nurse practitioner: lynne day clinical … ageing + care... · page 1 of 24 lynne day, acnp: cpgs...

of 24 Lynne DAY, ACNP: CPGs [October 2015]

NURSE PRACTITIONER: Lynne Day

CLINICAL PRACTICE GUIDELINES: October 2015

Health Service: Private Nurse Practitioner (Aged Care) Consultation Service

Area of Specialty: Community and Residential Aged Care

Setting:

The Consultant Aged Care Nurse Practitioner service operates to provide home based access to health and wellbeing services for aged people and their carers living in the community or Residential Aged Care Facilities.

Main areas of care activity include:

client's private home

retirement villages, supported living accommodation

Residential aged care facilities

GP practices or clinics.

Nurse Practitioner Role:

The Aged Care Nurse Practitioner (ACNP) works collaboratively by liaising with patients and their families, allied health professionals, general practitioners (GP's), specialists, pathologists, pharmacists, aged care service providers, nurses and autonomously, by being responsible for a complete and holistic episode of care. A complete episode of care encompasses comprehensive and/or targeted assessment, requesting of diagnostics, developing treatment/management care plans, coordinated implementations alongside recommendations to meet health goals, risk management strategies, monitoring, education (patient, family, staff),and timely evaluation with eventual discharge.

The ACNP works within the primary health setting to prevent unnecessary hospital presentations due to exacerbation of health conditions. To achieve that goal of care, the APNP ut i l ises guidance for self-management of chronic conditions, evidence-based education techniques for optimal adherence to health management interventions, comprehensive health assessment, and aged care advocacy and planning.

The ACNP is responsible and accountable for making professional judgments about the patient's condition and a timely referral to a medical officer as required.


As a Nurse Practitioner, I comply with my responsibilities for maintaining individual professional development at an expert level.

Client/Patient Population:

Males and females aged 65 years and older residing in the community (Including Residential Aged Care Facilities)

Aboriginal and Torres Strait Islander peoples approximately 45 years and over.

Date of Approval: 28 January 2016

Date for Future Review: 28 January 2019


CONTENTS Page

Clinical Practice Guideline Advisory Committee: Members and Signatures 3

Evidence of Additional Health Professional and/or stakeholder consultation 3

INTRODUCTION 5

ASSESSMENT 5-7

Define Nurse Practitioner Assessments Physical Examination 6

TRANSFER 6-7

Conditions for Urgent Transfer to Emergency Department 6

Conditions for Semi Urgent Transfer 7

REFERRAL 7

Conditions for Referral to other Health Professionals 7

MANAGEMENT 7-12

Treatment Options and Conditions for Nurse Practitioner 7

Diagnostic Investigations 9

Health Promotion/Illness Prevention Strategies and Referrals 9

Implementation of Treatment Plan 9

Non Pharmacological Management Approaches 10

Pharmacological Management 11

Prescribing Arrangements 12

Continuing Therapy Only 12

Shared Care Model 12

Follow Up Care 12

CLINICAL PRACTICE GUIDELINES 13

Plans for Dissemination of Clinical Practice Guidelines 13

Plans for Review and Revision of Clinical Practice Guidelines 13

MEDICATION FORMULARY 14-21

Medications 22

Schedule 8 Drugs 22

REFERENCES 23-24

CLINICAL PRACTICE GUIDELINES CHECKLIST 25


Clinical Practice Guideline Advisory Committee Members (CPGAC): Local Service Area

CPGAC team members, area of speciality/practice, signature and review dates:


INTRODUCTION

This C l i n i c a l P r a c t i ce G u i d e l i n e ( CPG) outlines the Aged Care Nurse Practitioner's (ACNP) role in providing a clear continuum of health and care, potentially reducing unnecessary hospital admissions for the elderly and a continuum of care for improved health outcomes.

The ACNP works autonomously and collaboratively within a multi disciplinary team which includes a general practitioner, registered nurse or NP and a pharmacist.

