The interRAI Palliative Care Assessment An innovative project - - PowerPoint PPT Presentation

An innovative project – where are we now? The interRAI Palliative Care Assessment

Karyn Foley, interRAI Educator Karen Goymour, interRAI Educator

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What is interRAI

International Resident Assessment Instrument Best practice approach to assessing people’s needs Comprehensive clinical assessment tools Standardised and designed for specific groups Common language, common measures, common concepts www.interRAI.co.nz

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CLINICAL TIME AND RESOURCES Practice Nurse NASC Occupational Therapist Physio therapist Provider Nurse District Nurse Social Worker

Palliative Care Community Nurse

ARC Nurse

MULTIPLE ASSESSMENTS, ACROSS DIFFERENT ORGANISATIONS = STORY POTENTIALLY RETOLD MANY TIMES

Hospice Nurse

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How it works

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Same assessment across New Zealand Assessments follow the person

10% of over 65s in New Zealand

Information publically available Evidence based decisions

interRAI Palliative Care Pilot

December 2015-December 2016

To test the use of the interRAI Palliative Care (PC and Hospice) assessments for:

• people with a prognosis of less than a year to live
• who are living in the community
• who would otherwise have been assessed with an interRAI Home

Care assessment to identify their support needs.

Prerequisites and competencies

Homecare trained Level one ACP or DHB equivalent training 2-hour training programme Clinical assessment reviewed by Educator Palliative Care on- line evaluation Competency interview

Assessments completed

So far:

• 142 assessors either trained or

about to be trained in New Zealand

• 979 Assessments completed

Assessors’ goal: Wellness for all

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Improving symptoms Addressing mental and physical health problems Assisting in coming to terms with death Enhancing comfort Improving quality of life

Useful language – talk about:

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Limited treatment

• ptions

Focus on quality of life Focus on symptom management/ treating symptoms

Supportive care

Living well for now

Focus is not curative/not rehabilitative

Comfort care

As you near the end of this journey…… Age related concerns

“Data! Data! Data!” he cried impatiently. “I can’t make bricks without clay.”

Sir Arthur Conan Doyle: Sherlock Holmes

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Assessors complete their assessments in:

Community: 73% Hospice: 18% Hospital: 9%

PC assessed population demographics – age

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2% 7% 15% 33% 34% 9% 0% 5% 10% 15% 20% 25% 30% 35% 40% <50 50-59 60-69 70-79 80-89 90+ Percentage of Assessments Age groups

PC assessed population demographics – ethnicity

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1% 9% 89% 1% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Asian Maori European/Other Pacific Peoples Percentage of Assessments Ethnicity

PC assessed population – estimated survival

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0% 12% 47% 40% 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% Death imminent (within days) Less than 6 weeks Between 6 weeks and 6 months 6 months or longer Percentage of Assessments Estimated survival time

PC assessed population: when pain is present

28% 13% 4% 55% 0% 10% 20% 30% 40% 50% 60%

• 0. No pain
• 1. With movement
• 2. At rest
• 3. Both

PC assessed population

PC assessed population: problem frequency

39% 56% 13% 27% 26%

0% 25% 50% 75% 100% C6g Nausea C6l Dry mouth C6m Excessive sweating Cachexia/wasting Reports persistent thirst Percentage of Assessments Problem frequency

Top areas for interventions – Clinical Assessment Protocols (CAPs)

30% 22% 23% 11% 52% 11% 8% 15% 14% 62% 30% 19% 30% 18% 15% 3% 0% 25% 50% 75% 100%

PC Fatigue PC Nutrition PC Mood PC Pain PC Dyspnoea PC Sleep Communication Delirium PC PressureUlcer

Percentage of Assessments CAPs Trigger level 1 Trigger level 2

Psychosocial well-being

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70% 75% 0% 25% 50% 75% 100% I1a Completion of responsibilities I1c Accepting of situation Percentage of Assessments Life completion

Self-reported spirituality

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36% 56% 11% 32% 5% 54% 33% 39% 35% I2A GUIDANCE IN RELIGION I2B STRUGGLING WITH MEANING OF LIFE I2D AT PEACE WITH LIFE PERCENTAGE OF ASSESSMENTS SELF-REPORTED SPIRITUALITY

• 0. No
• 1. Yes
• 8. Person could not (would not) respond

Legal responsibilities

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62% 14% 0% 25% 50% 75% 100% N1a EPOA N2a Advance Care Plan Percentage of Assessments EPOA/ACP

Person’s wish

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28% 56% 31% 10% 40% 33% 0% 25% 50% 75% 100% N3a Wishes to die at home N3c Wants to die now Percentage of Assessments Wishes regarding where to die

• 0. No
• 1. Yes
• 8. Unable to determine

Social supports – time with person

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2% 7% 31% 60% 0% 25% 50% 75% 100%

• 0. No contact
• 1. Less than 1 hour
• 2. 1-4 hours
• 3. More than 4 hours

Percentage of Assessments Time with person

Social supports – family carer status

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92% 28% 50% 0% 25% 50% 75% 100% O4a Strengths - Strong and supportive relationship with family O4c Primary informal helper expresses feelings of distress, anger, or depression O4d Unsettled relationships - Family or close friends report feeling overwhelmed by person’s support needs Percentage of Assessments Social supports

Depression Rating Scale (0-14)

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0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Depression Rating Scales 60% 50% 40% 30% 20% 10% 0%

Pressure Ulcer Risk (0-8)

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0 1 2 3 4 5 6 7 8 Pressure Ulcer Risk 30% 25% 20% 15% 10% 5% 0%

Pain Scale (0-4)

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35% 30% 25% 20% 15% 10% 5% 0% 0 1 2 3 4 Pain Scale

www.interrai.co.nz