Nurse Practitioner

1
Nurse Practitioner

• Making a Difference in
• Personal Care Homes

2
Introduction

• Practice Model
• Outcomes
• Success Factors
• Challenges/Obstacles
• Conclusion

3
Background

• ER Task Force
• 2004
• Collaborative project
• Lions Personal Care Centre and WRHA
• Recruitment
• Finding the right person
• Started June 2007

4
STRONG Model

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

5
Direct Comprehensive Care

• Biannual/Admission History and Physical
• Episodic illness management
• Chronic disease management
• End of Life Care
• Interdisciplinary team participation

6
Support of Systems

• Best practice guidelines and policies
• Bowel management
• Subcutaneous medication administration
• Hypodermoclysis
• Ear irrigation

7
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

8
Research

• Knowledge translation of research to practice
• Involved in evaluation of NP role at Lions PCC
• Increase focus for future

9
Publication and Professional Leadership

• Five publications on such topics as insomnia and
  BPSD management
• Two abstracts accepted for Alzheimers Society
  conference in March 2009
• Workshops and information sharing

10
Resident Outcomes

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

11
Better Care

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

12
Percentage of Residents with 9 or More Medications
55 Decrease
13
Percentage of Residents on Antipsychotic
Medications
57 Decrease
14
Staff Outcomes

• Role modeling
• Clinical leadership staff satisfaction with
  care
• Education
• Effective time management and planning
• Enhanced teamwork

15
Facility Outcomes

• Availability of on site clinical expertise
• Facilitation and issue resolution
• Enhanced primary care involvement with
  interdisciplinary team
• Increased family satisfaction with care

16
Family Satisfaction with Care
24 Increase
17
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

18
Drug Costs Per Bed Per Month
27 Decrease 37,584 annual savings
19
Number of Transfers to Hospital
28 Decrease
20
Success Factors

• Collaborative practice model with Medical
  Director
• Regional and facility support
• Model of care
• Strengths of individual NP

21
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

22
Challenges ROLE

• New specialty
• Limited education in geriatric care
• Recruitment
• Change/Innovation
• Building trust
• Changing practices
• Acceptance from specialist
• NP role versus RN role

23
Challenges - System

• Acute care communication
• Limitation of medical information
• Family expectations

24
Obstacles

• Legislation Vital Statistic Act/Controlled
  Substance Act
• Challenging the status quo Public Trustee
• Prescription of Part 3 Drugs
• Third Party Payers

25
Conclusion

• Success beyond expectations
• Key is individual and organizational support for
  implementation
• Opportunity to expand the model to other PCHs