Palliative care: a guide for facility leadership

What Outcome 5.7 requires

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  The Outcome. Providers must recognise and address each person’s needs, goals and preferences for palliative and end-of-life care, preserve their dignity, actively manage pain and symptoms with access to specialist palliative care when required, and inform and support families, including in the last days of life ³.

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  Action 5.7.1. Processes to recognise when a person needs palliative care or is approaching the end of life, to support them to prepare, and to respond to changing needs and preferences ³.

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  Action 5.7.2. Support for the person, family and substitute decision-maker to continue end-of-life planning conversations, discuss requesting or declining care and treatment, and review advance care planning documents ³.

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  Action 5.7.3. Palliative care that prioritises comfort and dignity, supports spiritual, cultural and psychosocial needs, manages pain and symptoms, gives timely access to specialist equipment and medicines, communicates the person’s preferred place of care, facilitates access to specialist palliative care, provides a suitable environment, and gives families information about dying, loss and bereavement ³.

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  Action 5.7.4. In the last days of life: recognising dying, anticipatory medicines available 24 hours a day, pressure, oral, eye, bowel and bladder care, recognising and responding to delirium, and minimising unnecessary transfer to hospital where in line with the person’s preferences ³.

Where the evidence points

Practical checks

These are the points most likely to fail on a Friday night, and the ones worth testing.

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  Anticipatory medicines. Is there a working route from prescription to supply to a nurse who can give medicines under the skin, at any hour? The 24-hour requirement is in Action 5.7.4 ³.

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  Advance care planning documents. Can night staff find the current document and the substitute decision-maker’s phone number in under a minute? Are documents reviewed when health changes, as Action 5.7.2 expects ³?

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  The state’s law. Do staff know which documents are legally binding in your state, and who the substitute decision-maker is under that state’s law? Queensland and New South Wales differ ^8,11.

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  Who coordinates. For each resident receiving palliative care, is it clear which clinician coordinates their care and how to reach them after hours?

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  Specialist palliative care. Is there an agreed route to specialist palliative care advice, and is it used before a crisis ^3,16?

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  Voluntary assisted dying. If the facility does not provide it, has it told the public, and do staff know the facility’s obligations to allow access to information and practitioners ⁴¹?

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  Bereavement and staff support. Do families receive information on dying and bereavement ³? Are staff told when a resident is dying and given a chance to debrief ³²?