Jill Kelly, St John of God Subiaco Hospital: Evaluating The Satisfaction, Acceptance And Outcomes Of Nurse Practitioner Implementation In An Acute Pain Service (APS)
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Jill Kelly, St John of God Subiaco Hospital: Evaluating The Satisfaction, Acceptance And Outcomes Of Nurse Practitioner Implementation In An Acute Pain Service (APS)

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Jill Kelly, Nurse Practitioner, Acute Pain Service, St John of God Subiaco Hospital, WA delivered this presentation at the 2013 Developing the Role of the Nurse Practitioner conference. The event is ...

Jill Kelly, Nurse Practitioner, Acute Pain Service, St John of God Subiaco Hospital, WA delivered this presentation at the 2013 Developing the Role of the Nurse Practitioner conference. The event is designed for organisations and managers looking to better understand, utilise and grow the role of the nurse practitioner in their health service. For more information about the annual event, please visit the conference website: http://www.healthcareconferences.com.au/nursepractitionersconference

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    Jill Kelly, St John of God Subiaco Hospital: Evaluating The Satisfaction, Acceptance And Outcomes Of Nurse Practitioner Implementation In An Acute Pain Service (APS) Jill Kelly, St John of God Subiaco Hospital: Evaluating The Satisfaction, Acceptance And Outcomes Of Nurse Practitioner Implementation In An Acute Pain Service (APS) Presentation Transcript

