We commonly encounter patients continuing disease preventative and control medicines at a time of commencing medicines to minimise suffering from common EOL symptoms. The increasing number of medications commonly leads to polypharmacy which has been associated with adverse outcomes (e.g early mortality, falls, adverse drug reactions (ADRs)). Risk of harm increases with increasing number of medications, avoiding harm is critical as any deterioration may lead to some degree of irreversible decline given the frailty of this population. While in some instances polypharmacy may be appropriate, it’s important to identify patients at heightened risk of poor health outcomes.

Medication-Related-Problems (MRPs) has been defined as ‘an event of circumstance involving drug treatment that actually or potentially interferes with the patient experiencing an optimum outcome of medical care’. Other terms include drug-related problem, medication error, ADR and adherence.

Previous studies have examined MRPs occurring in hospital, a gap remains investigating the home experience where the majority of care is delivered. Lack of understanding the patient and carer experience limits health services ability to assess risk, formulate effective and efficient approaches to resolving MRPs.

Aim

Investigate the prevalence and nature of MRPs for palliative people living in their home

Method

Experienced pharmacists embedded within a metro specialist palliative service undertook comprehensive-medication-reviews for patients meeting the inclusion criteria. A validated Australian tool was applied to identify, classify and grade clinical significance of MRPs and recommendations made to GP and/or specialist team.

Findings

Sixty-two patients were included (metro/rural), most frequently in unstable-phase with AKPS 50. On average each patient experienced 5 MRPs with one patient experiencing 19 MRPs. Mean number of Potentially-Inappropriate-Medicines was 1.7.

Eighty-five percent experienced a moderate-high clinically significant MRP. ADRs where identified in 40% of patients, 57% meeting the definition of being preventable.

Overall 469 recommendations were made to GP and/or specialist service to resolve the MRP.

Conclusion

This study provides one of the first insights of the medication experience at home demonstrating MRPs are significantly impacting patient comfort and safety.

We can now begin formulating efficient solutions, which may include greater utilisation of allied health funded commonwealth programs such as Home Medicines Reviews. 

Palliative care (PC) nurses provide a pivotal role in the care of the patient and families with life limiting illnesses. 

Liverpool hospital is the major tertiary referral and teaching hospital for the South- Western Sydney Local Health District. Palliative Care services include a 20 bed inpatient unit, serviced by a multidisciplinary team consult service. A gap analysis was conducted on the PC ward and identified that unique nursing skills such as critical thinking, holistic assessments and the ability to have sensitive and difficult conversations with the dying patient and their families were lacking. 

To address this, a rotation of a Registered Nurse from the PC ward to the consult team every 6 months to fill an existing vacant position (0.6 FTE) was initiated. The aim of the rotation was to meet the PC nurse educational needs, improve clinical skills and critical thinking, and an opportunity to experience the consult service first hand. At the completion of the rotation, it would be expected that the PC nurse could integrate this advanced palliative care knowledge and skills into their clinical practice on return to the PC ward. Since April 2022, two staff have rotated through the palliative care consult service.

Post rotation feedback from the participating staff included reporting incorporating newly gained skills and experience into clinical practice in the PC ward, improved confidence in physical assessment skills and overall performance as a PC clinician.

The rotation of the Registered nurses from the PC ward to the consult team has seen improved performance in documentation, their confidence in assessments and knowledge when interacting with other health professionals and communication with their patients and families. This rotation has become instrumental in succession planning for the future. 

Background: 

Specialist Palliative Care has traditionally focused on a medical model of care with nurses providing support for patients in the community. There is an identified shortage of Medical Specialists particularly in rural areas and this will present many challenges in the future. The role of the Nurse practitioner is not new but underutilised across most health care settings and is often poorly understood. This presentation will focus on highlighting the NP role as a solution for providing a high standard of patient care utilising a nurse led model of care. 

Aim: 

The role of the nurse practitioner is now well established more so in the most rural part of the district. The position supports GPs, nursing staff and patients in the delivery of specialist care. Feedback anecdotally has been positive with formal evaluation to occur. Staff report feeling supported and have a clear and simple escalation pathway. The GPs work collaboratively in providing patient care both in community and inpatient settings.  Most importantly patients and families are well supported in their choice of place of care.

Methods:

In 2020 the service was fragmented and differences in care delivery were apparent across the LHD. The use of redesign methodology with gap analysis and staff engagement was driven by the need for change to improve care delivery. The solution phase developed an innovative and progressive nurse led model of care as a way to provide sustainable care delivery into the future. This meant the role of the NP is now recognised and well established with a second NP position last year.

Conclusion:

The future delivery of specialist palliative care delivery is concerning. An ageing population with increased care needs will present challenges in the future. The Nurse Practitioner role is well suited to community palliative care and will provide and innovative approach to care improving patient and family experience.

Background:

Palliative Care Australia (PCA) and Paediatric Palliative Care Australia and New Zealand (PaPCANZ) have been funded for the Paediatric Palliative Care National Action Plan Project.  

One activity in the project is to update the critical resource for Paediatric Palliative Care Providers – ‘A practical guide to palliative care in Paediatrics’ also known as “the Green Book. 

This book was first developed in 1999, followed by three revisions with the last revision in 2014.

The target audience for the Green Book is health professionals from all sectors who care for an infant, child or young person with a life limiting condition.

Aim:

The aim of the update was to incorporate new content and refresh a number of sections to reflect the latest evidence and best practice.

