Developing Role of Nurse Practitioner
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1 Developing Role of Nurse Practitioner Adult Sickle Cell Program Margaret Crowley, CRNP
2 Introduction Adult program with 200 patients Hematology Oncology Office with 7 MDs. Initially independent practice affiliated with Pennsylvania Hospital and now part of UPHS. Nurse Practitioner joined team 5 yrs ago. Team Members: program coordinator, social worker, psychologist and medical director and physicians.
3 Program Initially medical director who saw most of the sickle cell patients on a routine basis Medical director followed patients in the hospital Five years ago it was agreed that all the hematologist would see sickle cell patients. Nurse Practitioner would see all of the patients.
4 Nurse Practitioner Role Central role in the care of sickle cell patient. Office visits for care management, preventive care Urgent care in infusion suite: not available prior to NP joining team. Coordination of care: ER care plans and hospital rounds.
5 Evaluation of the role Is there a way to look at the role as it is developing to clarify the role as well as identify future directions. Recent changes in the Hem/onc practice
6 Nurse Practitioner and chronic illness Recent consideration of role of NPs in chronic care particularly in diabetes and congestive heart failure, nephrology Nurse practitioners are well suited for chronic disease management due to their ability to address the multifactorial nature of chronic problems. (Fiandt 2006)
7 Multifactorial Nature Education needs. Community involvement Social needs. Holistic nursing approach.
8 Diabetic Program NP as primary provider of care for planned visits. Collaborative practice with use of medication intensification protocols Improved clinical outcomes in glycemic controls and control of hypertension.
9 Chronic Care Model Framework for chronic care management and sickle cell disease is chronic illness. Developed in 2001: incorporates the patient, provider and system interventions to improve care. Advanced nurse practitioners are ideally suited for interventions through this model.
10 Six Essential Concepts Delivery system Self-management support Decision support Community resources Clinical information system Health system organization
11 Delivery system Planned visit every 3 months is standard Visits alternate between primary hematologist and nurse practitioner Medical director does oversee medical practice for this populations
12 Delivery system: day hospital NP initiated outpatient or day hospital visits. Patients are treated in our infusion suite. Brief evaluation by coordinator for typical pain crisis. Seen by NP for evaluation Sickle cell pain protocol for the individual patient is initiated and carried out by infusion nurses. Initially two infusion nurses took responsibility: now all are familiar with procedure. See about 4-5 patients per week. Only available during office hours so ER is also part of our delivery system.
13 Delivery System Hospitalized patients are seen by their hematologist. Nurse practitioner makes daily hospital rounds and provides coordination of care.
14 Self-management Support: Patient is member of the team Social worker/ coordinator organize monthly support group run by patients. Twice a year education days for patients. Development of educational pamphlet for patients by team. Counseling regarding use of medications and procedure for accessing care at office visits.
15
16 Contents Variants of sickle cell anemia. How to use emergent care. Who to contact after hours. Components of a good diet. Understanding pain medications. What is a care plan.
17 Decision Support Use of NIH guidelines for care of adults with sickle cell disease. Summary provide to all providers. Use of transfusion guidelines. Specialty support: ID, GI, pulmonary Collaboration between sickle cell programs in Philadelphia.
18
19 Clinical Information System Computerized system Care plan for patients are developed by NP and entered into computer system for access in ER and on care units. Patients are given a copy of the plan and it is reviewed with them.
20
21 Clinical Information System Flu vaccine and Pneumococcal vaccine Information tracked during hospitalizations. Still need some coordination with outpatient
22 Community resources Team meetings on hospital unit with nurse manager, charge nurse and other hospital members as needed. SCDAA representative makes weekly hospital rounds. Participation in SCDAA events. Yearly attendance at ER staff meeting
23 CDC Report 2010
24 Health Care organization Support for program by our hematology Oncology practice. Health system support noted in terms of continued availability of care in infusion suite which is now part of the hospital Nursing support from nursing unit where patients are seen.
25 Financial Support Sub contractor of the Pennsylvania State grant at Thomas Jefferson University Hospital Sickle Cell Program.
26 Future Directions for Nurse Practitioner Need to consider quality assurance activities. Percentage of patients receiving flu vaccine? Number of patients on hydrea: currently know increase with unrefined data from 24% to 34 %. How can I use the new computer documentation system? Developing an in-patient NP service.
27 Summary Nurse practitioner can provide valuable care for sickle cell patients in the adult setting. The chronic care model can be used as a framework for development of a sickle cell adult program. Many questions to be answered and asked concerning best care for this population and nurse practitioners can be a part of the development of best care.
28 Bibliography Boville, Denise, Saran, Mandeep, Salem, James K., Clough, Lynn, Jones, Ronald 2007 An Innovative Role for Nurse Practitioners in Managing Chronic Disease. Nurs Econ, 25(6) Benjamin, LJ, Swinson, GI and Nagel, RL Sickle cell anemia day hospital: an approach for the management of uncomplicated painful crisis, Blood, Feb 15; 95(4): Braun, Christina 2008 The Nurse Practitioner s Role : Vital in Nephrology Medscape., Mar10, Flandt, Kathryn The Chronic Care Model: Description and Application for Practice. Topics in Advanced Practice Nursing e Journal. 6(4). Hydroxurea Treatment for Sickle Cell Disease, NIH Consensus Development Conference. February 25-27, 2008 Natcher Conference Center The Management of Sickle Cell Disease, NIH, Division of Blood Diseases and Resources. NIH Publication , June th Yusuf HR, Atrash, HK, Grosse SD, Parker, CS, Grant, AM, Emergency Department visits made by patients with sickle cll disease: a descriptive study Am. J Prev Med 2010: 38(45): S536-S541 as presented in CDC Features,2010.
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