Individuals lifetime risk of death since time began 100 Percentage - - PDF document

caring@home is funded by the Australian Government and led by Brisbane South Palliative Care Collaborative.

Introducing caring@home resources

Presented by:

Prof Liz Reymond MBBS(Hons), PhD, FRACGP, FAChPM Director Brisbane South Palliative Care Collaborative and Project Director caring@home

• n behalf of the caring@home team,

Brisbane South Palliative Care Collaborative (BSPCC)

BSPCC is the education and research arm of MSPCS with a catchment of over 1 million

• people. The service has dedicated wards in hospitals, provides consult services,

community services, NP led in-reach program to 91 aged care facilities and after hours service. 1

Presentation overview

• Background
• What resources are available, for whom?
• How will the resources help?

Today, I want to talk about:

• The background to the project
• What resources have been produced by this project and who are they used by.
• How will the resources help you, clinicians, patients and their carers.

Carers in this context means unpaid carers who could be families, friends, neighbours, members of compassionate communities. 2

Individual’s lifetime risk of death since time began

Percentage risk of dying

Today Beginning

• f time

100 50 Timeline

What we know is that despite great advances in medicine, an individual’s risk of dying has always been 100% and still is. We know that today most people die from a chronic disease after often living with multiple chronic conditions. We also know that most Australians express the wish to be cared for and to die at home if possible but few achieve this goal. A common reason for transfer to hospital is inability to manage symptoms adequately in the home. Frequently people at end of life lose the ability to swallow and subcutaneous medicines are required for breakthrough symptoms. Many people in the community do not have access to 24 hour nursing care and teaching carers to give s/c medicines can help to fill this service gap. Background About 8 years ago BSPCC received funding to produce, trial and evaluate resources to be used to teach carers to give subcutaneous medicines. The resources were Queensland specific and led by Sue Healy, caring@home CNC. There have been several published articles as a result of the implementation of these resources in Queensland. Research shows that carers can confidently give subcutaneous medicines if given appropriate support, and adequate high quality resources. They also say it helps with their bereavement. A RCT showed that carers felt equally confident whether a nurse, pharmacist or themselves drew up the medicine. 3

Carer’s comment

“We knew when the pain hit we were able to do something to try to relieve it immediately without having to sit waiting, powerless, for someone to come and do it. I believe it gave us confidence to keep him at home to the very end .”1

• 1. Healy S, Israel F, Charles M, Reymond L. Laycarers can confidently prepare and administer subcutaneous injections for

palliative care patients at home: A randomised controlled trial. Palliative Medicine. 2018; 32(7): 1208-1215.

This is what one carer said and this is the motivation for the project. Using these resources in Metro South Health has shown that in most cases if someone wants to stay at home, a carer will volunteer to learn to give subcutaneous medicines. 4

caring@home website: www.caringathomeproject.com.au

This is our website.

• 1. This project received funding in July 2017 from the Australian Government for a

period of 3 years as one of the National Palliative Care Grants.

• 2. The project is a consortium of 9 organisations:

Brisbane South Palliative Care Collaborative (BSPCC) Aged and Community Services Australia (ACSA) Leading Age Services Australia (LASA) The Royal Australian College of General Practitioners (RACGP) Australian Primary Health Care Nurses Association (APNA) CareSearch National Prescribing Service (NPS) Pharmaceutical Society of Australia (PSA) The University of Technology Sydney (UTS) We set up Steering Committees and an Education Advisory Group to review Queensland specific resource plus conducted focus group interviews with nurses and carers who had used the Qld specific resources recently. We also have a National Implementation Advisory Committee.

• 3. The aim was to produce high quality resources that would support clinicians to

provide consistent education to carers giving subcutaneous medicines to help manage 5

breakthrough symptoms.

• 4. It’s important to note that nurses are already doing this, sometimes with well

developed resources but often ad-hoc and often using different techniques. The caring@home project aims to offer best-practice resources to support practice. 5

caring@home resources

• Suite of resources released on 29th October 2018 for:
• Community service providers
• Health care professionals
• GPs, nurse practitioners and pharmacists
• Nurses
• Carers

We produced resources for 3 levels if you like

• Organisation level
• Health care professional
• GPs, nurse practitioners and pharmacists (prescribers)
• Nurses (primary person providing care)
• Carer – primary work

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Resources for community service providers

• ‘Guidelines for the handling of

palliative care medicines in community services’ National Prescribing Service (NPS) for caring@home

• ‘Example policy and procedures:

Supporting carers to help manage breakthrough symptoms safely using subcutaneous medicines in the home’

(Organisational Level) NPS developed guidelines for the handling of palliative care medicines in community services. Consensus-based approach to best practice to handling of palliative care medicines by community services. They consider jurisdictional legislative requirements across all states and territories. In consultation with the relevant state/territory department.

