Our Palliative Approach Residential Services
Our Palliative Approach Affirm Affirming your plans and making informed choices
Balance Balancing and reviewing your care as your needs change
Comfort Providing comfort care and support at the end of your life
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Table Of Contents
Table Of Contents
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About This Guide
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Introduction
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Key Features Of Each Stage
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AFFIRM
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BALANCE
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COMFORT
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Key Roles
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Palliative Care Link Nurse / Person
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Local Access To Specialist Palliative Care Services
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Resources Staff Training Resources Our Palliative Approach - Kit Contents
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DVDs
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Handbooks, Guidelines And Resources Supplied In The Toolkit
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Information Sheets For Your Clients And Families
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Quality Assurance And Continuous Improvement
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Useful Links
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Notes
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About This Guide Welcome to this guide which has been developed to assist staff in providing the BaptistCare Palliative Approach to our clients and their families in Residential Aged Care. BaptistCare recognises and has built upon the palliative approach resources funded by the Australian Government Department of Social Services and developed by the Brisbane South Palliative Collaborative (Queensland Health, 2013). This guide is part of a set of resources customised for BaptistCare Residential Aged Care Centres, to be used in conjunction with an evidence based approach to care for our clients. The policies and resources which are to be used in conjunction with this guide and toolkit include: • BaptistCare Advance Care Planning Policy and Procedure • BaptistCare Palliative Care Policy Procedure and Resource Guide • BaptistCare Deceased Client Care Policy and Procedure • The resources and tools provided within this BaptistCare Palliative Approach Kit • Resources and links on the BaptistCare Intranet
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Introduction
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The BaptistCare Palliative Approach in Residential Aged Care provides a model of care that enhances resident quality of life while recognising the journey of individuals living with life-limiting–illness. Clients, families and staff work together to clearly and openly communicate and achieve understanding on the client’s care goals, symptom management at each stage of their illness and to reduce potential distress. Our Palliative Approach focuses on three dynamic stages of care trajectory and prognosis as follows:
AFFIRM • The process of affirming the importance of quality of life and identifying lifestyle choices and goals as well as Advance Care Planning (ACP) for the future care for our clients and their families • Advance Care Planning ensures the future wishes of clients and families are identified and respected. We involve clients with illnesses including dementia, recognising that they have capacity to participate in making choices for their future
BALANCE • Balancing begins at a time where the client’s condition is no longer responding to current treatments and their life-limiting illness has progressed. At this time the use of the ‘surprise question’ …“Would you be surprised if the client died within the next six months?” is appropriate in order to effectively identify deterioration and decline (UK Gold Standard Framework, 2011) • A resident’s needs are reviewed by engaging all the stakeholders in a palliative care conference to ensure everyone is on the same page and supports ongoing optimal and appropriate care for the client. Reviewing care and choices encompasses the needs of clients with dementia through reminiscence and other methods
COMFORT • In the final days and weeks of a client’s life, providing comfort care and support is the priority. The comfort stage enables a person centred approach to care focused on the client and their family’s choices, religious and cultural beliefs and their right to die with dignity. Clinical staff and family focus on emotional and physical symptom management in the setting of their choice. At this time, the End of Life Care Pathway is reviewed daily. It is used to direct care and achieve a natural death. Care after death and bereavement support for family and employees is provided in this stage.
