Ten Implementation Steps for Establishing a Palliative Approach Workbook
Ten Implementation Steps for Establishing a Palliative Approach Workbook This Workbook was developed for use in workshops that were undertaken as part of the National Rollout of the Palliative Approach (PA) Toolkit for Residential Aged Care Facilities Project. This Project was funded by the Australian Government Department of Social Services under the Encouraging Better Practice in Aged Care (EBPAC) Initiative. The 10 implementation steps summarised in this Workbook are discussed in detail in the PA Toolkit resource: Workplace Implementation Guide: Support for Managers, Link Nurses and Palliative Approach Working Parties. Ten Implementation Steps Step 1: Identify Key Staff in Your Facility Step 2: Identify and Engage Stakeholders Step 3: Develop or Review Palliative Approach Policy and Procedures Step 4: Develop or Review Policies and Procedures for Medications to Manage End of Life (Terminal) Symptoms Step 5: Review Clinical Assessment Tools and Procedural Forms Step 6: Review Palliative Approach Key Processes Step 7: Use the Palliative Approach Trajectories Framework to Assist Key Process Selection Step 8: Review Each Resident s Clinical Care Step 9: Review Staff Education and Training in a Palliative Approach Step 10: Conduct Audits as Part of Continuous Improvement and Quality Control Brisbane South Palliative Care Collaborative 2014 Page 2 of 12
ACTIVITY: COMPLETE THE FOLLOWING AUDIT Organisational Policies and Structures Audit Tool (PTO) Brisbane South Palliative Care Collaborative 2014 Page 3 of 12
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STEP 1 IDENTIFY KEY STAFF IN YOUR FACILITY Palliative Approach Link Nurse(s): You will need to appoint a Palliative Approach Link Nurse(s). In particular, it s important to consider: How many Palliative Approach Link Nurses does your facility require? When determining the number of Palliative Approach Link Nurses required at your facility, remember to address issues of coverage and adequate support for all staff. For example: If you have a large facility, are Palliative Approach Link Nurses required for each unit? How will after hours and weekend staff be supported by a Palliative Approach Link Nurse? Can a Palliative Approach Link Nurse be contacted off duty to respond to urgent queries? Who takes on this role when the Palliative Approach Link Nurse is off duty or on leave? List some staff from your facility who could be approached about taking on a Palliative Approach Link Nurse role: Name Position or designation (e.g. RN, EN, Quality Manager) Work days/hours Section/floor/area at the facility Other issues you will need to consider include: How will you select the Palliative Approach Link Nurse(s)? Does your Palliative Approach Link Nurse require preparation to take on this role? How can you attract staff to the Palliative Approach Link Nurse role? How can you provide ongoing support for your Palliative Approach Link Nurse(s)? Write down some thoughts regarding these issues: Brisbane South Palliative Care Collaborative 2014 Page 5 of 12
Palliative Approach Working Party: Who will be the members of the Palliative Approach Working Party? How often will the Palliative Approach Working Party meet? Write down who will be approached to be on your facility s Palliative Approach Working Party: Name Role in organisation STEP 2 IDENTIFY AND ENGAGE STAKEHOLDERS To plan and undertake this implementation step you will need to consider: Who are your internal and external stakeholders? How can you engage your internal and external stakeholders? How will you engage residents and families in implementing a palliative approach? How will you engage general practitioners in implementing a palliative approach? How will you collaborate with your local specialist palliative care service? Write down some ideas about who your stakeholders are and how to engage them: Stakeholder name Internal/external Ideas on how to engage them Brisbane South Palliative Care Collaborative 2014 Page 6 of 12
STEP 3 PALLIATIVE APPROACH POLICY AND PROCEDURES To plan and undertake this implementation step you will need to consider: Do you have a palliative care policy? Does the policy require amending or updating? Have you set up a timeframe for policy review and who will undertake this review? Do you require specific policy/procedure documents (e.g. advance care planning, guidelines for use of artificial nutrition/hydration)? List your facility s current policies/procedures relevant to implementing a palliative approach and note whether or not a review is required: Policy/procedure name Requires review (yes/no) Write down any new policies/procedures relevant to implementing a palliative approach that need to be developed for your facility: New policy/procedure name Person(s) responsible for developing new policy/procedure STEP 4 POLICIES AND PROCEDURES FOR MEDICATIONS TO MANAGE END OF LIFE (TERMINAL) SYMPTOMS To plan and undertake this implementation step you will need to consider: What processes will be put in place to ensure that residents have optimal and timely access to medications for symptom control during the terminal phase of life? What are the roles and responsibilities of facility staff in the provision of optimal and timely symptom control during the terminal phase of residents lives? What medications are suitable for use in residential aged care for the management of symptoms in residents who are in the terminal phase? Do you have access to a syringe driver and appropriate equipment to deliver subcutaneous medications? How will you educate and train staff about the pharmacological management of terminal symptoms in residents? Brisbane South Palliative Care Collaborative 2014 Page 7 of 12
