Jill Kelly, St John of God Subiaco Hospital: Evaluating The Satisfaction, Acceptance And Outcomes Of...
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Transcript of Jill Kelly, St John of God Subiaco Hospital: Evaluating The Satisfaction, Acceptance And Outcomes Of...
![Page 1: Jill Kelly, St John of God Subiaco Hospital: Evaluating The Satisfaction, Acceptance And Outcomes Of Nurse Practitioner Implementation In An Acute Pain Service (APS)](https://reader033.fdocuments.us/reader033/viewer/2022060111/556802c4d8b42a242a8b48e1/html5/thumbnails/1.jpg)
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
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Objectives
-Background of the Acute Pain Service
-Implementation of the APS NP role
- Identify challenges in a private hospital model
-Where are now?
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St John of God Subiaco Hospital
• .
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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
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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
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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
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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
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Implementing the NP Role
-March 2012, SJOGSH Designated APS NP site
-April 2012, SJOGSH implemented APS NP role
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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
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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
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Additional NP roles
-Research
-Consultation on Policy Development
-Education
-Leadership
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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
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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
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Important Aspects of NP Role
- Collection of service data
- Ongoing mentorship and support
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0
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June July Aug Sep Oct Nov Dec Jan
Nu
mb
er
of
Ref
err
als
APS referrals 2012-2013
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0
100
200
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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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Pain Sedation N&V Pruritis DischargeAnalgesics
Pe
rce
nta
ge
Reason for patient referral
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Non Pharmacological Non Opioid Prescription Opioid Prescription Non Opioid + Opioid
Pe
rce
nta
ge
Patterns of NP prescribing
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Fen
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yl P
atch
Gab
apen
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Hyd
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Ke
tam
ine
Infu
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Analgesic Agent
Number of NP prescriptions July 2012- Jan 2013 = > 400 prescriptions
Number of Prescriptions
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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”
-
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Challenges
-Inpatient Billing
-Private insurance inpatient gap payments
- Succession planning
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Where are we now?
December 2012, Implementation of NP led Acute Pain Discharge Clinic
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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
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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)
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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
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Additional Outcomes
-Reducing length of stay
-Reducing amount of discharge analgesics dispensed for discharge
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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
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Thank you
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Research Proposal
“Towards an Understanding of the Role of the Nurse Practitioner in an Acute Pain Service in a Private Hospital Setting’’
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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
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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
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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
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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
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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
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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
-
-
- 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
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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
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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