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