MENTAL HEALTH EATING DISORDERS NURSE PRACTITIONER MODEL OF CARE REPORT

Transcription

1 MENTAL HEALTH EATING DISORDERS NURSE PRACTITIONER MODEL OF CARE REPORT MAY 2010 A report prepared by Kelvin Hicks, RN (Project Officer for the Southern Health Mental Health Nurse Practitioner Project) For the Victorian Department of Health: Nurse Policy Branch Approved by: Shelly Park (CEO Southern Health) Cheyne Chalmers (Executive Director of Nursing and Midwifery) Health) Anne Doherty (Executive Director of Mental Dr. Saji Damodaran (Program Medical Director Mental Health) Jakqui Barnfield (Acting DON Mental Health)

2 CONTENTS DEPARTMENT OF HEALTH: VICTORIAN NURSE PRACTITIONER PROJECT FUNDING ROUND 4.6 DELIVERABLE 1: SUMMARY OF PROPOSED SERVICE MODEL APPENDICES APPENDIX A: APPENDIX B: APPENDIX C: APPENDIX D: APPENDIX E: APPENDIX F: APPENDIX G: SOUTHERN HEALTH EATING DISORDERS SERVICE MAP GAP AND GROWTH CORRIDOR SUMMARY OF SOUTHERN HEALTH EATING DISORDERS SERVICE SH MHED NP GOVERNANCE FLOWCHART KEY SUPPORTS FOR MHED NPC RISK MANAGEMENT MODEL OF CARE DETAILS RESTRICTION S TO NP S CARE ACKNOWLEDGEMENTS: The work to develop the proposed Southern Health (SH) Mental Health (MH) Eating Disorders (ED) Nurse Practitioner (NP) model has resulted from of a willingness to share resources, including information and tasks in order to achieve a common goal. I wish to acknowledge the particular contributions of the following people and their respective organizations: The Department of Health Services: Nurse Policy Branch The Southern Health Eating Disorders Nurse Practitioner Steering Committee members: o Dr David Clarke Clinical Director of Primary Partnerships o Dr Michael Gordon Acting Clinical Director of CAMHS o Dr Jacinta Coleman Head of Adolescent Medicine o Dr Donald Campbell Head of General Medicine o Dr Winsome Hum Consultant Psychiatrist for EPS and CL Psychiatry o Lisa Lynch Director of CAMHS o Jakqui Barnfield Acting DON MH o Vrinda Edan Director Consumer & Carer Relations MH o Kym Forrest DON Clayton o Meaghan Jones Acting Manager Butterfly Day Program (BDP) o Jo Begbie Acting Manager Advancing Nursing and Midwifery Practice o Jacinta Winderlich Dietetics o George Streitberg - Pathology o Alla Shvayster Pharmacy o Kelvin Hicks Project Officer Mental Health Nurse Practitioner Project Members of the Victorian Mental Health, Alcohol and Drugs Nurse Practitioner Collaborative The Southern Health Mental Health and Nursing and Midwifery and Strategic Directorate Teams Martin Sharman South East Primary Mental Health Manager Page 2 of 16

