Sarah Crowe, MN, RN, CNCC(C) Clinical Nurse Specialist Critical Care Wendy Bowles, MN, NP F, CCN(C) Nurse Practitioner Lead, Regional Department Head Fraser Health Authority, B.C. For more information please contact: sarah.crowe@fraserhealth.ca 1 of 18
A costly area, critical care needs to look at new ways to provide high quality care Although new to BC, there is strong evidence to support improved patient care and reduction of costs in critical care with the addition of an NP to the interdisciplinary team A case was made to the senior leadership team; followed by an advanced practice nursing (APN) partnership to bring the idea of NPs in ICU from inspiration to implementation For more information please contact: sarah.crowe@fraserhealth.ca 2 of 18
A partnership between the Critical Care Clinical Nurse Specialist (CNS) and the Nurse Practitioner (NP) Lead for Fraser Health was formed Each APN brought unique perspectives to the project After identifying the vision for the program, the PEPPA framework was used to create a 1 year fellowship program to support & guide implementation of NPs into ICU For more information please contact: sarah.crowe@fraserhealth.ca 3 of 18
Incorporate NP expertise into an interdisciplinary Critical Care team within Fraser Health; starting at Abbotsford Regional Hospital Create a sustainable NP fellowship program to support integration of NPs into Critical Care For more information please contact: sarah.crowe@fraserhealth.ca 4 of 18
9. Long term monitoring 1. Define population & current state 2. Identify stakeholders & participants 8. Evaluate NP 3. Determine the need for a new model of care 7. Initiate 4. Identify priorities & goals 6. Plan implementation strategies 5. Define the new model of care & the NP role For more information please contact: sarah.crowe@fraserhealth.ca 5 of 18
1. Define Population & Current State Critical care patients are cared for by physician led interdisciplinary teams that include nurses, respiratory therapists, and other allied health professionals Some sites have residents who also rotate through Admission to critical care and patient care is determined by the ICU physician Physicians rotate through the ICU leading to multiple handovers & change For more information please contact: sarah.crowe@fraserhealth.ca 6 of 18
2. Identify stakeholders & participants To improve patient access, consistency of care, and address a service gap, key stakeholders were engaged early in the planning. Stakeholders: Critical Care Leadership including Executive Directors, Directors, Managers, CNS, and NP Lead Physicians NPs Critical Care Nurses Health Authority Professional Practice Patients and families For more information please contact: sarah.crowe@fraserhealth.ca 7 of 18
3. Determine the need for a new model of care Critical care is a costly area facing resource and provider shortages Across Canada & in other countries Critical Care NPs are part of the care teams Evidence supports improved care, reduced costs, and decreased complication rates with the integration of an NP into critical care Including: Reduction in UTIs, VAP, skin breakdown; and improved compliance with care bundles / guidelines For more information please contact: sarah.crowe@fraserhealth.ca 8 of 18
4. Identify priorities & goals Addition of an NP to the Critical Care interdisciplinary team will enable: Early diagnosis and establishment of treatment plan based on best practice standards Create capacity / access to critical care Demonstrate improved patient care and cost effectiveness Develop an innovative and desirable new role for NPs in B.C. For more information please contact: sarah.crowe@fraserhealth.ca 9 of 18
5. Define the new model of care & the NP role Incorporate 2 NPs into the ARH ICU team to enhance and provide consistent coverage Majority of NPs in B.C. are primary health / family practice trained; to support integration a 1 year fellowship program was created with the appointment of a physician mentor and protected education time For more information please contact: sarah.crowe@fraserhealth.ca 10 of 18
Partnership with CNS & NP Lead to create an educational program to ensure support and proper integration of the new NPs Fellowship was created using CNA, CRNBC, CACCN and AACN critical care guidelines as a framework Collaboration with other specialty NPs and Harborview Critical Care NP Leader to ensure content was comprehensive and appropriate For more information please contact: sarah.crowe@fraserhealth.ca 11 of 18
Included: Overall goals Principles Evaluation Mentors and mentees roles and expectations Technical Skills Development & Competency Systems Overview: Basic knowledge and skills required of Critical Care NP For more information please contact: sarah.crowe@fraserhealth.ca 12 of 18
6. Plan implementation strategies Once the fellowship program was completed, advertisement and hiring of 2 NPs occurred During the hiring process re-engagement of the health authority and the specific hospital site was done, including: Communication campaigns; including physician communication ICU staff engagement through unit huddles, staff meetings and a survey For more information please contact: sarah.crowe@fraserhealth.ca 13 of 18
7. Initiate Gradual implementation plan allowing time for integration and knowledge assimilation First 6 months of the fellowship program provide protected time for structured learning with physician mentor Last 6 months of the fellowship program provide time for consolidation and focused training as required For more information please contact: sarah.crowe@fraserhealth.ca 14 of 18
8.Evaluate NP self assessment & identification of learning needs BC ICU Database to monitor pre and post implementation length of stay, complication rates, compliance with care standards, etc Staff satisfaction surveys For more information please contact: sarah.crowe@fraserhealth.ca 15 of 18
9. Long Term Monitoring Fellowship program has been operating for 6 months Positive feedback from staff & NPs Continue to monitor ICU statistics for evaluation and opportunities for improvement Advocating to utilize fellowship program to incorporate NPs into other sites within Fraser Health For more information please contact: sarah.crowe@fraserhealth.ca 16 of 18
Becker, D., Kaplow, R., Muenzen, P.M., & Hartigan, C. (2006). Activities performed by acute and critical care advanced practice nurses: American Association of Critical Care Nurses study of practice. American Journal of Critical Care, 15(2), 130-148. Crowe, S. (2014). A role for nurse practitioners in the ICU: advocating for change. Dynamics, 25(3), 26 29. DiCenso, A., Martin-Misener, R., Bryant Lukosius, D., Bourgeault, I., Kirkpatrick, K., Donald, F., Charbonneau-Smith, R. (2010). Advanced practice nursing in Canada: overview of a decision support synthesis. Nursing Leadership, 23, 15-34. Fry, M. (2011). Literature review of the impact of nurse practitioners in critical care services. Nursing in Critical Care, 16(2), 58-66. Hoffman, L.A., Tasota, F.J., Zullo, T.G., Scharfenberg, C., & Donahoe, M.P. (2005). Outcomes of care managed by an acute care nurse practitioner / attending physician team in a subacute medical intensive care unit. American Journal of Critical Care, 14, 121 130. Kapu, A.N., Thomson Smith, C., & Jones, P. (2012). NPs in the ICU: the Vanderbilt initiative. The Nurse Practitioner, 37(8), 46-52 For more information please contact: sarah.crowe@fraserhealth.ca 17 of 18
For any questions or comments please contact: Sarah Crowe, RN, MN, CNCC(C) Clinical Nurse Specialist Critical Care Fraser Health sarah.crowe@fraserhealth.ca For more information please contact: sarah.crowe@fraserhealth.ca 18 of 18