Transcript Occupational Health and Safety in Western Health

DASWest
NP AOD Model
Mental Health and AOD Nurse
Practitioner Collaborative Meeting
December 2010
About DASWest
One of the largest AOD services in Victoria
Largest AOD service provider in the West
Programs encompassing:
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Home Based Withdrawal
Homeless Dual Diagnosis
Outreach
Post Withdrawal Linkages
Specialist Pharmacotherapy
Women’s and Children’s Program
Forensic Counselling Program
Community Residential Withdrawal Unit (Adult)
Community Residential Withdrawal Unit (Youth )
Youth and Family Services
Addiction Medicine Beds
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About DASWest
 Western Health auspiced
 6 Sites in Footscray and Sunshine
 60+ EFT (~ 90 individual staff members)
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Registered Nurses, Psychologists, Social Workers, Addiction Medicine
Physicians, Community Development Workers, Welfare Workers, Admin.
 Funders:
 DH
 ACSO COATS
 MBS
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2009-10 Service Activity Data
In 2009-10, DASWest delivered:
o 1,200 Outreach contacts
o 2,163 Episodes of Care, with Significant Treatment Goals attained for
clients. The Episodes of Care were delivered from the following programs:
Client EOC 2009-10
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Adult
888
CRWU Adult
551
Youth
585
CRWU Youth
94
Women's
45
Total
2163
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2009-10 Client Profile
Demographics:
oIn 2009-10, 64% of DASWest clients were Male, and 36% female
o 80% of clients were born in Australia, and 3.70% identified as ATSI
o 39% of clients were aged under 24 years of age
o 25% of DASWest clients in 2009-10 were aged 40 years or over
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2009-10 Client Profile
Primary Drug Use:
o Alcohol 31%
o Cannabis 27%
o Heroin 23%
o Reflects DH NWMR data
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NP AOD Model development - 2009
- Various Gaps identified throughout DAS re NP applicability
- Research and Models investigated
- 2009 Victorian Nurse Practitioner Project
- Funding Round Phase 4 Round 4.6
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Refining the Model – 2010
-High level support at WH and DASWest for the NP initiative; including
Executive, Nursing and DASWest Medical Director
- 2010 New Management at DASWest
- Lots of options canvassed
- Consultants engaged
- DASWest NP AOD Model Development Steering Group established:
DAS Ops Manager, Adult Services Manager, CRWU NUM, Medical Director, PNPC,
DON Footscray, Director Pharmacy
- Focus Group Sessions re Priority Areas and Service Gaps
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Refining the Model – Narrowing the scope
 Out of Scope:
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Youth Services
General Drug and Alcohol in Primary Health Care settings
Community Residential Withdrawal Unit
 Potential In-scope for the NP role:
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NP to work within the Adult Services Team for support, access & influence
Home Based Withdrawal (lack of community prescribers)
Potential role in specialist out-patient clinics, esp. re withdrawal
Pharmacotherapies; especially Bridging Pharmacotherapy post Actue
discharge
 Need to be cautious re Acute Consultation and Liaison Services across WH
campuses
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Considerations
1. Is there a service gap?
2. Which service? Which patients / clients?
3. What part(s) of the care continuum will the proposed NP role address?
4. What is the estimated value add? Can we measure it?
5. Where will the NP be physically located?
6. What will the NP relationship be with other WH clinicians including
FAChAMs and medical specialists, and with Community based medicos (GPs)?
7. What formulary will be utilised?
8. What diagnostics will be available?
9. How will clients access the NP?
10. What are the reporting and accountability lines for the NP?
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Three Models
Model One
Pharmacotherapy Prescriber (Clinic Based) NP AOD
Service Location
Services Provided
DASWest Clinic
Or
Community based
clinic (e.g. GP
Practice /
Community Health
Centre)
Alcohol pharmacotherapy
Opioid substitution program
Co-morbidty management
Dual diagnosis
Stabilisation
Referral to appropriate ongoing care and/or GP management
Hep C testing
Consult & liaison with GPs & referral co-management of complex
Pharmacotherapy clients
Transitional Pharmacotherapy / Bridging pharmacotherapy from acute
to community / primary care sectors
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Three Models
Model Two
Western Region Area based NP AOD
Service Location
Services Provided
May operate from various
locations, such as:
Outpatient AOD Clinics
Community Health Centres
Mental Health Services
Western Health Hospital
campuses
Other Hospitals
Home visiting
Assessment and Intake
Specialist Pharmacotherapy
Home Based Withdrawal
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Three Models
Model Three
Withdrawal and Transitional Pharmacotherapy NP
AOD
Service Location
Services Provided
Home based - Detox
In-patient - Detox
CRWU Detox (Adult)
Outpatient clinic Pharmacotherapies
Advanced Assessment and Intake triage role
Withdrawal management (home - based / inpatient/ outpatient)
Therapeutic and educational programs
Linkage to community based programs and support
Conduit to the GP community for D&A clinical advice
Transitional Pharmacotherapy / Bridging pharmacotherapy
from acute to com1010munity / primary care sectors
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Testing the models
Each of the models allowed for integration of the NP into MDTs and capitalises
on the NP's ability to prescribe from an agreed formulary and to order diagnostics.
10 key questions
Plus:
 Work load manageability: Is the work do-able? Is it satisfying? What can
be achieved? Will it be a satisfying role for a NP?
 Influence: Is the NP part of a team and to influence a team? How can the
NP influence DASWest AOD nursing practice and AOD directions in the
larger health service and the NWM region?
 Integration: How easy will it be to support and supervise the NP? How will
the NP interface with Western Health?
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Withdrawal and Bridging Pharmacotherapy Model
 Key features
 Located at DASWest in Adult Services Team
 Withdrawal management (home - based / outpatient / ? Inpatient CRWU)
Transitional Pharmacotherapy / Bridging pharmacotherapy from acute to
community / primary care sectors
Advanced Assessment and Intake triage role
 Prescriber role
 Therapeutic and educational programs
Discharge
 Linkages to community based programs and support
 Conduit to the GP community for D&A clinical advice
Clinical Leadership, Quality, Education and Research,
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Governance
- DASWest NP AOD Steering Group established:
DAS Ops Manager, Adult Services Manager, CRWU NUM, Medical Director, PNPC,
DON Footscray, Director Pharmacy
- Western Health NP framework
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ICU Liaison NP
Adult Emergency NP
Paediatric Emergency NP
- Western Health Scope of Practice Committee
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Terms
Of
Reference
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Accountability
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Recent discussions:
 Recent NP AOD Steering Committee Topics of discussion:
- Formulary (Mental Health and Primary Care)
- Opportunities for Integration with Western Health
- WH Scope of Practice requirements
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Integration Opportunities with WH
-Provision of expert AOD clinical nursing advice to:
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WH 1 East Addiction Medicine Beds
WH Emergency Departments (Footscray, Sunshine, Williamstown)
AOD clinical education to acute / sub acute staff via formal forums
Presentation at Grand Rounds
Representation on relevant WH Steering Committees re advanced
level nursing opinion and advanced clinical nursing practice
- Participation in Western Health’s Teaching, Training and Research
portfolio
- Participation in Western Health’s Accreditation and CQI portfolio
- Case Conference opportunities for shared clients
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Next Steps
-Final Model sign off via Western Health
-Advertise and appoint NPC
-Commence
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