3 DEPARTMENT OF HEALTH: VICTORIAN NURSE PRACTITIONER PROJECTS FUNDING ROUND 4.6 DELIVERABLE 1: SUMMARY OF SOUTHERN HEALTH MENTAL HEALTH EATING DISORDERS ENDORSED NP MODEL OF CARE BACKGROUND OF THE PROJECT In 2009 Southern Health recognised that the demands for Eating Disorder services were exceeding their current resources to provide best practice and cost effective care. An overview of the Eating Disorder service ensued which resulted in the Southern Health Mental Health Body Image and Eating Disorder Service: An integrated service though the lifespan being developed. The need to develop the right workforce was a key requirement to meeting the increasing needs of this client group and an Eating Disorder NP position was identified as a priority for the future SH Eating Disorders Service. In October 2009 Southern Health was successful in receiving funding from the Victorian Department of Health s Victorian Nurse Practitioner Project (VNPP) funding round 4.6 (Mental Health & Alcohol and Drug services) enabling employment of a project officer to coordinate the Southern Health Mental Health Nurse Practitioner Project. The project began with a gap and growth corridor analysis, (Appendix B) via individual key stakeholder meetings, across SH MH and General Medicine services. From this a Southern Health Eating Disorders Service Map, (Appendix A), was developed which again highlighted the gaps and growth expectations existing in the SH Eating Disorders Service. The SH endorsed MHED NP Model of Care has been developed by the SH MHEDNP Steering Committee, which was established at the onset of this project. The Steering committee consists of key stakeholders representing different specialities and services, which will be directly linked to the MHEDNP. A key role of the steering committee was to ensure alignment of the new model of care with the existing and developing service, structural and strategic frameworks which the Eating Disorder Nurse Practitioner position will exist within, these key documents included: Because MH Matters: Victorian Mental Health Reform Strategy Fourth National Mental Health Plan Southern Health Eating Disorder Service Mapping Project Southern Health Nursing and Midwifery Strategic Plan Southern Health Nurse Practitioner Framework The SH MH Eating Disorders NP Steering Committee created a SH MHEDNP model of Care utilising a NP model development tool (diagram1) developed by Michelle Thomas (Nursing Board of Victoria Nurse Policy Officer) which details how the SHMHEDNP will be involved with a client s whole episode of care, as well as other aspects of the MHEDNP roles. IN What clients? When? When not? Where? By whom? HOW, WHAT? Advanced assessment Diagnostics? Therapeutic interventions Advanced technical skills OUT Referrals? Admission? Discharge? Transfer? Diagram 1: Nursing Board of Victorias NP Model Development Guide (2010) Page 3 of 16

4 The SH MHEDNP Steering Committee also: Developed a governance structure for the role, (Appendix C) Identified the key supports in place for the new role, (Appendix D) Conducted a risk analysis of the new MHEDNP Model of Care, (Appendix E). The SH MHEDNP Steering Committee will provide ongoing support for the MHED NP role and model. These documents aim to anticipate any issues which might arise from the development of the project, and to have appropriate risk plans and strategies in place before the completion of the funded project. KEY PRINCIPLES REGARDING THIS NURSE PRACTITIONER MODEL OF CARE: The model does not replace existing services, such as CNC/Nursing Coordinators positions, it is to fill gaps where positions do not exist. This role has not been developed to only care for the easy/simpler clients, but designed to utilise the advanced clinical knowledge and skills of the MHEDNP in Psychiatric, Physical and Nutritional Assessment and Treatment planning to provide the best client care. This will also assist the MHEDNP to maintain their advanced level of skills and knowledge. However, while this role is autonomous, given the nature of the illness (including the complexities of co-morbidities), the multiple services involved and best practice, a collaborative Multidisciplinary Team Approach is essential for effective care In addition to the patient support, the MHEDNP will be a valuable resource for internal and external service providers. The Model of Care is a living/dynamic model. The model and role of the NP is expected to develop/adjust as the client and services needs change. GLOSSARY OF TERMS AMEDC: AMU: BDP: CAMHS: CEED: CL: ED: EDFV: EDS: EDU: EPS: GP: IACT: MH: MHDANPC: MHED: MHNIPP: NGO: NP: NPC: PMHT: PP: PTS: SH: Adolescent Medicine Eating Disorders Clinic Adolescent Medical Unit Butterfly Day Program Child and Adolescent Mental Health Service The Victorian Centre for Excellence in Eating Disorders Consultation Liaison Eating Disorders Eating Disorder Foundation of Victoria Eating Disorders Service Eating Disorders Unit Emergency Psychiatric Service General Practitioner Intake, Assessment and Consultation Team Mental Health The Victorian Mental Health, Drug and Alcohol Nurse Practitioner Collaborative Mental Health Eating Disorders Mental Health Nurse Initiative Partnership Program Non-Government Organisation Nurse Practitioner Nurse Practitioner Candidate Primary Mental Health Team Primary Partnerships Psychiatric Triage Service Southern Health Page 4 of 16

