Discovering the sexiness of ARC
Finalist
Discovering the sexiness of ARC
Louise Fowler , Clinical Nurse , Specialist Aged Residential Care , Western Bay PHO .
Left to right : Louise Fowler and Sally Webb
Background The BOPDHB population greater than 80 years of age is growing , and in 2015 admissions from Aged Residential Care facilities ( ARC ) rose to 858 from the 36 ARC facilities with funded beds and admission to hospital were trending upwards . Many residents have multi co-morbidities and are highly complex . A hospital admission is not only costly , but often results in unnecessary delirium , falls and complications for the elderly . All individuals deserve the best quality of care for the remainder of their life .
Aim Following high numbers of hospitalisations from ARC , the service commenced in July 2015 with a key performance indicator for the service as reducing inappropriate hospitalisations . Prior to this appointment there was minimal support given to ARC .
Method Over the past 20 months Louise Fowler , Clinical Nurse Specialist with the Western Bay of Plenty PHO has visited six facilities , ( selected on the basis of ED presentations and admissions ) regularly aiming for 3-4 hours in each facility a week . During this visit a complex assessment has been conducted and RN staff have benefited from coaching and mentored in regards to the findings . Where possible Healthcare Assistants ( HCA ’ s ) have also been involved , thereby improving their knowledge understanding and skills thus influencing the quality of care delivered to residents . Another key aspect of the service has been the delivery of formal education for two hours each month . This has been accessible to all of the RN ’ s and EN ’ s working within ARC ( and more recently an additional hour is provided for HCAs ). The nurses have been supported to advance their thinking and transform their nursing requiring critical reflection on practice which challenges their beliefs and assumptions . As a result nurses have identified reversibility in the older person ensuring they have the best day possible . They have also developed their skills to embark on difficult conversations involving end of life care .
Results Since commencement of this role it is estimated that 90 admissions have been avoided to hospital from Aged Residential Care , through complex assessments . Saved admissions included identifying and managing residents with congestive heart failure , orthostatic hypotension secondary to polypharmacy and Hypoglycaemia secondary nephrotoxic medications causing renal impairment . Admissions have also been saved and quality of life maintained through completion of Future Care Plans and engaging residents in conversations around their values and wishes for a “ good death ”. One facility has also been trained to administer IV therapy which has saved 5 admissions within the first 5 months , therefore potential delirium and falls . Many other admissions have been saved through increased knowledge and critical thinking now utilized by ARC nurses . Since commencement of this role , hospital admissions from ARC to Tauranga Hospital have decreased by 20 %, not taking into consideration that figures were trending upwards .
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