Nurse Practitioner Led Outreach Team (NLOT) Nurse Practitioners reduce unnecessary ER visits and improve the quality of care for residents in Long Term Care Homes. We can introduce ourselves.

Introduction What is the NLOT program? Our team consists of Nurse Practitioners Thirteen homes currently serviced in Windsor-Essex Collaborative approach to care Goal: to reduce unnecessary visits to the emergency room, hospitalizations and reduction of readmissions What is the NLOT program The Team consist of five nurse practitioners who work in long term care homes to help reduce avoidable transfers to the emergency department.  The role of the NP is to assess residents within the LTC facility and attempt to manage symptoms and conditions outside the emergency department to prevent burden of transfer on residents and families

Long Term Goal To have full time coverage for all LTC homes across Windsor-Essex region What is the NLOT program The Team consist of five nurse practitioners who work in long term care homes to help reduce avoidable transfers to the emergency department.  The role of the NP is to assess residents within the LTC facility and attempt to manage symptoms and conditions outside the emergency department to prevent burden of transfer on residents and families

LTC HOMES CURRENTLY SERVICED Nurse Practitioner Contact # Availability Huron Lodge Muna Al-Haddad (519) 995-0850 Monday-Friday Villages of St Clair Rachelle Patterson (519)995-1259 Iler Lodge Allison Coons (519) 819-1271 Brouillette Manor Extendicare SWL Berkshire L.J. Graovac  (519) 995-4689 Riverside (519) 995-1259 Regency Park Extendicare Tecumseh Aspen Lake L.J. Graovac (519) 995-4689 Herron Terrace Chateau Park Banwell Garden L.J. Graovac

Examples of Services Provided by the NP in LTC Facilities IV antibiotics* Minor procedures (sutures/I&D) Rehydration therapies* Troubleshooting of medical devices (i.e. PICC, G-tubes) Mobile imaging or arrangement for outpatient DI Wound care management Palliative care and support Medication management Bloodwork Provide education Referrals Repatriation visits IV antibiotic Initiate Hypodermoclysis Order O/P Xrays, U/S. Order O/P EKG Palliative visits Minor procedures Order labs; including troughs Arrange specialist appointments Manage acute on chronic conditions (This should be mentioned in the intro perhaps?) Manage G-Tubes Manage Tracheostomies (Do homes allow trachs?) Manage nephrostomies Provide Staff education We need to be careful and clear when we say we ‘manage’ in home. To me it seems like were implying managing over long-term. We assist with medical device issues/troubleshooting. We can educate re: management but I wouldn’t want to make myself responsible to be the one who manages anything on a long-term basis. We need to put the responsibility back on the home. I’ve never had to deal with nephrostomy issues or tracheotomies, I think some homes would actually refuse a resident with trach. More acute care – rehab type? *Services varies from home to home

Inclusion Criteria Main priority is to prevent ER transfers and hospital admissions Acute changes to resident’s baseline should be directed to the NP Examples: High BP, fever, nausea and vomiting, lacerations, altered mental status, G-tube failure, post hospital admission follow up, exacerbations of COPD, CHF, etc. ** DNR status should always be taken into consideration. POA involvement should also be reflected to guide treatment

Exclusion Criteria Residents who are in imminent distress and who are full codes should be transferred to hospital Any other concerns should be directed to the NP to decide if appropriate for assessment If the RN is unsure if the resident is an appropriate case for the NP to review, this should be discussed. If the NP decides this is not appropriate, this should then be directed to the residents MRP (MD).

Implementation of Communication Tool Residents name and Room # DNR status Presenting issue / concern Vital signs Attempted treatment NP ACTION Other M. Smith Room # 123 Full Code Shortness of breath BP 140/72 HR 96 O2 90% on room air Temp 38.1 2L oxygen -Ventolin nebs ordered PO Levaquin x 7 days Lasix 20mg x 7 days Other: nurse can write what her actions were, IE. Called POA, faxed order, etc. This sheet should be kept in an allotted binder on the LTC home for NP to review if needed. ER TRANSERS:

How Can You Help? In order for this to be successful we need: To ensure WRH staff is aware of NLOT Work collaboratively with all team members Ensure open communication between interdisciplinary team members Consistency and compliance with communication tool used in all homes