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6 DETAILED SH MHED ENDORSED MODEL OF CARE ENTERING THE MHEDNP s CARE Referral Criteria: o Clients and families accessing inpatient services requiring navigation through the ED service. o Clients requiring Psychiatric &/or Physical Assessment and treatment planning from IACT, AMEDC, BDP, and outpatient clinics as well as PMHT, case managers and primary care services o Resource and Support for clients, families and service providers internally and externally (Important note: role is not to deskill existing staff, rather enhancing their skills by being a resource) Sources of Referrals: o Psychiatric Triage Service referring to IACT o CL Psychiatry, inpatient settings and emergency departments o AMEDC, BDP and outpatient clinics o PMHT, case workers o Primary Care including Community Health Centres, Psychologists, Psychiatrists, Social Workers, Dieticians and GPs o GPs within The Divisions of General Practice through the MHNIPP (Please refer to Appendix G for restrictions to NP s care) CARE PROVIDED There are four key elements to the MHEDNP s role as outlined below (for more detail refer to Appendix F): Clinical Care Co-ordination: o Assess client s needs and determine the most appropriate service o o Refer and assist clients, families & carers to engage all appropriate therapeutic and support services Monitor the progress of clients throughout the system, enhancing communication, continuity and collaboration: Inpatient, outpatient and primary care Public and private Medical and psychiatric o Linking clients and service providers with specialist organisations e.g. CEED and EDFV Consultations: o Primary, Secondary and Tertiary consultations with Internal and external services o Follow up of long-term clients and their families/carers Research and Education: o Data collection and ensuring best practice o Facilitating education throughout the service and community Leadership and Service Development: Page 6 of 16

7 o o o Development of clinical guidelines Service development and review Bed Management MHEDNP Advanced Scope of Practice The MHEDNP will work within the Advanced Scope of Practice which is being developed by the SH MHED NP Steering Committee. This will provide a framework for the candidate to work within. This may include education and supervision for Physical, Psychiatric and nutritional Assessments and Treatment Planning. The existing SH Traffic Light System will be adapted to assist in this regard. It is important to note that the Traffic Light System is a living document, which will be reviewed every 6 months by the SH MHEDNP Steering Committee. Some items on the Advanced Scope of Practice Traffic lights will be: o o Ordering tests i.e. pathology and X-rays Medications Prescribing: anti-anxieties and nutritional supplements. This medication list will be developed in accordance with the Victorian MHNP Formulae, and then safety and costs measures will be addressed. Locations The MHEDNP will work across multiple sites within SH and externally, summarized below: o AMEDC, IACT, BDP and outpatient clinics o PMHT, Case Managers, GPs and Community Health Clinics o Telephone support for clients, families and service providers o Adolescent Medical Unit, Adult General Medical and specialty wards, as well as inpatient Psychiatric units as required TRANSITIONING FROM THE MHEDNP s CARE Referrals & Care Planning to: GP s, Community Health Centres and/or Private Providers (Psychiatrists, Paediatricians and Psychologists) for ongoing care. CAMHS Page 7 of 16

8 APPENDIX A: SOUTHERN HEALTH EATING DISORDERS SERVICE MAP EATING DISORDERS SERVICE PTS PRIMARY CARE AM ED CLINIC IACT PMH/ MHNIPP AMU CL SERVICES GEN MED WARDS INPATIENT PSYCHIATRIC SERVICES BUTTERFLY DAY PROGRAM ADULT DAY PROGRAM OUTPATIENT SERVICES GAPS Clinical Co-ordination/integration GROWTH Enhancing effectiveness in Primary Care: Early detection and intervention Page 8 of 16

