As you can see, the name of our Newsletter has changed.

Congratulations to the winners:

East Wimmera Health Service (Donald Campus) who gave us this explanation of why it should be titled

PalCare.

We all work together as a team – at least I like to think so (our ‘pals,’ or ‘friends’) – client, family & health care workers – hence the ‘Pal’ part of the name.

And we ‘care’ about all of those involved in this process – supporting each other throughout the process – hence the ‘Care’ part of the name.

I imagine that the newsletter will keep us all better in-formed of Palliative Care needs/issues/learning oppor-tunities, so we can ‘care’ for our ‘pals’ as best we can.

Thanks to all who came up with suggestions.

Office Contacts

Consortium Manager - Trish O’Hara (Mon, Tue, Wed, Thur)

lmconsortium@castlemainehealth.org.au

Phone 54711545 / 0447 526 626

Admin Assistant - Anne Forden (Mon, Tue, Wed)

lmpcc@castlemainehealth.org.au

Phone 54704205 (please note: days indicated are usual days worked, these may sometimes change)

L A U N C H O F N E W S L E T T E R

—N A M I N G C O M P E T I T I O N

S P E C I A L P O I N T S

O F I N T E R E S T :

Newsletter “naming” compe-

tition Winners

2009 SCTT inclusion of the 3

page Palliative Care Supple-

ment

Resources List continues to

expand . . . . . . .

Needs Analysis completed

and priorities identified

The “Do You Know” section

has been re-titled “To Con-

sider”

Syringe Driver update

WHO DO YOU CALL ??

PCNC - Melanie Shanahan (Wed & Fri)

mshanahan@mthcs.vic.gov.au

Phone 50910228 / 0419 181 838

PCNC - Merrill Cole (Mon & Wed)

mcole@castlemainehealth.org.au

Phone 54704206 / 0419 512433

L O D D O N M A L L E E R E G I O N A L S T R E N G T H E N I N G P A L L I A T I V E C A R E C O N S O R T I U M

PalCare Voice October/November 2009 Number 2

I N S I D E T H I S

I S S U E :

SCTT 2009 2

Resources in

Focus: End Of Life

2

Needs Analysis -

Priorities

3

Residential Care

Guidelines

3

End-Of-Life Care

(article)

4

Some resources

for Enhancing

Communication

Skills

5

Alternate Devices to the Grasby Syringe Driver

5

To Consider ! 5

Conference Report 6

Where you see a gold “star” in the newsletter, there is a resource

the CNC can forward to you.

Merrill & Melanie

The Service Coordination Tool

Templates (SCTT) are tem-

plates developed to facilitate

and support service coordina-

tion. Using the SCTT can im-

prove communication between

service providers, the re-

cording of information gener-

ated by screening and assess-

ment processes, information

sharing, and the quality of re-

ferrals and feedback between

service providers. This can as-

sist service providers to share

relevant information to support

better outcomes for consum-

ers.

The purpose of the Palliative

Care Supplement (3 pages) is

to develop a statewide ap-

proach to referral to and from

palliative care services.

• This supplementary referral

template contains essential

palliative care information not

contained elsewhere in the

SCTT.

• The information in the sup-

plement should assist the ser-

vice receiving the referral to

determine appropriateness of

the referral and how to triage

the referral.

• Detailed information regard-

ing the consumer’s medical his-

tory should be recorded on the

Summary and Referral Infor-

mation template.

• This tool will not replace the

need for a follow-up telephone

call after either making or re-

ceiving the referral.

• Completion of this tool is ap-

propriate for any service

(community, acute, primary

care, palliative care) referring

to a palliative care service.

• This tool has been developed

within the context of the De-

partment of Human Services

emerging Advance Care Plan-

ning policy in Victoria.

The SCTT Palliative Care Sup-

plement was discussed at

SCTT 2009—Palliative Care Supplement

P A L L I A T I V E C A R E R E S O U R C E S - E N D O F L I F E

If you don’t have internet access, please let us know and we can provide either file or hard copy or some alternative resourc es.

