1. 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.

2. 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

3. 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

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

5. 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

6. 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

7. 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).

8. 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:

9. 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