Transcript Slide 1
Nurse Practitioner - Palliative
Care
Karen Glaetzer
Nurse Practitioner – Palliative Care
Southern Adelaide Palliative Services
Lecturer (B) – Flinders University
Southern Adelaide Palliative Services
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Regional Service – Population 330,000
Interdisciplinary team
Clinical services, education and research
1200 referrals each year
380 current clients
Seamless care model
Gaps identified in Service Provision
> 30-40 families each year identified by SAPS
whose needs were not adequately addressed
> 82 referrals in 2002 under the age of 50
> Resource intensive
> Utilised Multiple Service Providers
> Complex psychosocial/psychological issues
> Primary service providers with limited specialist
palliative care skills
> Limited availability of institution based
resources
Triage Criteria
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Chronic complex mental health history
Long term mental health history who
require ongoing assessment and treatment.
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Multiple service providers
More than 3 community service providers (GP,
RDNS, Dom Care etc).
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Complex symptom issues
Patients who have significant, complex symptoms (physical or
psychological), that require advanced skills to assess and
manage.
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Family dysfunction
Families who have demonstrated difficulty coming to terms with the
diagnosis/prognosis and where there is significant ongoing conflict
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Complex individual caregiver issues
Carers who have significant ongoing personal (physical or psychological)
and who demonstrate difficulties adapting to the role of carer.
NP referrals meet 2 of these criteria
Nurse Practitioner - Palliative Care
> Direct clinical service provision to palliative clients
with overwhelmingly complex needs
> Coordination of case management, clinical problem
solving, clinical decision making and advance care
planning
> New patient OPD Clinics
> MND Clinic
Nurse Practitioner - Palliative Care
> Provision of education to patients,
families and professional care providers
> Initiate and participate in
research/projects
> Rural Mentor role
> Contributes to State and National Policy
(State Plan)
M
T
W
Th
Admin
OPD
NHS
Teaching
Team
Meeting
Home
Visits
(far
south)
Home Visits OPD
(alt MND,
new
4pm Nurses patients)
Education
Service
Development
Meeting
Research
F
Research
Meeting
Project
Work
Admin
OPD Clinics
> Hospital Funded OPD – not medicarised
> 3 patients – 1 hour appointments
> Palliative Medicine Consultant holds
concurrent review clinics
> 15 - 20 minute overlap to assist in cosigning investigations or to provide scripts
> Next appointment booked with Palliative
Medicine Consultant
NP Role Evaluation
Journal
> Maintained professional journal over the first 6 months of role
> Recorded
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Referral numbers from SAPS and reason for referral
Referral numbers from other health services and reason for referral
Planned and unplanned contacts
Input into care planning
Main activity – referral to others, consultation, prescription and ordering
rates
Non-clinical activities
Research/projects
Education
Networking and higher level activities
Results – Snapshot data
> Pre
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Diary
Mean contacts per day = 3.14
Number of NP criteria met = 2.25
Mean satisfaction scores = 8.56/10
> Post
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Diary
Mean contacts per day = 1.92
Number of NP criteria met = 2.6
Mean satisfaction scores = 9.16/10
Results – Staff questionnaire
> Community team n=8/11
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Identifying impacts of NP
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Responsibilities
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Most – NP as a support and resource, but varied opinion
Attitude to NP role
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Varied opinion (lessened for some, others thought no change)
Consultant seen as supporting NP
Support
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Possible reduced need for medical input
Streamline reviews and assessment
Reduce stress by reducing complexity of caseloads
Can be viewed as privileged, choice of patients, protected time
Service issues
Who decides NP patients, how does triage work
How does follow-up get handled
Results – Journal
Number of patients triaged
28%
Education activities
17%
Discussions with external nursing/allied
12%
Discussions with SAPS medical
9%
Referrals to others
8%
Discussions with external medical
6%
Research/project
6%
Discussions with SAPS nursing/allied
5%
Drug/treatment advice
5%
Admissions arranged
2%
Referred to NP intervention
2%
Clinical load, MND clinics
NA
Results
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Number referred to NP = 27
Reason for referral
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Complex symptoms = 8
Family dysfunction = 5
Multiple health providers = 4
Complex mental health history = 2
Caregiver issues = 8
Site of death (%)
Mean
age
%
male
Cancer/non
cancer %
Mean
LOS
(days)
Home
Pall
care
Hospital
Not specified
RACF
Alive
Mean MO
contacts
SAPS
71.9
56
82:18
60
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18
25
9
6
33
1.82
NP
49.2
55
91:9
69
52
33
14
0
0
1
1.72
Conclusions
> Patient profile
• By definition, more complex, more severe problems
• Younger
• Die at home
> Difficult to evaluate
• Small numbers
• Limited timeframe
• Methodological issues
Conclusions
> Triage detects 1/3 patient numbers, other referrals after clinical
assessment and as problems arise
> Journal
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Operates at local, regional, state and national level
Education
Policy
Research/project
Support and consultative
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Extended practice reflected (within legislative limitations)
Case load reflects patients identified through triage criteria
Discussion
> Outstanding features of the role
• High numbers of rural contacts
Those services where SAPS is already aligned
Using the knowledge and skill base of NP
• Maintains statewide MND clinic and support service
• Local, regional, state and national involvement in
Education
Policy
Consultative and support roles
Possible Palliative Care NP Roles
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Nurse led inpatient beds
Aged care/ Palliative care
Chronic disease/Palliative care
Consultative Clinics – hospital,
community, RACF
> Community
Contact Details
Karen Glaetzer
RN BN NP Cert Onc Cert Bioethics Grad Cert Health
(Palliative Care) MNg (Nurse Practitioner) MRCNA
Nurse Practitioner - Palliative Care
Southern Adelaide Pallliative Services
Repatriation General Hospital
700 Goodwood Rd
Daw Park South Australia 5041
ph. 61 8 8275 1732
fax. 61 8 8277 4957
Email. [email protected]