The ACNP Private Consultation service is able to provide a complete episode of primary health care to patients presenting via a personal request for service, general practice referral, residential aged care facility or Community Aged Care Service referral or specialist referral. NPs are legally and professionally accountable for their own practice. They work to complement existing services, and refer patients who fall outside their scope of practice, directly to the GP or local emergency department as required.

ASSESSMENT

The ACNP utilises advanced practice knowledge and skills to manage care delivery, undertaking a thorough health assessment of individual patients by use of the following as appropriate:

performing a comprehensive health assessment including psychosocial needs and health literacy

review of body systems

performing an appropriate physical examination, including vital signs, mental status and targeted system assessment according to client presentation

performing a comprehensive care planning assessment including environmental and caregiver needs, functional assessment, coping and adaptation strategies, formal and informal support networks

identifying individual requirements to access health data from relevant persons

identifying health risks

identifying prioritised problem lists associated with health and quality of life, wellbeing and environment

applying crisis intervention when indicated

evaluating patient's adherence and response to the plan of care.

If the assessment reveals that the care the patient / family require is beyond the scope of the ACNP, the patient will be referred to a GP or Emergency Department.


Defining Nurse Practitioner Assessments:

Physical Examination

This could include but not be limited to:

vital sign assessment

mental status assessment

respiratory assessment

musculoskeletal assessment: falls assessment

abdominal assessment

genitourinary assessment

lymphatic assessment

musculoskeletal assessment

neurologic assessment

cranial nerve assessment

skin assessment

ear examination

eye examination.

TRANSFER

Conditions for Urgent Transfer to Emergency Department (ED)

An enacted Advance Health Directive may preclude urgent referral to ED in consultation with the patient/family and other health professionals.

This could include but not be limited to clients presenting with:

medical emergency e.g. Acute Coronary Syndrome

drug reaction (life threatening)

loss of consciousness: Clients receiving palliative/terminal care who have an Advanced Care Directive in place may preclude urgent referral to ED)

cerebro-vascular accident

life threatening depression/psychosis/delirium

acute decline in respiratory function

pulmonary embolism I deep vein thrombosis.


Conditions for Semi Urgent Transfer


cardiac failure

gross heamaturia

acute abdomen

acute urinary retention (with no immediate access to catheterisation)

fracture (suspected)

unexplained or uncontrolled pain

Chronic Obstructive Pulmonary Disease (COPD), exacerbation not responding to empiric treatment.

REFERRAL

Conditions for referral to other Health Professionals:

Referral to a GP: Compromising exacerbation or new presentation


diabetes

severe & malignant hypertension

Parkinson's disease & Parkinsonism

behavioural disorders of dementia

psychosis

arthritis

depression

delirium

urinary tract infection presentation in males, after recent instrumentation or recurrence

COPD

post herpetic neuralgia unrelieved with Formulary Treatment.

MANAGEMENT

Treatment Options and Conditions for Nurse Practitioner Management

Clients who present or are referred with sub acute or non-acute conditions will be managed by the ACNP. Consultation with a GP will occur as required.

These presentat ions may include:

advanced and comprehensive health and wellbeing assessment


acute alteration in cognitive status

urinary tract infections (uncomplicated)

pain management (acute & chronic)

constipation and faecal incontinence

continence promotion & management, urinary incontinence: stress/ urgency/retention/functional/mixed

community acquired pneumonia

COPD exacerbation

shingles (post herpetic neuralgia)

soft tissues infection: folliculitis/cellulitis/impetigo

wound infection

fungal infections such as candidiasis

cerumen blockage of auditory canal

conjunctivitis

chronic disease management (in collaboration with other appropriate health providers)

lifestyle modification and health promotion

monitoring glycaemic control (diabetes type ii): HBA1C

malnutrition/unintended weight loss

dehydration

delirium management: reversible causes

dementia (management of behaviours associated with)

poly pharmacy, medication review (in consultation with the GP and Pharmacist)

peg tube care

supra-pubic catheter care

subcutaneous fluid administration

falls prevention/osteoporosis education vitamin. d deficiency/bone mineral density

palliative pathway/end of life care

pressure area prevention and management

community liaison/navigation for community care support, residential placement

screening assessment (falls, dementia, depression, caregiver burden, skin integrity, continence, under nutrition, functional assessment)

review and renewal of drugs prescribed by GP

vaccination


care planning/coordination

case management (as indicated).

