A residential aged care end-of-life care pathway (RAC EoLCP) for Australian aged care facilities
Liz Reymond A , Fiona J. Israel A C and Margaret A. Charles BA Brisbane South Palliative Care Collaborative, Queensland Health and Griffith University School of Medicine, PO Box 4069, Eight Mile Plains, QLD 4113, Australia. Email: elizabeth_reymond@health.qld.gov.au
B School of Psychology, University of Sydney, School of Psychology A18, Sydney, NSW 2006, Australia. Email: margaret.charles@sydney.edu.au
C Corresponding author. Email: fiona_israel@health.qld.gov.au
Australian Health Review 35(3) 350-356 https://doi.org/10.1071/AH10899
Submitted: 11 March 2010 Accepted: 10 November 2010 Published: 25 August 2011
Abstract
The objective of this study was to develop, implement and evaluate an end-of-life (terminal) care pathway and associated infrastructure suitable for Australian residential aged care facilities that improves resident and health system outcomes. The residential aged care end-of-life care pathway was developed by a multidisciplinary collaboration of government and non-government professionals and incorporated best clinical management for dying residents to guide care and increase palliative care capacity of generalist staff. Implementation included identifying and up-skilling Link Nurses to champion the pathway, networking facilities with specialist palliative care services, delivering education to generalists and commencing a Palliative Care Medication Imprest System in each facility. The primary outcome measure for evaluation was transfer to hospital; secondary measures included staff perceived changes in quality of palliative care provided and family satisfaction with care. Results indicated that the pathway, delivered within a care framework that guides provision of palliative care, resulted in improved resident outcomes and decreased inappropriate transfers to acute care settings.
What is known about the topic? Residential aged care facilities (RACFs) are the hospices of today. Many RACF staff are not confident in the delivery of high quality palliative care, resulting in inappropriate transfers of dying residents to acute care facilities. Needs-based palliative care pathways are being used increasingly to direct care in a variety of healthcare environments.
What does this paper add? Provides the first evidence in Australia that a residential aged care end-of-life care pathway (RAC EoLCP) improves outcomes of care for dying residents and results in fewer residents being inappropriately transferred to acute care facilities.
What are the implications for practitioners? Use of the RAC EoLCP will improve resident and health system outcomes by guiding the delivery of high quality palliative care and improving the palliative care capacity of generalist health providers.
References
[1] End of life care is everyone’s affair – tackling the challenge of ‘end of life’. Submission to the National Health and Hospitals Reform Commission. Canberra: Palliative Care Australia; 2008.[2] Abbey J. The reality for aged and community care and end of life. In: A Matter of Life and Death: Confronting the New Reality, Palliative Care Australia National Stakeholder Forum; 13 March 2008; Canberra. 2008.
[3] Residential aged care services in Australia 2006–6: a statistical overview. Aged Care statistics series 26 No. AGE 56. Canberra: Australian Institute of Health and Welfare; 2008.
[4] Abbey J, Froggatt KA, Parker D, Abbey B. Palliative care in long-term care: a system in change. Int J Older People Nurs 2006; 1 56–63.
| Palliative care in long-term care: a system in change.Crossref | GoogleScholarGoogle Scholar |
[5] Chan R, Webster J. End-of-life care pathways for improving outcomes in caring for the dying. Cochrane Database Syst Rev 2009; CD008006
[6] Ellershaw J, Wilkinson S. Care of the Dying – A Pathway to Excellence. New York: Oxford University Press, 2003.
[7] Ellershaw J, Foster A, Murphy D, Shea T, Overill S. Developing an integrated care pathway for the dying patient. Eur J Palliat Care 1997; 4 203–7.
[8] Hardy J, Maresco-Pennisi D, Gilshenan K, Yates P. Barriers to the care of the dying in Queensland, Australia. J Palliat Med 2008; 11 1325–9.
| Barriers to the care of the dying in Queensland, Australia.Crossref | GoogleScholarGoogle Scholar |
[9] Standards for providing quality palliative care for all Australians. Palliative Care Australia; 2005. Available at http://www.palliativecare.org.au/Portals/46/Standards%20for%20providing%20quality%20palliative%20care%20for%20all%20Australians.pdf [verified 23 June 2011].
[10] Guidelines for a palliative approach in residential aged care. Enhanced version approved by National Health and Medical Research Council. The National Palliative Care Program, Australian Government Department of Health and Ageing; 2006. Available at http://www.nhmrc.gov.au/_files_nhmrc/file/publications/synopses/pc29.pdf [verified 23 June 2011].
[11] A pilot study of the use of the Liverpool Care Pathway in Western Australia. Final Report. Perth: WA Cancer and Palliative Care Health Network, Department of Health, Western Australia; 2009.
[12] Duffy A, Woodland C. Introducing the Liverpool care pathway into nursing homes. Nurs Older People 2006; 18 33–6.
[13] Pathways for care in the last days of life: a review of current utilisation in Victoria. Melbourne: State Government of Victoria, Department of Health; 2009.