List some key action points that you will need to address in relation to these medication management issues: STEP 5 CLINICAL ASSESSMENT TOOLS AND PROCEDURAL FORMS The PA Toolkit recommends several clinical tools and forms. To plan and undertake this implementation step you will need to consider whether your facility s current clinical tools/forms are adequate or whether they require revision/replacement. Complete the following table in relation to your facility s clinical tools and procedural forms: Clinical care domain Current tool/form Requires revision/replacement Pain Dyspnoea Delirium Oral Care Nutrition/hydration Care processes Advance Care Planning Palliative Care Case Conferences End of Life Care Bereavement Needs How will staff be trained to use new clinical tools and procedural forms? Brisbane South Palliative Care Collaborative 2014 Page 8 of 12
STEP 6 PALLIATIVE APPROACH KEY PROCESSES To plan and undertake this implementation step you will need to consider the three key processes addressed in the PA Toolkit: (1) advance care planning, (2) palliative care case conferences, and (3) use of an end of life care pathway. Advance Care Planning: Does every resident have an advance care plan? Does the facility have a policy and procedure document for obtaining and reviewing advance care plans? Is this followed through? Is the current advance care plan for each resident readily accessible to all clinical staff (including casual staff)? And if not, how will you accomplish this? Based on the above points for consideration, how is your facility tracking with respect to advance care planning? List key issues requiring further action: Palliative Care Case Conferences: Who will arrange the date and time for the palliative care case conference and liaise with attendees? Who will prepare the meeting agenda for the case conference and collect up-to-date resident assessments and clinical summaries for discussion at this meeting? Who will facilitate the case conference? For example, do you want your Palliative Approach Link Nurse to facilitate all case conferences or will other nurses be mentored to take on this facilitator role? Do you have any palliative care case conference templates or would you use the ones in the PA Toolkit? Based on the above points for consideration, how is your facility tracking with respect to palliative care case conferences? List key issues requiring further action: Brisbane South Palliative Care Collaborative 2014 Page 9 of 12
Use of an End of Life Care Pathway: How will an end of life care pathway be implemented? Which end of life care pathway will you implement? Based on the above points for consideration, how is your facility tracking with respect to use of an end of life care pathway? List key issues requiring further action: STEP 7 USING THE PALLIATIVE APPROACH TRAJECTORIES TO ASSIST KEY PROCESS SELECTION Complete this table in relation to the residents currently living at your facility: Trajectory A more than 6 months to live Trajectory B less than six months to live Trajectory C less than one week to live Approximate number of residents Review process In planning and undertaking this implementation step consider the following questions: How will you determine a resident s estimated prognosis? How will staff be made aware of a resident s estimated prognosis? How will a resident s estimated prognosis be reviewed? Write down some key action points that need to be addressed at your facility in relation to this implementation step (use the above points as a guide): Brisbane South Palliative Care Collaborative 2014 Page 10 of 12
STEP 8 REVIEW EACH RESIDENT S CLINICAL CARE To plan and undertake this implementation step it will be important for you to consider: Which areas of a resident s clinical care should be assessed and reviewed regularly? How often should a resident s clinical care be reviewed? The PA Toolkit focuses on five clinical care domains (i.e. pain, dyspnoea, nutrition and hydration, oral care and delirium) but all symptoms experienced by residents are important. What processes do you have in place for regular clinical review of residents? For residents who are terminally ill and where symptoms may change quickly, what processes do you have in place to identify and manage these changes? STEP 9 STAFF EDUCATION AND TRAINING IN A PALLIATIVE APPROACH To plan and undertake this implementation step you will need to consider: What content related to implementing a palliative approach will be included in your staff education and training program and how will you prioritise content delivery? What methods will you use to train staff in implementing a palliative approach? How will you identify and evaluate the outcomes from your staff education and training program? How can PA Toolkit resources be used in your staff education and training program? List key action points that you will need to address in developing your staff education and training strategy related to implementing a palliative approach: Brisbane South Palliative Care Collaborative 2014 Page 11 of 12
STEP 10 CONDUCT AUDITS AS PART OF CONTINUOUS IMPROVEMENT AND QUALITY CONTROL To plan and undertake this implementation step you will need to consider: What audits could be conducted at your facility? When should particular audits be conducted at your facility? We suggest 2 audit tools that could get you started: 1. After Death Audit Tool: Involves auditing individual resident outcomes. 2. Organisational Policies and Structures Audit Tool: Involves auditing key organisational policies and structures relevant to the effective implementation of a palliative approach at your facility. A copy of this audit tool is provided at the end of this Workbook. Final Activity Working with your partner or alone: List 3 specific actions related to the Ten Implementation Steps that you will undertake at your workplace within the next month. 1 2 3 Brisbane South Palliative Care Collaborative 2014 Page 12 of 12