TITLE LINK / LOCATION COMMENTS DATE CHECKED

Liverpool Care Path-

way (LCP) http://www.liv.ac.uk/mcpcil/liverpool-care-pathway/index.htm History and intro-

duction 16.09.2009

NHS (UK) http://www.endoflifecareforadults.nhs.uk/eolc/lcp.htm Info on LCP im-

plementation in

UK

16.09.2009

EOLCP Phase 2 Re-

port (Sydney South

West Area Health

Service)

Available from Consortium Manager – Trish O’Hara Project to imple-

ment the LCP

16.09.2009

Communication with

Families http://www.helpthehospices.org.uk/clip/ Current Learning

in Palliative Care

– via Care-

Search

11.09.2009

Turning Policy Into

Practice http://www.health.vic.gov.au/palliativecare/turning.htm 2 DHS funded

projects on imple-

mentation of LCP

16.09.2009

Guidelines for Com-

municating Prognosis

& E.O.L. Issues

(MJA)

http://www.mja.com.au/public/issues/186_12_180607/

cla11246_fm.pdf MJA Supplement,

18 June 2007 16.09.2009

Page 2 PalCare

agency visits by the CNC.

The following link will take you

to the Victorian Government

Department of Health website

for the Service Coordination

Tool Templates and User Guide.

http://www.health.vic.gov.au/

pcps/coordination/sctt2009.htm

A condensed version of the code-sets for SCTT2009 will be circulated with this newsletter.

If you would like a file or

hard copy of the supple-ment, please let us know.

Primary Care results

The items identified as hap-

pening only sometimes for the

combined care settings ranged

across the Knowledge and

Process sections.

These included:

increasing community awareness

debriefing & clinical support

contribution to policy develop-

ment

transition to palliative care

formal acknowledgement of pa-

tient death

quality improvement

time for assessments

regular education on palliative

approach.

When care setting results were

viewed separately, there were

also some specific areas of

“Skill” items that were identi-

fied within each setting.

N E E D S A N A L Y S I S - P R I O R I T I E S

Firstly, thanks to all agencies

who have returned their com-

pleted questionnaires. The

response rate was 75% -

GREAT!!

Overall, the largest Care

Type by far is Residential

Care. 43% of visits were to a

RACF, with 55% of primary

care questionnaires being re-

turned from this sector.

Specialist Services results

Items were identified across the

range of sections. Some of

these have similarities to the

Primary Care results, others are

different. This possibly reflects

the degree of confusion, and

differing expectations between

primary care and specialist ser-

vices.

Recommendations

There are a number of recom-

mendations that will be the

basis of the PCNC business plan

for the next 12 months, and will

inform implementation strate-

gies for the Model of Support to

achieve the desired outcomes.

The full report will be distrib-

uted to all agencies once it has

been accepted by the Consor-

tium.

cated that the proportion of people dying in RACFs has steadily increased. This has led to the recognition that a palliative approach enhances the care already provided to both residents and the fami-lies. The residents are generally highly dependent and require many medications, further complicating the provision of a palliative approach. Older per-sons who are dying are con-sidered to have different pal-liative needs to those people diagnosed with cancer. These differences may include, that: • they have multiple clinical diagnoses that require a vari-ety of treatments; • they require end-of-life (terminal) care for a shorter

length of time (an average time of two days of intense care prior to death); • confusion, dementia, and/or communication difficulties may be present; and • some lack family support. These evidence based guidelines cover all major aspects of providing a pallia-tive approach for a resident, from attending to physical symptoms and spiritual needs to dealing with the re-actions of family members.

G U I D E L I N E S F O R P A L L I A T I V E A P P R O A C H I N R E S I D E N T I A L C A R E

There is a widespread recogni-tion that the benefits of pallia-tive care are not limited to the final days and weeks before dying. In response to this, there has been a shift in the provision of palliative care as health pro-viders’ move towards providing a palliative approach. A palliative approach has much to offer to residents, their fami-lies and staff in our aged care facilities. Developing the guide-lines involved a broad consulta-tion process that included both the palliative and aged care sectors. The thoroughness of this massive task is best recog-nised in the approval achieved for these guidelines from the NHMRC. In Australia, over the last two decades, research has indi-

For more information and For more information and

copy of the guidelines copy of the guidelines

follow the link: follow the link: http://www.nhmrc.gov.au/publications/synopses/ac12to14syn.htm

PalCare Page 3

Death and Dying Today

Most have fears and concerns about the "dying" and "death" processes. People fear experiencing pain and unrelieved symptoms; they worry that when "nothing more can be done," their healthcare providers will aban-don them; and they are concerned that their family will lose all their sav-ings paying for life-sustaining technol-ogy and invasive, debilitating treat-ments.