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Key Features Of Each Stage Recognising that the client has a greater than 6 months prognosis
Affirm
Usually within 6-8 weeks of admission key staff hold a care conference to set goals and optimise quality of life, introduce the BaptistCare Palliative Approach and support the client engagement in the facility community The Advance Care Planning conversation begins and often over several meetings an Advance Care Plan is developed Care is focused on quality of life, symptom management and setting treatment goals Care staff notice a deterioration in the client’s condition, and that they are no longer responding to current treatments
Balance
Prompted by recognising that the client has potentially 6 months or less to live using the ‘surprise question’ ”Would you be surprised if the client died in the next six months?’ (UK Gold Standard Framework, 2011) The palliative care conference invitation is sent to family and People Point Clinical resources (such as assessments) are used A palliative care conference is held focusing on: • Recognising the client’s deterioration • Reviewing symptom management and revising or setting treatment goals • Reviewing the Advance Care Plan • The resources book ‘Talking about Dementia and Dying’ is a useful tool to support staff when talking about dying with family of clients with dementia. Referral can be made at this time to a Specialist Palliative Care Service as required for complex symptom management
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Recognising the client is in the terminal phase and is Building Safer Families
dying (the last week of life) using the terminal stage BaptistCarecriteria has supported individuals families (meeting 3 to 6 or more and of the nine criteria) in End of Life Care Pathway (EoLCP) impacted bythedomestic violence for more than 30
domestic violence are Thisimpacted prompts a by consensus based approach where the Comfortyears. People
practitioner, client, family and clinical staff often mademedical vulnerable through manipulation, commence EoLCP toseeks support comfort care control andagree fear.toOur holisticthe approach measures to end the cycle of abuse by empowering Review the client’s Advance to ensure individuals and families to live safelyCare andPlan develop treatment choices and choice of place are recognised independence, personal wellbeing and mutual and supported respect.
Engage Specialist Palliative Care Service for complex symptom management (as required) Using a ‘whole of family’ approach, we respond
to domesticContinual violenceassessment by: of symptoms and treatment goals •
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•
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reviewed and revised daily Providingwhich crisisare and medium-term Family support and engagement accommodation for women and children escaping Care domestic violence. after death and bereavement support
Assisting women and children to secure long-term housing as they rebuild their lives. Offering counselling services to men, women and children. Making finances available through no-interest loans. Developing resources aimed at reducing domestic violence in the community.
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Key Roles
Palliative Care Link Nurse / Person This role provides quality palliative aged care services that are consistent with BaptistCare purpose and values, in order to meet clients and their family’s needs surrounding support during life-limiting illness. The Palliative Care Link Nurse/Person will support: •
Client comfort and emotional needs
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Client identity and their ability to express and record their wishes
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Meaningful engagement and maintenance of relationships and emotional attachments by providing a solid point of reference amidst shift / staff changes
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The lifestyle staff in their role of providing meaningful activities and enhanced environment
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Ongoing facility and community inclusion of both client and their loved ones to ensure that they feel part of the home, participating in all aspects of care planning and are able to safely assist with care as desired
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Enable referral and access to external services throughout each stage of the client’s journey
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The provision of bereavement care as necessary for families and carers
Local Access To Specialist Palliative Care Services While the care of the local medical practitioner will often be sufficient for most client’s end of life care management, clients with severe or complex problems can be referred to a Specialist Palliative Care Service, where a team of specialists will work together to meet their needs. These services provide consultative or ongoing care and can also support the caregivers and family. The Palliative Care Australia’s National Palliative Care Service Directory can assist you in locating a local Specialist Palliative Care Service, or you can go to the Palliative Care NSW Directory of Services.
