Authors (including presenting author) :
Karn KY (1), Lee KY (2)
Affiliation :
(1)Nursing Services Division, United Christian Hospital (2)Community Nursing Service, United Christian Hospital
Introduction :
88% of the patients under United Christian Hospital Community Nursing Service (UCH CNS)are over 65 years old. Some of them are multi-morbidities with frailty. It is a challenge for the frailty patient on the transportation to follow up the appointment. Moreover, some patient or career were reluctant to follow up their appointment during this pandemic moment. Furthermore, the occupy of the bedbound patient made the clinic more crowdy. Thus, a pilot program is initiated with the aim to provide a nurse-led clinic at home in order to minimize the challenge on transportation arrangement to follow up appointment for the multi-morbidity frailty patient in community.
Objectives :
•To develop and explore the effectiveness of a nurse-led clinic for the frailty patient at home •To lengthening the appointment schedule and minimize the specialty clinic attendance at hospital
Methodology :
A prospective pilot program supported by medical team had been launched from Apr to Dec 2020. The patient would be selected under the inclusion criteria: for those who were under CNS home cases and follow up at UCH Medical & Geriatric Team, and having chronic disease condition who need continuous medical and nursing care according to their total dependency on daily activities. The appointment schedule for the recruited patient would be extended from 3 months to 8-12 months. Meanwhile, a nurse-led clinic at home by Community Nurse Consultant (NC) would provide regularly or by patient's need in between the Medical & Geriatric follow up appointment. The role of NC as a specialty nurse to provide an intensive and comprehensive geriatric nursing assessment, core intervention and psychological support for the patient and their career at home. The specialty nurse would keep close communication and collaboration with physician. It encouraged the patient to stay at home by early detection and management. Virtual support such as video conference would also be provided by physician according to the patient’s health need.
Result & Outcome :
In total, four patients were recruited. Their clinical frailty score was around 7-8. Ten attendances of nurse-led clinic at home and two video conference were provided. The medical appointment was lengthened and the specialty clinic attendance at hospital had been reduced in 50% dramatically. The satisfaction score of career was high and they appreciated this innovative program minimized the patient’s suffering from the inconvenience transportation. Only one patient (109 years old) was admitted to hospital for pneumonia on public holiday. In conclusion, this pilot program showed the nurse-led clinic at home have perceived benefit for the patient and career by minimized the suffering of the patient on follow up appointment. For the health care system, it lengthened the appointment schedule and physician had more time for other consultation. However, the nurse-led clinic should be adjunct to general practitioner clinic. Thus, the adequate training, the structure framework and also the governance of this new care delivery model will be explored on the way forward.
