1. education

Integrating the Nurse
Practitioner (NP) into Aged
Care
Ann Brodie, MSN, NP
General Manager Clinical Services
Sir Moses Montefiore Jewish Home, Sydney, NSW
LASA National Congress 2014
(Clinical Innovation)
‘a ‘continuing tradition of excellence in care’
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Presentation Outline
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Purpose
Montefiore
Background & History
NP Introduction
Defining the NP Position
Objectives of the Role
Collaboration
Program Outcomes
The Future
Recognition
Concluding Remarks
‘a ‘continuing tradition of excellence in care’
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NP’s & Aged Care
How do you establish a
successful and viable NP
program that lends itself to
aged care?
‘a ‘continuing tradition of excellence in care’
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Montefiore & Aged Care
• 740 Residents Across 4 Facilities
 Hostel, Nursing Home & Dementia Care
• 96 HomeCare Packages
 Consumer Directed Care
 Fee For Service
• Over 1000 Staff
‘a ‘continuing tradition of excellence in care’
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Program Background & History
In 2010, Montefiore received a federally-funded
research grant in conjunction with Canberra
University to investigate the viability of the NP
model in Residential Aged Care (RAC).
Currently, we have 2 Australian Board endorsed
NP’s servicing four facilities in collaboration with 90
General Practitioners (GP’s)
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NP Introduction
• Ann J. Brodie, MSN, NP
• Joanne Russell, MSN, NP
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Introduction
• Ann J. Brodie, MSN, NP
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Residential Care
Clinical Resources
NP Program
After Hours Supervisors
Infection Control
• Joanne Russell, MSN, NP
• Nurse Practitioner
– Residential
– HomeCare
• Specialisation
– Palliative Care
– Wound Care
• Forums/Working
Parties
• Education
• Mentoring
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Defining the Position
A NP is a registered nurse
(RN) who is educated &
endorsed to function
autonomously and
collaboratively in an
advanced & extended
clinical role. The NP role
includes assessment &
management using advanced
nursing knowledge and skills
‘a ‘continuing tradition of excellence in care’
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GP’s Understanding of the NP
2013 Survey
‘a ‘continuing tradition of excellence in care’
2014 Survey
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Defining the Position
So what does an NP do – Roles & Duties?
• Disease & Illness
Diagnosis & Treatment
• Ordering, Investigation,
& Evaluation of
Diagnostics
• Prescribing Medications
• Collaborative Treatment
w/ GP’s
• Policy Development &
Collaboration
• Mentoring
• Education – Internal &
External
• Forum & Committee
Chairs
• Infection Control through
Immunisation
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Defining the Position
Why is the Role
Important to Define?
Our NP program offers the delivery of an advanced
level of person centred aged care leading to better
results for residents, their families, and the
Organisation as a whole. In addition, the NP is able
to educate, mentor and support staff to better
manage complex clinical situations
‘a ‘continuing tradition of excellence in care’
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NP Objectives
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Reduction of Avoidable Hospitalizations
Appropriate Referrals to Specialists
Appropriate Referrals From Staff to the NP
Prescribing Medications
Staff Mentoring and Education
Clinical Research
Policy Development
Successful Collaboration With GP’s
‘a ‘continuing tradition of excellence in care’
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Collaboration
Internal Support
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Management & Board Members
Clinical Resources Department
After Hours Supervisors
Customer Assurance Department
Learning & Development
Department
• IT Department
• Nursing & Allied Health
• Catering, Maintenance, &
Laundry
External Support
• Federal Government
• Canberra University
• Australian College of Nurse
Practitioners
• General Practitioners
• Community – including Residents’
families & friends
• Volunteers
• Public Health Units
• Quality Agency
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Involvement
Clinical Resources Department
• Education &
Mentoring
• Infection Control
• Immunisation
Clinics
• Chair &
Coordinators for
Forums &
Committees
• Policies, Forms, &
Work Instructions
SIR MOSES MONTEFIORE JEWISH HOME
RN AC Documentation Workshop
‘a ‘continuing tradition of excellence in care’
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Involvement
Customer Assurance Department
• Clinical Indicator
Reporting &
Auditing
• GP Matters
• Annual GP
Surveys
• Policies, Forms,
Documents
• User Tips &
Dashboards
‘a ‘continuing tradition of excellence in care’
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Involvement
Coordination & Collaboration is Key
Learning &
Development
• Research
• Education
• Training
Allied Health
• MDT Referrals
• HALT
GPs
• Referrals
• Collaboration
Project
Objective
Outcome(s)
1. HALT
(Halting Antipsychotics in LongTerm Care)
In collaboration with UNSW,
reduce use of anti-psychotics in
residential care in RWMT,
RWNH, Shirah, & CAM
HALT team established.
Collaborate with Professors
Brodaty & Chenoworth.
Program till June 2015.
2. Integrated Cognitive
& Sensory Program at
RWSCU
In collaboration with UNSW,
study effect of program on
resident's with dementia
Training package developed.
Awaiting final ethics approval.
3. Staff & Resident Flu
Vaccination Program
Improve staff rates & assist GPs
with resident vaccination
administration via CRD
administered program.
NP administered program – 475
staff & 450 residents vaccinated.
Plans to research data & educate
staff for those who declined
2014 vac.
4. Does residential
aged care impact
resident cognition
levels?
Review of cognition upon
admission & determine if
cognition level declines over time
Under consideration.
‘a ‘continuing tradition of excellence in care’
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Bringing it All Together
Clinical Indicator - Pressure Injuries
• Report
Production
• Review &
Coordination
• Implementation
of Education
• Re-evaluation
of Data
‘a ‘continuing tradition of excellence in care’
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Bringing it All Together
Infection Control – Vaccine Clinics
• Historical
Perspective
• Review &
Coordination
• Implementation
of Education
• NP directed
Vaccine Clinics
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Vaccine Clinic Results - 2014
NP Coordinated & Managed
• 95% of GPs
preferred NP
administration
• 440 residents were
vaccinated by the NP
with Fluvax and/or
Pneumovax
• 493 staff members
were also vaccinated
with Influvac
• 105% rise from 2013
‘a ‘continuing tradition of excellence in care’
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Reporting & Stats
Data Graph for Clinical Indicator Reporting
What are the Results?
‘a ‘continuing tradition of excellence in care’
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Reporting & Stats
950
Referrals Made to the NP by Staff
Wound, Catheter & Palliative
Care Are Top referrals Made to
the NP
150
Prescriptions Written
53
Hospitalisations Avoided
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Referrals to Specialists by the NP
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Current & Future Plans
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Recognition
2014 Better Practice Award
“a genuine case of leading
innovation …. slick,
professional, formally
funded, well-documented
….. implemented &
monitored thoughtfully,
delivering strong results ….
very impressive.”
comments from judging panel
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Meaning for Residents
Choice - Dignity - Wellbeing
As a result of these positive and innovative
approaches, we are able to deliver person-centred
aged care more effectively
Here at Montefiore, our vision is to be the leader in
the field of aged care. To develop, implement and
promote best practice in all aspects of aged care
by continuously reviewing and improving services
and service delivery
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What Does This mean in RAC?
Based on current trends, this is foreseen to become
a necessity as more complex and acute cases
present for care within our Residential and
HomeCare services.
“For every aged-care resident, unable to be cared
for in aged care (which is a maximum of $180 a
day in funding), the cost to impost to the acute
setting [will be about] $1500 a day – a funding
increase of more than seven-fold” (Larter, 2014)
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Montefiore Family
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