The benefits of being in-house... An innovative model of care for palliative care nurse practitioners in Residential Aged Care

Transcription

1 The benefits of being in-house... An innovative model of care for palliative care nurse practitioners in Residential Aged Care Peter Jenkin Nurse Practitioner

2 What s my point? A palliative care nurse practitioner who consults at a RACF can improve outcomes of care by providing clinical advice and support.

3 What s my point? A palliative care nurse practitioner who consults at a RACF can improve outcomes of care by providing clinical advice and support. A palliative care nurse practitioner working within a RACF can improve outcomes of care by also providing direct care and influencing clinical practice improvement and other key processes.

4 Why does it matter? End of life care is not done well in Australian RACFs

5

6 Why does it matter? End of life care is not done well in Australian RACFs Our model of care can positively influence outcomes of care

7 In 30 minutes... Context Nurse practitioners Palliative care in aged care Process Model of care Outcomes Clinical Professional

8 Context... Nurse Practitioners

9 What is a Nurse Practitioner? A Registered Nurse who has completed both advanced university study at a Masters Degree level and extensive clinical training to expand upon the traditional role of a Registered Nurse. They use extended skills, knowledge and experience in the assessment, planning, implementation, diagnosis and evaluation of care required. Australian College of Nurse Practitioners 2012

10 Grounded in the nursing profession s values, knowledge, theory and practice Not a substitute doctor! May add value to medical care Scope of practice is determined by the role in which the NP is employed

11 Australian NP Specialties % %

12 NP Aged Care Models of Practice Program demonstrate effective, economically viable and sustainable models of practice Facilitate growth of aged care nurse practitioner workforce improve access to primary health care for clients of residential &community aged care services Funded by Australian Government Department of Health & Ageing

13 Context... Palliative care in aged care

14 Focus of care is changing Residential model Sub-acute clinical Increasing acuity Multiple morbidities Increasing technical clinical care e.g. Intrathecal infusions

15 Lynn J, Adamson DM. Living well at the end of life. Adapting health care to serious chronic illness in old age. Washington: Rand Health, 2003.

16

17 Built environment, meals, lifestyle activities equally important Competence & confidence to provide increasingly complex clinical care (including palliative & end of life care)

18 % increase DEMENTIA prevalence in Australia Australian Institute of Health and Welfare (AIHW) 2006

19 Catholic Health Australia 2010

20

21 What to do? Increase funding Capacity building Palliative approach toolkit Advance care planning Training for careworkers Incentives for GPs havent worked Specialist support Nurse practitioners? External or internal?

22 Process... Model of care

23 Resthaven s NP NP candidate Endorsed NP Three Six residential sites high care low care Two community services

24 Scope of Practice Palliative Care for Older Adults

25

26

27 Scope of Practice Palliative Care for Older Adults Advance care planning Palliative Care case conferences End of Life Care Complex symptom management Psychosocial distress Early intervention/screening clinics?

28 Referral criteria Progressive life limiting condition. Not surprised if dead in 6 months Complex physical symptoms/psychosocial issues requiring direct clinical care by NP and/or advice to primary care team Goals of care = relief of symptoms & QoL Resident/family/ GP aware of referral

29

30 Why is it important?...done well, these conversations are the engine that drives the elucidation and treatment of suffering... Weiner & Roth 2006

31 Extended practice m/wp-content/uploads/2013/02/chest-x-ray.jpg

32 Collaborative Arrangements Mutual trust and respect Communication Teamwork

33 Funding Project funded till June 2014 Permanent position from July 2013 Salary offset (slightly) by income from Medicare

34 MBS item numbers for NPs

35 Palliative Care: NP v GP

36 Outcomes

37 National Evaluation Conducted by University of Canberra Data from project organisations Australian Institute of Health and Welfare Medicare PBS

38 Clinical Outcomes Too early to know... Baseline retrospective audit All residents with referral to NP died at home High satisfaction from families Less after hours locum visits at EoL

39 Clinical Outcomes GPs more willing to attend case conferences Increased proactive prescribing (and de-prescribing) of medicines at the end of life Better identification and Rx of delirium

40

41 Professional outcomes Modelling best practice Opportunities for targeted clinical education

42

43 Professional outcomes Modelling best practice Opportunities for targeted clinical education Championing advance care planning Improved understanding & use of pain assessment and delirium screening tools Staff support re grief & loss

44

45

46 Keys to success Well defined implementation process Access to experienced clinical & professional mentors Quarantined professional development time Stakeholder engagement

47 What s my point? A palliative care nurse practitioner who consults at a RACF can improve outcomes of care by providing clinical advice and support.

48 What s my point? A palliative care nurse practitioner who consults at a RACF can improve outcomes of care by providing clinical advice and support. A palliative care nurse practitioner working within a RACF can improve outcomes of care by also providing direct care and influencing clinical practice improvement and other key processes.

49 Thank you... Nurse Practitioner Aged Care Models of Practice Project This is an Australian Government initiative.

50