Dr. Jennie Wells, Chief, Division of Geriatric Medicine Medicine - Geriatric Medicine. All SJH sites SJH PKWD SOUTHWEST CENTRE RMHC L MT HOPE
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1 Medical Directive Title: Lead Contact Person: Physician Lead: Program: Nurse Practitioner / Clinical Nurse Specialist Specialized Geriatric Services Rob Mackenzie, RN(EC), MScN Dr. Jennie Wells, Chief, Division of Geriatric Medicine Medicine - Geriatric Medicine Approval By: Medical Advisory Committee Original Effective Date: October 8, 2014 Revised Date: October 8, 2014 Review Date: October 8, 2016 This Medical Directive Applies to the following sites: All SJH sites SJH PKWD SOUTHWEST CENTRE RMHC L MT HOPE Other: This Medical Directive Applies to the following patient population: In-Patients Out-Patients Order: Nurse Practitioners (NP) in Ontario have the following diagnostic and prescriptive authority: With advanced specialty knowledge, the NP / Clinical Nurse Specialist (CNS) in the Specialized Geriatric Services Program requires medical directives only for additional diagnostic and prescriptive authority which falls outside this jurisdiction, to provide timely and appropriate care as outlined in Appendix 1. Recipient Patients: Patients admitted to Specialized Geriatric Services. Appendix Attached? Yes No Authorized Implementers: Identify individuals or groups of individuals by position and qualifications who will be involved in implementing the medical directive Position / Title NP/CNS Qualifications / Certifications RN (EC) as per College of Nurses of Ontario (CNO) standards and Preparation at the Masters Level Page 1 of 4
2 Indications & Contraindications: Indications: These medical directives apply to patients admitted to Specialized Geriatric Services. Consent as per the consent policy. Contraindications: These medical directives do not apply to patients who are not admitted to Specialized Geriatric Services. Medication / Drug Table: Please identify all medications/drugs, using the chart below, which are included under this medical directive by listing the AHFS classification and then identifying which drugs are EXCLUDED. Note: medical directives for medication orders excludes: non-formulary medications, special access program medications/investigational drugs, off-label use medications, and narcotics, controlled drugs, and benzodiazepines (definition of practitioner as defined under CDSA and Narcotic Regs restricts prescribers). It is not necessary to list these exclusions. For any off-label use of a specific medication to be included, the actual drug and indication must be listed individually and not in the AHFS classification section (e.g. Gabapentin for pain). Check off the boxes for which formulary medications will be applied to this medical directive: Admission Medication Orders reorder or continue Initiate Changes to existing orders (e.g. discontinue, adjust dosages, schedules, or routes) Initiate new orders for the following medications Drug Name (GENERIC) by AHFS category LIST EXCLUSIONS N/A Route of Administration Special Consideration (e.g. monitoring, lab tests) (for formulary listings see - Consent All necessary consents will be obtained by the subject of this medical directive (Rob Mackenzie RN(EC) ), and will be in compliance with St. Joseph s consent policy. Educational Requirements The Specialized Geriatric Services NP/CNS demonstrates a comprehensive knowledge base in the specialty of older adult/geriatric care. The NP/CNS is prepared at the graduate level (master s degree in Nursing) and has additional education in a nurse practitioner program and is a Registered Nurse in the Extended Class (RN EC). The NP/CNS is accountable within a scope of practice that is outlined by the CNO for the RN (EC). The Specialized Geriatric Services NP/CNS functions within the Mission, Vision, Values, and Philosophy of St. Joseph s Health Care, London (St. Joseph s) using the five interrelated components of the Advanced Practice Nurse role: clinical practice, education, consultation, research, and leadership. The NP/CNS maintains competency as outlined by CNO practice standards. Appendix attached? Yes No Page 2 of 4
