The Northern Adelaide Nurse
Practitioner Project

A Cognitive and Culturally
Sensitive Response to Residential
and Communi...
Overview
• Northern Adelaide Nurse Practitioner Project (NANPP)
• Service providers (1) Helping Hand, (2) ACH Group and
(3...
Background Project Aims
• DoHA funded “Nurse Practitioner Aged Care Models of
Practice”
• Improve timeliness and access to...
Background Project Aims
• Test sustainable funding models for Nurse
Practitioners in aged care
• Identify facilitators
• O...
Helping Hand Aged Care
• Residential Aged Care Facility (RACF)
– Ingle Farm 96 places (16 dementia secure), 2
respite, 6+ ...
Helping Hand – Gaps and Windows
• RACF
– Ingle Farm x 5 General Practitioner meet and greet – GP
suggestions = INR, unstab...
ACH Group
• ACH Group already has NPC
• RACF
– Highercombe, Hope Valley 120 places + 15 TCP
– Milpara, Rostrevor 92 places...
ACH Group – Gaps and Windows
• RACF
– Emphasis on active ageing
‘Partners in Positive Ageing’ model
– Supportive Residenti...
Aboriginal Elders Village and
Community Care

• Residential
• Aboriginal Elders Village Davoren Park
23 residential places...
Aboriginal Elders – Gaps and Windows
• Residential Identified Gaps
– TRUST and CULTURAL RESPECT
– Systematic resident revi...
Essential Requisites Cognitive and Cultural Sensitivity
Helping
Hand Aged
Care

ACH Group

Aboriginal
Elders &
Community
S...
NP Cognitive Health ScOP - Judy Deimel
Declining
Memory

• Healthy brain ageing

Dementia

• Comprehensive assessment; Dx/...
ScOP Donna Preston
Chronic
complex
needs

Personcentred
care

Mobility,
vigour and
self-care

Skin
integrity

Medication

...
Working Across 3 Organisations
Nurturing the NP Schedule
Collaborative
Partnering
with Acute
Care
Partnering
with GP,
Specialist
and Family
Home,
residential
& clinic
option

NP
r...
Collaborative Reality
• Medical mentoring  drawn-out due to project lead
change  NP initiated resolution
• Geriatrician ...
Marketing on a Budget
Service Archetype
Referral Guidelines
1.
2.
3.
4.

5.

Referral Criteria
Client meets NP ScOP
Age
Catchment Area
Treatment...
Service Archetype
Referral Form
Triage

Referral
Pathways
• Helping Hand,
ACH Group, &
Aboriginal
Elders
• Residential /
community
• TCP
• GP, SAAS,
Geria...
NP Clinical
Report
•ISBAR format
•Information
•Symptoms
•Background
•Assessment
•Recommendations
Key Performance Indicators (KPI)
• Identify best use of NP skill set
– Appropriate, safe, timely and accessible

• Data ca...
KPI Clinical Leadership
• Education: Delirium, Cog Assessment, Dehydration
• Research Projects:
– Audit: Antipsychotic pre...
Northern Adelaide Nurse
Practitioner Satisfaction Survey
Referee & Client Contact Source
Reason for Referral
Location for NP Assessment & Review
6/12 Referral Numbers and Gender
6/12 Evaluation – Age and Ethnicity
Barriers and Facilitators
• Nursing peers
– some suspicion with new NP role

• General Practitioners
– NP recommendations ...
Barriers and Facilitators
•
•
•
•
•
•
•
•
•
•
•

NP Project Facilitator Michelle Hogan RN
NP service information – GP and ...
The Future - Financial Viability
• Key assumptions - the majority of clients require
item numbers 82210 x3 and 82215 x3 re...
Conclusion
• NPs working in RACF must have philosophy espousing cultural and
cognitive sensitivity
• Allocate sufficient t...
Thank you
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Judy Deimel,Northern Adelaide Nurse Practitioner Project: : A Cognitive and Culturally Sensitive Response to Residential and Community Aged Care

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Judy Deimel, Nurse Practitioner (Cognitive Health), Northern Adelaide Nurse Practitioner Project 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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Judy Deimel,Northern Adelaide Nurse Practitioner Project: : A Cognitive and Culturally Sensitive Response to Residential and Community Aged Care

