Nurse Practitioner - Like services in Residential Aged Care Services - Evaluation Report
3. The Trial Sites
It should be noted that this background is derived from information available from the sites and represents the intent of the sites, but not necessarily actual practice.
3.1 Warrabrook, NSW
3.1.1 The locality
This trial site is located in the Hunter region of New South Wales. There are 37 General Practitioners who service Warabrook Centre for Aged Care. There is also access to three pharmacies that service the facility via communication of resident needs through care staff and residents. There are no onsite Allied Health professionals but access can be arranged through appropriate referral processes. Examples of regular Allied Health Professionals who service Warabrook include Mental Health for Older Persons Team, Podiatrist, Speech Pathologist and Pathology Services.3.1.2 The facilities
The Warabrook Centre for Aged Care is a 151 bed facility with a client mix that includes 51 High Care and 100 Low Care Residents including 2 respite places. Residents have complex health care needs, and chronic illnesses which compound their care requirements. The facility is operated by a church-related, charitable, not-for-profit organisation. Throughout this report, the Warabrook Centre for Aged Care will also be identified as RACF 6.3.1.3 The nurse practitioner candidate
The NPC had completed 75% of a masters degree linked to licensure as a nurse practitioner in New South Wales when the trial commenced and has since completed. The Nurse Practitioner-like service included the use of agreed protocols and standing orders by the NPC to initiate diagnostic investigations and referral to other health professionals. Throughout this report, the NPC from Warabrook Centre for Aged Care will also be identified as NP 6.Top of page
3.2 Australian Capital Territory
The ACT had been previously undertaking research into the potential of the role of the aged care nurse practitioner. Thus, the national 'Aged Care Nurse Practitioner Trial' was deemed a 'nested' project for ACT Health, ie, the ACT provided data and information to JBI who were undertaking the evaluation component on behalf of the Australian Government.During this period, ACT Health continued to research the role of the nurse practitioner in aged care with 'Implementing the Nurse Practitioner Role in Aged Care (INPRAC)' project which is a jointly funded initiative between the Australian Government (Department of Health and Ageing, Quality Outcomes Branch) and ACT Health to implement the NP role in Aged Care. The project resulted from negotiations between representatives of ACT Health and the Department of Health and Ageing to extend the parameters of the 2004-05 Aged Care Nurse Practitioner Pilot Project.
3.2.1 The locality
The ACT and surrounding regions has a population of over 500,000 people and provides a wide range of health care services. The primary and community care system is a fundamental part of the ACT health care system. This sector provides a range of care including aged care, drug and alcohol, dental and indigenous health services, community-based allied health services, mental health services, alcohol and drug services, home and community care support services, health promotion services and community nursing. General Practitioners play an integral role with about 85 per cent of people seeing a GP each year (ACT Government 2002). In any given year there are about 65,000 separations from public hospitals (ACT Health 2004-5). All these services play a vital role in preventing and reducing the need for hospital admissions, maintaining the wellbeing of the community outside of the hospital setting and supporting consumers following discharge from hospital (ACT Government 2002). There are currently twenty-eight residential aged care facilities (includes both low and high level) in the ACT.3.2.2 The Canberra Hospital and Calvary Healthcare.
The Canberra Hospital is a major national tertiary hospital that provides a full range of medical, surgical and obstetric services as well as the provision of complex services such as major cardiac surgery and intensive care services. Calvary Public Hospital also provides a comprehensive range of surgical, medical and obstetric services and is a major centre for elective surgery. Services at both acute hospitals are moving towards clinical streaming, increasing the emphasis on a client centred health system. Clinical streaming builds upon a networking of services to focus on the provision of services across the care continuum. Streamed services operate under one management model and provide services such as health promotion, early intervention, community and outpatient services through to acute care services. Areas that are already established as service networks include ACT pathology, cancer services and aged care and rehabilitation (ACT Government 2003-2004). Throughout this report, the Canberra Hospital and Calavary Healthcare will also be referred to as RACF 8.3.2.3 Mirinjani Retirement Village
Uniting Care Ageing has provided the clinical placement for the NPC through the Implementing the Nurse Practitioner Role in Aged Care (INPRAC) project. Uniting Care Ageing is a not for profit organisation. The Uniting Church in Australia Property Trust (NSW) has been providing quality aged care services for over 40 years and has a long-term commitment to continue to meet the growing needs of the community. The Church's aged care services group, UnitingCare Ageing NSW/ACT, is one of the largest aged and community care providers in Australia, operating some 92 residential aged care facilities containing 5771 places, 72 community care services providing for over 4000 clients and 3000 self care units located at 80 different sites. The total annual turnover of these operations is in excess of $300 million. UnitingCare Ageing NSW/ACT employs in excess of 5000 staff to support these operations. Throughout this report, the Mirinjani Retirement Village will also be referred to as RACF 7.3.2.4 Nurse Practitioner/Nurse Practitioner Candidates
Within the national Aged Care Nurse Practitioner trial and the INPRAC project there were two NPCs. One position was placed with ACT Health (public sector) within the Aged Care and Rehabilitation Service. Although this position was physically located at the Canberra Hospital, the role worked across the acute (The Canberra Hospital and Calvary Healthcare), the community and the residential aged care sectors. Throughout this report, this NPC will also be identified as NP 8.The other NPC position was placed with the private residential sector with the organisation of Uniting Care Ageing at Mirinjani Retirement Village, Weston Creek, ACT. Throughout this report, this NPC will also be identified as NP 7.
