Ms Larissa McIntyre1, Ms Bronwyn Arthur2, Ms Kaitlyn Thorne2, Ms Laura Byrce2
1Catholic Healthcare, Macquarie Park, Australia, 2University of Wollongong – PACOP, Wollongong, Australia
Biography:
Larissa (Lara) has been a RN for 36 years and has worked across multiple sectors in clinical, research and management roles with the last 22 years in aged care.
Lara is a NP-Palliative Care Aged Care and is the Senior Palliative Care Lead for a large not–for-profit aged care organisation, NSW.
Lara has a passion for palliative care and advance care planning, sitting on multiple groups working towards better palliative care outcomes, especially for older people.
Lara is an active member of her local SLS Club and enjoys spending time with her family including their three dogs and cat.
Abstract:
Background:
Residential Care (RC) in Australia is changing rapidly, with 37% of people dying in RC annually (n=65,000), with the median length of stay 22 months. Stringent governance and compliance processes in RC includes review of the quality and clinical care including palliative care. Nurse-Led Palliative Care Rounds are considered the ‘Gold Standard’ in supporting palliative care in RC. However, there is limited availability of experienced palliative care teams to facilitate them.
Aim:
To implement a data-assessment driven Nurse-Led Round (NLR) model in RC, identifying people transitioning towards the last 12-months of life thereby reducing ‘unexpected resident deaths’, improving palliative care planning and end-of-life care.
Method:
The Resident-of-Concern tool (RoC) uses data collected by RC for the mandatory National Quality Indicators Program, the mandatory Risk-Register, and the ‘STOP & WATCH’ program. When integrated with the Palliative Aged Care Outcomes Program (PACOP) assessments, the data supports early identification of palliative care needs. A RoC NLR is completed weekly in dedicated time to review an older person, monitoring symptoms, changes in baseline function, performance, frailty, cognition, and spiritual and emotional well-being of them and their family. After-death audits evaluate the impact of the RoC NLR model.
Results:
Initial outcomes suggest improved early identification of palliative care needs prior to the commencement of terminal care, ensuring advance care planning is undertaken, that Family Conferences occur and there is timely General/Nurse Practitioner (GP/NP) management of symptoms. Benefits and barriers to implementation will also be discussed.
Conclusion:
The ROC NLR model supports RC teams in developing sustainable practices, facilitating early identification of the palliative care needs of older people. It provides the ability to communicate the changes of the older person to their family, GP/NP, to facilitate collaboration in care planning and goals-of-care, thereby improving death outcomes and the experiences of all involved.