  1. 1. The Northern Adelaide Nurse Practitioner Project A Cognitive and Culturally Sensitive Response to Residential and Community Aged Care Judy Deimel NP
  2. 2. Overview • Northern Adelaide Nurse Practitioner Project (NANPP) • Service providers (1) Helping Hand, (2) ACH Group and (3) Aboriginal Elders and Community Care Services • Philosophy of respecting culture and cognition • Nurture, nature and mentoring the nurse practitioner • Collaboration for successful planning, evaluation & sustainability – – – – Service archetype Key performance indicators Barriers and facilitators Financial viability • Conclusion
  3. 3. Background Project Aims • DoHA funded “Nurse Practitioner Aged Care Models of Practice” • Improve timeliness and access to care for the most vulnerable and disadvantaged older people i.e. – – – – – Aboriginal and Torres Strait Islanders; Individuals with dementia and/or mental health issues; Acute illness or acute exacerbation of chronic conditions; At risk of hospitalisation; Palliative care • Test the best use of Nurse Practitioner (NP) skills and expertise in aged care
  4. 4. Background Project Aims • Test sustainable funding models for Nurse Practitioners in aged care • Identify facilitators • Overcome barriers to Nurse Practitioners in aged care • Streamline care delivery for older people when transiting from/to aged care, general practice and acute care
  5. 5. Helping Hand Aged Care • Residential Aged Care Facility (RACF) – Ingle Farm 96 places (16 dementia secure), 2 respite, 6+ Transitional Care Packages (TCP) • Community – Healthy Ageing Clinic Commercial Road Salisbury Coordinators, Allied Health and NP office
  6. 6. Helping Hand – Gaps and Windows • RACF – Ingle Farm x 5 General Practitioner meet and greet – GP suggestions = INR, unstable Type 2 Diabetes, Behavioural & Psychological Symptoms of Dementia (BPSD), delirium, antipsychotics, staff education, 1 x “show me your Scope of Practice (ScOP)” – Ingle Farm weekly intervention meeting – Orientation week needed to break down the wariness to effect resident review and handover teaching sessions on delirium • Community – Consumers with cognitive impairment no diagnosis; behavioural changes – Education
  7. 7. ACH Group • ACH Group already has NPC • RACF – Highercombe, Hope Valley 120 places + 15 TCP – Milpara, Rostrevor 92 places • Community – Community East, Newton: Nursing, Care Coordinators, OT, physiotherapist, TCP, DVA, community packages
  8. 8. ACH Group – Gaps and Windows • RACF – Emphasis on active ageing ‘Partners in Positive Ageing’ model – Supportive Residential Services Manager (RSM) – Transition Care Program – declined NP support – Early Intervention Working Party 1/12 meeting keen for NP input, source for resident referrals; – Antipsychotic audit; delirium education – GP mentor identified; 1 x indemnity discussion • Community – Allied Health receptive, TCP RN
  9. 9. Aboriginal Elders Village and Community Care • Residential • Aboriginal Elders Village Davoren Park 23 residential places – Enrolled Nurses and Care Workers (CW) +++, Registered Nurse (RN) 1/7, Activity Coordinator – 2 GPs, unused examination room (now NP room) • Community • Aboriginal Home Care Bowden – 53+ HACC clients – Coordinators and CWs +++
  10. 10. Aboriginal Elders – Gaps and Windows • Residential Identified Gaps – TRUST and CULTURAL RESPECT – Systematic resident review (ScOP) – Education • Community – HACC = opportunity for early intervention ,not yet requiring packaged care – Funding for day respite with potential for NP clinic – Possible referrals from Muna Paiendi Primary Health Care Service Elizabeth Vale – Education
  11. 11. Essential Requisites Cognitive and Cultural Sensitivity Helping Hand Aged Care ACH Group Aboriginal Elders & Community Services Nurse Practitioner Cognitive Health Nurse Practitioner Candidate Primary Health Care Gerontology
  12. 12. NP Cognitive Health ScOP - Judy Deimel Declining Memory • Healthy brain ageing Dementia • Comprehensive assessment; Dx/DD • Living well with dementia PWD/carer • BPSD - recognisable, understandable, and treatable Delirium • Prevention / diagnostic assessment • Multi-component non-pharma/pharma management • Education – person with delirium, staff, family Depression • Rapport and assessment • Dx defined by DSM-IV • Cognitive Impairment, dementia & phenomenology of depression
  13. 13. ScOP Donna Preston Chronic complex needs Personcentred care Mobility, vigour and self-care Skin integrity Medication Nutrition Primary Health Care Gerontology Continence Infections Dementia Depression Delirium
  14. 14. Working Across 3 Organisations Nurturing the NP Schedule
  15. 15. Collaborative Partnering with Acute Care Partnering with GP, Specialist and Family Home, residential & clinic option NP responsive to urgency criteria Ideal Partnering with host site #1 CONSUMER Partnering with host site #3 Partnering with host site #2