• In Victoria Drugs and Poisons Regulation, Dept of Health and Human Services

Difficult to write nationally but where there are state/territory differences highlighted in green. These will be reviewed later in the year so if any feedback please let us know. The Example Policy and Procedure: Supporting carers to help manage breakthrough symptoms safely using subcutaneous medicines in the home was developed as a basis for services to develop their own Policy and Procedure if they wish. This is a word document that can be cut and pasted to suit individual services and can be downloaded from the caring@home website. 7

Get the app

palliMEDS

National Prescribing Service (NPS) for caring@home

An app for prescribers eg GP, NP and pharmacists. Targeted especially GPs who report that they do not see large number of palliative patients and so not using the medicines all the time Available from the app store for both Apple and Android devices. Based on the ANZSPM list of medicines used for common end of life symptoms. Eg. pain, anxiety, nausea and vomiting Very clinical orientated Can search on symptom and medicine Has additional data about off-label use of medicines, medico-legal issues, PBS listing The app received an unsolicited review in the Medical Observer by a GP recommending it as an essential tool for GPs. 8

This list of nine medicines was developed as part of a consensus-based approach with GPs, specialists, pharmacists and nurse practitioners. Endorsed by ANZSPM which is professional organisation for palliative medicine specialists 9

Online modules for nurses

2 modules The first introduces resources. Takes 20 minutes. The second is how to teach a carer to give s/c medicines safely using the caring@home

• resources. Divided into 2 parts with each taking about 20 mins. This fits with the time

availability of community nurses. Not trying to teach specialist nurses to suck eggs but have needed to make it appropriate for non specialist nurses also. Does help promote systematic consistent approach. 10

caring@home package for carers

www.caringathomeproject.com.au

Resources for carers (which is most of the resources). Two important points.

• Services that use these resources to teach carers to give subcutaneous medicine must

provide a 24 hour phone number where the carer can obtain clinical advice (not a general number)

• These resources are not being marketed directly to carers; must be brokered through

you ie a clinical service Produced in high production value and very robust box. But can be reproduced more cheaply by services. Limited number able to be produced by the project initially. Freely available from caring at home website with funding from DHHS via Shannon’s Bridge Includes resources for carers that support a variety of learning styles Handbook – lots of explanations Step by step guides Videos for visual learners Medicines diary for recording medicines given Resources developed into five other languages (Arabic, Greek, Italian, Traditional Chinese and Simplified Chinese) with an additional two languages being translated now (Vietnamese, Tagalog) 11

Step by step guides These were developed to be as visual as possible. Across Australia it varies as to whether the carer draws up medicine and leaves it in the fridge or whether carer draws up medicine. 12

Practice demonstration kit

The practice demonstration kit is a teaching tool to allow the carer to practice drawing up and giving subcutaneous medicines. Very important to give carer confidence in giving the medicine. Dressing will contain a few mLs of liquid allowing for repeated practice. Contains drawing up needles, plastic and glass ampoules, syringes Carer can also practice by themselves 13

Colour-coded labelling system

All syringes should be labelled. The safest way to ensure that the correct medicine is given for a symptom is to read the label on the syringe. But we have developed a colour-coded system as a visual aid to help carers especially when they are tired and it is the middle of the night. These colours are according to National Standards from the Australian Commission on Safety and Quality in Health Care (ACSQHC). There is a fridge chart where nurse can write in the medicine and symptom in appropriate coloured box. There is also a One-on-one training checklist and carer post-training competency assessment (competency checklist) that can be filed in the patient’s notes. 14

Nurse feedback

“ Yesterday we used the package with a family and the feedback was great. They were able to go through the information and practice with the equipment supplied. The family were able to demonstrate how to do everything on the checklist you provided. In summary, this is an amazing resource for patients, carers and

• nurses. ”

Palliative care CNC, NSW

First feedback 15

caring@home website: www.caringathomeproject.com.au

• All printed resources can be

downloaded from the website.

• Hard copies of carer resources can be
• rdered via website

In Victoria carers resources are being developed by Shannon’s Bridge. In Queensland carers resources are being funded by Care at the End of Life through the Healthcare Improvement Unit, Clinical Excellence Queensland. 16

Summary of number of carer packages ordered per State and Territory as of June 2019

WA = 85 ACT = 52 NSW = 695 NT = 8 QLD = 686 SA = 268 TAS = 113 VIC = 446 Total = 2353 17

Number of resource packages ordered from each

• rganisation type Nationally as of June 2019

SPCS – Community = 1012 SPCS – Hospital = 191 SPCS – Community and Hospital = 267 GP Practices = 55 Aged Care Providers = 67 Domiciliary Nursing Services = 353 Other = 408 Total = 2353 18

Number of resource packages ordered from each

• rganisation type in Western Australia as of June 2019

SPCS – Community = 26 SPCS – Hospital = 12 SPCS – Community and Hospital = 24 GP = 0 Aged care provider = 6 Domiciliary nursing service = 0 Other = 23 Total = 91 19

w: www.caringathomeproject.com.au t: 1300 600 007 e: caringathome@health.qld.gov.au

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