Methods: 

A Clinical Expert Advisory Group (CEAP) was established to provide clinical advice, oversight and coordination of the update. The CEAP met regularly to progress the update and PCA provided secretariat and project management support.

A survey was distributed to health professionals to understand how often the Green Book was used, the preferred format and what information was most useful and required updating. 

Authors of previous versions invited to participate in the latest update and additional authors were approached for their expertise.

Results:

A total of 57 authors have participated in the update including peer reviewers. All sections of the Green Book have been updated and informed by literature reviews, First Nations voices and other social[NO(4] changes in Australia. More detail has been included in some sections and a new section has been added on community development. 

Conclusions: 

The passion and commitment of the CEAP and authors who contributed to the Green Book update cannot be underestimated. The final product which will be available in June 2023 will continue to provide a readily accessible and reliable source of information for health professionals.

Tragically, some people with severe and enduring (SE) eating disorders (EDs) e.g. (terminal) anorexia nervosa (AN), may experience traumatic deaths due to a lack of recognition of their need for palliative care, or their specific needs within a palliative care context (Gaudiani et al 2022). 

 

There has been increasing debate as to whether people experiencing life-limiting complications from SE-EDs should have equitable human rights to receive palliative care. Furthermore, there is a need to upskill the health and mental health workforce to, a) provide quality palliative care and b) best support individuals with life-limiting/terminal EDs and their loved one/s. Evidence from multi-disciplinary teams and lived experiences showed that those receiving palliative care for life-limiting EDs experienced an improved quality of life and momentous relief no longer requiring frequent and sometimes traumatic life-saving interventions.

Aims:

- Share a lived experience perspective on the paradox of quality of life versus recovery with a severe and enduring ED.

- Discuss how taking a system approach will look for treating palliative care in eating disorders.

- Identify opportunities to upskill treating teams to provide compassionate, trauma-informed care for people with life-limiting/terminal EDs.

- Highlight the need for ethical decision-making on a case-by-case basis when determining if palliative care is/is not an appropriate pathway of care e.g., age, symptoms, history, and access to evidence base treatment. 

- Recommendations for discussing options of care with the individual and their loved one/s.

Conclusion:

Recognizing the complexity and burden of this ethical dilemma, a palliative care discussion paper has been co-designed to synthesize clinical, research and lived experience perspectives, to support community and health professionals understand what palliative care and end-of-life support means for people with life-limiting EDs. The paper will form the foundation for developing Palliative Care Guidelines for life-limiting/terminal EDs. 

Introduction: Nurse practitioners (NP's) are highly skilled and experienced registered nurses who are required to have  three years full-time experience at the clinical advanced nursing practice level within the past six years, hold masters  level qualifications and endorsement with the Nursing and Midwifery Board of Australia. There is inadequate awareness and understanding of NP roles by the general public, other health professionals and employers. This can act as a barrier through inaccurate perceptions about NPs’ scope of practice. In order to function effectively NP's must be able to prescribe all essential palliative care medicines, including Schedule 8 opioids medicines. A  palliative care NP role has been established at a cancer centre in Melbourne Victoria for more than 10 years. The position was developed with the aim of improving service capacity, equity of access for patients and support for family members and other Health Care Providers (HCP).

 

Aims: 

Outline the framework that supports palliative care nurse prescribing.

Provide a snapshot of the prescribing practices of a palliative care nurse practitioner working in an outpatient setting in a comprehensive centre.

 

Description/ Methodology:  

A retrospective audit of the prescribing activity arising from NP consultations for the period January 2022 to June 2022.

 

Results: During this 6 month period,  742 medications were prescribed over 580 consultations. 482 medications were opioids.  The NP operates from a diverse formulary but only prescribed within their field of expertise and scope of practice. There have been zero incidents or adverse events reported from NP prescribing at our centre.

Conclusions: This audit demonstrates that NPs practising within their specialist expertise can prescribe medicines safely and effectively. We would recommend that other services consider the development of NP positions as part of their multidisciplinary team.

Eldercare is a not for profit residential aged care provider operating in South Australia with 1200 beds across 13 sites. Eldercare undertook a project named Hospice in the RACF in 2022/23. This project was funded through the South Australian and Commonwealth Governments under the Comprehensive Palliative Care in Aged Care Project.
As part of this project Eldercare ran a palliative care traineeship program for certificate 3 personal care workers in partnership with an RTO. The palliative care traineeship program is an innovative model of training future palliative care workers and is linked to Eldercare's unique model of aged care. 
Learnings from this program showed that successful implementation of a specialist traineeship program is complex, requiring strong collaboration and coordination between various organisations  including external training organisations, government and general practitioners as well as different aged care homes and individuals within the organisation. 
Experience from the Eldercare program showed that the right expectations of the trainees should be set from the early stage of advertising the program through to recruitment, induction, training and mentoring.  The program also revealed that supervision/mentoring is the core component of such a model.  
Investment in the selection and training of mentors and a formal structure in place to support mentors, individual and group mentoring, debriefing sessions and feedback process is critical to the success of this type of training program.  Without proper training and support system, it is not realistic to expect additional an mentoring role from already busy aged care staff which, in turn, negatively impact on trainees’ experience. 
The presentation will give an overview of the learnings from the traineeship program from Eldercare's perspective, from the formal evaluation undertaken by Flinders University and from a few trainees themselves through very short films in which they describe their experiences.