WISE Medicines Care by Community Nurses

Transcription

1 WISE Medicines Care by Community Nurses Ann Johnson, RN Royal District Nursing Service (RDNS Vic) On behalf of WISE Medicines Care Workforce Innovation for Safe & Effective Medicines Care Aged Care Workforce Reform Project

2 Co-authors Rohan Elliott, Pharmacy Department, Austin Health, Centre for Medicine Use and Safety, Monash University Dr Christine Beanland, Senior Research Fellow, RDNS Institute, RDNS Dr Cik Yin Lee, Research Officer, Centre for Medicine Use and Safety, Monash University Dr Dianne Goeman, Senior Research Fellow, RDNS Institute, RDNS Ann Johnson, Senior Clinical Nurse Advisor (Medicines Management), RDNS Juliet Thorn, Manager, Community Programs, Aged Care, Austin Health A/Prof Susan Koch, Director, RDNS Institute, RDNS Acknowledgement Kirsty LeGassick, RN, Honours student LaTrobe Uni., RDNS 2

3 WISE Medicines Care Workforce Innovation for Safe & Effective Medicines Care Project partners: Austin Health (Pharmacy & Aged Care) RDNS Monash University (Centre for Medicine Use & Safety) Project sponsored by: Health Workforce Australia Aged Care Workforce Reform Project National Workforce Innovation & Reform Strategic Framework for Action

4 Project background HWA Aged Care Workforce Reform Program Subproject 1: Building workforce capacity for safe medications management in the community Drivers: Current workforce structure unsustainable: Increasing demand for medicines support Projected shortages of nurses Decline in the availability of informal/unpaid carers Assistant workforce under-utilised Suboptimal inter-disciplinary teamwork & co-ordination 4

5 Objectives: Project aim To develop and pilot a new workforce model of medication management support for older people living in the community; and To identify the support and enablers required for national large-scale uptake and replication of successful workforce reform models and approaches 5

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7 Medicines management at RDNS 1.9 million home visits (2013) Over 552,000 included medicines support >60% on weekdays >85% on weekends >1,400 visits per day Most visits by RN s 7

8 Project strategies Focus of the new workforce model: 1) Improved, standardised assessment of clients medicines management support needs by nurses 2) Expanded role for RDNS Community Care Aides (CCAs) to support stable clients with medicines support 3) Provision for full scope of practice of nurses with clients with high end needs and medicines administration 4) Enhance interdisciplinary communication and teamwork (GPs, nurses, case managers, pharmacists) 5) Increase focus on client education & support to promote independence 6) Use of alternative strategies for medicines support 8

9 Training Participating sites RDNS Heidelberg RDNS Diamond Valley Staff profiles at the 2 participating RDNS sites Registered Nurses (RNs): ~131 Enrolled Nurses (ENs): 6 Community Care Aides (CCAs): 8 9

10 Training 1) CCAs: Industry Skills Council units - HLTAP301B Recognise Healthy Body Systems in a Health Care Context and CHCCS305C Assist Clients with Medication Number of CCAs completed training: 8/8 CCAs 10

11 Training 2) Nurses and case managers: Self-directed learning Case studies and multiple choice questions Reference materials and readings 3-hour face-to-face training Medicines Care Pathway and risk assessment tool Nurses role in delegation and supervision Number of nurses completed face-to-face and self-directed training: 67/137 nurses (22 Heidelberg and 45 Diamond Valley) 11

12 Medicines assessment RDNS Medicines Care Pathway (electronic) Validated assessment tool (Delphi) Involves reconciliation of current medicines Explores beliefs & values & addresses the needs of diverse groups Addresses all acceptable & possible support options to enable independence Appropriately utilises the scope of practices of CCAs, ENs & RNs Minimises preventable adverse events when clients are prescribed high alert medicines 12

13 Implementation activities completed within RDNS Revision of CCA policy/guidelines for delegation & supervision to CCAs for medicines support Implementation of Medicines Care Pathway and medicines risk assessment tool Gradual implementation of expanded CCA role 13

14 Post-implementation data for home visits Across the 2 project sites Baseline (16 July 12 Oct 12) ~3 month period (n = 16,864 visits) Postimplementation (15 July 11 Oct 13) ~3 month period (n = 21,552 visits) Change Visits by CCA 43 (0.25%) 714 (3.3%) +3.05% Visits by ENs 1,694 (10.1%) 2,105 (9.8 %) -0.3% Visits by RNs 15,127 (89.7%) 18,733 (86.9%) -2.8% Referrals for visits for medicines management assessment using the MCP. Not all clients required MCP. 0 41/245 new clients (16.7%) +16.7% 14

15 Focus group findings RN/EN Pre implementation -Concern about increased risks associated with CCAs doing medicine support visits Post implementation -Nurses mostly positive experiences with medicines support tasks provided by CCAs. -High levels of trust confidence &communication between nurses and CCAs 15

16 Focus group findings RN/EN Assessment Medicines Care Pathway Time consuming given the mandatory general assessments that are required at admission Complex for clients with poor cognition and concentration K. LeGassick (2013) 16

17 Focus group findings CCAs Pre-implementation -CCAs were receptive to undertaking more medicines support and were keen to learn new skills Post implementation -Earlier concerns related to identifying medicines and who is responsible for errors was resolved -CCAs reported expanded role was well accepted & reported mostly positive experiences 17

18 Implementation Enablers Ongoing support and advocacy from RDNS managers Staff (RNs and ENs) attendance and participation in the face to face training sessions Enthusiasm and commitment of site staff, especially CCA s who embraced their new role 18

19 Barriers to Implementation Difficulty with accessing RDNS staff for training and implementation due to competing demands and projects. Low numbers of CCAs and ENs employed by RDNS limiting capacity to up-scale implementation of the model. Difficultly engaging GPs to implement inter-disciplinary team activities 19

20 Achievements WISE Medicines Care Improved client assessment to inform safe delegation and supervision of care to CCAs by nurses with clients at low risk with medicine regime Demonstrated effectiveness and sustainability across RDNS Further information 20