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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)
Phone 54711545 / 0447 526 626
Admin Assistant - Anne Forden (Mon, Tue, Wed)
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)
Phone 50910228 / 0419 181 838
PCNC - Merrill Cole (Mon & Wed)
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