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4-5 December 2006 Hobart

Community Outreach Program Mobile PEG Service Presenter: Ibolya Nyulasi Manager Nutrition Services Hospital: The Alfred. 4-5 December 2006 Hobart. KEY PROBLEMS. In 2001, a patient with a gastrostomy tube related problem was presenting to the emergency department of The Alfred every 5 days.

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4-5 December 2006 Hobart

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  1. Community Outreach ProgramMobile PEG ServicePresenter: Ibolya Nyulasi Manager Nutrition Services Hospital: The Alfred 4-5 December 2006Hobart

  2. KEY PROBLEMS • In 2001, a patient with a gastrostomy tube related problem was presenting to the emergency department of The Alfred every 5 days. • Sixty five percent of these patients were from the residential care setting. • These patients could access an outpatient “PEG clinic”, but the model of care provided is problematic for the frail elderly patient.

  3. INNOVATIONS IMPLEMENTED • A new program was integrated into The Alfred Mobile and Assessment Treatment Service (MATS), which was already providing medical and nursing care to patients from local residential care facilities. The objectives of this “M.A.T.S PEG” program were to provide: • effective specialised nutrition and gastrostomy care, • reducing tube and stoma related complications thus preventing avoidable hospital transfer. • An advanced training program was developed to improve dietitians and nurses knowledge of gastrostomy tube management and credential them to replace gastrostomy tubes in the community. • The program required the development of a credentialing process. This was developed in conjunction with the Gastroenterology department who undertook the responsibility for training, supervising and credentialing. • Indemnity for gastrostomy tube replacement by non medical practitioners was reviewed by the Alfred legal team, then supported by the clinical risk committee and finally endorsed by The Alfred insurers.

  4. RESULTSKey Performance Indicators %

  5. How we did it • Developed advanced practitioner model which required the clinician to have the following skill sets: • Significant experience in Nutrition Assessment & enteral monitoring • Credentialed to perform invasive procedures such as PEG tube assessment, modification & replacement includes; • Minimum of 12 months attendance at PEG clinic • Dietitian required to change 20 PEG tubesunder supervision Other skills required: • The ability to Effectively educate & train residential care staff Program requires the Support/ Liaison of the Gastroenterology Unit at The Alfred

  6. Current Situation • From 5 Patients in 2004  35 patients under MATS care in 2006 • Still 45 patients present /year in ED • Of these only 5% present during working hours The skills of the advanced practitioner dietitian are further utilised to meet the increasing service demand. The MATS/PEG coordinator dietitian treats emergency/unscheduled PEG related problems either in ED or fast tracks to Endoscopy

  7. LESSONS LEARNT • This innovative model of care reduces • gastrostomy related presentations to the emergency department and develops an advanced practitioner role for dietitians and nurses. • Improves patient care and reduces mortality and morbidity risks associated with ambulance transfer and tube replacements • With appropriate training and credentialing medical substitution can take place. • Services need to have the flexibility to cover weekend and after hours presentation

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