9 APPENDIX B: GAP AND GROWTH CORRIDOR SUMMARY OF SOUTHERN HEALTH EATING DISORDER SERVICE Gaps No service wide integration Lack of consistent consumer and family involvement No shared care models with Primary Care Multiple referral pathways with General Medicine and Psychiatry No funded outpatient service or Day Programs for clients over 24 years Different Care Models Lack of expertise both inpatient and primary care services Lack of accurate data in Adult General Medicine and Psychiatry Location of Adult Eating Disorder Unit (inpatient Psychiatric) not ideal Details Lack of co-ordination and leadership. Multiple service providers and streams of service: - inpatient, outpatient and primary care - Adolescent and adult services - Medical and Psychiatric services Multiple service providers inhibits the ability to consult and include consumers and families in service delivery Inconsistent, isolated care No integration with Mental Health service Lack of appropriate Psychiatric &/or Medical Assessment and Treatment Planning Inconsistent service provision. Lack of support for clients once transitioned from Adolescent to Adult services Necessary differing models between Adolescent and Adult brings further complexity and challenges to service delivery Delays detection and inconsistent intervention Relatively low prevalence translates to difficulty and delay to gain expertise in service delivery Difficult to determine capacity and demand Currently co-habited with Mother/Baby Unit Will be relocated in the new service model Page 9 of 16

10 APPENDIX C: SH MHED NP GOVERNANCE FLOWCHART - Page 10 of 16

11 APPENDIX D: KEY SUPPORTS FOR MHED NPC Type of Supports Details Commencing Position Supports Getting Started Pack developed by Project Officer Mentoring Supports Medical Nursing Dietetics Professional/organisational Educational Supports SH NP Master Class SH NP Action Learning Sets Program Linking into existing SH MH Educational Supports Linking in with the SH MH Registrar training opportunities Organisational Supports SH very supportive of NPs Cohort of SH NPCs in July 2010 Governance Structure A 3-fold governance structure exists to provide oversight, accountability and support for the NP External Supports Victorian MH, Drug and Alcohol Collaborative South Eastern Education and Training Cluster Australian College of NPs Explore the opportunity of linking with various NGOs (e.g. CEED; EDFV) Page 11 of 16

12 APPENDIX E: RISK MANAGEMENT Description Impact Consq. Prob. Score Strategy (C+P) Unable to recruit the appropriate candidate Southern Health does not implement the program as required High Unlikely Medium Promotion and Marketing widely throughout all Southern Health Campuses Lack of understanding of the benefits of the role as part of the Specialist Team Transition period for candidate from existing role into NPC Position Model unrealistic for one MHEDNP to undertake Sustainability of position Inability of candidate to meet the competing academic and professional requirements Appropriate patients are not referred or are not identified. NPC not used as part of the Specialist Team Misunderstanding and misconception of NPC Role Position tasks not completed due to not enough time. Position not continually funded, therefore program not sustainable. No position while NP on leave. MHEDNPC does not complete training to become an endorsed NP. High Unlikely Medium Education and Promotion of the role and the benefits to all Southern Health Mental Health Program and throughout Southern Health. Referral Criteria for the role clearly identified. Role is clearly different and not taking over any existing roles. Medium Unlikely Low Candidate will have identified mentors medical, professional and operational as well as support from other SH NPCs and MHDANPC. Finally a clear Job Description will be created. Medium Possible Medium Evaluate the role 6 months post endorsement of NP. Aim to commence another MHED NPC at the same time the NP is endorsed to help spread the role and provide leave support etc. High Possible High Plan in place for leave cover. The funding person is on the Steering Committee The DON MH chairs the Steering Committee. NPC ongoing funding source. NP model partially self-funded Medium- High Unlikely Medium Recruitment of NPC with existing postgraduate studies. Funded non-clinical and study leave opportunities. Additional supports in place with a cohort of SH NPCs commencing together. SH NP Master Class education opportunities for NPCs. Consequence Probability Score (C+P) High Likely Very High High Possible High High Unlikely Medium Medium Likely High Medium Possible Medium Medium Unlikely Low Low Likely Medium Low Possible Low Low Unlikely Very Low Page 12 of 16

