KERN COUNTY. Nurse Clinics

Transcription

1 KERN COUNTY Nurse Clinics 3 rd Annual Ambulatory Care Nursing Symposium Presentation: May 19 & 20, 2010 Presenter: Candace Kielty BSRN, AMGA SCPMG: Kern County 1 KP Kern County Demographics KP Kern County Membership: YTD 91,561; 43.9% Hispanic, 38% Caucasian; higher percentage of membership in 0-34 age category Seven MOBs spread across the Incorporated Area of Bakersfield Non-licensed, Business Occupancy Space 2K/4K* Central Discovery Plaza* East Hills* Ming* Northwest/Coffee Rd* Stockdale* *MOB with Nurse Clinic 2 1

2 Kern County Care Delivery Model Internalized Services Primary Care Adult & Peds Majority of Specialty Care; Some Specialty Care i.e. GI, Has Internal & External Contracted Providers Rotating SCPMG Providers: Peds Cardiology, Perinatology, etc. 3 Kern County Care Delivery Model Contracted/External Services Out Patient Surgery Inpatient Care Home Health Some Surgical & Medical Sub-specialties; Examples: -Infectious disease - Cardiology 4 2

3 Kern County CSG Imperatives Rank of Mean Period 5 of 2009 Breast Cancer Screening 6* Lipid Control for Patients with CV Conditions 4 Lipid Control in Members with Diabetes 2 HbA1C <= 9% in Members with Diabetes 1 HbA1C <= 8% in Members with Diabetes 1 HbA1C testing in members with Diabetes 1* Controlling High BP 1* Lipid Control 4 *Impacted Through Nurse Clinic Visits 5 RN Staffing MOB RN Staffing MD s/md Primary RN Clinic Specialty RN Clinic 2K/4K 7 15 Discovery East Hills Ming 9 26 Northwest 2 6 Stockdale Hours of Operation: Primary RN Clinics Monday Friday 8am 10pm; Stockdale Saturday & Sunday 9am 9pm Specialty RN Clinics Monday Friday 8am 5pm 6 3

4 Nurse Clinic Staffing/Levels/Skill Set Staffing Decentralized at Each MOB with Back Up by Centralized Float Pool RN Levels Primary and Specialty RN Clinics Level 2 RN Level 4 Charge RN Skill Set One Year Experience in Adult and/or Peds, (Nurse Clinics Will Handle Both Populations) BCLS IV Certified PICC Line (Will Train) Specialty Allergy - ACLS OB - NST/FHT Float Pool as Above and Trains at all MOB s Art of Nursing Develop Meaningful Connection With Our Clients/Patients Skillfully Perform Our Nursing Activities Use Critical Thinking Skills to Always Choose the Appropriate Nursing Action to Treat Our Patients Most Importantly, Conduct Our Nursing Practice Ethically View the Patient Holistically 7 Nurse Clinics Primary & Specialty Physical Space Holding Rooms 2-6 Beds for Assessment, Treatment & Observation Usually Discharge Home May Transfer to Higher Level of Care Nurse Clinic Schedules Walk-in or Scheduled Appointment Use Regional Templates 8 4

5 RN Schedule Visit Type INFUS4H INFUS4H OVF20 RPROC30 RPROC30 EKG20 Length 240 Minutes 240 Minutes 30 Minutes 30 Minutes Appt. Notes Remicade Infusion Lab Test Results Humira BP CK Check per Dr. Ear Check per Dr. PICC Dressing & Lab Draw, Change Knee Dressing Therapeutic Phlebotomy EKG per Dr. EKG for Bariatrics PICC Care, Labs, Schedule Follow-up w/ Dr. Travel Imms, Orders in HC Bil Audiogram/Tympanogram/BP check EKG Pre Op Recheck Wound on Back per MD 9 Provision of Care Individualized Provider Orders Pre-Printed Order Sets Methotrexate Remicade Accutane Standardized Procedure & Protocols Wound Care 10 5

6 Process: Walk-in MD Referred Scheduled into Clinic Member Intake Members Include: Primary Adult Pediatric Specialty OB Allergy Peds & Adult Dermatology Peds & Adult Surgery/Urology - Adult 11 Services Provided Triage / Assessment / Evaluation Patient Monitoring Arterial Blood Gas (ABG) draw Phlebotomy EKG s POCT Culture Collection (Sputum, Wound, Throat, Urine etc.) Peak Flow Testing Verify Meds for Non-licensed 12 6

