nurse practitioner making a difference in personal care homes

Nurse Practitioner

Making a Difference in Personal Care Homes

Introduction

Practice Model Outcomes Success Factors Challenges/Obstacles Conclusion

Background

ER Task Force 2004

Collaborative project Lions Personal Care Centre and WRHA

Recruitment Finding the right person

Started June 2007

STRONG Model

Direct Comprehensive Care (80%) Support of Systems (5%) Education (5%) Research (5%) Publication and Professional

Leadership (5%)

Direct Comprehensive Care

Biannual/Admission History and Physical

Episodic illness management Chronic disease management End of Life Care Interdisciplinary team participation

Support of Systems

Best practice guidelines and policies Bowel management Subcutaneous medication

administration Hypodermoclysis Ear irrigation

Education

Education to support best practice guidelines implementation

Management of behavioral and psychological symptoms of dementia

Chemical restraints

Preceptor for NP students and colleague orientation

Research

Knowledge translation of research to practice

Involved in evaluation of NP role at Lions PCC

Increase focus for future

Publication and Professional Leadership

Five publications on such topics as insomnia and BPSD management

Two abstracts accepted for Alzheimer’s Society conference in March 2009

Workshops and information sharing

Resident Outcomes

Improvement in quality of life Increased feeling of security Education, counseling by NP Enhanced end of life care and

decision-making

Better Care

Evidenced based care Timely interventions On-site suturing Improved medication management

Percentage of Residents with 9 or More Medications

0

5

10

15

20

25

30

2007 2008

55% Decrease

Percentage of Residents on Antipsychotic

Medications

0

5

10

15

20

25

30

35

40

2007 2008

57% Decrease

Staff Outcomes

Role modeling

Clinical leadership – staff satisfaction with care

Education

Effective time management and planning

Enhanced teamwork

Facility Outcomes

Availability of on site clinical expertise

Facilitation and issue resolution

Enhanced primary care involvement with interdisciplinary team

Increased family satisfaction with care

Family Satisfaction with Care

0

10

20

30

40

50

60

70

80

90

100

2007 2008

24% Increase

System Outcomes

Addresses shortage of primary care physicians in PCC

Reduced need for external consultations (e.g. WRHA PCH and Palliative Care CNS)

Cost efficiency Decreased medication utilization Decreased acute care utilization Decreased physician billings

Drug Costs Per Bed

Per Month

0

10

20

30

40

50

60

70

80

90

100

2007 2008

27% Decrease

$37,584 annual savings

Number of Transfers to Hospital

0

10

20

30

40

50

60

2007 2008

28% Decrease

Success Factors

Collaborative practice model with Medical Director

Regional and facility support

Model of care

Strengths of individual NP

The Right NP

Pioneer spirit Self-directed Able to work in the gray zone Willing to shape own practice Thirst for knowledge

HAS MADE ALL THE DIFFERENCE

Challenges – ROLE

New specialty Limited education in geriatric care Recruitment

Change/Innovation Building trust Changing practices Acceptance from specialist NP role versus RN role

Challenges - System

Acute care communication

Limitation of medical information

Family expectations

Obstacles

Legislation – Vital Statistic Act/Controlled Substance Act

Challenging the status quo – Public Trustee

Prescription of Part 3 Drugs

Third Party Payers

Conclusion

Success beyond expectations

Key is individual and organizational support for implementation

Opportunity to expand the model to other PCH’s