Background: The literature has shown that at least one medication discrepancy occurs in 75% ofhospital-to-skilled nursing facility (SNF) admissions. Medication discrepancies are responsible for over 1.5 million adverse drug events costing the United States health care system over $3.5 billion. The use of an electronic health record (EHR) to minimize medication discrepancies lends one of many avenues for further studies to evaluate means of reducing these discrepancies thereby improving patient care and outcomes. Objectives: This pre and post study design project evaluated the efficacy of an EHR on decreasing medication discrepancies during transition of care (TOC) of patients from the hospital to the SNF. Methods: Evaluation of the impact of a iii practice change (implementing the new EHR) focused on comparing medication discrepancies on patients admitted to one SNF from two related Los Angeles area hospitals. The pre-EHR group was compared to the post-EHR group for number and type of medication discrepancies. Documents reviewed included the hospital discharge (DC) summary, the hospital interfacility transfer summary, and finally the SNF admission orders for accuracy of medication lists. Results: Four types of medication discrepancies were significantly lower in the post-EHR sample compared to the pre-EHR sample. Specifically, discrepancies were lower post-EHR for omissions (p = .03), additions (p = .004), incorrect doses (p = .04), and missing frequencies (p = .01). Although the chi square analysis was not statistically significant at the p=.05 level, from a clinically significant standpoint two times as many post-EHR patients (34.1% versus 16.3%) had no medication discrepancies compared to pre-EHR patients. These results provide an indication that further projects exploring the implementation of an EHR to reduce medication discrepancies may be a valuable tool to aid in and improve patient care and outcomes specifically in relation to maintaining accurate medication lists. Conclusion: An EHR implemented into routine SNF care can reduce medication discrepancies on patients being admitted to the SNF from the hospital when used by SNF nurses to input newly admitted patient medication lists. Keywords: skilled nursing facility, medication errors, transition of care, medication reconciliation.

Background: Caregivers are the foundation of care for patients with dementia (PWD), yet they receive little support or information when the PWD is hospitalized. Insufficient caregiver support results in poor caregiver self-efficacy (SE), which is the perception of one’s ability to successfully and confidently provide care for another individual. This project evaluated if a guidebook developed specifically for caregivers of PWD increased caregiver SE scores after an acute hospitalization. Methods: Using a single-group, single-center design, SE was evaluated in 35 caregivers before and after implementation of the Inpatient Dementia Guidebook in the geriatric unit of a large academic medical center in the Western United States. The Caregiver SE scale was administered pre-intervention and repeated within two weeks after discharge (post-intervention). Statistical analyses included descriptive statistics and Wilcoxon tests. Results: After administration of the Inpatient Dementia Guidebook, caregivers showed higher scores on the Caregiver SE scale, compared to the pre-tests (p < 0.001), which demonstrated an improvement in caregiver SE. Results also exhibited an increase in caregiver self-reported health (p = .002) and more frequent use of community-based organizations (p = .02) after the guidebook intervention. Conclusion: The provision of a guidebook was beneficial in supporting caregivers during an acute hospitalization. Thus, healthcare systems and hospitals should adopt similar measures to support caregivers for PWD. Key words: dementia, caregivers, self-efficacy, hospitalization, Alzheimer’s Disease

Background: The use of many medications is common among those over 65 and older living inthe United States. However, the increased number of medications used, especially prescription medications, results in harmful consequences: prescription of potentially inappropriate medications (PIMs) and medications without clinical indications. The World Health Organization reported that four out of ten patients are harmed in outpatient settings because of unsafe healthcare-related to wrong prescriptions. There are works of literature suggesting that healthcare providers (HCP) often do not follow clinical practice guidelines. Objectives: This quality improvement project implemented an NP-led educational intervention to decrease the frequency of potentially inappropriate medications in older patients in the outpatient setting. The intervention provided the healthcare providers a mechanism to address PIMs. Methods: This pre-post quality improvement project used a nurse practitioner-led educational intervention and applied an evidence-based screening tool to manage PIMs. This study was conducted between November 2020 and March 2021. Quantitative measurements were used to evaluate the intervention's effects in addressing PIMs in the outpatient setting in eight weeks. Descriptive statistics were used to characterize variable distributions. The t-tests estimated group comparisons between pre-educational intervention and post-educational intervention number of inappropriate medications, the proportion of patients with inappropriate medications, patients with duplicated medications, and medications that had matching diagnoses. Results: There were a total of 166 patients' medical records reviewed. The mean age for all the patients was 73.2, 49.4%, and the majority were female and predominantly Hispanic (50.6%). Throughout the entire period, reviewed medical records showed that the three most prevalent diagnoses were hypertension (63.9%), hyperlipidemia (49.4%), and type 2 diabetes mellitus (43.4%). There was no observed statistically significant difference in the number of inappropriate medications between pre-and post-intervention. However, there was a trend of improvement in the number of patients receiving duplicated medications from pre-intervention to post-intervention. Conclusion: Although there was no significant decrease in the frequency of inappropriate medications in the eight weeks, issues associated with PIMs in the multimorbid older patients require further quality improvement projects. A longer process evaluation period is necessary to provide HCPs the time to adapt and use evidence-based screening tools and increase patient-provider consistency in decreasing PIMs.

Keywords: inappropriate medications, older patients, outpatient setting, nurse practitioner-ledintervention.

This poster was presented at the UCSB EEMB research symposium in 2024.

Seed predation by granivores limits plant survival and recruitment of new germinates, especially of rare species limited by small populations and increasing pressure from nonnative invasives. The relationship between granivores and native flora at the Dune Protected Area in Callandar, CA is currently shifting away from historic patterns; Nipomo  mesa lupine (L. nipomensis) and other dune stabilizing plant species have been impacted by the habitat-wide colonization by the invasive perennial veldt grass (Ehrharta calycina). Current veldt management practices prevent the use of herbicide to control the grass within a 15-foot buffer of extant lupine populations. Understanding how dense stands of veldt grass may support increased populations of L. nipomensis seed predators can inform the management of veldt grass and the recovery of the endangered lupine. This study assessed seed predation through low profile boxes baited with L. nipomensis seeds and camera traps capturing both video and still images to compare seed predation rates relative to dense stands of veldt grass. Conservation implications were further assessed by considering the role of cages (fencing) in reducing seed predation.  We found that increased proximity to veldt grass modestly increased seed predation, and that uncaged bait stations lost the most seeds (~70% loss rates compared to ~15% in caged plots). The most common seed predators captured on camera were Heermann’s kangaroo rats, Dipodomys heermanni (found outside of cages and away from veldt grass), Deer mice, Peromyscus maniculatus (found outside of cages and adjacent to veldt grass), and California towhees (found within cages and away from veldt grass). Our results establish patterns of seed predation consistent with predicted results and emphasize potential vulnerability to seed predation in areas near veldt or areas unprotected by caging.

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