nurse practitioner making a difference in personal care homes
TRANSCRIPT
Nurse Practitioner
Making a Difference in Personal Care Homes
Introduction
Practice Model Outcomes Success Factors Challenges/Obstacles Conclusion
Background
ER Task Force 2004
Collaborative project Lions Personal Care Centre and WRHA
Recruitment Finding the right person
Started June 2007
STRONG Model
Direct Comprehensive Care (80%) Support of Systems (5%) Education (5%) Research (5%) Publication and Professional
Leadership (5%)
Direct Comprehensive Care
Biannual/Admission History and Physical
Episodic illness management Chronic disease management End of Life Care Interdisciplinary team participation
Support of Systems
Best practice guidelines and policies Bowel management Subcutaneous medication
administration Hypodermoclysis Ear irrigation
Education
Education to support best practice guidelines implementation
Management of behavioral and psychological symptoms of dementia
Chemical restraints
Preceptor for NP students and colleague orientation
Research
Knowledge translation of research to practice
Involved in evaluation of NP role at Lions PCC
Increase focus for future
Publication and Professional Leadership
Five publications on such topics as insomnia and BPSD management
Two abstracts accepted for Alzheimer’s Society conference in March 2009
Workshops and information sharing
Resident Outcomes
Improvement in quality of life Increased feeling of security Education, counseling by NP Enhanced end of life care and
decision-making
Better Care
Evidenced based care Timely interventions On-site suturing Improved medication management
Percentage of Residents with 9 or More Medications
0
5
10
15
20
25
30
2007 2008
55% Decrease
Percentage of Residents on Antipsychotic
Medications
0
5
10
15
20
25
30
35
40
2007 2008
57% Decrease
Staff Outcomes
Role modeling
Clinical leadership – staff satisfaction with care
Education
Effective time management and planning
Enhanced teamwork
Facility Outcomes
Availability of on site clinical expertise
Facilitation and issue resolution
Enhanced primary care involvement with interdisciplinary team
Increased family satisfaction with care
Family Satisfaction with Care
0
10
20
30
40
50
60
70
80
90
100
2007 2008
24% Increase
System Outcomes
Addresses shortage of primary care physicians in PCC
Reduced need for external consultations (e.g. WRHA PCH and Palliative Care CNS)
Cost efficiency Decreased medication utilization Decreased acute care utilization Decreased physician billings
Drug Costs Per Bed
Per Month
0
10
20
30
40
50
60
70
80
90
100
2007 2008
27% Decrease
$37,584 annual savings
Number of Transfers to Hospital
0
10
20
30
40
50
60
2007 2008
28% Decrease
Success Factors
Collaborative practice model with Medical Director
Regional and facility support
Model of care
Strengths of individual NP
The Right NP
Pioneer spirit Self-directed Able to work in the gray zone Willing to shape own practice Thirst for knowledge
HAS MADE ALL THE DIFFERENCE
Challenges – ROLE
New specialty Limited education in geriatric care Recruitment
Change/Innovation Building trust Changing practices Acceptance from specialist NP role versus RN role
Challenges - System
Acute care communication
Limitation of medical information
Family expectations
Obstacles
Legislation – Vital Statistic Act/Controlled Substance Act
Challenging the status quo – Public Trustee
Prescription of Part 3 Drugs
Third Party Payers
Conclusion
Success beyond expectations
Key is individual and organizational support for implementation
Opportunity to expand the model to other PCH’s