Diagnostic Investigations

The ACNP accurately conducts and interprets diagnostic tests to inform diagnosis including.

UEC, FBC, LFT, CRP Vit. D, TFTs, Glycosylated Haemoglobin, Iron Studies, Coagulation Studies, FOBT, Lipid Studies, 812, Red Cell folate

dementia screening

microbiology culture and sensitivity of urine, sputum, wound swabs, stool, cervical and vaginal pathology

medical imaging (plain axial skeleton and chest, UltraSound: various).

Health Promotion/Illness Prevention Strategies and Referrals

The ACNP will aim to develop and implement a management plan to achieve evidence-based treatment targets, addressing any barriers identified in partnership with the patient and health team. The NP:

prescribes non-pharmacological therapies

prescribes pharmacological agents

identifies individual requirements to access health care services that support the implementation of care

makes appropriate referrals to other health care professionals and community agencies

provides relevant health promotion, restoration, lifestyle modification and prevention education to the patient/carer.

Implementation of Treatment Plan

Interventions are based upon priorities identified in consultation with client and/or advocate.

Treatment is individualised and specific to the client’s situation I active condition.

Treatment is based on scientific principles, theoretical knowledge and clinical expertise that has a sound contemporary evidence basis

Priorities are established, and a mutually acceptable plan of care is devised to maximise the health potential of the individual.

Non-Pharmacological Management

The ACNP acknowledges that nursing implementations to meet identified goals importantly includes the use of evidence-based non-pharmacological approaches. Accordingly the ACNP may include the following management approaches, including:


individually tailored evidence-based programs (assessment, intervention and monitoring)

education

monitoring

carer education and support

medication review

exercise programs

weight loss strategies

pain management strategies

mobility, independence and safety aid information

dietary information

home safety assessment

home modification information

behavioural modification strategies

information and/or referral to community services

symptom management strategies

coordination and provision of carer support

case management/case conference

pressure relieving techniques

advance health planning, advocating for Enduring Power of Attorney

(EPOA) advocacy information

provision of consumer health promotion literature

elder abuse information

referral/linkages with support organisations residential care options

wound care

nursing care plan support

pelvic floor exercises

sleep programs

continence care/Bowel Management.


Pharmacological Management

See Formulary for detailed list.

Conditions the ACNP could consider for pharmacological management include:

dementia

delirium

anxiety disorders

depression

insomnia

restless legs syndrome

gout

osteoarthritis

fall prevention

osteoporosis

dyslipidaemia

oedema

orhthostatic hypotension

asthma

chronic obstructive pulmonary disease

chronic cough

community acquired pneumonia

nursing home acquired pneumonia

influenza

immunisation

dyspepsia

gastro-oesophageal reflux disease

peptic ulcer disease

nausea and vomiting

malnutrition

non acute dehydration

constipation

diarrhoea

peri-anal conditions

urinary tract infections

iron deficiency anaemia


conjunctivitis

dry eyes

eyelid problems

ear wax

otitis media and externa

rhinitis

sinusitis

scabies

herpes zoster (shingles)

skin infections

dry itchy inflamed skin

pain management

palliative care issues.

Prescribing Arrangements

Pharmaceutical Benefits Scheme (PBS) prescribing is limited by a Nurse Practitioner's scope of practice and State/Territory prescribing rights.

Continuing Therapy Only (CTO)

Continuing therapy occurs when the patient's treatment and prescribing of a medicine has been initiated by a Medical Practitioner and further prescribing is continued by the Nurse Practitioner. No titration or cessation of the medication is allowed without prior consultation with the GP.

Shared Care Model (SC)

A shared care model of practice occurs when care is shared between a NP and a medical practitioner via a formalised arrangement, in a patient-centred model of care. The details surrounding shared care arrangements will depend on the practitioners involved, patient needs and the health care context. Medication initiation, titration and/ or cessation may occur autonomously by the NP in the context of the formalised, patient-centred agreement, on a patient by patient basis.

