Advocacy
AGNA’s Response to CARNA’s November 2010 Request for Feedback on the AHS Overcapacity Protocols
AGNA’s Response to CARNA’s November 2010 Request for Feedback on the AHS Overcapacity Protocols
The Alberta Gerontological Nursing Association (AGNA) is pleased to offer our feedback on the Emergency Department Surge Capacity Protocols (OCP) as announced by Alberta Health Services to address current overcapacity issues in Emergency Departments across the province.
The OCP have been developed as a contingency response when demand exceeds supply. Emergency Department (ED) waits are long in some parts of the province and the ability to respond in an emergent manner is compromised by sheer volume. While easy to believe the problem root lies in ED staffing and capacity issues alone, we as nurses working across the continuum of health service contexts understand this is not the case. ED overcapacity is the result of a myriad of related issues ranging from staffing, capacity, internal hospital flow, availability of adequate home care resources and options for support, and public belief in the role of emergency room as an equivalent substitution for family doctor services, to individuals adopting responsible self care activities to maintain their own health.
Neither is ED overcapacity a new problem; but it is a problem that has current public, media, and political attention. As such AGNA believes the OCP strategies cannot be “knee-jerk” responses to public opinion but rather careful, conscientious, and ethical interventions. “Everyone Acts So No Sick Person Is Left Behind” is an admirable goal and reflects the “we are all in it together” philosophy needed to address overcapacity issues.
Older adults make up 25% of individuals using emergency services. The majority of older adults coming to emergency need emergency services as measured by the acuity index in place across the province. Therefore, it is important to Gerontological Nurses these older adults are not victims of ageism and denied the urgent care they need. AGNA is cautiously pleased to note the OCP plans indicate this will not be the case. Individuals in emergency will be assessed for their need for care regardless of age, based on a standardized set of priority situations. AGNA advocates for continuation and expansion of ED based Seniors Health care coordinator positions that can immediately link older adults to community assistance and can authorize immediate additional home support to assist the individual to return home safely.
Older adults can and do experience negative effects including delirium when they are transferred between units or between sites. Older adults are often less able to articulate their needs and transitioning runs the risk of losing important information, the continuous thread of effective care planning and staff-family relationships. Such risks are more acutely possible in larger hospital sites. Therefore AGNA advises caution and supportive transitional care and communication regardless of the type of move. AGNA notes the OCP plans indicate people will be assessed prior to moving; clients who are medically stable and waiting a living option will be considered first – contributing to a timely discharge, an ongoing goal of gerontological nursing.
Therefore, given the OCP plans that have been developed in part by our nursing colleagues as a supportive strategy for equitable patient care across the province, AGNA can cautiously support OCP in principle. Operationally however, careful and deliberate assessment of effects and outcomes is required and we trust nursing judgement holds appropriate weight in any global or individual transition decision making.
Two types of beds have been created within the acute care system to operationalize a response to two different types of capacity issues. The use of additional beds associated with OCP makes sense as a way to keep emergency clear for emergent issues and to remove people from the proverbial “stretchers in the hallway”. However, unless these units are staffed with adequate numbers and appropriate expertise they will become holding places rather than a health service. Therefore decision makers need to be aware of and respond to the needs of those individuals moving into overcapacity.
The other capacity related beds are transition units, units set up to support individuals assessed and waiting for another living option. Again this temporary service makes sense but can succeed or fail to give health service depending upon the nursing staff’s understanding of transition as a client experience.
AGNA strongly recommends AHS consider the staffing type, numbers and expertise required to provide care in this challenging time.
That OCP has to be put in place regardless of how well care is provided during these events is of concern to AGNA. But the solution lies not in isolated responses through increased resources or moving patients to one area or another, but in examining the “hot spots” as system issues. Examining opportunities for change in the health system as a whole is the answer because the health system as a whole has created the problem.
So what does AGNA recommend in response to OCP and as contribution to eliminating the need for OCP in the first place?
