Waitemata dhb
Dr Michal Boyd, RN, NP, ND –
Nurse Practitioner, Aged Care Primary Health
Clinical Leader – Community Services for Older Adults
Waitemata DHB – Home and Older Adult Services
Population
Care of Older Adults with high and complex needs that live in the community.
Identified Need
Older adults with high and complex issues (approximately 5% of those over 65 years) require individualised care coordination and proactive advanced nursing assessment and intervention to prevent illness exacerbation.
Lack of coordinated care for high needs older adults results in:
- Avoidable hospitalisations and Emergency Department presentations
- Fragmentation of care leading to gaps and duplication in services
- Reactive care rather than early intervention proactive chronic illness care
- Decreased client and family coping ability
Service delivered
- Clinical responsibility and care coordination for people for older adults with high and complex needs. Responsibilities include:
- Chronic Illness Care, medication review and symptom management
- Comprehensive gerontology assessment and care planning
- Coordination with the inter-disciplinary team across health care settings
- Clinical Leadership Responsibilities
- Strategic planning and programme development
- Clinical coaching and education for nurses and clinical nurse specialists
- Consultation regarding advanced nursing practice for older adults across primary, secondary and palliative care settings
- Programme evaluation and research
Implementation/ funding of NP Position
Example of New Programme Development:
Residential Aged Care Integration Project. provides DHB Gerontology Nurse Specialist/Practitioner outreach to residential aged care. The three main focus areas of this project include: (1) Proactive clinical coaching for residential aged care nurses and caregivers, (2) Development of evidence-based practice guidelines for common older adult health concerns, (3) Comprehensive assessment, care coordination and advanced care planning for high needs residents.
Nurse Practitioner Outcome Data:
Figure 1: Total number of hospitalisations for pre and post Nurse Practitioner intervention (n=67)
Figure 2: Total acute care hospital days pre and post Nurse Practitioner intervention.
Figure 3: This figure represents the total mean hospital days per NP client pre and post intervention. A statistical significance of p = 0.00 is demonstrated using a single sample T-test.