Published on March 17, 2014
Palliative Care Nurse Practitioner Peter Jenkin
Why does it matter? End of life care is not done well in Australian RACFs My model of care can positively influence outcomes of care
In 10 minutes... Context • Palliative care in aged care Process • Model of care Outcomes • Clinical • Professional
Australian NP Specialties 32 15 14 10 6 5 4 3 1 6 4 0 5 10 15 20 25 30 35 % %
NP – Aged Care Models of Practice Program • demonstrate effective, economically viable and sustainable models of practice • Facilitate growth of aged care nurse practitioner workforce • improve access to primary health care for clients of residential &community aged care services Funded by Australian Government Department of Health & Ageing
Context... Palliative care in aged care
Focus of care is changing • Increasing acuity • Multiple co-morbidities • Increasing technical clinical care e.g. Intrathecal infusions Residential model Sub-acute clinical
Lynn J, Adamson DM. Living well at the end of life. Adapting health care to serious chronic illness in old age. Washington: Rand Health, 2003.
Catholic Health Australia 2010
What to do? • Increase funding • Capacity building • Palliative approach toolkit • Advance care planning • Training for careworkers • Incentives for GPs havent worked • Specialist support • Nurse practitioners? • External or internal?
Process... Model of care
Resthaven’s Nurse Practitioner NP candidate Endorsed NP Three six residential sites 159 285 high care 236 400 low care
Scope of Practice Palliative Care for Older Adults
Scope of Practice Palliative Care for Older Adults • Advance care planning • Palliative Care case conferences • End of Life Care • Complex symptom management • Psychosocial distress • Early intervention/screening clinics?
Referral criteria • Progressive life limiting condition. • Not surprised if dead in 6 months • Complex physical symptoms/psychosocial issues requiring direct clinical care by NP and/or advice to primary care team • Goals of care = relief of symptoms & QoL • Resident/family/ GP aware of referral
Extended practice http://www.google.com.au/url?q=http://www.emergucate.co m/wp-content/uploads/2013/02/Chest-x-ray.jpg
Collaborative Arrangements Mutual trust and respect Communication Teamwork
Funding • Project funded till June 2014 • Permanent position from July 2013 Salary offset by income from Medicare
MBS item numbers for NPs
Palliative Care: NP v GP
Clinical Outcomes All but one resident with NP involvement in 12 months died ‘at home’ High satisfaction from families Less after hours locum visits at EoL GPs more willing to attend case conferences Increased proactive prescribing of medicines at the end of life Better identification and Rx of delirium
Professional outcomes • Modelling best practice • Opportunities for targeted clinical education
Professional outcomes • Modelling best practice • Opportunities for targeted clinical education • Championing advance care planning • Improved understanding & use of pain assessment and delirium screening tools • Staff support re grief & loss
Keys to success • Well defined implementation process • Access to experienced clinical & professional mentors • Quarantined professional development time • Stakeholder engagement – Executive & management – GPs – Nursing & care staff – Residents & family members
What’s my point? A palliative care nurse practitioner who consults at a RACF can improve outcomes of care by providing clinical advice and support. A palliative care nurse practitioner working within a RACF can improve outcomes of care by also providing direct care and influencing clinical practice improvement and other key processes.
Thank you... firstname.lastname@example.org Nurse Practitioner Aged Care Models of Practice Project This is an Australian Government initiative.
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