Person Centered Care: Walk the Talk

Transcription

1 Person Centered Care: Walk the Talk Integration of Nurse Practitioner (NP) Role into Extendicare Michener Hill Long Term Care (LTC) Presented by: Sandi Engi MN, NP Michener Hill Extendicare November 25 th 2015 Walk the Talk: Enhancing Resident Care Objectives: Increase awareness of how the NP role can enhance Resident care Identify areas of Advanced Practice that can enhance care 1

2 Walk the Talk: Enhancing Resident Care Introduction of the Nurse Practitioner Role Prior to introduction of the role in 2013 extensive research was undertaken by the Senior Management team examining benefits to residents, families and the Health Care Team. A decision was made by the Senior management team to introduce the NP role into Extendicare Michener Hill LTC I was then introduced to the team in February of 2013 Walk the Talk: Goals for integration of NP role in LTC Provide enhanced on site Clinical services: Provide advanced health assessment and diagnosis Assess urgent conditions and prescription of interventions that may prevent a trip to Emergency Department Order appropriate diagnostic testing Prescribe appropriate Pharmacotherapy 2

3 Walk the Talk: Goals for integration of NP role in LTC Provide enhanced on site Clinical services Monitor complex medical conditions Consult other health care practitioners as warranted Provide ongoing communication to all members of the health care team, residents and family members Work with the health care team on quality improvement initiative Walk the Talk: Goals for integration of NP role in LTC Outcome Measures were identified but have expanded as the NP role has evolved to meet the needs of the community Reduction in number of transfers to Emergency Departments More home deaths versus hospital Drug cost savings Completion of Annual History and Physical exams 3

4 87 Y old Male with increasing necrosis to right lower leg NP consulted by Household RN to assess current wound and order appropriate treatment History of Present Illness Deterioration of pressure ulcer right heel and Achilles tendon area over the last 7 days since return from Hospital. Wound had progressed in size, developed increasing slough and development of eschar to left heel, discharge from the wound had increased and odor had changed to foul smelling. Peri-wound area reddened and inflamed Temperature increased to 37.6 from baseline 36.4; BP 94/50; HR 115, R14 4

5 Walk the Talk: Case Study Hx of Present Illness: 3 weeks prior had been admitted to hospital for below the knee amputation to left lower leg from pressure wound 2 nd to severe peripheral arterial disease and immobility post hip fracture. prior to his admission to Long Term Care he experienced a difficult course in hospital following a left hip fracture. During hospital admission he developed massive GI bleed and necrosis of left lower leg 2 nd to immobility and peripheral arterial disease. Past med hx: CAD with insertion of 3 stents 5 years previous, Mild cognitive impairment, HTN, COPD, T2DM Med List: Bisoprolol 5mg po daily, Hydrochlorothiazide 25mg po daily, Spiriva 18 ug inhaled daily, Lantus insulin 24 units qhs, Humalog 8 units tid Goals of Care: M1 5

6 Advanced health assessment and diagnosis Temp 37.8, BP 87/92; HR 105; R 16, 02 sats 90% room air CBG 28 Pain 10/10 Physical Assessment as described Sepsis 2 nd to acute wound infection Hyperglycemia secondary to sepsis Hypotension secondary to sepsis and medication effect Assessment of Urgent condition and prescription of interventions that may prevent a trip to ER Prescribed oral antibiotics appropriate for acute diabetic wound infection Adjusted insulin to address hyperglycemia Ordered appropriate pain medication Held medications that may affect hypotension 6

7 Provide ongoing communication to all members of the health care team Discussed next steps with family who did not wish him transferred at this point back to ER and wanted interventions commenced that were available onsite Discussed case with Attending Physician and Nursing team Coordinate multidisciplinary meetings to review clinical treatment plan Once condition improved a multidisciplinary team meeting with the family and resident in attendance was held to discuss further care options 7

8 Consult other Health Care Professionals as needed Consult to Orthopedic Surgeon Appointment booked for next day in an Outpatient Clinic Monitoring Client Outcomes Client returned to facility following appointment and he was booked for surgery but no beds were available in Hospital NP provided ongoing assessment and adapted treatment plan including medication changes daily 8

9 Coordinate Health Care Services 4 days later resident was transferred to hospital for surgery Bed control spoke with NP daily to update status of bed availability NP provided updates to Orthopedic Surgeon and Attending Physician Walk the Talk: NP Role Integration in to LTC NP involvement with Extendicare Quality Initiative Teams: Anticoagulation Management Quality Improvement of Diabetic Care Quality Improvement of Respiratory Health Reduction of Antipsychotic Use- 60% taper success Medication Reduction-266 reductions in 2014 Medication Reviews Medication Reconciliation completion 9

10 Walk the Talk: NP Role Integration into LTC NP involvement with Extendicare Quality Initiative Teams: Advanced Wound Care Consultation Pain Management with the Nursing Team-2.6% residents report worsening pain (provincial average 14.3%) Education and Mentorship of Staff Annual History and Physical Exams- 90% complete 10