Community Nursing Program Information Session 2 Guidelines for the provision of community nursing services - 2010 Clas

1. Community Nursing Program Information Session 2 Guidelines for the provision of community nursing services - 2010 Classification System and Review of Care December 2010

2. Session Objectives At the end of this session the participants will have • A good understanding of the Guidelines for the provision of community nursing services (Guidelines) applicable from March 2010 • A good understanding of how to apply the Community Nursing Classification System and DVA’s requirements regarding review of care • Knowledge of how DVA can support DVA-contracted community nursing providers’ ongoing learning and future education needs regarding the Community Nursing Classification System

3. Classification Entitled persons are classified under DVA Community Nursing Classification System (Classification System) Classification System is divided into levels based on identifying: • Service type • Client type • Visit type, dependency, length, range or frequency • Additional Components or Other Items, if required The Classification System is based on retrospective 28-day claim period

4. Service Types The Classification System is comprised of the following Service Types: • Clinical Care (includes Additional Components) • Personal Care • Clinical Care Variations Each Service Type has an associated Schedule and Fees The Classification System also includes: • Other Items

5. Entitled Persons whose care needs change within the 28-day claim period Entitled persons may require care from more than one Service Type within a 28-day claim period • Classified according to the majority of care

6. Clinical Care Schedule

7. Clinical Care Clinical Care Service Type is defined as the direct nursing care required to treat a clinical need Clinical Care Schedule includes the following Client Types • Clinical Monitoring • Technical • General • Medication Administration • including Medication Administration – Post-Operative Eye Drops

8. Clinical Monitoring The goal of Clinical MonitoringClient Typeis to maintain the entitled person’s optimal health status through monitoring and education Personnel used to deliver Clinical Monitoring services include • RNs, EEN or ENs based on their qualifications • Cannot be delivered by NSS

9. Technical The goal of the Technical Client Type is to maintain the entitled person’s optimal health status Technical interventions require a knowledge of • expected therapeutic effects • possible side effects • possible complications Technical Client Type has two (2) visit lengths • 20 minutes or less per visit • 21 minutes or more per visit

10. Technical - Personnel Personnel used to deliver Technical services include • RNs, or EEN/ENs based on their: • qualifications • experience and • the legislative requirements of their State or Territory • Cannot be delivered by NSS

11. General The goal of the General Client Type is to support and maintain an entitled person’s level of function and health status by safely maximising their independence • Used for broad range of direct nursing activities • General Client Type has two (2) dependency levels: • Low dependency • High dependency • Entitled person’s assessed dependency level determines General item number to be claimed

12. General Determining high or low dependency level • Any validated dependency tool/s used by the CN industry can be used to determine high or low dependency • DVA recognises four domains of dependency for functional activities: • Mobility and transfers • Toileting and continence • Personal hygiene • Cognitive and behavioural issues

13. General - Personnel Personnel used to deliver General nursing services include RNs, EEN and ENs based on their • Qualifications • Experience • Legislative requirements of the State or Territory NSS cannot provide general nursing services but can be used to deliver personal care services, if this intervention is required.

14. Medication Administration The goal of the Medication Administration Client Type is safe and effective administration of the prescribed medication Medication Administration Classification • Is based on the number of visits in a 28-day claim period for an entitled person who requires regular prescribed Medication Administration (i.e. generally no other community nursing services are required) • Includes sub-classification Medication Administration – Post-Operative Eye Drops • Provision for ‘Limited Clinical Care Services’ see Guidelines section 6.3.3.3.1

15. Medication Administration Limited clinical care services may be provided under the Medication Administration client type in the following circumstances: • an entitled person requires a regular but infrequent one-off clinical or personal care intervention (e.g. indwelling urinary catheter change) • an entitled person has a short term clinical need due to a superficial skin tear for a maximum of two (2) consecutive 28-day claim periods and may also require Additional Component – Wound Management Consumables

16. Medication Administration Personnel used to deliver Medication Administration services must be • RNs or • EENs based on their • Qualifications • Experience • Legislative requirements of the State or Territory NSS cannot provide Medication Administration services.

