National Palliative Care Initiatives in Australia Karen Glaetzer - - PowerPoint PPT Presentation

National Palliative Care Initiatives in Australia

Karen Glaetzer Palliative Care Nurse Practitioner Southern Adelaide Palliative Services Lecturer (B) School of Medicine Flinders University

Southern Adelaide Palliative Services

 Specialist Palliative Care Service  Southern Adelaide Metropolitan Area  Population 350,000 (Adelaide 1.3m)  Provides inpatient care, community and consult liaison service to 3 Public Hospitals  Works collaboratively with existing community and home care services  Clinical Care, Education and Research  Coordinates Statewide Service for MND

SA Health

SA Health

SA Health

The Australian Government's National Palliative Care Program

SA Health

Aims

 Improve access to and quality of palliative care  The program offers support in four broad areas:

• support for patients, families and carers in

the community;

• increased access to palliative care

medicines in the community;

• education, training and support for the

workforce;

• research and quality improvement for

palliative care services.

SA Health

Specific Programs

 National Standards Assessment Programme (NSAP)  Knowledge Network (Caresearch)  Programme of Experience in a Palliative Approach (PEPA)  Palliative Care Clinical Outcomes Collaborative (PCOC)  Palliative Care Clinical Studies Collaborative (PaCCSC)  Palliative Care Curriculum for Undergraduates (PCC4U)

National Standards Assessment Program

Improving quality in palliative care

National Standards Assessment Program

Improving quality in palliative care

Who is involved?

• Over 90% of Australian Specialist Palliative Care Services are

currently participating in NSAP (including 100% of paediatric services)

• 20 Peer Mentors (experienced palliative care practitioners

trained in quality improvement)

• NSAP support team of 5 people based in Canberra and Sydney

NSAP Overview

What is NSAP?

• Quality improvement program
• Funding by the Australian Government and administered by

Palliative Care Australia

• Aiming to support Australian Specialist Palliative Care Services

to develop and implement a quality improvement program based on a reflection against the National Palliative Care Standards

• Free to participate
• Underpinned by the reflective practice, PDSA and collaborative

improvement methodology

What are the outcomes of the program

• Services are provided a framework to bring the National Palliative Care Standards ‘to life’
• Services receive reports of their self assessment and NSAP cycle results
• Services receive support and training from quality improvement and palliative care experts
• National and Jurisdictional system-level quality improvement opportunities are identified

from aggregated results

National Standards Assessment Program

Improving quality in palliative care

National Standards Assessment Program

Improving quality in palliative care

The outcome

Changes to improving quality in palliative care

The process

Identify

Key Improvement Areas

Develop

Quality Improvement Action Plan

Complete

Self Assessment Snapshot

How the NSAP process creates change?

NSAP is 2 year cycle with 3 phases:

• 1. Sign up to participate
• 2. Self Assess against the National Palliative

Care Standards and prioritise a key improvement area from the standards review

• 3. Plan and implement your Continuous

Quality Improvement Program

• Develop and implement a quality

improvement action plan

• Receive a peer mentor visit

(optional) to support the quality improvement activities

SA Health

Knowledge Network

www.caresearch.com.au

Delivering culturally responsive palliative care

Janine Brett PEPA Project Officer

Session Overview

• What is the Program of Experience in the Palliative

Approach (PEPA)?

• The PEPA aims
• PEPA activities
• PEPA website
• Evaluation

What is PEPA?

• Provides an opportunity for health

professionals to improve knowledge, skills and confidence in working with people with palliative care needs and their families

• PEPA offers workforce placements

in specialist palliative care services

• PEPA offers tailored workshops in

the palliative approach

PEPA aims

• To further improve the skill and confidence of generalist

workforce working with people with palliative care needs

• To provide opportunities to ensure palliative care

providers are aware of and provide appropriate palliative and end of life care and support

PEPA Activities

• Placements

– Supervised clinical placements in specialist services – Reverse placements

• Workshops

– Palliative Approach – Palliative Approach in an Aged Care setting – Community Outreach Program for Aboriginal and Torres Strait Islander communities – Culture and Diversity

Who can apply

• Placements are available for:

– Aboriginal Health Workers – Medical Practitioners – Nurses – Allied Health Professionals – Aged Care Workers – Community Care Workers – Health Professionals servicing culturally and linguistically diverse (CALD) populations

Placements

• Placements available in

– Community – Hospital – Hospice

• Reverse PEPA placement

– Palliative professional attends workplace to provide education

• Up to four days depending on health

profession and availability

• Integration of learning into practice
• Post placement support
• Linkages and knowledge sharing

with specialist palliative care providers

.

Flexibility and Assistance

• Contribution towards backfill and assistance with

travel and accommodation

• Placements individually or groups
• Assistance through Learning Guides given to

participants

PEPA website

www.pepaeducation.com

• Information of upcoming workshops
• Newsletters
• Spotlights on host sites
• Participant testimonials and

reflection

• Online learning modules for GPs,

Aboriginal Health Workers, Nurses and Mentors

• Guidelines for PEPA facilitators and

mentors

• Evaluation tools (placement and

workshops coming)

• Contact details for PEPA managers

Evaluation

• Evaluation of workshops

assists with improvements of the project

• Thank you for completing

pre-survey

• Important: match unique

identifier

• Please complete post-survey

at end of workshop

Funded by the Australian Government through the National Palliative Care Program

Program of Experience in the Palliative Approach Workshop Pre-workshop Questionnaire

n Nursing Assistant n

n

n

n

n

n Counselor n

n

n Aboriginal and Torres Strait

n

n

n

n

n

n

n

n

n

n

Palliative Care Outcomes Collaboration PCOC

Funded under the National Palliative Care Program and is supported by the Australian Government Department of Health

What is PCOC?

