www.oltca.com LONG TERM CARE TODAY 35 EMERGENCY CARE NP expanded the home’s on-site abilities for diagnosis, treatment, and clinical support for staff and families. A significant part of the nurse practitioner’s role is finding ways to keep residents in the home and avoid transfers to the emergency department. This involves a two-pronged approach: diagnosing and treating potential problems early, and educating families who often want their loved one taken to the hospital when it isn’t necessary. Diagnosing and treating problems early Having a full-time nurse practitioner means that the staff have an on-site resource person they can contact whenever they have concerns, and together they can identify problems before they escalate to a stage that needs hospital attention. As one example, urinary tract infections were previously a major cause of emergency department transfers. “We have an early-detection system by watching for delirium,” says Barlow. “Staff will come to me and say, ‘Something isn’t quite right with Mr. Jones.’ We can then diagnose and treat the urinary tract infection right away before it goes any further.” Another example is abdominal pain. While distressing, it’s not uncommon for the underlying cause to be constipation from medications such as narcotics. Providing laxatives along with drugs known to cause constipation can help reduce a resident’s discomfort as well as concerns about the need for a visit to emergency. The home’s medical director is a significant supporter of having a nurse practitioner, says Lori Turcotte, as he appreciates having someone on-site to manage day-to-day concerns and allow the physicians to focus on the most complex residents. Educating families While transfer to the emergency department is appropriate in some cases, families in long-term care often ask for their loved one to be transferred for conditions that don’t require hospital attention. They frequently believe that only a hospital can diagnose, treat or manage the symptoms. Starting at admission, Director of Care Diane Garrett begins ongoing communication with families about their loved one’s health concerns, which involves talking about what level of clinical care the home can offer, and when it’s appropriate to go to emergency. In particular, discussing the pros and cons of emergency department visits is a significant part of the nursing team’s role. “We explain that a hospital, particularly a busy emergency department, is not the best place for seniors who require turning, positioning, incontinence care and total assistance for activities of daily living,” says Barlow. “Their loved ones are at risk of picking up organisms, of altered skin integrity, and of increased confusion and behaviours when they transfer to hospital.” The home uses Choosing Wisely Canada’s resources to explain alternatives to hospitalization, and the nursing management team completes health care treatment plans with residents that outline their wishes around hospital admissions. End of life is a sensitive time when families often ask for a transfer to hospital. “It’s a very common reaction,” Barlow explains. “But we help families understand that the hospital would be a stressful environment, whereas we can manage their loved one’s symptoms and create an opportunity for them to say goodbye, to reflect, to be close to their loved one at the end of life.” Residents and their families can decide at any time that they would rather go to the emergency department, and that is their right. The ability to have open conversations about the pros and cons, and for the family to agree to stay at the home, comes down to trust. That trusting relationship is built incrementally by the nursing leadership team, says Lori Turcotte, through a regular meeting schedule with families, through a planned series of conversations and resource materials on the topic, and through families’ access to a nurse practitioner who works full-time at the home. To read more on the Millennium Trail Manor success story, read their profile on Health Quality Ontario’s website, https://quorum.hqontario.ca. LTCT architects www.garchitects.ca We’re in it for the Long-Term