17. Medication Administration Entitled person should be classified under Medication Administration Client Type if they require the administration of • Any medication prescribed by an LMO, GP or Specialist and dispensed by a pharmacist • Schedule eight drugs • Schedule eight transdermal patches • Cytotoxic drugs or creams • Ongoing prescribed eye-drops • Prescribed creams

18. Medication Administration Does not include assistance with self medication • Assistance with self medication is included in the Personal Care client type If ongoing clinical or personal care intervention/s are also required, the entitled person needs to be classified under another client type

19. Medication Administration Post-Operative Eye Drops Used for an entitled person who • Requires Post-operative eye drops only • Up to four times daily • For one 28-day claim period only Can be claimed only once - per eye, per annum

21. Clinical Care Schedule Additional Components

22. Additional Components The following Additional Components can be claimed as ‘add-ons’ to some specified item numbers in the same 28-day claim period • Wound Management Consumables • Palliative Care Use the same start date for all classification item numbers claimed for the 28-day claim period

23. Additional Component - Wound Management Consumables Item includes all wound management consumables used in one 28-day period Where appropriate wound management consumables should be sourced through DVA’s Repatriation Pharmaceutical Benefits Scheme (RPBS) Wound management consumables products cannot be claimed if the products are part of the DVA ‘Nurses Toolbox’

24. Additional Component - Wound Management Consumables The Clinical Care Schedule includes 15 Additional Component - Wound Management Consumables item numbers for consumables costing up to $150 in a 28-day claim period Wound Management Consumables totalling more than $150 in 28-day period can be claimed through your State Office DVA closely monitors all Wound Management Consumable claims Wound Management Consumables fees are not indexed annually Resources : Wound ManagementConsumables Claiming Rules and Wound ManagementConsumables Claiming Rules Table

26. Additional Component - Palliative Care The goal of Additional Component - Palliative Care is to improve the quality of life and relieve suffering for entitled persons with a diagnosis of a life-limiting illness who require a palliative approach Four (4) palliative care phases . Stable . Unstable . Deteriorating . Terminal Additional Component - Palliative Carefocuses on the psychosocial aspects of the care Clinical aspects (eg symptom control) would be claimed under a Clinical Care Client Type

27. Palliative Care - Stable Symptoms • symptoms are adequately controlled and • family/carer situation is settled Common Psychosocial Aspects • Care plans/advanced care plans • Referrals for appropriate services/home supports • Explore goals of care/treatment options • Identify family/carer situation • Assessment of psychosocial status The Additional Components - Palliative Stable and Palliative Stable Variation are the only Palliative Care phases that can be claimed with the Clinical Monitoring or Personal Care client types

28. Palliative Care - Unstable Symptoms • Development of a new or unexpected problem or • Rapid increase in severity of existing problems requiring urgent change in management/emergency treatment or • Family/carers experience sudden change requiring urgent intervention Common Psychosocial Aspects • Management psychosocial crisis eg suicidal ideation/severe depression • Family or carer crisis • Emergency respite options • Care plan reviews to address unstable phase • Referrals to appropriate services

29. Palliative Care - Deteriorating Symptoms • Gradual worsening of existing symptoms or • Development of a new/unexpected problem that requires specific treatment/care plan • No urgent or emergency treatment is required • Family/carers have gradually worsening distress and may require planned support/counselling Common Psychosocial Aspects • Treatment/care plan review to address deteriorating phase • Counselling for family/carers • Referrals to appropriate services

30. Palliative Care - Terminal Symptoms • Death is likely in a matter of days • No acute interventions are planned Common Psychosocial Aspects • Increased support and counselling for family and carers • Treatment/care plan review to address terminal phase • Increase in home visits • Referrals to appropriate services

