jill kelly, st john of god subiaco hospital: evaluating the satisfaction, acceptance and outcomes of...
DESCRIPTION
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/nursepractitionersconferenceTRANSCRIPT
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
Clinical Leadership Coordinator
APS Nurse Practitioner
Director of Anaesthesia and Pain Medicine
Director of Nursing and Midwifery
APS Consultants and Anaesthetists
Organizational Chart
APS Clinical Nurses
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 Nurse Practitioner Triage
APS Consultant or Anaesthetist
APS Team Consultant, Nurse Practitioner,
Clinical Nurses, Clinical Pharmacist
Specialist Anaesthetist Physician
Surgeon,RMO
APS Referral
APS Nurse Practitioner
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
0
50
100
150
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450
500
June July Aug Sep Oct Nov Dec Jan
Nu
mb
er
of
Ref
err
als
APS referrals 2012-2013
0
100
200
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400
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600
700
800
Total Number of Patients Treated by NP Total Number of NP Patient Visits
Nu
mb
er
of
Pat
ien
ts
100 working days of NP practice
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10
20
30
40
50
60
Pain Sedation N&V Pruritis DischargeAnalgesics
Pe
rce
nta
ge
Reason for patient referral
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100
Non Pharmacological Non Opioid Prescription Opioid Prescription Non Opioid + Opioid
Pe
rce
nta
ge
Patterns of NP prescribing
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60
Fen
tan
yl P
atch
Gab
apen
tin
Hyd
rom
orp
ho
ne
Ke
tam
ine
Infu
sio
n
Lyri
ca
No
rsp
an
Oxy
cod
on
e
Pan
ade
ine
Fort
e
Pan
ado
l Ost
eo
PC
A O
pio
id R
ota
tio
n
PC
A C
om
me
nce
d
Targ
in
Tem
gesi
c
Tram
ado
l
Analgesic Agent
Number of NP prescriptions July 2012- Jan 2013 = > 400 prescriptions
Number of Prescriptions
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 internationally- contributing 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
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- 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 April 2014 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