Nursing initiative reduces preventable elderly admissions
- January 2002
Advanced Practice Nurse Cindy Barielli assesses 91-year-old Florence Mills at Dorchester Manor in Niagara Falls
An innovative pilot project designed to reduce preventable elderly admissions to hospital has been so successful it will become a permanent fixture for the Niagara Health System (NHS) and may be expanded to include more Long Term Care (LTC) facilities in the region.
Many residents of 27 LTC facilities in the region have benefited from this health-care initiative - said to be the first of its kind in Ontario - since it began in November 2000. The key goal of this important effort is to enable Niagara's LTC residents to remain in their home facility when they require advanced nursing skills, such as intravenous therapy.
The success of the program has been recognized by the Ministry of Health and Long Term Care, so much so that the funding for three Advanced Practice Nursing positions has become permanent.
When a variety of Emergency initiatives were announced last fall in Ontario, the made-in-Niagara solution was proposed to help NHS hospitals work with LTC facilities to reduce the number of preventable frail elderly admissions to hospital. Three part-time Advanced Practice Nurses were hired, initially on a temporary contract, to liaise with and educate staff at the LTC facilities.
Nurse Practitioners Cindy Gabrielli, Joanne Wilkinson and Melanie Stansfield have their Masters degrees in Family Nurse Practice as well as Bachelor of Science degrees in Nursing. These dedicated professionals have single-handedly, and at all hours of the day and night, responded to the needs of LTC facility staff.
By performing assessments with physicians and providing on-site training, the Advance Practice Nurses have made an incredible difference. They ultimately ensure residents receive the care and support they require in the comfort and convenience of their home facility. Previously, residents who became dehydrated and required IV therapy, for example, would typically travel by ambulance to an area hospital, where they would be in an acute care bed for five or more days, and then be returned by ambulance to their LTC facility.
As well as teaching intravenous therapy, the team of nurse practitioners educates RNs and RPNs at the LTC facilities on pain management, chest physio and other key health concerns. When called to a facility (team members are on 24-hour call) to provide assistance, they conduct a head-to-toe assessment, consult with the physician in charge, and offer staff any education and hands-on training required. Team members also do follow-up visits to ensure appropriate care is being given.
"We’re focusing on how to keep the residents in their home facility," commented Cindy. "The elderly generally do not do well in Emergency Departments or when admitted into hospital. They are easily confused in a new setting and can go downhill more rapidly.
"We have many physicians on board now, and they are starting to refer the facilities to contact us when they have a resident who may be in congestive heart failure, for example," Cindy said.
Another benefit of the program is the cost savings, which totalled more than $514,000 health care dollars from January to November 2001. That translates into 658 hospital patient days saved, allowing more acutely-ill patients access to those much-needed beds. An amazing 610 ambulance trips have also been saved, thereby freeing up ambulances for acute emergencies.
The LTC facilities are extremely pleased with having Advance Practice Nurses as resources. Jane Freeman is Director of Care at Extendicare in St. Catharines. "We call them constantly, and transferring a patient to hospital is now our last option, instead of our first."
"Not only do the Advanced Practice Nurses offer education and follow-up for pain management, IV therapy and antibiotics, but they also work with staff, residents, families and physicians around advance directives," Jane said. "This means we are offering better palliative care for our end-of-life residents and our families really appreciate that."