31. Palliative Care - Personnel Personnel used to deliver Palliative Care services include • RNs, EEN or ENs based on their • Qualifications • Experience and • Legislative requirements of the State or Territory NSS can provide Personal Care services, but cannot provide other Palliative Care services

32. Palliative Care Registration Claims for Deteriorating or Terminal phases require • Appropriate palliative care plan and • Involvement of a palliative care specialist and • Registration on ECU Palliative Care – Deteriorating or Terminal Phase Register To register complete and lodge with the ECU the Palliative Care - Deteriorating or Terminal - Notification Form available on the DVA website

33. Palliative Care Registration The ECU palliative nurse specialist can: • Advise on palliative care and treatment options, if required and/or • Approve short term overnight nursing care in the Terminal phase, on application, where appropriate

34. Overnight Nursing Care Provider may apply to the ECU for Overnight Nursing Care for an entitled person who: • Is in the terminal phase of their disease • Requires overnight clinical nursing care in the short term • Meets the criteria • For both Schedule of Fee and Exceptional Case Status To apply, complete and lodge with the ECU the Palliative Care – Overnight Nursing Care Form available on the DVA website

36. Clinical Care Variations Schedule

37. Clinical Care Variations Schedule Clinical Care Variations Schedule is used when • Clinical care which is usually provided for the full 28-day claim period is provided for 14 days or less in the 28-day claim period due to a ‘break in service’ Resources : Classification SystemExamples ‘Breaks in Service’

38. Clinical Care Variations Schedule A ‘break in service’ is when an entitled person • Is absent from their place of residence for: • residential respite • hospitalisation • holidays • Leaves care due to • move to another area • discharged and returns to self care • permanent admittance to residential care • death

39. Clinical Care Variations Schedule The Clinical Care Variations Schedule contains variations for: • Technical and General client types • Additional Component - Palliative Care phases of: • Stable • Unstable • Deteriorating

41. Personal Care Schedule

42. Personal Care Schedule The Personal Care classification is used for an entitled person who: • Requires observation or assistance with activities of daily living, and • Does not require a clinical classification Classification is based on the number of visits provided during the 28-day claim period Personal Care services may be delivered by RN, EN or NSS However all Personal Care services require minimum of one visit by RN or EN in 28-day claim period

43. Personal Care - Medication Physical assistance (prompting) can only be given with self administration of medication in the Personal Care Schedule when • There is a blister pack filled by a registered pharmacist which meets the DVA Dose Administration Aid Service guidelines • There is an established medication regime • The drugs are Schedule four or below only

44. Personal Care - Medication Entitled person should not be classified under Personal Care if they require the administration of • Schedule eight drugs • Schedule eight transdermal patches • Cytotoxic drugs or creams • Prescribed eye drops • Prescribed creams These entitled persons should be classified under the Medication Administration Client Type

45. Personal Care - Clinical Care Limited clinical care services may be provided under the Personal Care Client Type for: • Regular but infrequent one-off clinical intervention of short duration (eg regular catheter change) • Psychosocial services covered by an Additional Component - Palliative Care (Stable Only) • Superficial skin tear for maximum of two consecutive 28-day claim periods • Requirement for the administration of prescribed medication 4 times or less in a 28-day claim period (e.g. Buprenorphine transdermal patches for chronic severe pain)

47. Case Studies Resource : Classification System Case Studies

48. Other Items Schedule

49. Other Items Assessment Only (no on-going community nursing care) • Can be claimed for assessments • When no other services are provided • Once within three consecutive 28-day claim periods Bereavement Follow-up ‘add-on’ • Can be claimed • As an ‘add-on’ • Once per entitled person • After entitled person’s death

50. Additional Travel Provided where • An exceptional amount of travel is required • The entitled person lives in a rural or remote area • The provider is the nearest suitable provider • For both Schedule of Fee and Exceptional Case status Payment • Will vary depending on individual circumstances • Based on the calculated kilometres travelled Note: This item requires prior approval Resources : Classification System Claiming Rules Tableand Classification SystemMultiple Item Number Claiming Spreadsheet