Follow Up Care

The ACNP is responsible for follow up and evaluation of appropriate episodic health care issues, managing abnormal results within scope of practice, and monitoring progress.

Frequency of ACNP follow up is determined by individual patient requirements and the treatment plan. Actions taken by the NP are communicated to the GP and/or allied health professionals as indicated.


This document reflects current safe clinical practice. However, as in all clinical situations there may be factors which cannot be governed or guided by a single set of guidelines. This document does not replace the need for application of expert clinical judgement to each individual presentation.

CLINICAL PRACTICE GUIDELINES

Plan for Dissemination of Clinical Practice Guidelines

A copy of the ACNP CPGs will be:

posted on the ACT Health website held at the Nursing and Midwifery Office, ACT Health held at Aged Health and Care Consulting Pty Ltd

Plan for Review and Revision of Clinical Practice Guidelines

This CPG will be reviewed and evaluated on a regular basis through a local collaborative team to ensure that it meets the needs of the patients, the NP and the GP.

Formal review and evaluation of the CPGs is required within a three year period. Any changes to the CPGs will be notified to the Office of the Chief Nursing Officer to ensure that they remain current.


MEDICATION FORMULARY

This formulary provides for the poisons and restricted substances that may be possessed, used, supplied or prescribed by the ACNP.

Medication Class Medication Form/Concentration Notes

Anti-infectives Nitrofurantoin Capsule

Ketoconazole Tablet, cream, shampoo

Antibiotics/Antifungals/

Antihelmintics

Aciclovir Tablet, cream

Amoxycillin Trihrdrate Tablet, capsule, oral liquid

Amoxycillin trihydrate with potassium clavulante Tablet, liquid

Azithromycion Tablet, liquid

Cephalexin Capsule, liquid

Chloramphenicol 0.5% Eye drop, ointment

Clindamycin Capsule

Clotrimazole 1% Cream, vaginal cream

Ciprotloxacin Tablet

Clarithromycin Tablet, liquid

Dicloxaciollin sodium Capsule

Doxycycline Tablet, capsule

Erythromycin Tablet, capsule, liquid, gel (80mg.ml)

Famciclovir Tablet

Flucloxacillin Capsule, oral liquid: 50mg/ml

Fluconazole Capsule, liquid

Framycetin Dexamethazone, gramicidin (Sofradex) Ear drops

Lyermectin Tablet

Metronidazole Tablet, liquid, cream

Miconazole 2% Cream, liquid, spray, powder or shampoo,


vaginal cream.

Mupirocin Ointment or cream

Norfloxacin Tablet

Nystatin Oral drops, tablet, capsule, cream

Oseltamivir Capsule

Phenoxymethylpenicillin Tablet, capsule, liquid

Pytantel Tablet, liquid

Roxithromycin Tablet

Silver Sulfadiazine Cream

Terbinafine Tablet, cream, liquid, gel

Trimethoprim/sulfamethoxole Tablet, liquid

Valaciclovir Tablet

Analgesia Asprin Soluble tablet

Paracetamol Tablet, liquid, suppository

Paracetamol: controlled release Tablet

Paracetamol 500 mgs & codeine 8mg Tablet



Non-steroidal anti-inflamatories Diclofenac Tablet, suppository, topical gel

Ibuprofen (adult) Tablet, suppository, topical gel

Meloxicam Tablet, capsule

Opioid analgesia Tablet, capsule

Buprenorphine Patch

Fentanyl Patch, lozenge, oral liquid

Morphine HCL Liquid

Morphine Sulphate Ampoule, capsule, oral liquid

Tablet: controlled release


Oxycodone Tablet, Tablet: controlled release, capsule, liquid, suppository, granules

Hydromorphine Injection

Cardiovascular Drugs Spiranolactone Tablet CTO

Frusemide Tablet

Bumetanide Tablet CTO

Nitrates (lsosorbide di/mononitrate, Glyceryl Trinitrate) Tablet CTO

Thiaizides (Hydrochlorthiazide with/ without Triamterene, lndapamide)