7 Services Provided Treatment Medication Administration Injections (SQ, IM, ID) & Oral Administration of Immunizations, Travel, Peds, Adult Portacath Access and Flushing IV (Routine/Specialty Infusions & Same Day MD Ordered Infusions) TB Skin Test Administration and Reading Glucose Checks, Insulin Administration Teaching PICC Line Care & Dressing Changes Blood Draw from Central Line Wound Care Suture Removals Steri-strip Administration Splinting Assisting MD with Procedures Ear Lavage (Ear Wax Removal) Administration of Breathing Treatments 13 Services Provided Education Glucometer Teaching Insulin Administration Teaching Home Dressing Change Teaching Home Injection/IV Teaching HIV/STD Counseling (pre and post testing) Lab Results and Explanation Post Op Follow-up Calls Example: Myringotomy Tube Placements, Tonsils & Adenoids Pre-op Surgery Education 14 7

8 Services Provided Monitoring/Coordination of Care/POE/CSG Blood Pressure Monitoring/ Checks Blood Pressure Patient Call Backs Glucometer Download Arrange Patient Transport to ER or Direct Admit Patient Advocate / Emotional Support / Dispute Mediator Post Discharge Care Local and from Southern or Northern California Region Arrange Out Patient Blood and Blood Product Transfusions Book Appointments Update Child Immunizations Dispensing DME and Soft Goods Crutches, Nebulizers, Splints Enter Referrals Proactive Office Encounter Order Entry / Care Experience Summary Sheets Lab Order Entry/Trouble Shooting Report to/consult With MD s 15 Services Provided Quality Assurance POCT log Maintenance Maintain KITS Lot Numbers and Immunizations, Fridge Temperature Logs POCT QC & Trouble Shooting Urine Pregnancy Hemo Cue Glucometer Urine Dip 16 8

9 Interface with/coordination of Care CLN s PCM (Complete Care) Coordinators FCM / Focused Care Management Nephrology Procrit Home Health Discharge Follow-up 17 Interface with/coordination of Care Communication between Clinics Documentation of Coordination Care Experience Summary Sheet Discharge Summary Sheet 18 9

10 Care Experience Summary For Everyone Blood Pressure Screening Body Mass Index (BMI) Smoking History Passive Smoker Colorectal Cancer Screening Osteoporosis Screening For Women Cervical Cancer Screening Breast Cancer Screening Chlamydia Screening Chronic Conditions Diabetes Heart Disease Asthma Immunizations 19 Discharge Summary Sheet Discharge Summary Report Kaiser Permanente Patient Information: Patient Name: Kaiser Medical Record #: Family Contact / Care Provider: Patient agreed with IV Home Infusion: Yes No Discharged Diagnosis: Intravenous Access Information: Type of Intravenous Access: Date of Placement: Last Dressing Change: Type of IV Flush: Other Tubes: GT; Tracheotomy; Others Age: Primary Care Provider: Admitting / Discharging Doctor: Size of PICC: Size of Mid Arm Circumference: Length of Catheter: Medication(s) ordered: Last dose of medication given: Attached Copy of order: Yes No Ordering Doctor: Home IV Teachings: Other Home Health Teachings: Equipment / Supplies: IV Pump IV Supplies Medications Home Health Pharmacy: Kaiser Home Infusion Pharmacy: Contact Number: Others Home Health Pharmacy: Contact Number: Information Faxed to Kaiser Nurse Clinic: Yes No Medication Administration Record Doctors Progress Notes / Discharge Notes Latest Labs Result Nursing Notes Current Doctors Orders List of current discharged Home Medications: Follow-up Appointment with PCP / Specialty Doctors: Report given to Kaiser Nurse Clinic RN: Discharge Planner: Print Name Signature Date: Time: Contact Number: 20 10

11 Productivity/Utilization Measures Each RN / Each Department worked Cadence/Clarity Reports Scheduled, walk-in, add appointments Telephone Encounters Nurses Note Budget FTE Data for Same Period = Patient Encounters / FTE 21 Phone Encounter Data Kern County Encounters, 3/1/2009 to 9/30/2009 Provider FTE Specialty Encounter Type Telephone Note/Clinic Total RN 1.0 Surgery, General RN 1.0 Otolaryngology

12 Every Patient Every Time 23 12