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.com/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

Outcomes

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...

pjenkin@resthaven.asn.au

Nurse Practitioner Aged Care Models of Practice Project

This is an Australian Government initiative.