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 Alzheimer’s 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 PCH’s