  16. 16. Collaborative Reality • Medical mentoring  drawn-out due to project lead change  NP initiated resolution • Geriatrician / Specialist – referral blockers  meetings without achieving outcomes  6/12 in NP initiated resolution DBMAS Geriatrician • GPs  letters  NPs practice visit  informal meeting on site  5/12 later GP Clinic/Round • Healthy suspicion from some nurses, Care Worker +ve • Community slow on uptake  education sessions • Forged links with 3 Emergency Departments  +ve
  17. 17. Marketing on a Budget
  18. 18. Service Archetype Referral Guidelines 1. 2. 3. 4. 5. Referral Criteria Client meets NP ScOP Age Catchment Area Treatment (I.E. NP can provide evidence based treatment/ intervention that referrer cannot provide themselves NANPP Referral form completed with sufficient information to enable triage
  19. 19. Service Archetype Referral Form
  20. 20. Triage Referral Pathways • Helping Hand, ACH Group, & Aboriginal Elders • Residential / community • TCP • GP, SAAS, Geriatric Area Service, nursing, allied health, client, family • Nurse Practitioners • Project Facilitator • Dedicated email, mobile numbers, fax number • Meeting ScOP +/- referee notified • Meeting ScOP client review via: • Telephone +/or clinic response NP Assessment • Consent process • Comprehensive assessment • Report sent to referee, GP +/specialist, family • Referral to other services (outside NP ScOP) • Client follow-up short and long term/discharge • Medi+Assist evaluation NursePractitioners@helpinghand.org.au
  21. 21. NP Clinical Report •ISBAR format •Information •Symptoms •Background •Assessment •Recommendations
  22. 22. Key Performance Indicators (KPI) • Identify best use of NP skill set – Appropriate, safe, timely and accessible • Data capture – – database (location, name, age, sex, ethnicity, first language, referral – reason, date, referee (e.g. Nurse, GP, GP round), date seen, NP name, Medicare, NP referrals, Length of service, date of follow-up, hospital avoidance, referral closed, time for report writing • • • • Transitioning between RACF, home and acute care Identify barriers and facilitators to service delivery Education, mentoring, clinical expertise for other HP Feedback clinical care/education client, staff and family
  23. 23. KPI Clinical Leadership • Education: Delirium, Cog Assessment, Dehydration • Research Projects: – Audit: Antipsychotic prescribing in dementia audit – Audit: RACF Dementia diagnosis audit of brain imaging – Project: Hospital Avoidance – Project: End of Life Dementia Care (DTSC Palliative Care) and QOL-MB (Quality of Life – Melva Brock) – Project: NP INR Protocol and Guidelines • Committees: Aboriginal Elders Dementia Respite • Publishing: Gentian Violet in Wound Treatment
  24. 24. Northern Adelaide Nurse Practitioner Satisfaction Survey
  25. 25. Referee & Client Contact Source
  26. 26. Reason for Referral
  27. 27. Location for NP Assessment & Review
  28. 28. 6/12 Referral Numbers and Gender
  29. 29. 6/12 Evaluation – Age and Ethnicity
  30. 30. Barriers and Facilitators • Nursing peers – some suspicion with new NP role • General Practitioners – NP recommendations not always welcomed/applied • Specialist – reluctant to attend RACF clients • RACF Health facility – lack of NP role awareness despite letters & orientation – NPs learning the ropes e.g. who what where and why – Insufficient documentation of medical history • Community - slow on the uptake
  31. 31. Barriers and Facilitators • • • • • • • • • • • NP Project Facilitator Michelle Hogan RN NP service information – GP and site letters, brochure Setting aside sufficient time for orientation, soft & subtle Setting up a referral pathway Support from GPs, attending rounds, phone contact ScOP and mini version at RACF Attending multi-D meetings Formal reports in ISBAR format Education for staff and clients Education resources e.g. delirium, hydration Michelle Hogan Christmas cards; project email updates
  32. 32. The Future - Financial Viability • Key assumptions - the majority of clients require item numbers 82210 x3 and 82215 x3 reflecting care complexity and patient acuity • Service sustainability – require average client through put on a daily basis of 6 - 8 MBS clients along with RACF co-payment • Future o Secure funds via another project initiative? o Combined RACF CN wage with MBS remuneration?
  33. 33. Conclusion • NPs working in RACF must have philosophy espousing cultural and cognitive sensitivity • Allocate sufficient time for NP orientation to service • For a successful recipe to develop the NP role - add large scoops of nurturing and mentoring for the person that is the NP • NPs in aged care address skilled workforce issues where the predominance of RACF workforce are care workers • NPs improve resident and staff education access • NPs add value to collaborative case management, care coordination and research findings • Marketing can be achieved on a low-cost budget • Collaboration takes time, persistence & persuasion • Maintain a comprehensive database for KPI and QA • NP fiscal viability cannot be achieved with MBS remuneration alone
  34. 34. Thank you
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