The benefits of being in-house... An innovative model of care for palliative care nurse practitioners in Residential Aged Care Peter Jenkin Nurse Practitioner
What s my point? A palliative care nurse practitioner who consults at a RACF can improve outcomes of care by providing clinical advice and support.
What s my point? A palliative care nurse practitioner who consults at a RACF can improve outcomes of care by providing clinical advice and support. A palliative care nurse practitioner working within a RACF can improve outcomes of care by also providing direct care and influencing clinical practice improvement and other key processes.
Why does it matter? End of life care is not done well in Australian RACFs
Why does it matter? End of life care is not done well in Australian RACFs Our model of care can positively influence outcomes of care
In 30 minutes... Context Nurse practitioners Palliative care in aged care Process Model of care Outcomes Clinical Professional
Context... Nurse Practitioners
What is a Nurse Practitioner? A Registered Nurse who has completed both advanced university study at a Masters Degree level and extensive clinical training to expand upon the traditional role of a Registered Nurse. They use extended skills, knowledge and experience in the assessment, planning, implementation, diagnosis and evaluation of care required. Australian College of Nurse Practitioners 2012
Grounded in the nursing profession s values, knowledge, theory and practice Not a substitute doctor! May add value to medical care Scope of practice is determined by the role in which the NP is employed
Australian NP Specialties % 35 30 32 25 20 15 10 5 0 15 14 10 6 5 4 3 1 6 4 %
NP Aged Care Models of Practice Program demonstrate effective, economically viable and sustainable models of practice Facilitate growth of aged care nurse practitioner workforce improve access to primary health care for clients of residential &community aged care services Funded by Australian Government Department of Health & Ageing
Context... Palliative care in aged care
Focus of care is changing Residential model Sub-acute clinical Increasing acuity Multiple morbidities Increasing technical clinical care e.g. Intrathecal infusions
Lynn J, Adamson DM. Living well at the end of life. Adapting health care to serious chronic illness in old age. Washington: Rand Health, 2003.
Built environment, meals, lifestyle activities equally important Competence & confidence to provide increasingly complex clinical care (including palliative & end of life care)
500000 450000 400000 350000 300000 250000 200000 150000 100000 50000 0 40% increase 2003 2031 DEMENTIA prevalence in Australia Australian Institute of Health and Welfare (AIHW) 2006
Catholic Health Australia 2010
What to do? Increase funding Capacity building Palliative approach toolkit Advance care planning Training for careworkers Incentives for GPs havent worked Specialist support Nurse practitioners? External or internal?
Process... Model of care
Resthaven s NP NP candidate Endorsed NP Three Six residential sites 159 289 high care 236 391 low care Two community services
Scope of Practice Palliative Care for Older Adults
Scope of Practice Palliative Care for Older Adults Advance care planning Palliative Care case conferences End of Life Care Complex symptom management Psychosocial distress Early intervention/screening clinics?
Referral criteria Progressive life limiting condition. Not surprised if dead in 6 months Complex physical symptoms/psychosocial issues requiring direct clinical care by NP and/or advice to primary care team Goals of care = relief of symptoms & QoL Resident/family/ GP aware of referral
Why is it important?...done well, these conversations are the engine that drives the elucidation and treatment of suffering... Weiner & Roth 2006
Extended practice http://www.google.com.au/url?q=http://www.emergucate.co m/wp-content/uploads/2013/02/chest-x-ray.jpg
Collaborative Arrangements Mutual trust and respect Communication Teamwork
Funding Project funded till June 2014 Permanent position from July 2013 Salary offset (slightly) by income from Medicare
MBS item numbers for NPs
Palliative Care: NP v GP
Outcomes
National Evaluation Conducted by University of Canberra Data from project organisations Australian Institute of Health and Welfare Medicare PBS
Clinical Outcomes Too early to know... Baseline retrospective audit All residents with referral to NP died at home High satisfaction from families Less after hours locum visits at EoL
Clinical Outcomes GPs more willing to attend case conferences Increased proactive prescribing (and de-prescribing) of medicines at the end of life Better identification and Rx of delirium
Professional outcomes Modelling best practice Opportunities for targeted clinical education
Professional outcomes Modelling best practice Opportunities for targeted clinical education Championing advance care planning Improved understanding & use of pain assessment and delirium screening tools Staff support re grief & loss
Keys to success Well defined implementation process Access to experienced clinical & professional mentors Quarantined professional development time Stakeholder engagement
What s my point? A palliative care nurse practitioner who consults at a RACF can improve outcomes of care by providing clinical advice and support.
What s my point? A palliative care nurse practitioner who consults at a RACF can improve outcomes of care by providing clinical advice and support. A palliative care nurse practitioner working within a RACF can improve outcomes of care by also providing direct care and influencing clinical practice improvement and other key processes.
Thank you... pjenkin@resthaven.asn.au Nurse Practitioner Aged Care Models of Practice Project This is an Australian Government initiative.