What was the issue you were addressing or working on?
Traditionally older adults with a long term condition who had or are having frequent uncomplicated exacerbations would be highly likely to be admitted to hospital care. This is due to the fact that other than GPs there is no other professional that has traditionally been able to offer advanced assessment in the community.
Under the new approach, the ANPs would identify individuals who would benefit from an anticipatory intervention and develop a personalised ACP through advanced nursing assessment to support them to be remain at home for as long as possible.
What you did?
Three Advanced Nurse Practitioners have been recruited through the Change Fund, and came into post at staggered intervals in 2012 and 2013. The initial journey has involved undertaking a year-long PGCert in Advanced Nursing Practice, comprising of the following modules: 1. Advanced Patient Assessment, 2. Diagnostic Decision Making, 3. Prescribing in Advanced Practice. All of the ANP’s have successfully completed this advanced course and have now fully taken on development of pathways, documentation and their caseloads.
Whilst undertaking the course which has involved theoretical and hands on learning, the ANP’s have developed proactive and reactive service pathways, managed a small caseload and begun recording activity and impact using the local RCOP performance framework. Each of the ANP’s are aligned to a GP cluster area and therefore are able to build effective relationships within their cluster area to manage referrals.
What were the outcomes - benefits or otherwise?
The major milestones to date have been the completion of the PGCert in Advanced Nursing Practice. Now this has been achieved, recent activity has been around raising the profile of the service amongst all referral sources including GP Practices, and to gradually increase the caseload being managed. To date, the ANP’s have successfully managed to avoid 33 hospital admissions for older people who would have previously been highly likely to be admitted to hospital. A typical hospital admission for this patient group would last for 2 weeks. If we take each hospital admission to be on average 14 bed days, then to-date around 462 bed days have been saved where admissions were avoidable. These are the result of the partnership arrangements in place with the ANPs, GPs, wider health and social work colleagues and partners in the third sector.
A recent case example highlights some key benefits realised:
- 82 year old urgently referred to ANP as unwell for a few days and wife struggling to cope at home.
- Patient had seen GP a few days before and did not wish to be admitted to hospital, had been prescribed antibiotics for presumed urine infection
- District Nurses concerned patient having frequent falls, and wife increasingly stressed.
- ANP undertook advanced nursing assessment on same day of referral, identified range of issues including poor mobility, confusion, poor speech and general distress.
- The ANP developed a plan with the couple to help them to remain at home, which is what they wanted.
- Urgent homecare was arranged to begin that night, providing immediate relief and support for the carer. Enlisted nearby family for emergency support and urgent referrals to rehabilitation team who brought equipment to make the environment safer and reduce likelihood of falls.
- Urgent referral for wife to carers’ centre and support put in place.
- ANP continued to liaise with GP and District Nurses to discuss and update on plan.
- ANP visited again following morning, and on following week to review progress. Patient stable and has improved mobility with zimmer, and carer stress has significantly reduced.
- Information on telecare shared with couple, who then requested a community alarm and a falls detector, and report greater peace of mind. Couple can contact ANP in future for advice with an anticipatory action plan however in meantime the District Nurses will provide support to the patient as necessary.
- Crisis admission to hospital avoided.
A slideshow of the work can be viewed here
Contacts - to find out more
Wilma Hepburn, Wilma.firstname.lastname@example.org 0141 577 3376