1.21 PALLIATIVE CARE

IRT.0001.0003.0952

1.21 PALLIATIVE CARE

This policy is applicable to: All IRT Lifestyle & Care employees

DISCLAIMER

The information contained in this document remains the intellectual property of IRT. Any unauthorised copying or use (including emailing) is prohibited without the express permission of IRT. Any reference contained within this policy to 'IRT Employee/Staff Member' equally applies to IRT College Learner/Student or Client in receipt of training &/or assessment services.

POLICY TITLE: 1.21 PALLIATIVE CARE VERSION: 2.0 Page 1 - 8

Document is uncontrolled when printed

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DOCUMENT CONTROL

Policy Number: Policy Owner: Version: 1.21 General Managers Lifestyle & 2.0

Care

Contact position: Approved for circulation: TRIM classification reference: Clinical Advisor Group Leadership T earn EDOC2016/37381

Date approved: Review due to: Next review due: March 2016 Scheduled review March 2019

Procedure or Process Compliance/Accreditation/ Standards reference: reference no: Accreditation Standard 2.09 Palliative Care 1.21.1 Palliative Care Best Practice

REVISION RECORD

Date Version Revision description

Nov07 1.0 New policy

Jun 08 1.1 Scheduled review

Aug 11 1.2 Scheduled review

Aug 15 1.3 Scheduled review, Annexure 1 and 2 moved to Procedure 1.21 .1 Palliative Care Best Practice

Mar 16 2.0 Approved by GLT

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1. TITLE

1.21 PALLIATIVE CARE

2. POLICY STATEMENT

IRT policy is to support terminally ill residents/clients to die with dignity by promoting the comfort and well being of the resident/client and their family and friends during the final stages of life. This will occur by meeting their needs within their chosen environment where possible, with a multiple disciplinary approach to physical, emotional, social, spiritual , cultural and environmental health needs.

3. PURPOSE

The purpose of this policy is to comply with Accreditation Standard 2.09 Palliative Care

4. SCOPE

The scope of this policy is to recognise and support the right of residents/clients to live with dignity and comfort with an aim to maintain and where possible, improve the quality of life and comfort of those reaching the end of life.

5. OBJECTIVE

The purpose of this policy is to:

• To ensure early identification of pain and discomfort

• To ensure pain is assessed and managed to provide the best possible dignity and comfort

• To ensure cultural and spiritual preferences are identified and provided

• To ensure a resident/client dies with as much dignity and respect that is possible

• To ensure family and friends are involved in the persons care where the person and/or their loved ones desires

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6. POLICY DETAILS

6.1 Definition

The World Health Organisation (2003) defines Palliative Care as: "An approach that improves quality of life of individuals and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual".

Palliative care is care provided for all people of all ages who have a life limiting illness, with no prospect of a cure and for whom the primary treatment goal is comfort ans quality of life.

6.1.1 There are three forms of Palliative Care

i. A palliative approach: the primary goal of a palliative approach is to improve the resident's/clients level of comfort and function , and to address their psychological, spiritual and social needs.

ii. Specialised palliative service provision: this form of palliative care involves referral to a specialized palliative team or health care practitioner . .. however this does not replace a palliative approach but rather augments it with focused , intermittent, specific input as required.

iii. Terminal care: this form of palliative care is appropriate when the resident is in the final days or weeks of life and care decisions may need to be reviewed more frequently. Goals are more sharply focused on the resident's physical, emotional and spiritual comfort, and support for the family. Please refer to the Palliative Care best practice guidelines attached to implement care. (Procedure OP 1.21.1 Palliative Care Best Practice)

The following information is to be considered when assessing and reviewing the residents/clients under the palliative approach.

Physical

Pain Management Once the cause of pain is assessed and documented, the best form of pain relief is determined, implemented, monitored and reviewed.

Symptom Management Recognition and management of symptoms are documented as they appear, e.g. nausea, vomiting, bladder (frequency, urgency, spasm), bowels (constipation, faecal impaction, diarrhoea), anorexia, hiccup, respiratory symptoms (breathlessness, respiratory secretions, cough), agitation, restlessness, confusion and delirium.

