End of Life Care and discharge planning

Increased Educational support to all health professionals regarding End of Life Care Planning. Palliative care expertise is important in discussions and complex descision making regarding EOL Care. Recognition of clinical predictors of poor survival, identification of limits of care, mandatory advanced care planning for groups of patients ie: terminl cancer, communication, policy and cultural changes should be addressed to ensure that patients receive the best possible care. Currently the PAH has an inpatient consultative service ONLY for Palliative Care patients which is significantly deficient for the types of patients that are admittted to the facility. EOL care should include the patients wish to die with dignity at a place of their own choosing, therefore discharge planning and integrating community services is essential for the patient and family. A significant amount of cancer patients benefit from these services and investment will result in a reduced length of stay and patient satisfaction.

Why the contribution is important

Increased educational support to all heatlh professionals regarding End of Life Care Planning can facilitate the appropriate care to patients on an individual basis.

by powercm on May 21, 2019 at 02:47PM

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4.95652173913
Average score : 4.9
Based on : 23 votes

Comments

  • Posted by parkergr May 24, 2019 at 15:58

    Absolutely agree, I think you have eloquently articulated a range of very pertinent and essential elements that is worthwhile drilling down and requires a multipronged approach, including in some aspects a system rethink. Dedicated Educational support and a systematised framework of care is such a crucial part of the puzzle among other things. It all however needs appropriate and adequate resourcing to shift the pendulum.

       In regard to educational support there would, for example be clear ROI from having dedicated palliative care educators at the PAH and in deed the district - currently non existent. MSH is fortunate enough to have a person-centred end of life policy and framework that is able to successfully guide care, however the resourcing is lacking when it comes to implementation and beyond.

    There is clear evidence from a number of studies, evaluations, and recent inquiries and our own experience in MSH that highlights most of the points you mention.

      If consumers have documented person centred conversations through facilitated Advance Care Planning processes clearly articulating choices and appropriate care at the end of life, as well as having awareness of what was available to support an alternative place of palliative and end-of- life care be it Home Based/Palliative Care Unit and this was adequately resource matched to meet their needs from a specialist palliative care perspective then they would not want to have and in deed do not have their end-of-life care in an acute hospital bed in the majority of cases. MSH has made significant progress in the space of advance care planning. Having dedicated ACP facilitators in acute facilities across the district has shown clear sustained benefit to the community, and clinicians alike, however funding for this is time limited and at this stage remains non- recurrent.

    When it comes to the downstream impact of delivering palliative and end- of life care in an appropriately and adequately supported environment, I believe that we are fortunate in our district MSH to have a relatively mature integrated palliative care service and model of care that provides acute consultation in reach, inpatient, ambulatory, and home based care including RACF in reach consultation care, that is beneficial to the community and in part addresses choice and challenge 1. However essential gaps remain as you correctly point out that restricts service care delivery from truly being comprehensive and able to meet demand from both the patient/carer and the health system's perspective. This is in most part due to the historic budgetary framework apportioned to palliative care in Metro South .

      Adequately resourcing the Metro South Palliative Care Service to meet current demand and in line with the contemporary care environment can only positively contribute to addressing growing patient/carer and system needs. The service has progressed some way to meeting patient centred care in the context of attempting to facilitate appropriate place of care at the end of life as a choice for those patients, however essential gaps remain for historic budget reasons primarily which unfortunately limits the ability to achieve maximum impact and penetrance in care delivery for a still significant number of our patients who would not want to be stuck in an acute hospital bed and unfortunately are as a default.
  • Posted by SueHealy May 29, 2019 at 15:21

    I agree that a nurse educator for the palliative care service is essential for the future development of palliative care within Metro South Health. Having a designated educator would support both the hospital and community; improve access to better patient centred end of life care within the hospital environment, by providing opportunities for all health professionals to gain a greater understanding how palliative care services. This can enhance end of life decision making process, allow a person centred approach to end of life care by being supported with good care through the promotion of good symptom assessment and ongoing management of a persons physical and psychosocial needs, allowing patients to move from an acute care model of care to a palliative approach.
    This role would also support the uptake of advance care planning within the hospitals, RACF and community settings.
  • Posted by SutherJu May 31, 2019 at 11:58

    In addition to above comments, all of which I strongly support, if we are truly to claim to be a person-centered organization then we need to genuinely include our community members in having sufficient information and inclusion in planning their future health care according to their views and preferences. Along with further educating all clinicians to provide good end-of-life and palliative care we must be able to be responsive to provide care across all sectors: acute hospital, aged care facilities and in homes. Until we resource service provision adequately for OUTSIDE hospital care, we will continue to have bed pressures. Providing engaging education sessions to inform our communities helps to give them a voice and ways to communicate their preferences and be supported. Very often we hear people state very firmly they would rather not come to our hospitals in the first place! This is called advance planning for health care. Our community is ready, if only we would respond.
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