 Voluntary program for specialist palliative care services  Provides an evidence based, multi-dimensional, quality improvement initiative  Supports continuous improvement through routine clinical

• utcome measurements, periodic surveys and

benchmarking  Contributes to the international evidence on how to measure palliative care quality and outcomes

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Standardising Palliative Care Assessment

PCOC is a national approach towards the routine assessment in palliative care practice using standardised assessment tools.

Assessment Tools

Phase (Eagar et al, 2004¹) RUG-ADL AKPS PCPSS SAS

(Fries et al, 1994) (Abernethy et al, 2005) (Eagar et al, 2004²) (Kristjanson et al, 1999)

Benefits of Standard Assessments

Consistent, formal approach to documentation of assessments A common language is established Assessments drive the focus of care

Benefits of Standard Assessments

Benchmarking Resource Requirements Needs based care

Conclusions

• Outcomes in palliative care are not resource dependent
• Palliative care services in Australia are providing better care

than 5 years ago and outcomes have improved overall

• There is marked variation across the sector, further research

is required to understand the reasons for this

• Collaboration between patients, clinicians, services,

researchers and the palliative care sector has resulted in this unique, internationally renowned palliative care data collection and outcomes program

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Achieving improved quality of care for patients through access, awareness and quality use of palliative care medicines through clinical studies.

For further information: Linda Devilee National Manager p (08) 8275 1926 e paccsc@flinders.edu.au

Flinders University receives funding for PaCCSC from the Australian Government Department of Health and Ageing under the National Palliative Care Program.

Challenge to providing medicines for palliative care

 The medicine is not registered for supply in Australia

PaCCSC studies

 The medicine is registered but not PBS listed

new section of the PBS (February 2004)

 The specific dosage, indication or formulation for use

in palliative care patients are not covered by the TGA

• r PBAC mostly covered in the new section
• f the PBS

 The discontinuation of older or low usage medicines

by manufacturers negotiation with sponsors

Palliative Care Medicines Working Group (PCMWG)

Primary aims were to:

 Improve access for palliative care medicines

• n the PBS in the community

 Raise awareness within the primary care

workforce of existing palliative care medicines already listed on the PBS

 Promote the quality use of palliative care

medications to health professionals and the broader community

Off patent medications

 There are no industry incentives to update

clinical practice or registration when medications go off-patent

 Generic competition enters the market – no

longer one manufacturer with a vested interest to register medications for other indications

PaCCSC studies to date – double- blind, multi-site, randomised, controlled trials

 Ketamine (complex pain) - results impacting:

– Therapeutic Guidelines – Palliative care – ANZSPM member survey – Cochrane Collaboration – Pain

 Octreotide (bowel obstruction)  Risperidone / haloperidol (delirium), megestrol /

dexamthasone (anorexia), morphine/oxycodone (dyspnoea), sertraline (dyspnoea)

 Phase IV – pharmacovigilance medication studies

continue to build evidence

Ketamine study

 Adequately powered, double blind, RCT result

negative: ketamine does not have net clinical benefit

• ver placebo when used this way in people already

heavily pre-treated for cancer pain.

 Net toxicity that was significant  Wide dissemination of results

– Published in high impact, well respected journal – Agreement from Therapeutic Guidelines to review for 2013 version – Agreement from Cochrane Collaboration to undertake early review – Raised awareness & has created an environment for

• ngoing debate and discussion

Collateral Benefits Beyond Palliative Care

 Application of findings to other clinical settings  Informing PBAC processes (caregiver impact statements;

McConigley et al)

 Scope and governance of PaCCSC beyond palliative care  Large number of clinicians from a wide range of areas are

now involved, building clinical research capacity within the sector

 Large number of clinicians refining their critical appraisal

skills

 Improved clinical care in participating sites (Lobb et al)

……. in accordance with the National Palliative Care Program’s objective to fund initiatives related to palliative care education, training and support for the workforce

PCC4U

Aims to increase the inclusion of palliative care principles in all heath care education , to improve the skill and confidence of the generalist workforce to work with people with palliative care needs.

www.pcc4u.org

Graduate capabilities

1. Effective communication in the context of an individual’s responses to loss and grief, existential challenges, uncertainty and changing goals of care. 2. Appreciation of and respect for the diverse human and clinical responses of each individual through their illness trajectory. 3. Understanding of principles for assessment and management of clinical and supportive care needs. 4. The capacity for reflection and self evaluation of one’s professional and personal experiences and their curriculum and their cumulative impact on the self and others.

Evidence based curriculum resources

Outcomes

At December 2013 – all pre-registration health professional courses nationally Of 197 courses identified: 86 (44%) actively implementing palliative care initiatives/content 68 (34%) in process of reviewing and increasing palliative care content Since 2008: 19 courses supported financially to implement curriculum initiatives development of curriculum exemplars in palliative care Capacity building workshops – academics and clinicians to support quality teaching in palliative care education Expanded suite of resources - students, academics and clinicians