Tablet CTO

ACE Inhibitors (Enalapril, Trandolapril, Perindopril, Rampiril, Lisinopril, Fosinopril, Quinapril, Captopril) C

Tablet CTO

Sartans (Eprosartan, Telmisartan, lrbesartan, Candesartan, Valsartan, Olmesartan, Karvezide)

Tablet CTO

Calcium Channel Blockers (Amlodipine, Diltiazem, Lercandipine, Verapamil)

CTO

Beta Blockers (Propranolol, Metoprolol succinate and tartrate , Atenolol, Bisoprolol , Carvedilol)

Tablet CTO

Prazosin Tablet CTO

Clonidine Tablet CTO

Anti-arrhythmics (Digoxin, Amiodarone, Sotalol) Tablet CTO

Statins (Simvastatin, Pravastatin, Rosuvastatin, Atorvastatin, Fluvastatin)

Tablet CTO

Bile Acid Binding Resins (Colestipol, Cholestyramine)

Tablet CTO

Fibrates (Fenofibrate, Gemfibrozil) Tablet CTO

Ezetimibe Tablet CTO

Statins (Simvastatin, Pravastatin, Rosuvastatin, Atorvastatin, Fluvastatin)

Tablet CTO

Bile Acid Binding Resins (Colestipol, Cholestyramine)

Tablet CTO

Fibrates (Fenofibrate, Gemfibrozil) Tablet CTO


Benzodiaiazepines Midazolam Ampoule

Lorazepam Tablet, wafer

Laxative & anti-diarrhoel Drugs Loperamide Tablet or capsule

Macrogol(Movicol) Sachet

Lactulose Oral liquid

Docusate (Coloxyl) Tablet

Docusate & Senna Tablet

Sodium Citrate, sodium laurel sulfoacetete, sorbitol and sorbic acid (Microlax enema)

Squeeze bottle solution

Fleet enema Squeeze bottle solution

Fluid Therapy Sodium Chloride 0.9% Intravenous fluid

Oral Rehydration Salts (Gastrolyte) Powder for liquid

Blood & electrolytes Heparin Sodium Subcutaneous CTO

Warfarin Tablet CTO

Clopidogrel Tablet CTO

Dabigitran Capsule CTO

Apixaban Tablet CTO

Rivaroxaban Tablet CTO

Potassium Chloride Tablet

Magnesium Aspartate Tablet

Folic Acid Tablet

Iron Tablet

Vitamin 812 Tablet/intramuscular

Ear, nose & throat Drugs Betahistine Table

Cerumenolytics Drop

Tramcinolone, Neomycin, Nystatin and Gramicidin Drop/ointment


Betahistine Table

Endocrine Drugs Sulfonylureas (Glipizide, Glimepiride, Cliclazide,

Glibenclamide)

Tablet CTO

Thiazolidinediones (Rosglitazone, Pioglitazone) Tablet CTO

Metformin Tablet CTO

Insulins Subcutaneous CTO

Thyroxine Sodium Tablet CTO

Alendronate Tablet CTO

Vitamin D Tablet/capsule

Calcium Tablet

Carbimazole Tablet CTO

Gastrointestinal Drugs Ondansetron Tablet/wafer/I iquid

Anorectal Products Supp/liquid

Antacids Tablet, /liquid

Bisacodyl Tablet, /suppository

Bulking Agents Cap/granule/powder

Docusate Tablet

Domperidone Tablet

Ginger Tablet, capsule

Hyoscine butylbromide Tablet, SCI

Lactulose Liquid

Loperamide Tablet, capsule

Metoclopromide Tablet, injection

Oral Rehydration Salts Powder for liquid

Peppermint Oil Capsule

Polyethylene glycol laxatives Powder for oral liquid


Prochlorperazine Tablet/injection

Musculoskeletal Drugs NSAIDS (Sulindac, Meloxicam, Piroxicam,

Ketoprofen)