Alternative Therapies Meditation, gentle therapies, massage, oil burners, relaxation tapes or music of choice are examples of alternative therapies that may assist in effective symptom management.

Comfort Measures E.g. mouth care, eye care, skin care and optimal posit ioning are to be attended by care staff as necessary. If appropriate family members to be involved in attending comfort measures i.e. mouth care.

Diet and Fluids If the resident/client is able to tolerate food they should be given small amounts of what they want. It is normal for appetite to decrease in the final stages of life.

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Emotional

Communication Communicate openly and compassionately with the residenUclient and their family/friends and support and respond to the needs of the individual. Information asked for by the residenUclient and/or their family/friends concerning diagnosis and prognosis should be given honestly, empowering the person to make informed choices about their care and environment.

Grief and Bereavement Provide information on support systems or resources to help family cope during end of life stage and their own bereavement. This can be done by giving a Palliative Care Information Pack. The grief and bereavement needs of staff should be considered and where necessary direct staff to support services if required. Memorial services arranged in-house may assist with ongoing grief management for family, friends and staff.

Social

Relationships Be aware of family and friends dynamics to ensure effective and appropriate support. Encourage family and friends to be involved in the care of the terminally ill to the extent they wish to.

Counselling Refer residenUclient, family and/or friends to appropriate counselling services as required .

Financial Assist residenUclient family and/or friends to access financial support services if necessary.

Spiritual

Beliefs Spiritual beliefs are the essence of a person and can encompass religious, individual and cultural needs. All needs are identified, respected and accommodated, where possible, at the resident's/client's and/or the family's or friends request.

Environmental

Flexibility During the final stages of life, where possible, the resident is placed in a single room to enable family, friends, clergy and carer's to attend in private. In the case of a client living at home, they should be supported to stay at home if so desired, and if practicable. External noises should be kept to a minimum. A homelike environment is encouraged with the resident's/client's personal belongings, photographs etc visible. Above all, be flexible and allow the residenUclient to die with dignity and peace.

Palliative Care planning encompasses comprehensive nursing, medical, allied health and social assessment. Formal and informal consultation with the resident, family, LMO and the care team is an integral part of the palliative care planning. Residents and family are encouraged and supported to participate as much or as little as they can or wish to and to communicate their needs openly with the care team.


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7. ROLES AND RESPONSIBILITIES

All employees are required to comply with this Policy. There are no specific roles or responsibilities other than those outlined in the table below.

IRT.0001.0003.0957

Specific roles and responsibilities of employees and management are outlined in Section 6 of this policy.

Specific roles and responsibilities of areas/departments/functions are outlined in the table below.

Role Responsibility

Policy Owner - General Manager Lifestyle & Care

Subject matter expert - Clinical Advisor

8. EDUCATION AND STAFF DEVELOPMENT

Education and Staff development relevant to this policy will occur:

• A consistent evidence based approach should be used to guide education sessions aimed at all levels of staff.

• Staff to be encouraged and supported to attend external courses/studies.

• Standards for providing Quality Palliative Care for all Australians

9. MONITORING, EVALUATION AND REVIEW

Feedback regarding this policy can be referred to:

The policy will be reviewed every 3 years by the General Managers Lifestyle & Care. Triggers for review outside of the usual cycle include:

• Changes to the business activity relating to this policy

• New business activities impacting on this policy

• Changes to internal controls relating to this policy

• Changes to legislative requirements

10. DEFINITIONS AND ABBREVIATIONS

I Tenn Not applicable

I Meaning

11. ASSOCIATED PROCEDURES AND FORMS

Name and number of document

Procedure OP 1.21.1 Palliative Care Best Practice

Form 408 - Family Palliative Care Survey

Palliative Care Plan

Palliative Care Assessment (Platinum)


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12. REFERENCES-COMPLIANCE AND BEST PRACTICE

Legislative references

Refer to IRT policy Fl 5.02 - Regulatory Compliance for a full listing of Acts, Regulations and Legislation.

Best Practice references

IRT Best Practice Protocol (Procedure OP 1.21.1 Palliative Care Best Practice)

Recognise End of life And Care Holistically (REACH) project 2010-11 , Wollongong University. (Annexure 1 of Procedure OP 1.21 .1 Palliative Care Best Practice)

Follow the Guidelines to a Palliative Approach in Residential Aged Care.

