Transcript right care, right time, right place

Community Innovation:
The Development of a
Nurse Practitioner Model of Care
in Palliative Care
Debbie White
Nurse Practitioner Palliative Care
Port Macquarie Community Health Campus
October 2013
Purpose
 Explore model of care and the NP role
 To share a narrative of my experience
 Illustrate the highlights and challenges
along the way
 Demonstrate the benefits for the
patients and families
Model of Care
 A way of working
 A multidimensional concept that describes how
health services are delivered (QLD Govt 2000)
 Encompasses: patient centred, safe, effective,
equitable, quality, efficient, cost effective,
innovative care (NSW Health 2005, WA Govt 2008)
 Ensuring right care, right time, right place
Nurse Practitioner
“A registered nurse who is educated and endorsed
to function autonomously and collaboratively in an
advanced and extended clinical role…”
 Assessment & management skills
 Referral, prescribing medications, ordering diagnostic
investigations
 The role is grounded in nursing – values, theories, knowledge
 Provides innovative and flexible health care delivery that
complements other health care providers
Safety & Quality Framework for NP’s
Nurse Practitioners in Palliative Care
 Standards for Palliative Care (PCA) – NP
listed as part of specialist level services
 In NSW there are 5 NP’s and 1-2
Transitional NP’s in place
 A valuable addition to the Palliative Care
MDT
Palliative Care
 For people with a life limiting illness
 Multidisciplinary approach
 Cares for the patient and family
 Impeccable assessment and early treatment of
symptoms
 Holistic approach: physical, spiritual, cultural, emotional
(WHO 2005)
Palliative Care in NSW
 In rural / regional NSW → 1.6 fte Palliative Care Specialists
 High chronic disease burden
– 10% of patients with chronic disease receive palliative care
– 66% of cancer patients receive palliative care
 Flexible, innovative approaches to meet the demand and
provide a sustainable service
The Journey…..
The Beginning….
 Role commenced in 2011
 Hastings Macleay Clinical Network
 Community based role
– Home
– Wauchope PCU
– Residential Aged Care
– Kempsey Hospital
– Nurse Led Clinic
 Clinical, Education, Leadership, Research
Finding ‘my place’
 An additional position for an already established team
– Skilled Clinicians
 Transitioning from CNC to NP
– Different responsibilities
– New CNC role developing
 In the team, or an extension of the team?
Challenges…..
 Doctors and NP’s
 MBS Number
 Lack of understanding of the role
 Covering a large geographical area
 No Palliative Care Specialist
 Developing a new role
– support systems
– Structure
– expectations
Data
 54 weeks
 612 OoS
(n of patients 150 – 160)
 Referrals n =160
P/U
PCT
GP
RACF
Direct
Hosp
40
31
7
9
35
38
25%
19%
5%
6%
22%
24%
 Malignant 65% Non-Malignant 20% Unknown 15%
 Consults ?
An Evolving Role……
 Learning, researching, waiting
 Changing expectations without changing beliefs and
values
 Working with the team – challenging ways of
working
 Introducing innovation, identifying gaps
 Collecting data
 Expanding own scope of practice
A Model of Care….
RACF
NP Led
Clinic
Community
NP
Chronic
Disease
Wauchope
PCU
The biggest lesson or realisation..
The role is still very new despite recent progress at state and
national level
Questions…