13 APPENDIX F: MODEL OF CARE DETAILS CLINICAL CARE CO-ORDINATION Area of Practice Details of Practice IACT Work-up of clients for Assessment (pathology, triaging) Biopsychosocial and Nutritional Assessment and treatment planning within the MDT Prescribing Anti-anxiety medications and nutritional supplements Referring Clients for inpatient admission (both Psychiatric and Medical) as required Referring Clients to the other appropriate internal and external services as required Communicating with GPs re: treatment plans AMEDC Biopsychosocial Assessment and treatment planning Monitoring and evaluation in line with assessment and treatment planning Referring clients for a Psychiatric services (inpatient, outpatient and primary care) as required Communicating with GPs re: treatment plans BDP/Outpatient Services Assisting links between inpatient services, OPC/BDP and GPs Ordering pathology and diagnostic imaging tests as required Undertaking physical Assessments, including nutritional assessment, for those over 18 Prescribing medications and nutritional supplements where appropriate Referring clients for admission to either the EDU or general medical ward as required There is potential for limited intake and participation in therapeutic management as time and expertise allow PMHT/Case Managers/CL Services Assisting clients, families and carers to engage outpatient, specialist and community services Primary Care Liaising with GPs of clients participating in Outpatient/Day programs, ensuring continuity of care Page 13 of 16

14 APPENDIX F: MODEL OF CARE DETAILS CONSULTATIONS Area of Practice Details of Practice PMHT/Case Managers provide secondary and Tertiary consults focus to enhance the service, specifically in regards to appropriate physical and psychiatric assessments, and treatment pathways refer clients for admission to either the EDU or general medical ward as required Assist PMHT to formulate, monitor and evaluate Treatment plans with GPs Monitoring and evaluation in line with assessment and treatment planning CL Services/Wards provide secondary and Tertiary consults focus to enhance the service, specifically in regards to appropriate physical and psychiatric assessments, and treatment pathways collaborate with clients, families/carers, CL services and inpatient wards regarding discharge planning Primary Care Primary consultations providing biopsychosocial assessments and treatment plans in conjunction with the Mental Health Nurse Incentive Partnership Program in each of the Divisions of General Practice within Southern Health s catchment Primary consultations would be provided for Community Health Centres and Paediatricians as required Secondary and Tertiary consults with GPs, private Psychiatrists, Paediatricians, Psychologists, Social Workers, Dieticians, and Community Health Centres would be given enhancing collaboration and continuity of care Advising Primary care providers, Clients, families and carers as to treatment options Referring clients for further assessment with IACT or AM EDC Referring clients for admission to either the EDU or general medical ward as required Assist co-ordination of a self-help group for clients Follow up with GPs, clients and/or families/carers as to long term progress Page 14 of 16

15 APPENDIX F: MODEL OF CARE DETAILS RESEARCH AND EDUCATION Area of Practice Details of Practice Whole of Service Data collection and research to assessing effectiveness and efficiency of service Ensures SH provides best evidenced based service Whole of service internally and Externally including Psycho education regarding refeeding and compensatory behaviours for families/carers enabling them to assess their support requirements clients, families, schools, Signs of at risk behaviours and available resources for teachers, students, and work and community community groups to enable early detection and early intervention In-services on topics such as physical assessments, co-morbidity awareness, meal groups supervision, and current best practice interventions Early detection, identifying treatment pathways, and latest best practice principles for primary care LEADERSHIP AND SERVICE DEVELOPMENT Area of Practice Details of Practice Whole of Service Assisting in the development, implementation and ongoing review of clinical guidelines for assessment, care, admission and discharge for inpatient services (both medical and psychiatric), outpatient services, and primary care services Implementing, ensuring, and reviewing best practice. Ensuring appropriate and timely use of inpatient services Participate in the ongoing review and restructure of the Southern Health Eating Disorder Service Inpatient Services Monitoring inpatient resources Being a consultant for inpatient units in prioritizing use of resources Sourcing alternative treatment options as required ensuring safe, efficient and effective care Contact person for all internal and external services for advice on the process for treatment and engagement of resources Page 15 of 16

16 Clients aged over 65 years will be provided service by Aged Psychiatry. APPENDIX G: RESTRICTIONS TO NP S CARE Workload will be monitored by the MHEDNP and operational manager, as well as the steering committee. Priorities and functions may be modified in consultation with the MHEDNP to prevent overload and maximize effectiveness, and respond to the evolving needs of consumers and the service. Page 16 of 16