At the beginning of the national aged care NP trial, the two NPC were finalising the requirements for the Master of Nurse Practitioner degree at the University of Canberra. Both had completed the required lectures and clinical viva, however needed to complete a thesis that would fulfil the final component. Both candidates successfully completed all requirements and are continuing in NP positions following the completion of this trial.
3.2.5 Aged Care Clinical Practice Guidelines
Aged Care Clinical Practice Guidelines were developed by the NPCs during the ACNPPP and have been reviewed and updated during the INPRAC project. During these clinical placements the NPCs enhanced the clinical practice guidelines that were developed as part of the Aged Care Nurse Practitioner Pilot Project, 2004-2005. These included the scope of practice, diagnostic investigations and medication formulary for the Aged Care NP. (Appendix III).Clinical Practice Guidelines are regulated in the ACT. Before the NP is able to enact and practice within the full scope of the role, such as prescribing, ordering diagnostic tests and referring to other health care professions, written endorsement of the multidisciplinary stakeholders who have been involved in the development/adaptation of the guidelines including the medication formulary is required. Additionally, formal agreement and signed approval is required from the CEO and General Manager of the health service in which the NP is employed. Therefore, after assessment of the client/resident any initiation of medication or diagnostic tests (those activities normally associated with the extension of the NP role) was conducted in consultation with the appropriate medical officer.
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3.3 Barossa Village, SA
3.3.1 The locality
The facility is located in the Barossa Valley, South Australia.3.3.2 The facility
The Barossa Village Residency is an 80 bed facility with a client mix that includes 49 high care beds and 24 low care beds, and seven unfunded beds being used for rehabilitation services and other care. Residents at Barossa Village Residency have complex health care needs and chronic illnesses that compound their care requirements. The facility is operated by a community managed, charitable, not-for-profit organisation that provides a wide range of other services to the ageing population including, 54 Community Aged Care Packages, 5 Extended Care at Home Packages some of whom have already been seen by the Nurse Practitioner (though not as part of this trial), 7 Extended Care at Home (Dementia) packages and approximately 200 people in small groupings of retirement cottages across the region. It enables socially isolated residents of the region to attend congregate programmes at a Nuriootpa based Community Centre and works collaboratively with many other service providers within the region to achieve the best range of options for care possible within funding availability. Throughout this report, the Barossa Village Residency will also be identified as RACF 11.3.3.3 The nurse practitioner candidate
The NPC had completed a masters degree linked to licensure as a NP in South Australia when the trial commenced and has since been licensed as a NP by the Nurses Board of South Australia as the first Aged Care Nurse Practitioner in South Australia. The NP has previously operated as a Clinical Nurse and deputy Residential Services Manager at Barossa Village for a number of years and has shown a great passion for this quality service for the better health treatment of residents and clients. The NP service included the use of agreed protocols and standing orders by the NP to initiate medications, diagnostic investigations and referral to other health professionals. Throughout this report, this NPC will also be identified as NP 11.Top of page
3.4 Resthaven, Paradise, SA
3.4.1 The locality
The Resthaven nurse practitioner-like service is in North East Adelaide. Pharmacy services are provided by a local pharmacy and allied health services from Resthaven are been used. GP involvement for the project has concentrated on the two primary GPs who have the majority of the residential facility resident numbers. The outer northern suburbs of Adelaide are identified areas of GP shortage. During phase 2 of the national evaluation, a further site was added to the candidate's jurisdiction – Resthaven Leabrook is situated on the corner of Kensington and Glynburn Roads in Adelaide's Eastern suburbs.3.4.2 The facilities
The Resthaven Paradise site has 40 high care and 87 low care residents. The service is operated by a church-related, charitable, not-for-profit organisation. The Resthaven Leabrook site has 40 high care and 71 low care beds, including a 14 place low dependency secure dementia care unit and two low dependency respite care places. Throughout this report, this facility will also be identified as RACF 10.3.4.3 The nurse practitioner candidate