Response to OCP
- Entering into the OCP plans and activities with a sense of trust in each other as professional and caring nurses trying to make the right decisions for those in our care
- Ensure gerontological expertise is included in assessment and decisions regarding transfers of older adults
- Ensure any OCP units created as a short term “holding” place are staffed adequately and gerontological expertise is available
- Ensure comprehensive communication between sites with the goal to support the client through a transition rather than the goal to reduce capacity demands
- Ensure support in the way of supplies or medications are available to be there when the individual transfers back to the community rather than adding their acquisition to the required tasks of an already stretched support system
- Use the added care resources available for short term intensive support to individuals in the community
- Monitor both anticipated and unanticipated consequences of the protocol weighing the benefits and the adverse outcomes before identifying the protocol to have addressed capacity issues
- Monitor individuals returning to acute care or ED immediately following a discharge under OCP. These numbers are another source of efficacious data
Eliminating the need for OCP
- Support capacity increases in home care and continuing care programs through funding – eliminate the need for home care to cut their budgets yet serve higher numbers of people
- Support the use of Seniors Case Managers in ED to assist older adults to access community services and short term added resources
- Support the use of Nurse Practitioners in the care of older adults not only as physician extenders but as nursing experts
- Support the expansion of living options and the training of all levels of staff in gerontological care especially in the area of dementia and delirium
- Support Zone based expertise to address common problems that send older adults to seek emergency services such as falls, medication mismanagement, and care giver fatigue
- Support expansion of community based short stay beds for assessment and care provider respite
- Support the appropriate community case load numbers so nurses have the opportunity to speak with clients and plan for future contingencies thus eliminating ED visits because of client fear, miscommunication, or not knowing what to do
- Support the need for gerontological nursing leadership across all settings where older adults receive health services
These are trying times. Nurses have and continue to work hard to do what they came to nursing to do: care for people and support them in their journey to health. AGNA does support the need for the right care in the right place and at the right time. OCP is intended as a contingency plan but like all protocols could experience slippage into common everyday practice. AGNA believes this slippage is more the danger than the stated intensions of OCP. AGNA encourages CARNA to advocate for eliminating the need for OCP through recommended longer term strategies. AGNA can help and are ready to respond with membership expertise and commitment to care of older adults. Again, we are here because of our clients and they remain our focus.
Thank you for the opportunity to respond.
Respectfully submitted
Alberta Gerontological Nurses Association
Download AGNA-s-Response-to-CARNA-s-November-2010-Request-for-Feedback-on-the-AHS-Overcapacity-Protocols.pdfCARNA SURVEY Scope of Practice October 8 2010 deadline
The College and Association of Registered Nurses of Alberta (CARNA) is seeking feedback on the following document, which is now under regular review by CARNA:
- Scope of Practice for Registered Nurses (October 2005)
As a member of CARNA, we encourage you to provide comments on the issues identified within the document.
It is preferred that feedback be provided by using our online survey tool on the CARNA website at www.nurses.ab.ca, however you can complete the attached form and email, fax or mail your feedback to Ruby Sutton, Assistant to the Director, Policy and Practice (email: rsutton@nurses.ab.ca; or fax: 780-452-3276; or mail: 11620 168 St,
To access the online survey tool please click here: https://www.surveymonkey.com/s/CZWLHBR
Deadline for submitting feedback is Friday, October 8, 2010.
Thank you in advance for your participation.
Advocacy Committee - Support Our Efforts!
If you are interested in joining the Advocacy Committee, please contact the above or any of the AGNA Executive.
Input from members on advocacy issues is of interest to the AGNA Executive.
Please send your comments, questions, or issues to president@agna.ca
AGNA Submission to Committee Developing New Health Act.
The advocacy committee on behalf of AGNA presented a submission to the committee developing the new Health Act. Following is the full text of our submission (a downloadable pdf is also attached):
AGNA
Box 67040 Meadowlark,
Edmonton, Alberta, T5R 5Y3
July 8, 2010
Fred Horne, MLA
Edmonton-Rutherford
Government of
Dear Mr. Horne
Alberta Gerontological Nurses’ Associations (AGNA) central purpose is to bring together nurses who are interested in gerontology and whose intent is to improve the health, wellness and quality of life of older adults. Our mission is to provide leadership in promoting excellence in gerontological nursing in Alberta, and our objectives include advocating, fostering, and participating in activities which promote the health and quality of life of older adults in Alberta; and the presentation of the views of AGNA to government, educational, professional and other appropriate bodies. We therefore welcome the opportunity to submit AGNA’s views in regard to a new Alberta Health Act.
We will answer your questions as they were presented in your letter.
1. What are your organization’s views on the appropriateness of the overarching principles proposed for the Alberta Health Act? Are there additional principles you would propose?
Put people and their families at the centre of their health care.
AGNA strongly supports this principle. It is important that families of the elderly be included in their health care. Decisions must be made by the senior whenever possible but families need to be included in order to provide support to the senior.