Tablet, capsule

Methotrexate Tablet CTO

Allopurinol Tablet CTO

Neurological drugs for Parkinsonism Amantadine Tablet CTO

Entacapone Tablet CTO

Levodopa with benserazide or carbidopa Tablet CTO

Rasaqiline Tablet CTO

Seleqiline Tablet CTO

Apomorphine CTO

Pramipexole CTO

Rotigitine CTO

Cabergoline CTO

Anticholinesterases in Alzheimer’s disease

Donepezil Tablet CTO

Galantamine Tablet, capsule CTO

Rivastiqmine Tablet, patch CTO

Anti-epileptic Drugs Gabapentin Tablet, capsule CTO

Phenytoin Tablet, capsule CTO

Pregabalin Tablet, capsule CTO

Valproate Tablet, liquid CTO

Psychotropic Drugs SSRIs (fluvoxamine, Citalopram, Escitalopram, Sertaline, Paroxetine, Fluoxetine)

Tablet, capsule CTO

Amitriptyline Tablet CTO

Other anti-depressants (duloxetine, mirtazapine, venlafaxine, desvenlafaxine)

Tablet, capsule CTO

Respiratory Drugs Salbutamol Solution, inhaler


Ipratropium-bromine Solution, inhaler

Oxygen Inhaled gas

Ocular Drugs Hypromellose 0.5% Eye drops

Polyvinyl alcohol 1.4% Eye drops

Carbomer 980 0.2% Eye drops

Anaesthetic agents Lignocaine 1% Injection

Prilocaine & Lignocaine (EMLA) Cream or patch

Antipsychotic Drugs Haloperidol Tablet, oral liquid, injection

Risperidone Tablet, oral disintegrating tablet, oral liquid

Genitourinary system drugs Oxybutynin Hydrochloride Tablet

Solifenacin Tablet

Urinary Alkalinisers Sachet

Immunomodulation Betamethasone 0.5% Cream, lotion, ointment, lotion

Hydrocortisone 1% Cream, spray

Prednisone/Prednisolone Tablet

Mometasone Cream, ointment, lotion

Methylprednisolone Cream, lotion, ointment

Emergency Drugs Adrenaline Injection 1mg/ml

Glucagon Injection

Glyceryl Trinitrate Tablet, spray

Immunisations as per National Immunization Schedule

Diptheria, tetanus and pertussis (ADT) Injection

Influenza Vaccine Injection

Pneumococcal Vaccine (23 valent) Injection

Miscellaneous Glucosamine Tablet

Cranberry Tablets Tablet, capsule

Urinary Alkaliniser Sachet


Medications

Drugs will be carried by the ACNP as per the emergency list, for administration to persons in private homes as required.

If attending residents in a residential aged care facility drugs will be used from the residents' own supply or from the Drug Imprest maintained by the facility. Should the RACF not have a stock of the drug(s) required, the ACNP may utilise the stock carried by them if it is not possible to have a prescription dispensed in an appropriate time frame for initiation of treatment.

Schedule 8 Drugs

Should a patient in the community be suffering severe pain, the Ambulance Paramedics will be called to attend the patient.

Any scheduled drugs (requiring a prescription) will be locked securely in the nominated place of practice of the ACNP or in a locked, temperature appropriate container in the boot of the ACNPs car if in transit to see a patient in the community.

All stock medication will be monitored for use-by-date and any signs of deterioration.

The ACNP will comply with all guidelines and legislation relating to the storage and disposal of medications.

Unused or out of date medications will be returned to the pharmacy for destruction.

Used equipment such as syringes and needles will be placed in an approved sharps safety container for high temperature incineration. This container will be taken to a local pathology collection centre, when full, for disposal.

Used opioid dermal patches which are removed from a patient will be disposed of in the sharps container or returned to pharmacy for destruction depending on the environment in which the NP is working at the time.

The NP will comply with Vaccination Policies and Procedures as informed by The Australian Immunisation Handbook (10th Edition 2013).

LEGISLATION:

Human Rights Act 2004

Health Practitioner Regulation National Law (ACT) Act 2010

Health Records (Privacy and Access) Act 1997

Medicines, Poisons and Therapeutic Goods Act 2008

Privacy Act 1988 (Cwlth)

Public Health Act 1997


REFERENCES

Aged Care Emergency Manual. (2008). Aged care and Rehabilitation Services, Concord Hospital.

