As one of two South East CCAC Nurse Practitioners providing outreach to long-term care homes Donna Blair’s most frequently used tool is questions. She asks a lot of them.
Donna begins her afternoon by faxing a consult request to a hospital Diabetes Education Centre clinical nutritionist followed up with a phone call to discuss. “Working with a nutritionist, we are seeking to stabilize blood sugars for a resident in a local long-term care home. This resident has had longstanding fluctuations in blood glucose levels and requires significant changes in her insulin regime.”
Donna’s car becomes her office for a good portion of the afternoon travelling between long-term care homes and trouble shooting a steady stream of phone calls from front line health care workers seeking guidance.
“Time management is a critical skill,” says Donna as she pulls her car to the side of the road to take a phone call from a nurse at a long-term care home. Again, firing off a half dozen questions to systematically assess the resident’s needs, Donna provides education and reassurance to the caller. “Front-line health care providers are extremely busy and at times they need help with decision making. They usually already have the right course of action and they just need validation and support.”
Donna is immediately welcomed on every stop during her busy day. “The Nurse Practitioner led outreach from the CCAC is very valuable to long-term care homes,” said Anita Garland, Administrator of EJ McGuigge Lodge in Belleville. “The service is invaluable for medication reconciliation alone not to mention all of the other value added skills and knowledge Donna brings. She has also been a tremendous asset in dealing with residents who have challenging behaviours.”
After a quick check in with the administrator and nursing staff, Donna is off to visit two residents for follow up. After checking vital signs, encouraging a resident to drink plenty of fluids and providing advice about managing a difficult wound, Donna is off to visit the next resident. On the way, she is approached in the hall by more nursing staff and once again launches into a series of new questions with the curiosity of an investigative reporter. “Sometimes even with a quick consult, we can potentially avoid an emergency department visit and hospital admission,” says Donna.
Upon entering the room of resident William May, Donna is welcomed with a big hug of appreciation. “They have made a home for me here at MCQuigge Lodge. We are all family here and I appreciate all you have done for me to be able to stay here,” said William. “I am also deeply grateful for the four years that the CCAC provided nurses to help my wife live at home. They taught me so much and we could not have done it without them.”
En route to visit another resident, Donna receives a call from a long-term care home whose resident physician has requested her to consult on a resident with a persistent cough. After more questions, enquiry and probing, Donna agrees to stop in to see the resident in a neighbouring town on her way home at the end of the day.
Once again upon entering Westgate Lodge, Donna is welcomed as a vital part of the care team.
“The Nurse Practitioners are particularly helpful for those residents who refuse to go to hospital,” said Carrie Deline, Director of Nursing at Westgate. “Donna can offer a similar level of care to what the resident would receive in the hospital right here in the home.
“If we can manage a resident’s care in the long term care home and avoid an emergency department visit, we will,” confirms Donna. “To ensure the best possible care for a resident, the Nurse Practitioner may request CCAC services, consult with other allied health providers, communicate or consult with the physician, and most importantly communicate with the resident and/or their family members. When a resident has to be sent to the hospital we communicate with the Emergency Department staff, so they are aware of the health status of the resident. It is also communicated to the hospital staff that the Nurse Practitioner is available to transition the resident back to the home expeditiously.”
Not only does Donna use her phone to provide consultation and education to health professionals, she has used her phone to send a photo of a necrotic, non-healing acute wound to the resident’s vascular surgeon. Upon seeing the photo the surgeon scheduled surgery for the next day instead of a clinic appointment that was being scheduled in one week. Post-operatively, that resident is now healing nicely back in the home.
This service is available to all long-term care homes across southeastern Ontario.