job responsibilities.
Interested in a quick, easy, and confidential way to assess your mental wellness? Access online mental health screening tools HERE.
The screening results are a great way to start a conversation with a physician, which leads to a stronger, happier you!
We all have mental health; let’s prioritize it!
Consistently caring for others without attending to your own mental health can lead to burnout and decreased effectiveness in job responsibilities.
Interested in a quick, easy, and confidential way to assess your mental wellness? Access online mental health screening tools HERE.
The screening results are a great way to start a conversation with a physician, which leads to a stronger, happier you!
We all have mental health; let’s prioritize it!
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Contact us:
For more information, please call 1-844-314-1433 or email coeinfo@allianthealth.org.
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Alliant Health Solutions (AHS) was awarded a three-year cooperative agreement from the Substance Abuse and Mental Health Services Administration (SAMHSA), in collaboration with the Centers for Medicare & Medicaid Services (CMS), to create a COE-NF. AHS has over 50 years of experience working with nursing homes and behavioral health in nursing homes.
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This newsletter was made possible by grant number 1H79SM087155 from the Substance Abuse and Mental Health Services Administration (SAMHSA). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Substance Abuse and Mental Health Services Administration.
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