Integrating the Nurse Practitioner (NP) into Aged Care

Transcription

1 Integrating the Nurse Practitioner (NP) into Aged Care Ann Brodie, MSN, NP General Manager Clinical Services Sir Moses Montefiore Jewish Home, Sydney, NSW LASA National Congress 2014 (Clinical Innovation) 1

2 Presentation Outline Purpose Montefiore Background & History NP Introduction Defining the NP Position Objectives of the Role Collaboration Program Outcomes The Future Recognition Concluding Remarks 2

3 NP s & Aged Care How do you establish a successful and viable NP program that lends itself to aged care? 3

4 Montefiore & Aged Care 740 Residents Across 4 Facilities Hostel, Nursing Home & Dementia Care 96 HomeCare Packages Consumer Directed Care Fee For Service Over 1000 Staff 4

5 Program Background & History In 2010, Montefiore received a federally-funded research grant in conjunction with Canberra University to investigate the viability of the NP model in Residential Aged Care (RAC). Currently, we have 2 Australian Board endorsed NP s servicing four facilities in collaboration with 90 General Practitioners (GP s) 5

6 NP Introduction Ann J. Brodie, MSN, NP Joanne Russell, MSN, NP 6

7 Introduction Ann J. Brodie, MSN, NP Residential Care Clinical Resources NP Program After Hours Supervisors Infection Control Joanne Russell, MSN, NP Nurse Practitioner Residential HomeCare Specialisation Palliative Care Wound Care Forums/Working Parties Education Mentoring 7

8 Defining the Position A NP is a registered nurse (RN) who is educated & endorsed to function autonomously and collaboratively in an advanced & extended clinical role. The NP role includes assessment & management using advanced nursing knowledge and skills 8

9 GP s Understanding of the NP 2013 Survey 2014 Survey 9

10 Defining the Position So what does an NP do Roles & Duties? Disease & Illness Diagnosis & Treatment Ordering, Investigation, & Evaluation of Diagnostics Prescribing Medications Collaborative Treatment w/ GP s Policy Development & Collaboration Mentoring Education Internal & External Forum & Committee Chairs Infection Control through Immunisation 10

11 Defining the Position Why is the Role Important to Define? Our NP program offers the delivery of an advanced level of person centred aged care leading to better results for residents, their families, and the Organisation as a whole. In addition, the NP is able to educate, mentor and support staff to better manage complex clinical situations 11

12 NP Objectives Reduction of Avoidable Hospitalizations Appropriate Referrals to Specialists Appropriate Referrals From Staff to the NP Prescribing Medications Staff Mentoring and Education Clinical Research Policy Development Successful Collaboration With GP s 12

13 Collaboration Internal Support Management & Board Members Clinical Resources Department After Hours Supervisors Customer Assurance Department Learning & Development Department IT Department Nursing & Allied Health Catering, Maintenance, & Laundry External Support Federal Government Canberra University Australian College of Nurse Practitioners General Practitioners Community including Residents families & friends Volunteers Public Health Units Quality Agency 13

14 Education & Mentoring Infection Control Immunisation Clinics Chair & Coordinators for Forums & Committees Policies, Forms, & Work Instructions Involvement Clinical Resources Department SIR MOSES MONTEFIORE JEWISH HOME RN AC Documentation Workshop 14

15 Clinical Indicator Reporting & Auditing GP Matters Annual GP Surveys Policies, Forms, Documents User Tips & Dashboards Involvement Customer Assurance Department 15

16 Learning & Development Research Education Training Allied Health MDT Referrals HALT GPs Referrals Collaboration Involvement Coordination & Collaboration is Key Project Objective Outcome(s) 1. HALT (Halting Antipsychotics in Long- Term Care) 2. Integrated Cognitive & Sensory Program at RWSCU 3. Staff & Resident Flu Vaccination Program 4. Does residential aged care impact resident cognition levels? In collaboration with UNSW, reduce use of anti-psychotics in residential care in RWMT, RWNH, Shirah, & CAM In collaboration with UNSW, study effect of program on resident's with dementia Improve staff rates & assist GPs with resident vaccination administration via CRD administered program. Review of cognition upon admission & determine if cognition level declines over time HALT team established. Collaborate with Professors Brodaty & Chenoworth. Program till June Training package developed. Awaiting final ethics approval. NP administered program 475 staff & 450 residents vaccinated. Plans to research data & educate staff for those who declined 2014 vac. Under consideration. 16

17 Report Production Review & Coordination Implementation of Education Re-evaluation of Data Bringing it All Together Clinical Indicator - Pressure Injuries 17

18 Historical Perspective Review & Coordination Implementation of Education NP directed Vaccine Clinics Bringing it All Together Infection Control Vaccine Clinics 18

19 Vaccine Clinic Results % of GPs preferred NP administration 440 residents were vaccinated by the NP with Fluvax and/or Pneumovax 493 staff members were also vaccinated with Influvac 105% rise from 2013 NP Coordinated & Managed 19

20 Reporting & Stats Data Graph for Clinical Indicator Reporting What are the Results? 20

21 Reporting & Stats 950 Referrals Made to the NP by Staff Wound, Catheter & Palliative Care Are Top referrals Made to the NP 150 Prescriptions Written 53 Hospitalisations Avoided 25 Referrals to Specialists by the NP 21

22 Current & Future Plans 22

23 Recognition 2014 Better Practice Award a genuine case of leading innovation. slick, professional, formally funded, well-documented.. implemented & monitored thoughtfully, delivering strong results. very impressive. comments from judging panel 23

24 Meaning for Residents Choice - Dignity - Wellbeing As a result of these positive and innovative approaches, we are able to deliver person-centred aged care more effectively Here at Montefiore, our vision is to be the leader in the field of aged care. To develop, implement and promote best practice in all aspects of aged care by continuously reviewing and improving services and service delivery 24

25 What Does This mean in RAC? Based on current trends, this is foreseen to become a necessity as more complex and acute cases present for care within our Residential and HomeCare services. For every aged-care resident, unable to be cared for in aged care (which is a maximum of $180 a day in funding), the cost to impost to the acute setting [will be about] $1500 a day a funding increase of more than seven-fold (Larter, 2014) 25

26 Montefiore Family 26

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