Pilot project aims to reduce preventable emergency department visits
March 19, 2015
LETHBRIDGE – Specially trained registered nurses have been placed within two local continuing care facilities as part of a pilot project designed to provide timely, on-site care to residents and reduce the need for emergency department visits.
St. Therese Villa and St. Michael’s Health Centre – both operated by Covenant Health – have each expanded their care teams to include a nurse practitioner. These health care providers are registered nurses with advanced education that enables them to diagnose and treat health conditions, order tests and prescribe medications. Nurse practitioners also provide health promotion, disease prevention, health education and counselling.
“The goal is to provide better care to our frail elderly and to help reduce some of those non-emergent emergency visits,” says Karen Fritz, Seniors Health manager for Quality Patient Care in the South Zone of Alberta Health Services.
“Mobility issues and other factors can make it hard for them to go to the doctor sometimes. Our goal was to utilize the nurse practitioners’ scope of practice to meet the needs of seniors where they live and see if we could assist in improving care for them.”
The nurse practitioners – Klaas Vanden Beld and Nicole Kinniburgh – started work at the facilities late last year; Vanden Beld at St. Therese Villa, Kinniburgh at St. Michael’s Health Centre.
Nancy Campbell, site administrator for both facilities, says more data needs to be collected before providing an initial assessment of the pilot program. But she says early results appear promising.
“I see the nurse practitioners as being that next phase in the evolution of seniors care, particularly facility-based seniors care,” Campbell says, adding that the team knows they will never be able to prevent 100 per cent of emergency visits and that, at times, the ED is where a resident does need to be assessed. “Those things will still happen. The philosophy is, though, that many of them are preventable with proactive care and that’s what Nicole and Klaas do.”
Moira Warnock recalls how her mother, Peggy Dunn, couldn’t walk or speak when she first moved to St. Michael’s and her dementia was rapidly worsening.
“I really felt that she was going to die soon,” Warnock says. “But Nicole started making some changes right away and, within three or four weeks, my mom was a different person. Now she’s up and walking, she feels good, she’s talking to everyone.”
Dunn also avoided an emergency department visit when Kinniburgh provided on-site treatment for dehydration, says St. Michael’s resident care manager Lisa Zubach.
“Nicole was able to get on top of the dehydration and make a couple of little medication adjustments in collaboration with the physicians,” Zubach recalls.
“Had we not had that collaboration, the response might well have been to send Mrs. Dunn to the hospital, and she might have had to be there for as long as four weeks.”
Vanden Beld’s expanded scope of practice helped St. Therese resident Margaret Pommen and her family. While Pommen was recovering from surgery at her daughter’s home in Calgary, Pommen decided to extend her stay, which meant she would run out of medication while there. The decision to stay in Calgary was made on a Sunday, when physicians can be hard to reach to renew prescriptions. Vanden Beld was on site and able to get a new medication order to Calgary within minutes.
“Klaas was efficient and able to respond quickly, which was such a relief for myself and our family,” says Pommen’s son, Gord.
The nurse practitioners also act as a resource and support for continuing care staff throughout the South Zone, including home care nurses.
“The home care nurses consult us when they see a change in a resident’s status,” says Kinniburgh. “They might ask us to do an assessment and make our diagnosis, create a treatment plan or prescribe medications. If we feel that the resident is too ill for us to manage in the community, then we would follow up with their family physician or seek the next level of treatment, A really important part of the role is partnership with the family physicians.”
Colin Zieber, Executive Director of Seniors Health for AHS South Zone, says the pilot project will be evaluated before deciding whether to expand the use of nurse practioners in South Zone continuing care sites.
Covenant Health is Canada’s largest Catholic health care organization with over 14,000 physicians, employees and volunteers serving in 12 communities across Alberta. A major provider in Alberta’s integrated health system, Covenant Health works with Alberta Health Services and community partners to positively influence the health of Albertans through a broad range of programs and services. Covenant.Health.ca
Alberta Health Services is the provincial health authority responsible for planning and delivering health supports and services for more than four million adults and children living in Alberta. Its mission is to provide a patient-focused, quality health system that is accessible and sustainable for all Albertans.