People are dying in institutions with strangers caring for them, as they suffer from prolonged, chronic ill-nesses, and in many cases, receiving expensive, futile treatments that pose an enormous financial burden.

Common barriers to the kind of death many would prefer include:

Failure to acknowledge the limits of

medicine, leading to futile care and using inappropriate and aggressive curative treatments that can pro-long the dying process and contrib-ute to physical and emotional suf-fering

Lack of adequate training for

healthcare providers, especially in regard symptom control;

A delay in initiating Hospice and

palliative care services prevents patients and families from reaping the full benefits of these services;

Issues regarding access to care,

regulation of controlled sub-stances, and insurance coverage compound confusion around hos-pice and palliative care;

Denial of death prevents many

from accessing palliative care.

What Is Hospice?

The word "hospice," borrowed from the Middle Ages, was used to desig-nate way-stations for pilgrims on their way to the Holy Land. Dame Cicely Saunders, the founder of St. Christo-pher's Hospice in London, viewed life as a journey, and just as the pilgrims needed a place of respite to finish their journey, so those near the end of life's journey needed support to complete their passage.

What Is Palliative Care?

Palliative care is a philosophy of care that provides an organized, interdisci-plinary system for delivering care. The goal of palliative care is to improve the quality of life of patients and their families who are facing life-threatening illness, through the pre-vention and relief from suffering. Pal-liative care provides early identifica-tion, impeccable assessment, and treatment of pain and other physical, psychosocial, and spiritual problems.

The key difference between palliative and hospice care is that palliative care is appropriate regardless of the stage of the disease or the need for other therapies, and can be rendered along with life-prolonging treatment or as the main focus of care. In addition, palliative care expands traditional dis-ease-model medical treatments to include the goals of enhancing quality of life for patients and family mem-bers, helping with decision making, and providing opportunities for per-sonal growth. Palliative care is inte-gral to all healthcare delivery system settings including emergency depart-ments, nursing homes, assisted living facilities, home care, outpatient, and nontraditional settings.

Excellent Care Requires Ex-

ceptional Communication

Although terminal illness is a family experience, imparting accurate infor-mation is critical. Communication needs are different between patients and family members. For example, the communication needs of a patient include: need for information, opportu-nity to disclose feelings, maintaining a sense of control, and a need for knowing that their life has meaning and purpose. Communication needs of family members include: need for information, permission to speak, and to be listened to.

Patients and their families expect nurses and the entire interdisciplinary team to be honest with them and to elicit and respect their values and goals.

The Quality of Life model (next page) can help to identify actual or potential

problems within each of the 4 dimen-sions.

Attentive Listening

Listening is a critical aspect of com-munication and can be used to cir-cumvent some of the barriers. Nonver-bal messages are constantly sent to patients and their families. Studies have shown that 80% of communica-tion is nonverbal. We are afraid to speak with patients and their families, because we are terrified of saying the wrong thing. Yet, only 20% of what we communicate is verbal.

Family Meetings

The primary purpose of a family meet-ing is to discuss goals of care and advance care planning. In addition, the family meeting assures consistent information, identifies areas of dis-cord, and provides the opportunity to formulate strategies of excellent inter-disciplinary care. A family meeting can improve communication between the patient, family, and the entire team about all end-of-life issues. The meet-ing must be well-planned, using the 7 basic recommendations for conduct-ing a family meeting.

1. Prepare for the meeting

2. Open the meeting.

3. Elicit family understanding

4. Elicit patient and family val-

ues and goals

5. Deal with decisions that need

to be made

6. Close the meeting

7. Follow up on the meeting

Continued next page

End-of-Life Care: Improving Communication Skills to Enhance Palliative Care (excerpt from “Topics in Advanced Practice Nursing eJournal”)

Communication Communication Communication needs are needs are needs are

different between different between different between patients and patients and patients and

family membersfamily membersfamily members

Page 4 PalCare

from previous page

Advocacy Can Require Both Communication

and Conflict

Whenever a group of people are working for the good of a patient and his family, expect to have conflicts along the way. Conflicts, however, do not have to be negative en-counters. Many times, conflict brings out discussions that may not have otherwise taken place. So when conflict arises, take a step back identify and try to describe your own emotions, but do not display them. Ask yourself : "Is this about me? Is this about me getting my way?" Cultural differences among patients, families, and team members may also cause conflict in decision-making.

