How evidence Informs NP practice- Regina Lutheran Home Experience.

1. How evidence Informs NP practice- Regina Lutheran Home Experience. Leah Clement BSN RN Director of Care/Leader for Elder Services Maureen Klenk MHs (APN) RN(NP) Nurse Practitioner

2. Eden Philosophy • Mission – to improve the well-being of Elders and those who care for them by transforming the communities in which they live and work • Vision – to eliminate the 3 plagues • Loneliness, helplessness, boredom – bulk of suffering for those living in LTC

3. Eden Care Philosophy • Guided by 10 Principles • Human habitat • Loving relationships • Give and receive care • Loving companionship • Spontaneity • Meaningful activity • Medicine the servant not the master • Elder centered care – autonomy in decision making • Human growth • Wise leadership

4. How to build an Eden Care LTC facility? • Dream a Dream • Create the Vision • A HOME in which all Elders have an opportunity to have timely access to a primary care provider • Elders have the best possible opportunity for a healthy quality of life so they can grow and flourish • Add an RN(NP) to the staffing complement as a ‘best fit’. • RN(NP)s are evidenced based providers with a holistic philosophy of care.

5. Implementing RN NP in LTC • Steps in the Process: • Plant the seeds with physicians, nursing team, pharmacist, others • Advertise & Recruit • Plant more seeds and warm the soil • Hire • Muddle through………..

6. Nurse Practitioners in Long-Term Care Facilities: Clinical and Cost-Effectiveness and Guidelines – CADTH (2012) • RESEARCH QUESTIONS • What is the clinical effectiveness of having nurse practitioners in long-term care facilities? . • What is the cost effectiveness of having nurse practitioners in long-term care facilities? • What are the evidence-based guidelines for having nurse practitioners in long-term care facilities?

7. Nurse Practitioners in Long-Term Care Facilities: Clinical and Cost-Effectiveness and Guidelines – CADTH (2012) • KEY MESSAGE • The evidence identified suggests that the implementation of nurse practitioners in long-term care facilities may result in an increase in family satisfaction and improved health services.

8. NP care improves Elder Care • Present –Monday to Friday • Able to observe Elders first hand. • Raises the ‘bar’ for assessment and learning for all staff. • Lowers the cost to the system, the facility and the elder.

9. NP utilize evidence to improve outcomes • Reduce adverse events by reducing pill burden • Reduce antibiotic resistance by decreasing the use of antibiotics – less UTI • Reduce fall rates-decrease use of antipsychotic and BEERS list medications • Reduce levels of pain- provide consistent analgesia

10. Still to work toward • Improve Incontinence by increasing fluid intake • Improve mental status by improving sleep- do elders need q2h turning? • “Younger’ Elders are coming under how care- how can we improve the social need for this age group.

11. Outcomes • Falls • Antipsychotic use • Pain control • Pressure ulcers • Elders with 8 prescriptive medications or less • Less visits to ER/Hospital admissions • Survey results- • Elder • Family • Care Team • Physicians

12. Implementing RN NP in LTC • Final Thoughts: • PERSERVERE!!!! • Innovation is hard! • “How will this contribute to the quality of life to Elders I serve?”

13. Thank you! • Questions? • Contact Information: • Leah Clement • Maureen Klenk