| Project Objectives / Summary:
The project sought to address an ongoing problem of the breakdown in communication between GPs and nursing homes and thus to improve the care of frail aged nursing home residents.
The main aims of the project were:
- Improve communication between nursing home staff, GPs and Pharmacists.
- Provide a forum in which to address problems encountered by any of the participating groups.
- Increase GP awareness of the legislative requirements under which nursing homes operate.
- Improve GP skills and knowledge in treating the frail aged.
- Improve skills and knowledge of Registered Nurses working in nursing homes.
- Reduce inappropriate hospital admissions.
- Ensure the nursing homes within the area covered by the PMDGP pass the Commonwealth Outcome Standards for Nursing Homes related to medical care.
- Adequate uniform documentation of care in all nursing homes in the area.
- Work towards achievement of RACGP Guidelines for Medical Care of Older Persons in Nursing Homes (1999) and the Commonwealth Outcome Standards for Nursing Homes.
- Optimise medication use in Nursing Homes.
- Make recommendations as necessary.
- Establish consultant liaison.
Project Collaboration:
Participation from all seven Nursing Homes in the Division's catchment area and their respective GPs
Project Outcomes:
Consultation by questionnaire and discussion showed that the key issues were:
- Visiting Medical Officers
- Inadequate remuneration
- Excessive paperwork
- Unnecessary requests for visits
- Unrealistic expectations of Nursing Home staff
- Nursing Home Directors of Nursing
- Lack of understanding by Doctors of the Regulations that govern nursing homes
- Problem with getting Doctors to visit
- Problem with urgent after hours care
- Doctor's don't allocate sufficient time for visits and are not well prepared
- General lack of interest in Nursing Home participation within the practice
As the title suggests, a key element of this project was liaison. The project report identifies action taken under each of the 12 aims to address this issue and notes where more success or underachievement was made.
Recommendations:
- Uniformity in documentation. This would alleviate some difficulties in case conferencing and patient transfer. It would be particularly useful to have a full case history of the patient. Increasing paperwork and lack of remuneration were once again highlighted as barriers to this occurring.
- Funding for a continuation programme "Link"
- Establish a "Clinical Service Agreement" between Nursing Homes and the attending Doctors. The agreement is only to clarify the responsibilities relative to the use of the facility.
- Questions the usefulness of Accredited Pharmacists within the Nursing Home sphere. Medications are reviewed, dispensed and monitored through a strict protocol. The medication reviews conducted by the Accredited Pharmacist are costly and no longer paid for through the health system. The medication review within this project highlighted that little or no changes in the prescribing or dispensing of medications have changed with the introduction of the Pharmacist review.
Lessons / Assessment:
This project involved a great deal of personal effort and commitment by the GP Director of the project, Dr Keith Beck. All seven Nursing Homes within the Division's catchment area are fully accredited and, while it is difficult to make the conclusion that this was largely connected with the project, it is reasonable to take the view that the liaison and communication efforts involved did assist to some extent. The project identified issues that will require continued review. |