Realize that conflicts will occur, and recognize that it is im-portant to define the area of disagreement. Attempt to ob-tain agreement on differences, even if they cannot be re-solved. Always keep the patient and family's best interests in mind.

Conclusion

End-of-life care is a privilege for the nurses and other healthcare providers who do this work. Therefore, it is im-portant to become educated, to communicate well, to prac-tice with integrity, and to care for those who are dying with great dignity and compassion.

TO CONSIDER !

On the first day of school, a young student handed his teacher a note from his mother. The note read:

'The opinions expressed by this child are not necessarily those of his parents.'

IS YOURS A PERSONAL OR PROFESSIONAL OPINION ??

PalCare Page 5

Some Resources for enhancing Communication Skills

The Training Resources for the Guidelines for a Palliative Approach in Residential Aged Care has a study topic titled “Support of and Communicating with the Family (see link http://agedcare.palliativecare.org.au or if you need a hard copy, call the CNC).

In the Palliative Care Curriculum for Undergraduates (PCC4U) learning package, there is a module con-sisting of a number of learning activities titled “Communication” (8 sections). This can be accessed by fol-lowing the link to www.pcc4u.org , go to PCC4U Resources, then to CD Contents, or you can borrow the CD from the CNC.

ALTERNATE DEVICES TO THE GRASBY SYRINGE DRIVER

changes to the Therapeutic Goods Administration’s Medical Device registration process be-

came effective October 2007, the manufacturer concluded that the Graseby syringe drivers would not meet the Australian Standards, and sales of these would cease at close of business

on 3 October 2007. Graseby MS16A and MS26 syringe drivers currently in use can continue

to be used and the Australian supplier has given an undertaking to continue servicing existing syringe drivers for at least 5 years (ie to end of 2012).

Alternate devices have been indentified in the PCA report (circulated with this newsletter and available on PCA web-site). The Specialist Services across LM Region have adopted purchase and use of the Niki T34.

Page 6 PalCare

PCA facilitated a workshop to identify issues needing to be considered for a national framework approach to End-of-Life care. The overall guide was the notion that End-of-Life care is “Everyone’s Responsibility” across all health care settings, and not limited to specialist services.

This was reflected by having 7 different workgroups, which addressed the following questions:

1.What are the challenges to providing quality EOL care?

2.How do we address these issues / change? 3.Who needs to make this happen?

The 7 workgroups were:

Aged Care

Primary Care

Acute Care

Specialist Palliative Care

Paediatric Palliative Care

Cancer

Non-malignant Palliative Care

The notes from each group were then presented and the papers taken by the PCA to be collated and used as the basis for their development of a National End-of-Life Framework. It is envisaged this framework will inform and shape policy direction into the future.

Merrill Cole (CNC)

P C A C O N F E R E N C E - “ E N D - O F -

L I F E ” F R A M E W O R K W O R K S H O P

Palliative Care in Aged Care – where is it going? The conference brought with it a wonderful opportunity to meet with other health care professionals with a specific interest in Aged Care.

Professor Leon Flicker discussed the leading causes of disease amongst the aged population with Dementia, Chronic Heart Failure (CHF) and Chronic Obstructive Pulmonary Disease (COPD) being the three most com-mon areas of disease burden and arthritis the most com-mon co-morbidity.

This also brings to it a different skill set and knowledge base in palliative care service provision as aged care (both residential and community) chronic disease symp-tom management provides a different trajectory than is traditionally known within palliative care.

It is truly an exciting time for palliative care service provi-sion within the field of aged care……… watch this space! In the mean time, drop us a line if you want to know more.

Melanie Shanahan (CNC)

P C A C O N F E R E N C E - P A L L I A T I V E

C A R E I N A G E D C A R E

Dr M.R. Rajagopal (Chairman, Pallium India) and Profes-sor Margaret O’Connor (President of PCA)

Perth city, viewed from

Kings Park. Convention

& Exhibition Centre is

the long building be-

tween the high-rise and

the roadway.

PERTH CONVENTION EXHIBITION CENTRE PERTH • WESTERN AUSTRALIA

PALLIATIVE CARE 2009 COMBINING THE 10th APCC & THE 8th APHC

Cultural connections for quality care at the