Academic journal article Australian Health Review

A Residential Aged Care End-of-Life Care Pathway (RAC EoLCP) for Australian Aged Care Facilities

Academic journal article Australian Health Review

A Residential Aged Care End-of-Life Care Pathway (RAC EoLCP) for Australian Aged Care Facilities

Article excerpt

Introduction

There is agreement across policymakers, peak relevant professionals in palliative care and aged care, consumers and carers that residents of residential aged care facilities (RACFs) should be able to age and, if possible, to die 'in place' in their RACF.1,2 In Australia, 7% of people aged over 65 years live in RACFs and in 2006 the proportion of separations from RACFs due to death was 86.8% with 25% of those residents having had a length of stay of less than 26 weeks.3 RACFs are the hospices of today and likely to remain so into the future; nonetheless there is professional consensus that people in RACFs frequently receive less than optimal palliative care.4 Management and staff of Australian facilities need to be supported to provide high quality end-of-life care for this growing and vulnerable population. Failure to do so can result in poor resident outcomes as well as poor health system outcomes if dying residents are inappropriately transferred to emergency departments.

There is increasing support for the use of integrated care pathways to implement and monitor standardised best practice of various medical conditions or sets of symptoms.5 The Liverpool Care Pathway (LCP) for the Dying Patient is a palliative care pathway designed in the UK to enable all healthcare workers to provide optimal end-of-life care to dying patients in their last hours or days of life by guiding clinical decision making. The LCP is evidence-based and provides guidance around key aspects of care including symptom control, comfort measures, anticipatory prescribing of medications, discontinuation of inappropriate interventions, psychological and spiritual care and care of the family (both before and after death of the patient). It is structured to facilitate audits of documented processes rather than evaluating outcomes of care.6,7 The LCP has been adapted to suit most local healthcare environments, including many in Australia where evaluation of effect has been limited to documentation audits.8

The aim of this project was to develop an end-of-life (terminal) care pathway suited for use within Australian RACFs, to implement it within a framework of care across demonstration sites and to evaluate it using various outcome measures.

Methods

The pathway and associated infrastructure

A working group was established to produce the residential aged care end-of-life care pathway (RAC EoLCP). The group was a multidisciplinary collaboration of professionals from government and non-government bodies including Aged Care Queensland, the Royal Australian College of General Practitioners (RACGP), Divisions of General Practice, Metro South Palliative Care Services (Queensland Health), Blue Care Queensland, as well as clinical representatives from RACFs.

Development of the pathway was an iterative process requiring numerous drafts to achieve a user-friendly final document. The document needed to provide a comprehensive template of care that could empower generalist workers to deliver consistent and appropriate palliative care and which complied with jurisdictional and workplace constraints.

Particular developmental requirements of the pathway were:

* Inclusion of evidence and consensus-based best clinical management and care coordination for dying residents as defined by the core values of palliative care expressed by Palliative Care Australia (PCA).9

* Relevance of content in the context of Australian RACFs and, specifically, the need for content to be simple to understand and follow.

* Avoidance of the need for clinicians to duplicate the documentation of clinical information in multiple records.

* Compliance with Australian Council of Health Care Standards (ACHS) and Aged Care Standards accreditation requirements.

* Fulfilment of Health Insurance Commission (HIC) requirements to enable General Practitioners (GPs) or other medical officers to claim Medicare items, if appropriate. …

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