American Geriatrics Society Panel on the Pharmacological Management of Persistent Pain in Older Persons. (2009). Pharmacological Management of Persistent Pain in Older Persons. JAGS: 57, 8: 1331-1346.

Australian Doctor (2012). How to Treat: Depression. 2 November, pp25-32.

Australian Institute for Health and Welfare. (2010). Aged Care. Accessed 18/4/11 from: http://www.aihw.gov.au/aged-care-indigenous/

Australian Medicines Handbook. (2015). Adelaide: South Australia. (electronic version via subscription). https://shop.amh.net.au/

Behaviour Management: A guide to Good Practice Managing Behavioural and Psychological Symptoms of Dementia DBMAS.

AMH Drug Choice Companion: Aged Care. (2010). 3rd Edition. Australian Medicines Handbook Pty Ltd: Adelaide, South Australia. ( via electronic subscription).

Government of South Australia (nd). Metro homelink: Anaphylaxis Treatment Protocol.

NHMRC. Australian Immunisation Handbook (2013. 10th Ed. Available online at: http://www.health.gov.au/internet/immunise/publishing.nsf/Content/Handbook-home

Department of Health and Human Services. (2008). Palliative Care, Care Management Guidelines: Pain Management. Tasmania. http://www.dhhs.tas.gov.au/__data/assets/pdf_file/0006/36951/Pain_Management_Final211209_PCSSubComm.pdf

Selby, W. & Corte, C. (2010). Managing constipation in Adults. Australian Prescriber, 33, 4. August.

Medicines Management Team. (2013). STOPP START Toolkit: Supporting Medication Review. NHS Cumbria.

The Royal Australian College of General Practitioners. (2006). Medical care of older persons in Residential aged care facilities. RACGP. Melbourne.

http://www.aihw.gov.au/aged-care-indigenous/

https://shop.amh.net.au/

http://www.health.gov.au/internet/immunise/publishing.nsf/Content/Handbook-home

http://www.health.gov.au/internet/immunise/publishing.nsf/Content/Handbook-home

http://www.dhhs.tas.gov.au/__data/assets/pdf_file/0006/36951/Pain_Management_Final211209_PCSSubComm.pdf

http://www.dhhs.tas.gov.au/__data/assets/pdf_file/0006/36951/Pain_Management_Final211209_PCSSubComm.pdf


WEBSITES:

Advance Care Planning Australia: ACT resources: http://advancecareplanning.org.au/resources/australian-capital-territory

Care Search: Clinical Evidence

http://www.caresearch.com.au/caresearch/tabid/132/Default.aspx

eTG complete [Internet]. Melbourne: Therapeutic Guidelines Limited. (via subscription)

National PrescriberService ( NPS) http://www.nps.org.au/health-professionals

palliAGED Decision Assist (via app). Telehealth resources funded by Australian Government Department of Health. http://www.caresearch.com.au/caresearch/tabid/3224/Default.aspx

Wolters Kluwer Health Clinical Solutions. Up to Date. (2015). (via subscription): http://www.uptodate.com/home/wolters-kluwer-health-clinical-solutions

http://advancecareplanning.org.au/resources/australian-capital-territory

http://www.caresearch.com.au/caresearch/tabid/132/Default.aspx

http://www.uptodate.com/home/wolters-kluwer-health-clinical-solutions


Clinical Practice Guidelines Checklist

Before submitting your Clinical Practice Guidelines for approval and endorsement by the ACT Chief Nurse and Director-General, please ensure all the following elements have been addressed, including:

Designated Logo on the Clinical Practice Guidelines if applicable

Description of the Patient/Client Population

Date and Version Number of the Clinical Practice Guidelines

Review Date Stated

Plan for Dissemination, Review & Evaluation of CPGs

Reference list included.

nurse practitioner: lynne day clinical … ageing + care... · page 1 of 24 lynne day, acnp: cpgs...

Documents