The principles in the new Adult Guardianship and Trusteeship Act are an excellent basis for decision making regarding older adults.
Be committed to quality and safety.
AGNA supports this principle and the use of the Health Quality Matrix. In order to ensure quality and safety in the provision of care, and minimize risk to older adults, adequate staffing must be available. This could be accomplished through the development of standards for staffing which match required professional levels to the care needs of older adults. Funding to meet standards of staffing and education of staff must be available to enable standards to be met.
Ensure equitable access to timely and appropriate care.
This is an important issue for older adults. Access for older adults includes access to health care services but also includes other important aspects. Older adults need access to community based support services (such as housekeeping, home maintenance, foot care, respite for caregivers) that will enable them to continue to live successfully in the community. Another example, transportation is very important as many older adults are no longer able to drive and, in rural areas, do not have access to appropriate transportation services. Staying connected to social and recreational opportunities is a key component of health for the older adult. Increasing access to these supports in the community may lessen the need for institutional care.
AGNA recommends that this principle be amended to include affordability, as many seniors are challenged to pay for pharmaceuticals, immunizations, transportation, and living expenses. It is important that seniors not be forced to make a choice of paying for living expenses over paying for needed medications.
Enable decision-making using the best available evidence.
AGNA is committed to utilizing the best available evidence in the provision of care to older adults. This value implies a support for research that will provide the evidence and AGNA strongly supports this. The principles of knowledge translation need to be incorporated into decision making processes to ensure that health care practices change to reflect new evidence. For clinical practice to change it is also essential that all health care providers have access to education and ongoing learning opportunities which requires funding so that they can be aware of best practices and be able to implement these practices into their care for seniors.
Be focused on wellness and public health.
This essential principle needs to be the first one articulated. The concept of healthy aging needs to be introduced as early as possible in society and incentives need to be in place to make it easier to do the right thing / health behaviour to minimize or mitigate preventable health issues. In order for this principle to be effective, the social determinants of health must be incorporated and prevention and treatment supports need to be well-funded and made accessible, available and appropriate within the senior’s community. Effective collaboration between government ministries and agencies is essential.
Foster a culture of trust and respect.
This is an important principle; it is essential to foster a culture of trust and respect within our health care system. Constant change in the system creates uncertainty and mistrust and adds unnecessary challenges to resources and users.
Currently the elderly are vulnerable to the stigma of ageism. There is a risk that this will put older adults in the position of being blamed for the situation and potentially disrespected.
2. What are your organization’s views about rights, responsibilities and other components that should be included in the Alberta patient charter?
AGNA supports the inclusion of the elements listed. We would suggest the inclusion of the concept of affordability to the elements in the charter.
We would suggest that the term “patient” be changed as the term patient implies that the individual is ill. It is not in keeping with the principle of putting people and their families at the centre of health care and the principle of wellness and public health reviewed earlier. We would recommend that the charter be called “Health Charter for Albertans”.
3. Please provide your views as desired on the other components of the Alberta Health Act.
AGNA would agree that the Act should consolidate the many Acts now governing health care and incorporate the services currently not covered by any Act. We would suggest that the Act cannot be so broad as to leave all specifics to regulations. The needs of seniors for different care at different times must be respected; e.g. the needs of a senior in an acute care hospital are different from the needs of the senior in facilities now covered by the Nursing Home Act. It is important that the provisions in current legislation, such as the Nursing Home Act, not be lost in more general provisions in a new Act.
4. Going forward, how should the public, health professionals and other stakeholders be consulted in the development and review of future legislation, regulation and policy?
AGNA believes that it is important that all changes in legislation, regulations, and major policies be open to public discussion and consultation. The consultation process should be included in the Act so that it is mandatory. The process should be transparent, and allow adequate time for responses. Proposed decisions should be supported by best evidence and research. Information should be disseminated through multiple forms such as open forums, mass media, the internet, and communication to associations, organizations, regulatory colleges, researchers, educators and other interested parties. Responses should be solicited through on-line surveys and questionnaires, as well as through public meetings. Communication of information and availability of opportunities for responses must take into account the methods of communication used by vulnerable individuals, such as the frail elderly.
Thank you for the opportunity to share the views of AGNA. We look forward to the results of your consultations.
Sincerely
Lisa LeBlancLisa LeBlanc RN MN
President
Alberta Gerontological Nurses’ Association
Download AGNA_Response_to_AB_Health_Act_July_2010.pdf