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Resources
Staff Training Resources Role title
Probation 1-6 months
CSE care
ELearning (LIDO) Palliative care: Approach Pain management: Non pharmacological
Annually
Clinical Skill Resources Hammond Palliative Bridge
Other Resources BaptistCare Palliative Approach
RAC EoLCP CSE Catering Laundry Cleaning Care Supervisor CIV ACW Med Comp
Palliative care: Grief and loss ELearning
BaptistCare Palliative Approach
Palliative care: Approach ELearning Palliative care: Approach Pain management: Non pharmacological
Hammond Clinical competencies Palliative Bridge
BaptistCare Palliative Approach
Clinical Hammond competencies Palliative Bridge
BaptistCare Palliative Approach
Pain management: The use of analgesics Pain management: Recognising and responding Medication Administration: Syringe drivers RAC EoLCP Care Supervisor Enrolled Nurse Med Comp
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Palliative care: Grief and loss ELearning Palliative care: Approach Pain management: Non pharmacological Pain management: The use of analgesics
Role title
Probation 1-6 months
Care Supervisor Enrolled Nurse Med Comp
Pain management: Recognising and responding
Registered Nurse
Annually
Clinical Skill Other Resources
Medication Administration: Syringe drivers RAC EoLCP Palliative care: Grief and loss ELearning Pain management: Non pharmacological
Clinical Hammond competencies Palliative Bridge
BaptistCare Palliative Approach
Clinical Hammond competencies Palliative Bridge
BaptistCare Palliative Approach
Pain management: The use of analgesics Pain management: Recognising and responding Palliative care: Approach Medication Administration: Syringe drivers RAC EoLCP Palliative Care case conferences in RACF Palliative Care Link Nurse
Palliative care: Grief and loss ELearning Pain management: Non pharmacological Pain management: The use of analgesics Pain management: Recognising and responding Palliative care: Approach Medication Administration: Syringe drivers RAC EoLCP Palliative Care case conferences in RACF Palliative care: Grief and loss
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Role title
Probation 1-6 months
Care team Manager
ELearning Palliative care: Approach Pain management: Non pharmacological
Annually
Clinical Skill Resources Clinical Hammond competencies Palliative Bridge
Other Resources BaptistCare Palliative Approach
RAC EoLCP Medication Administration: Syringe drivers Palliative Care case conferences in RACF Residential Manager
Palliative care: Grief and loss ELearning Palliative care: Approach Pain management: Non pharmacological
Hammond Palliative Bridge
BaptistCare Palliative Approach
Hammond Palliative Bridge
BaptistCare Palliative Approach
Hammond Palliative Bridge
BaptistCare Palliative Approach
RAC EoLCP Chaplain
Palliative care: Grief and loss ELearning Pain management: Non pharmacological Palliative care: Approach RAC EoLCP
Palliative care: Grief and loss Allied health ELearning Diversional Pain management: Non Therapist pharmacological Recreational Pain management: Activities Recognising and responding Officer Palliative care: Approach RAC EoLCP Palliative care: Grief and loss Client Liaison Officer
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ELearning Palliative care: Approach Palliative care: Grief and loss
BaptistCare Palliative Approach
Our Palliative Approach - Kit Contents DVDs 1. All on the same page - Palliative Care Case Conferences in RACF - from PA Tool Kit University of Queensland, 2012 2. How to use the Residential Aged Care End of Life Care Pathway (RAC EoLCP) – from PA Tool Kit University of Queensland, 2012
Handbooks, Guidelines And Resources Supplied In The Toolkit 1. 2. 3. 4. 5.
Capacity Toolkit Lawlink NSW Our Palliative Approach - Residential Services Therapeutic Guidelines Palliative Care, Version 3 2010 The Palliative Care Handbook, Hammond Press 2014/15 Talking About Dementia and Dying – a discussion tool for RACF staff, Hobart Print Press 2011
Information Sheets For Your Clients And Families Information and resources to support and optimise communication with client’s and family throughout their journey are available and will continue to be developed. These info sheets can be shown to the client or family and then placed into the Client Care and Services Folder MY CARE section for future reference. Topics initially available include: •
The BaptistCare Palliative Approach
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Advance Care Planning
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Falls Prevention
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Using the End of Life Care Pathway
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Future insert sheet topics may include: •
Dementia Care
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A palliative care conference
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Accessing Specialist palliative care services
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Pain management
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End of life comfort care and symptom management
Quality Assurance And Continuous Improvement •
After Death Audit tool monthly
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Feedback from stakeholders monthly
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MOA annual surveys Standard 2.8 and 2.9
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Emergency palliative medication stock audit (S8 weekly and stock monthly)
Useful Links ACT Respecting Patient Choices http://advancecareplanning.org.au CareSearch http://www.caresearch.com.au Residential Aged Care Palliative Approach Tool Kit Joanna Briggs Institute (JBI) Clinical Procedure manual NSW Health Planning Ahead Tools http://planningaheadtools.com.au Palliative Care Australia http://palliativecare.org.au Palliative Care NSW https://palliativecarensw.org.au Palliative Care Australia’s National Palliative Care Service Directory https://palliativecarensw.org.au/site/about-palliative-care
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