Bridging Community Health Nursing & Primary Care to Communities Devastated by Hurricane Sandy

Transcription

1 Bridging Community Health Nursing & Primary Care to Communities Devastated by Hurricane Sandy Mary Ann Christopher, MSN, RN, FAAN Yvonne Eaddy, MPH, BSN, RN Eloise Goldberg, MSN, BSN, RN Jill Goldstein, MS, MA, BSN, RN Rose Madden-Baer, DNP, RN, MHSA, PHCNS-BC, CPHQ, CHCE, COS-C MaryJo Vetter, DNP, MS, A-GNP, RN Presentation ID: L14 1 1

2 Disclosure Today s presenters do not have any relevant financial interests presenting a conflict of interest to disclose. Participants must attend the entire session(s) in order to earn contact hour credit. Continuing Nursing Education credit can be earned by completing the online session evaluation. The American Organization of Nurse Executives is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center s Commission on Accreditation. AONE is authorized to award one hour of pre-approved ACHE Qualified Education credit (non-ache) for this program toward advancement, or recertification in the American College of Healthcare Executives. 2 2

3 Introduction Jill M. Goldstein, MS, MA, BSN, RN 3 3

4 Objectives Recognize the role of community health nursing after a natural disaster Describe strategies to integrate the full scope of advanced practice nursing in the community response Identify long term risks that develop in communities and their impact on health maintenance 4 4

5 Lillian Wald 5 5

6 Challenges 6 6

7 VNSNY Vision VNSNY will become the most significant, best-in-class, nonprofit, community-based integrated delivery system providing superior care coordination and care management services to vulnerable populations across a broad regional footprint. 7 7

8 Leadership Mary Ann Christopher, MSN, RN, FAAN 8 8

9 Leadership Mobilize the interorganizational assets Board of Directors Volunteer Auxiliary Donors Marketing and PR Function Cross Enterprise Response 9 9

10 Leadership Mobilize external partners Governmental leaders Academic Partners Cross continuum partners Community based organizations Peer organizations nationally 10 10

11 Leadership Build Resiliency National consultant to enhance the effort Staying the course in communities Spreading the word Disseminating the model 11 11

12 Leadership Celebrate the effort Board Retreat Internal recognition National recognitions Affirmation breakfasts Honor partnerships New York Stock Exchange 12 12

13 Leadership Embrace leadership Be present Be creative Be empowering Be passionate Believe 13 13

14 Role of Community Health Nursing Eloise Goldberg, MSN, BSN, RN Yvonne Eaddy, MPH, BSN, RN 14 14

15 Role of Community Health Nursing Regional Perspective 2 boroughs Brooklyn and Staten Island Northern areas on Lower New York Bay Total population = 2.9 million Average daily census = 3400 Borough differences Economic Ethnic 15 15

16 Role of Community Health Nursing Regional Perspective 2 counties Nassau and Queens Southern areas on Atlantic with barrier islands Total population = 3.6 million Average daily census = 3800 County differences Economic Ethnic 16 16

17 Role of Community Health Nursing Pre-storm Self preparedness Staff preparation Patient preparedness Incident Command System Planning and preparedness Communication of the plan Drills Potential Redeployment 17 17

18 Role of Community Health Nursing Post-storm Facility impact Assessing staff capacity Directly impacted by disaster Non-directly impacted Accommodating staff temporarily working in new locations Responding to disaster imposed obstacles Travel and safety 18 18

19 Beyond Home Care to Community 3-5 days Post Storm A Tale of two cities Manhattan began to normalize Barrier areas still heavily impacted Power outages continued Flood and fire damage extensive in impacted location Physicians offices, pharmacies and supermarkets closed Hospitals struggling to keep up Counties had different levels of impact Impact on patient care 19 19

20 Role of Community Health Nursing Community Response CEO commitment for broad based response Re-focused efforts Used all agency resources Created a emergency labor pool 20 20

21 Advanced Practice Nursing Community Response Mary Jo Vetter, DNP, MS, A-GNP, RN 21 21

22 Primary Care for Vulnerable Communities Primary Care providers and Pharmacy equally impacted and unable to operate Demands for medical care in hospitals exceeded capacity Ambulatory clinic operations slow to return Non-urgent issues, over time, increased vulnerability of community residing individuals Medications / DME lost in flood waters Inability to fill prescriptions Inability to procure vaccinations Flu Pneumonia Tetanus Worsening clinical status Wounds URI 22 22

23 ESPRIT Medical Care, P.C. Licensed in New York state with expertise in public health and chronic illness management Multi-specialty home visiting practice providing medical and behavioral health services Staff Deployed during relief efforts: 25 Nurse Practitioners 7 Physicians 6 Psychiatric providers Primary Care GOAL: Keep community members safely in the home so not as to overburden hospitals with issues that could be managed safely in the community Newly Homebound status related to environmental conditions 23 23

24 Advanced Practice Clinical Interventions Home visiting as part of canvassing team Comprehensive and focused clinical assessments Medication inventory and compliance history Comprehensive urgent assessments to determine appropriateness of staying in the home / community Triage and Disposition recommendations: Remain at home Follow up visit scheduled Access emergent care First Aid and subsequent surveillance Referrals Home care Behavioral Health 24 24

25 Pharmacy Collaboration Facilitated NY State Board of Pharmacy extending the 3 day emergency refill to 2 weeks Prescriptive support: Coordination with Duane Reade / Walgreens for on-site pharmacy staffed with pharmacist and business support No-cost OTC products at Command Center Off-site prescription fulfillment Pick up at the command center or delivery by outreach teams 25 25

26 Principle of Care: Ensure Continuity Worked with community members and other relief workers to provide for the LONG TERM needs of affected individuals Care coordination with PCP and other referral sources Communicate with established providers: At time of encounter if possible, or thereafter Via home care admission Continuous community assessment for re-emergence of primary care infrastructure, tapered community presence accordingly Mobile van deployment Continued for several weeks in hardest hit areas Primary Care services remained available during the entire time 26 26

27 Risk Discovery and Impact on Health and Wellness Rose Madden-Baer, DNP, RN, MHSA, PHCNS-BC, CPHQ, CHCE, COS-C 27 27

28 VNSNY Friendly Visiting Program Door to door nursing assessments Building a simple and effective assessment and checklist Consider basic hygiene, psychosocial and mental health needs 28 28

29 Canvassing Communities 29 29

30 Educating a Community 30 30

31 After Disaster Longer Term Impact Longer term personal/community risks and public health surveillance such as geographic access (housing) Access to providers Medication adherence Nutrition, Health and Safety Fitness and well being 31 31

32 Post-Disaster Community Supports Heart 911 and Gerritson Beach Event Supporting a devastated community Education on PTSD and Depression Psychological first aid Education/support for Health and Wellness Keeping families and communities intact Project Hope Counseling 32 32

33 American Red Cross Award Grant submission for $1,000,000 Longer term health, wellness and mental health components. Grant awarded till 2015 to follow post-sandy victims touched during DOHOMH initial response. Initial registry 1062 individuals. Through Red Cross grant as of November 2013; 962 individual contacts

34 Contacts

35 Video