The NPC had no previous education or training in the NP role when the trial commenced. The Nurse Practitioner-like service introduced included the use of agreed protocols and standing orders by the NPC to initiate medications, diagnostic investigations and referral to other health professionals. Throughout this report, this NPC will also be identified as NP 10.Top of page
3.5 Clarence Estate Residential Health and Aged Care
3.5.1 The locality
The facility is located in Albany, a regional centre in the south-west of Western Australia which serves a population of 31900 thousand people. Albany is a retirement destination for many Western Australians, and the proportion of its population aged 65+ is greater than 18%, compared with the state average of 11%. It is expected that Albany's aged will comprise 30% of the population by 2012.Residents at Clarence Estate have the right and opportunity to allocate a pharmacy or pharmacist of their choice. There are approximately eight pharmacies in Albany. The facility uses an artromick system. As with the choice of pharmacist, residents also nominate a General Practitioner of their choice. They have approximately 33 General Practitioners to choose from and usually nominate the General Practitioner who had cared for them in the community.
Clarence Estate has an on-site physiotherapist and occupational therapist. A podiatrist visits six-weekly. Clarence Estate also has a dietitian and social worker, who are based centrally. Clarence Estate's residents can be referred to any private allied health worker they wish to see in the community.
3.5.2 The facility
Clarence Estate Residential Health is an 86 bed facility with a client mix that includes 36 high care beds; 18 dementia-specific standard high care beds; 16 extra services high care beds; and 16 extra services low care beds. Residents have complex health care needs, and chronic illnesses which compound their care requirements. The facility is operated by a private, for-profit organisation. Throughout this report, this facility will also be identified as RACF 5.3.5.3 The nurse practitioner candidate
The NPC had no previous education or training in the NP role when the trial commenced. The Nurse Practitioner-like service introduced included the use of agreed protocols by the NPC to make recommendations to participating medical practitioners regarding the ordering of medications, diagnostic investigations and referral to other health professionals. Because of restrictions to the use of standing orders in Western Australia, it was not possible to use standing orders on this site and, thus, the nurse practitioner-like service was mediated through medical practitioners.Top of page
3.6 Kensington Park and McDougall Park Aged Care Home, Perth, WA
3.6.1 The locality
Both of these facilities are located in Perth, Western Australia and together serve around 10% of the total population of Perth which is 1, 292 297. Access to pharmacy and allied health services is good and GP services are in the vicinity. A doctor service gap is evident after hours and on the weekends. While a locum service is operating it does mean that the resident often has to wait some time before the locum can visit the resident.3.6.2 The facilities
Kensington Park Aged Care Home is a 60 bed high care facility. All residents admitted to this facility have dementia and it is essentially a dementia specific facility. Additionally, residents have complex health care needs, and chronic illnesses which compound their care requirements.McDougall Park Aged Care Home is a 52 bed high care facility. The client mix includes residents with complex care health needs, chronic diseases including dementia which compound their care.
Residents at Kensington Park and McDougall Park homes are offered the services of the organisation's allocated pharmacy services. The Artromick system is used. Residents have a choice to nominate their own general practitioner however it is more likely that the resident uses the services of a general practitioner nominated by the facility, ie a general practitioner who has already agreed to take on another client.
Both facilities use an on site Physiotherapist, Occupational Therapist, Podiatrist and the organisation employs a Dietician and Social Worker. Both facilities are operated by a private, for profit organisation. Throughout this report, these facilities will also be collectively identified as RACF 4.
3.6.3 The nurse practitioner candidate
The NPC had no previous education or training in the NP role when the trial commenced. The Nurse Practitioner-like service introduced included the use of agreed protocols by the NPC to make recommendations to participating medical practitioners regarding the ordering of medications, diagnostic investigations and referral to other health professionals. Because of restrictions to the use of standing orders in Western Australia, it was not possible to use standing orders on this site and, thus, the nurse practitioner-like service was mediated through medical practitioners. Throughout this report, this NPC will also be identified as NP 4.Top of page
