COLLABORATIVE PRACTICE

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COLLABORATIVE PRACTICE IN HOME CARE CLINICAL
NURSE SPECIALIST AND FAMILY PHYSICIAN
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Collaborative Practice for Wound Care

• Collaboration is characterized by an atmosphere
  of mutual respect for one anothers knowledge and
  competence, and a mutual concern for the
  provision of quality of care.

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Collaborative Practice for Wound Care

• The overlap of scopes of practice of registered
  nurses and physicians (or shared competencies)
  are areas of common ability to provide services.

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Collaborative Practice for Wound Care

• Decisions regarding which professionals provide
  service in areas of shared competency must
  consider
• the needs of the patient,
• individual competencies
• context of practice

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Collaborative Practice for Wound Care

• Collaborative decision making conducted in an
  atmosphere of trust, respect and open
  communication facilitates care
• (CPS of MB Code of Ethics)

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Role of the CNS (for the Program)

• Acts as a clinical expert/resource/consultant
• Provides leadership support for staff and the
  Program
• Sets standards for practice to ensure decision
  making is evidence based

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Role of the CNS (for the Program)

• Provides education
• Participates in and initiates research
• Disseminates knowledge through presentation and
  publication

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Role of the CNS (for Individual Clients)

• Advanced assessment
• Chronic wounds (PU, DFU, VLU/AU/Mixed)
• Non healing surgical wounds
• Continence
• Diabetes management

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Role of the CNS (for Individual Clients)

• Investigations (Handheld Doppler)
• ABPIs
• Toe Pressures
• Initiate Treatment
• Evidence based advanced wound care products
• compression therapy
• silver products
• VAC therapy etc.

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Role of the Family Physician

• Continuing Education regarding
• Collaborative Practice
• Wound Care
• General Medical Care of patients with complex
  wounds
• Holistic view of patient in terms of nutritional,
  psychosocial, medical factors, mobility
• Familiarity with regional resources

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Role of the Family Physician

• Integration of care between programs, disciplines
  and medical specialties
• Continuity of care
• Patient advocacy

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Role of the Family Physician

• Identify opportunities for collaborative practice
  with CNS/ WCBPT for individual clients
• Be available and open regarding collaborative
  discussions relating to investigations and
  treatment plan
• Make appropriate referrals to Physician
  Specialists and specialty programs

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Role of the Family Physician

• Order investigations as required (ie. ESR,
  albumin/pre-albumin)
• Order medications and prescription
  creams/ointments as medically indicated
• Share positive collaborative experiences with
  physician colleagues

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Elements of Success

• Supportive management structure
• Sr.VP Community Care
• Director for Home Care
• Medical Director (past and present)
• Physician Champions based on personal experience,
  continuing education and positive outcomes

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Elements of Success
Committed CNS who never gives up!!
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Challenges and Barriers

• Physician/Specialist comfort with expanding role
  of nursing practice
• Comfort level for Nurses- following CNS treatment
  plan without physician order

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Collaborative Wound Care

• Mr. A (3 years on service) 
• Bilateral venous leg ulcer
• Costs (various treatments, sterile technique)
• 33.18 per dressing change/2 nursing visits per
  day (25/visit)
• 116.36/day
• Total Costs
• Per Year 42,471.00 

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Collaborative Wound Care

•  
• Outcomes
• Client had been on service for 3 years with no
  healing
• Total costs for 3 years 127,414.20
• Client frustrated, unable to go out

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CNS consulted..

• Evidence based wound care
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• Costs (2x week dressing change clean no touch
  technique )
• 46.30 (Profore dressings)
• 50 (2 Nursing Visits per week )
• 96.30/week 
• Total Costs (until healed)
• 96.30 x 16 weeks 5.13 (one box of clean
  gloves) 1545.93 

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CNS consulted..

• Outcomes
• Clients wound healed in 16 weeks!!!
• Client satisfied and able to go out

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QUESTIONS?