    • Implementing a Collaborative Acute Pain Service (APS) Model of Care in a Private Hospital Setting: What have we done well and what could we have done better? Jill Kelly Nurse Practitioner, APS
    • Objectives -Background of the Acute Pain Service -Implementation of the APS NP role - Identify challenges in a private hospital model -Where are now?
    • St John of God Subiaco Hospital • .
    • St John of God Subiaco Hospital -2012 activity: over 70,000 admissions -Elective surgery -over 50,000 cases performed -Main surgical specialties: orthopaedics, neurosurgery colorectal, gynaecology, plastics, urology and obstetrics
    • Acute Pain Service: APS -APS commenced in 1996 as a nursing only model -2007 sessional based pain specialists joined service -2010 Director of Anaesthesia took over responsibility for the medical APS Aim: Collaborative medical and nursing team
    • Highlighting a Service Gap -Anaesthetist’s are a transient population -No anaesthetic registrar -Pain Consultants are also transient- single round per sometimes after hours -Limited RMO/ registrar cover -No emergency department on site
    • Highlighting a Service Gap It was identified: -Patient’s pain needs were increasingly more complex -Timely intervention was challenging -Strong reliance on interim phone orders
    • Implementing the NP Role -March 2012, SJOGSH Designated APS NP site -April 2012, SJOGSH implemented APS NP role
    • Organizational Chart Director of Nursing and Midwifery Director of Anaesthesia and Pain Medicine Clinical Leadership Coordinator APS Nurse Practitioner APS Clinical Nurses APS Consultants and Anaesthetists
    • APS NP Model of Care -Collaboration and referral -Guided by clinical protocol -Link between medical colleagues hospital wide and APS -Support for nursing and midwifery colleagues -Early patient access to pain management and review
    • Additional NP roles -Research -Consultation on Policy Development -Education -Leadership
    • APS Referral Specialist Anaesthetist Physician Surgeon,RMO APS Nurse Practitioner Triage APS Nurse Practitioner APS Consultant or Anaesthetist APS Team Consultant, Nurse Practitioner, Clinical Nurses, Clinical Pharmacist
    • Early Successes -Hospital wide nursing/ midwifery support of APS NP role -NP able to provide RMOs with support in relation to treatment of complex pain -Medicare rebates for NP outpatient consults
    • Important Aspects of NP Role - Collection of service data - Ongoing mentorship and support
    • APS referrals 2012-2013 500 450 Number of Referrals 400 350 300 250 200 150 100 50 0 June July Aug Sep Oct Nov Dec Jan
    • 100 working days of NP practice Number of Patients 800 700 600 500 400 300 200 100 0 Total Number of Patients Treated by NP Total Number of NP Patient Visits
    • Reason for patient referral 60 Percentage 50 40 30 20 10 0 Pain Sedation N&V Pruritis Discharge Analgesics
    • Patterns of NP prescribing 100 90 80 Percentage 70 60 50 40 30 20 10 0 Non Pharmacological Non Opioid Prescription Opioid Prescription Non Opioid + Opioid
    • Analgesic Agent Tramadol Temgesic Targin PCA Commenced PCA Opioid Rotation Panadol Osteo Panadeine Forte Oxycodone Norspan Lyrica Ketamine Infusion Hydromorphone Gabapentin Fentanyl Patch Number of NP prescriptions July 2012- Jan 2013 = > 400 prescriptions 60 50 40 30 20 Number of Prescriptions 10 0
    • Hallmarks of APS NP practice -Collaboration with the multidisciplinary team - Communication and interpersonal skills - Accessability -Patient follow up -Non pharmacological input -Thinking “outside the square” -
    • Challenges -Inpatient Billing -Private insurance inpatient gap payments - Succession planning
    • Where are we now? December 2012, Implementation of NP led Acute Pain Discharge Clinic
    • APS’s across Australia have striven to improve analgesia for patients, but by doing so: Is there potential to create problems for our GP colleagues? Time shortages, inadequate funding and manpower are challenges to providing follow up for these patients. Kumar, 2011
    • Rationale for a Timely Implementation - “The painkiller oxycodone also known as oxycontin has overtaken heroin as the drug of choice among injecting users , but the bulk of its victims are middle aged pain sufferers ”(Herald Sun 2012) - 465 Oxycontin related deaths in Australia between 2001- 2009 - 2,611,531 dosages of oxycodone hydrochloride recorded on the PBS in 2012- almost double the number than in 2006-2007 (Medicare 2012)
    • Clinic Goals -Reassessment of patient analgesic needs post discharge -Reviewing the patients progress in weaning prescribed opioids -Providing the GP with a written estimated duration of opioid therapy, and a suggested dose reduction schedule -Referral to a pain clinic for ongoing follow up if required
    • Additional Outcomes -Reducing length of stay -Reducing amount of discharge analgesics dispensed for discharge
    • Moving the APS NP Role Forward - Review and extend SJOGSH APS NP clinical protocol - Increase number of APS discharge clinics - Pursue Medicare rebates for NP inpatient visits - Evaluation
    • Thank you
    • Research Proposal “Towards an Understanding of the Role of the Nurse Practitioner in an Acute Pain Service in a Private Hospital Setting’’
    • Literature Review - Lack of publications describing and critiquing NP roles in the private hospital sector nationally and internationallycontributing to a lack of clarity in the service that the NP role can provide in a private hospital setting - Limited available literature relevant to NP role in acute pain
    • A Collaborative Study -SJOGSH APS NP research study in collaboration with Curtin University - Approval from St John of God Health Care and Curtin University ethic committees
    • Study Objectives - Describe the patterns of practice of the APS NP role - Elicit NP service satisfaction from patient, nursing, medical and pharmacy perspectives -Inform decision relating to the implementation of additional NP roles at SJOGSH
    • Participant Recruitment -Patients treated by the APS NP as an inpatient, outpatient or both -Medical Practitioners referring to the NP - Nurses, midwives and pharmacists at all levels working collaboratively with the APS NP to deliver everyday patient care hospital wide
    • Study Methodology - Mixed methods Quantitative/Qualitative - Multidisciplinary Team Questionnaire – “Perceptions of the Acute Pain Service Nurse Practitioner Role”. - to elicit referring medical practitioners , pharmacists and nursing views relevant to the APS NP role (Adapted from AUSPRAC Tool Kit, 2011) - NP Patient Satisfaction Questionnaire.- “Perceptions of the Acute Pain Service Nurse Practitioner Role” - to elicit patient satisfaction with the care provided by the NP (Adapted from McCabe, 2011) - “IBA” data management system and “Fred Dispense” pharmacy data collection system
    • Study Design - Conducted in two stages over a 12 month period. During each of the two stages the data shown in the table below will be collected concurrently Multidisciplinary Questionnaire Patient Questionnaire IBA/ Prescribing Data - Stage 1: Retrospective data collection October 2012 to January 2013 - Stage 2: Prospective data collection August 2013 to October 2013
    • Data Analysis - Quantitative data - Recorded on an Excel data base comprising patterns of service data, number of patients contacts and the reason for contact and the number and type of pharmacological agents prescribed - Qualitative data- Common themes will be highlighted, analysed and reported
    • Research Methods-Timeline Research Project Oct 2012 Develop Research Proposal Develop Research Tools Obtain Participants Gather Data Stage 1 Stage 1 Data Analysis Gather Data Stage 2 Stage 2 Data Analysis Research Report Publish Research Findings April 2014