3 Documentation & Communication All orders and documentation will be completed following established guidelines provided by CNO Documentation Standards, St. Joseph s Clinical Documentation Guidelines, and the Nurse Practitioner Standards. Review and Quality Monitoring Guideline: All questions/clarifications of a medical nature will first be raised to the Specialized Geriatric Services Physician (MRP), second to the medical director of Geriatric Medicine, and if necessary to the IVP of Medical Affairs. Professional nursing questions/clarifications will be raised to the Director of Nursing Practice or delegate. Questions/clarifications by other disciplines affected by this directive will first be raised to the NP/CNS, second to the Specialized Geriatric Services Physician (MRP), and if necessary to the professional practice leader of the discipline. Professional Staff Approvals (Physician, Dentist, Midwife): Identify all Professional Staff members (less than 10 list by individual name, greater than 10 list by title & program) responsible for patients who may receive an order or procedure under this medical directive. NAME Dr. Michael Borrie Dr. Richard Crilly Dr. Laura Diachun Dr. Manuel Montero-Odasso Dr. Jennie Wells Dr. SheriLynn Kane Dr. Chris Brymer Dr. Joel Hurwitz Dr. Mary Margaret Taabazuing Dr. Mon Dasgupta Dr. Raza Naqvi DEPARTMENT/PROGRAM Page 3 of 4
4 Administrative Authorization Approval Form Please note: signature pages are not to be signed until the medical directive has been approved. Name of Directive: Lead Contact Person (s): Nurse Practitioner / Clinical Nurse Specialist Specialized Geriatric Services Rob Mackenzie, RN(EC), MScN IMPORTANT: This template is a general document that may need modification based on the needs of the directive. Please modify appropriately. Identify all administrative bodies, including individuals (PPL s, managers, directors, chiefs) and other approving bodies (i.e. Medical Advisory Committee, Pharmacy & Therapeutics Committee) that must approve the medical directive. Administrative Authorizations (approved by): Chair, St. Joseph s Medical Advisory Committee Dr. Sarah Jarmain Director of Nursing Practice, St. Joseph's - Amanda Thibeault Chief, Division of Geriatric Medicine Jennie Wells Director, Specialized Geriatric Services - Elizabeth McCarthy Site Chief, Diagnostic Radiology St. Joseph s Dr. Ali Islam Implemented by: (Person(s) performing initiation or person representing a large group and responsible for notification of that group) Rob Mackenzie, RN(EC), MScN Signature Signature Date Date Page 4 of 4
5 APPENDIX 1 to Medical Directive MED Name of Directive: Nurse Practitioner / Clinical Nurse Specialist Specialized Geriatric Services Lead Contact Person(s): Rob Mackenzie RN(EC), MScN Order Indications/Conditions Notes/Contraindications Point of Care Testing: Diabetes -Finger Pick Glucose Syncope/presyncope -Urine dip -X-ray of abdomen and spine -CT of Head, Spine, Thorax and Abdomen -Venous/Extremity Ultrasound -Modified Barium Swallows -Electrocardiograms in urgent/acute circumstances -Echocardiograms EMG Nuclear Medicine: VQ Scan Bone Scan WBC Scan Restraint orders Suspicion of urinary tract infection Proteinuria Abdominal pain; feeding tube placement Nausea/vomiting/diarrhea/constipation Rule out vertebral compression fracture Metastatic work-up Skeletal survey for Multiple Myeloma Focal neurological signs & symptoms (rule out TIA/stroke); normal pressure hydrocephalus Rule out/follow-up discitis/epidural abscess/osteomyelitis Rule out/follow-up possible abdominal malignancy Rule out/follow-up possible lung malignancy DVT; Vascular injury/pathology Oropharyngeal dysphagia Suspicion of cardiac event Assess cardiac function in patients with known or suspected CHF or cardiomyopathy Diagnostic for peripheral nerve/neuromuscular pathology PE work-up Metastatic work-up Infection work-up (Osteomyelitis) Agitated/combative patient - for shortterm use during treatment, or for safety +/- consultation with GRU consultant, radiologist +/- consultation with GRU consultant, radiologist Consultation with Speech Language Pathologist +/- consultation with GRU consultant +/- consultation with GRU consultant +/- consultation with GRU consultant, and/or Physical Medicine & Rehab consultant, or Neurologist Consultation with GRU consultant & radiologist Consultation with GRU consultant & radiologist Review daily with a goal of removal of restraints as soon as possible Page 1 of 1
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