6 minute Speed talk Palliative Care Nurses Australia Conference 2020

Excellence in End of Life Care in the Acute Setting (70434)

Lisa Bethune 1
  1. Palliative Care, Northern Health, Melbourne, VIC, Australia

Excellence in End of Life Care in the Acute Setting

It is well established that the quality of end of life care in the acute setting is impacted by clinical staff lacking confidence in diagnosing dying, prescribing and administering appropriate symptom management medications, communicating with family and carers about dying and referring to palliative care.  Northern Health has a research project based on the implementation of a Care of the Dying Plan to improve the care of the dying. The Care of the Dying plan was introduced on four wards in the hospital; an Intensive Care Unit, an Emergency Department, Oncology/ Haematology/Medical Unit and a Renal/Medical Unit.  The Care of the Dying Plan, adapted from an end of life care plan used in other major acute hospitals, includes a ‘track and trigger’ chart for nurses to monitor and act on common symptoms at end of life.

The implementation evaluation used mixed methods to ascertain clinicians’ views about end of life care pre and post implementation of the Care of the Dying Plan, as well as completing a pre and post implementation audit to ascertain whether there was an improvement in care at the end of life. The audit aimed to determine whether the Care of the Dying Plan changed clinical care, diagnosis of dying, communication with patients and carers and the use of interventions.

Findings from the clinicians’ questionnaire are that the majority of clinicians (54%) found the Care of the Dying Plan useful in improving end of life care, by

  • Providing greater clarity about managing symptoms, especially for less experienced staff
  • Increasing prescriber confidence
  • Supporting staff advocacy for end of life care management
  • Improving ease of documentation

 A small percentage (4%) of clinicians expressed negative views that the Care of the Dying Plan relied on doctors diagnosing dying, was extra documentation and needed more definitions.

 The pre and post implementation audit results are currently being collated and will be available in next few months. Positive preliminary questionnaire results have fostered plans for the Care of the Dying Plan to be rolled out across all wards at Northern Health.