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Nurse Practitioner. Making a Difference in Personal Care Homes. Introduction. Practice Model Outcomes Success Factors Challenges/Obstacles Conclusion. Background. ER Task Force 2004 Collaborative project Lions Personal Care Centre and WRHA Recruitment Finding the right person
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Nurse Practitioner Making a Difference in Personal Care Homes
Introduction • Practice Model • Outcomes • Success Factors • Challenges/Obstacles • Conclusion
Background • ER Task Force • 2004 • Collaborative project • Lions Personal Care Centre and WRHA • Recruitment • Finding the right person • Started June 2007
STRONG Model • Direct Comprehensive Care (80%) • Support of Systems (5%) • Education (5%) • Research (5%) • Publication and Professional Leadership (5%)
Direct Comprehensive Care • Biannual/Admission History and Physical • Episodic illness management • Chronic disease management • End of Life Care • Interdisciplinary team participation
Support of Systems • Best practice guidelines and policies • Bowel management • Subcutaneous medication administration • Hypodermoclysis • Ear irrigation
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
Research • Knowledge translation of research to practice • Involved in evaluation of NP role at Lions PCC • Increase focus for future
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
Resident Outcomes • Improvement in quality of life • Increased feeling of security • Education, counseling by NP • Enhanced end of life care and decision-making
Better Care • Evidenced based care • Timely interventions • On-site suturing • Improved medication management
Percentage of Residents with 9 or More Medications 55% Decrease
Percentage of Residents on Antipsychotic Medications 57% Decrease
Staff Outcomes • Role modeling • Clinical leadership – staff satisfaction with care • Education • Effective time management and planning • Enhanced teamwork
Facility Outcomes • Availability of on site clinical expertise • Facilitation and issue resolution • Enhanced primary care involvement with interdisciplinary team • Increased family satisfaction with care
Family Satisfaction with Care 24% Increase
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
Drug Costs Per Bed Per Month 27% Decrease $37,584 annual savings
Number of Transfers to Hospital 28% Decrease
Success Factors • Collaborative practice model with Medical Director • Regional and facility support • Model of care • Strengths of individual NP
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
Challenges – ROLE • New specialty • Limited education in geriatric care • Recruitment • Change/Innovation • Building trust • Changing practices • Acceptance from specialist • NP role versus RN role
Challenges - System • Acute care communication • Limitation of medical information • Family expectations
Obstacles • Legislation – Vital Statistic Act/Controlled Substance Act • Challenging the status quo – Public Trustee • Prescription of Part 3 Drugs • Third Party Payers
Conclusion • Success beyond expectations • Key is individual and organizational support for implementation • Opportunity to expand the model to other PCH’s