Ms Jenny McKenzie1, Nicole Carson1
1Murrumbidgee Local Health District (MLHD), Wagga Wagga, Australia
Biography:
Jen McKenzie became a Nurse Practitioner in 2006. She is passionate about improving palliative care services in rural areas and driving an equitable approach to service delivery. Jen actively participates in education for all clinicians working in health and loves encouraging interest in working in the palliative care specialty.
Abstract:
Background: MLHD is a large geographical area in southern NSW covering regional to remote areas. Inequitable palliative care service delivery had evolved over the decades because of historical funding patterns and siloed, protective health care practices. Depending on geographical location, service delivery ranged from seven days a week with on call support to no cover. Variation of knowledge distribution and clinician skillsets meant higher level specialists were locked into limited sites.
Aim: To achieve equitable out of hours access and support to all palliative care patients and their carers registered to the MLHD palliative care service and to deliver services according to the patients assessed need, not their geographical location.
Method: A review of all community based clinical services, resulted in palliative care transitioning to a district wide clinical stream. A literature review, retrospective analysis of on call usage and death data was attended. Out of hours on call provision was rolled out in a staged approach across MLHD.
Results: MLHD now has a district wide Specialist Palliative Care nurse on call service to support registered palliative care patients and their carers. Preferred place of death is recorded routinely. Calls received and commensurate location of home death has been noted to be dispersed in a wider geographical pattern.
Conclusion: Under pinned by a risk stratification approach, all patients who require out of hours support have access to a specialist palliative care nurse on call. This change of practice has become a foundation for collaborative partnerships with NSW Ambulance and generalist service providers. This model of care has embedded quality initiatives such as development of Morbidity and Mortality Meeting, daily Interdisciplinary complex patient and handover meeting and standardised documentation and resources. Equitable delivery of palliative care services is possible in rural areas.