Ms Clare Warren1,2,3,4,5
1Silverchain, Western Sydney, Australia, 2Member of Palliative Care NSW, Australia, 3Member of Palliative Care Nurses Association, Australia, 4Member of Royal Australian College of Nursing, Australia, 5Member of LGBTIQ+ Health Australia, Australia
Biography:
Clare Warren is a Registered Nurse with a 37-year experience of working in palliative care in inpatient and community settings in Sydney and in Regional NSW. Positions held include Registered Nurse, Nursing Unit Manager, Clinical Nurse Consultant, Nurse Manager and most recently, Quality, Safety and Risk Officer.
Abstract:
Background: Data supplied by the Palliative Care Outcomes Collaboration (PCOC) in 2023 indicated 36% of our patients who had died at home in 2022 were not phased Terminal.
Recognition of the terminal phase triggers specific conversations with patients, families and carers. These may include explaining death is imminent, addressing concerns and plans for end-of-life care.
Aims: To reduce the incidence of people dying outside the terminal phase in Western Sydney Community Palliative Care Service to 15% by 2025 and to less than 10% by 2026.
Methods:
The PCOC terminal phase audit provided a retrospective analysis of the end-of-life care provided in 2022.
Staff were surveyed to seek their feedback on death outside the terminal phase.
Consumer feedback was considered through a review of documented client feedback from 2022.
Interventions were commenced through PDSA cycles – education, new electronic care record, continuity of care project.
Results:
The PCOC terminal phase audit demonstrated staff were consistent in phasing patient’s terminal once they were moribund.
The staff survey identified that a lack of knowledge and experience and fear of getting it wrong contributed to not phasing patient’s terminal.
Review of consumer feedback didn’t identify any specific issues.
The results of the first PDSA cycle covering education on PCOC phases, resulted in reduced deaths outside the terminal phase.
Conclusions: Recognising that education alone is a weak improvement intervention “often necessary but rarely sufficient” (Soong & Shojania, 2020) other interventions were also required. These include a redesign of the Electronic Care Record to promote ease and consistency of recording PCOC assessments, rolling out the PCOC assessments to all clinicians (previously only attended by nursing) and a quality improvement project promoting continuity of care which includes buddying and mentoring with more experienced clinicians.