Guidelines for Palliative Approach in the Community.

Incorporating the Competency Units CHCPA01A Deliver Care Services Using a Palliative Approach.

CHCPA02A Plan for and Provide Care Services Using a Palliative Approach.

Australian Government Department of Health and Ageing, 2004, Guidelines for a palliative approach in residential aged care. Canberra: Rural Health and Palliative Care Branch, Australian Government Department of Health and Ageing.

Ellershaw J & Wilkinson S, 2003, Care of the dying: a pathway to excellence. Oxford: Oxford University Press.

Froggart KA, 2001, Palliative care and nursing homes: where next? Palliative Medicine,15: 42-48.

Griffen J, 2007, End of life clinical pathway pilot in two rural residential aged care facil ities: Stakeholder's report. South East NSW Division of General Practice Ltd.

Hockley J, Dewar B & Watson j, 2005, Promoting end-of-life care in nursing homes using an 'integrated care pathway for the last days of life . Journal of Research in Nursing, 10(2): 135-52.

Nair B, Kerridge I, Dobson A, McPhee J & Saul P, 2000, Advance care planning in residential care. Australian and New Zealand Journal of Medicine, 30: 339-343.

National Palliative Care Strategy: a national framework for palliative care service development, 2000, Canberra: Commonwealth Department of Health and Ageing.

Palliative Care Australia : Standards for providing quality palliative care for all Australians, 2005, Canberra: Palliative Care Australia.

Phillips J, Davidson P, Jackson D, Kristjanson L, Daly J & Curran D, 2006, Residential aged care: the last frontier for palliative care. Journal of Advanced Nursing, 55(4 ): 416-24.

Sidell M, 2003, the training needs of carers, in J Katz & S Peace (eds), End-of-life in care homes: a palliative approach. Oxford: Oxford University Press, pp. 115-30.

Taylor D & Cameron PA, 2002, Advance care planning in Australia: overdue for improvement. Internal Medicine Journal, 32: 475-80.

Guidelines for a Palliative Approach in Residential Aged Care, Enhanced Version, May 2006, NHMRC.


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If a business unit's compliance plan makes reference to this policy as a control for a particular compliance risk, the relevant compliance plan should be referred to here.

Compliance Plan reference: Not applicable

References:

A Guide to Palliative Care Service Development: a population based approach, 2005, Palliative Care Australia

Ellershaw, J. & Wilkinson, S. 2003 Care of the dying: A pathway to excellence, Oxford University Press, Oxford

Froggart KA, 2001, Palliative care and nursing homes: where next? Palliative Medicine, 15: 42-48

Guidelines for a Palliative Approach in Residential Aged Care, Enhanced Version, May 2006, NHMRC.

Griffin J, 2007, End of Life Clinical Pathway Pilot in two Rural Residential Aged Care Facilities: Stakeholders report, South East NSW Division of General Practice Ltd.

Hockley J. Dewar B. Watson J. 2005 Promoting end-of-life care in nursing homes using an 'integrated care pathway for the last days of life, Journal of Research in Nursing, 10, 2, 135 -52

McD. Taylor D & Cameron PA, 2002, Advance care planning in Australia: overdue for improvement, in Internal Medicine Journal, 32: 475-480.

Nair B, Kerridge I, Dobson A, McPhee, J & Saul P, 2000, Advance care planning in residential care, in Australian and New Zealand Journal of Medicine, 30: 339-343.

National Palliative Care Strategy, October 2000, www.health.gov.au

Palliative Care Standards, 2005, Palliative Care Australia

Phillips J, Davidson P, Jackson D, Kristjanson L, Daly J and Curran D, 2006, Residential aged care: the last frontier for palliative care, in Journal of Advanced Nursing, 55(4 ): 416-424

Sidell M, 2003, The training needs of carers, in J. Katz & S. Peace (eds), End of Life in Care Homes: a palliative approach, Oxford: Oxford University Press, pp. 115-130

www.aqedcare.pallcare.orq.au

www.pallcare.orq.au

13. LINKS TO OTHER POLICIES

Fl 5.02 Regulatory Compliance


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1.21 PALLIATIVE CARE