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Welcome to the August edition of End-of-Life Essentials news. This newsletter aims to keep you informed with what’s happening in the project and end-of-life care.
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What's New in the Project?
Have you had time to access all the online modules?
Perhaps you have completed one module, but you want to complete more. We know things can get busy. Remember you can easily register or return to the End-of-Life Essentials website to access all the learning modules at any time. All the resources, videos and quizzes are conveniently available on the website.
Have you ever wondered how you can strengthen your ability to recognise a patient in the last year of life, or even in the last weeks or days of life? Recognition of end-of-life is vital in terms of providing quality care.
In Module 3 you will learn more on the use of tools and triggers to recognise the end of life. You will also learn about telling the truth with kindness, understanding uncertainties of prognostication, and realising the opportunities of end-of-life conversations. You will also have access to evidence-based care plans, frameworks and prescribing guidelines for the last days of life.
Ms Kate Munro (End-of-Life Care Coordinator, Hunter New England Health District) shares a patient’s story about recognising end-of-life:
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All modules are free to access. Getting started or returning is easy! Go to our website at www.caresearch.com.au/EndofLifeEssentials and discover more resources and education. The next 3 modules will be available in October 2016.
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Sector News
For health care professionals wanting to know more about advanced cardiopulmonary resuscitation decision-making in the hospital setting, a teaching package is available. The Advance CPR decision-making in the hospital setting teaching package consists of a suite of videos and a Facilitator’s Guide. The teaching package aims to:
- Support clinicians and medical students to develop the knowledge, skills and confidence to initiate and engage in patient-centred conversations about CPR decision-making, particularly for those patients who have progressive deteriorating illness and are unlikely to do well with CPR;
- Ensure that patients are actively involved in determining their goals of care and preferences for appropriate intervention and treatment, in the event of their deterioration;
- Influence system-wide change in end-of-life decision-making and care; and
- Encourage reflection and critical thinking.
The teaching package is for use by clinicians to stimulate discussion and sharing of experiences. It is intended to be used flexibly, according to the audience’s experience, needs and time available.
Are you looking for more free training in end-of-life care? The Program of Experience in the Palliative Approach (PEPA) provides opportunities for the health, aged and community care workforce employed in non-specialist palliative care settings to improve their confidence and skills people when supporting people with palliative care needs. PEPA provides funded clinical workforce placements and a suite of workshops. PEPA also assists placement participants to integrate their learning into practice and to establish networks of support with specialist palliative care services. PEPA is funded by the Australian Government Department of Health and is coordinated nationally by a team located at the Queensland University of Technology (QUT) and managed locally by PEPA teams in each State and Territory.
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Latest Evidence
Each month we will feature a few articles that cover topics relevant to end-of-life care in hospitals:
- Mason E, Jenkins D, Williams M, Davies J. Unscheduled care admissions at end-of-life - what are the patient characteristics? Acute Med. 2016;15(2):68-72.
Unscheduled acute hospital admissions and subsequent deaths in hospitals of patients considered palliative are increasing, despite many patients' preference to die at home. A large proportion of these patients are admitted via acute medical units or emergency departments. The integration of primary and secondary care within Wales should enhance the delivery of end-of-life care at home but unscheduled admission for patients with palliative care needs remains prevalent. The aim of our study was to explore the characteristics amongst patients who die shortly after unscheduled hospital admission. A retrospective, observational study was conducted in all unscheduled admissions at end-of-life at a single health board in South Wales, UK over a period of one month. The result showed that 47% of patients who died within 48hrs of unscheduled admission are considered to be palliative. The majority of these patients were admitted via 999 ambulances and out of normal working hours (65%). They were elderly (median age 80) and had a poor performance status (78%). Over 1/3 (39%) were admitted from a nursing or residential home. Less than a quarter (22%) had an advance care plan in place.
- Wilkinson E, Randhawa G, Brown E, Da Silva Gane M, Stoves J, Warwick G, et al. Exploring access to end of life care for ethnic minorities with end stage kidney disease through recruitment in action research. BMC Palliat Care. 2016 Jul 11;15(1):57. doi: 10.1186/s12904-016-0128-1.
This article reports on research undertaken in the UK on the variation in provision of end of life care in kidney services and practitioner concerns to provide equitable access led to the development of this study which focussed on the perspectives of South Asian patients and their care providers. As people with a South Asian background experience a higher risk of Type 2 Diabetes (T2DM) and end stage kidney failure (ESKF) compared to the majority population but wait longer for a transplant, there is a need for end of life care to be accessible for this group of patients. Furthermore because non English speakers and people at end of life are often excluded from research there is a dearth of research evidence with which to inform service improvement. This paper aims to explore issues relating to the process of recruitment of patients for a research project which contribute to our understanding of access to end of life care for ethnic minority patients in the kidney setting.
- Liu D, Weil J, Boughey M, Sutherland T. A tertiary hospital audit of the use of medical imaging in the 24 h preceding death. Intern Med J. 2016 Feb;46(2):220-2.
This Australian study, examines the use of medical imaging in the 24 h preceding death. Medical imaging is a key component of modern medical care and progressive improvements in image quality and availability have led to a dramatic increase in imaging utilisation. However, imaging, and specifically the processes involved in procuring the images, necessarily imposes a degree of discomfort, inconvenience and morbidity for patients, especially those who are critically ill. As with all medical interventions, the risks and benefits of imaging must be considered for all patients. Data were obtained from retrospective analysis of deceased patients from a university affiliated tertiary hospital over a 2-year period and it was found that around one in five inpatients received medical imaging in the last 24 hrs of their life (364 of 1855, 19.6%).
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For Your Notice Board
Each month we will feature a fact sheet, a poster or other resource that you can print and share on you notice board or in your tea room.
This month we highlight a poster from the Irish Hospice Foundation, Am I dying? Responding to difficult questions (476kb pdf), for your service.
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Next Newsletter
September 2016
The End-of-Life Essentials News is distributed on the first Wednesday of each month. You are also welcome to forward the newsletter to others who may be interested or follow this link to subscribe to the newsletter. To share something, please email eolessentials@flinders.edu.au
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End-of-Life Essentials is based on the Australian Commission on Safety and Quality in Health Care’s National Consensus Statement: Essential elements for safe and high-quality end-of-life care, and the Commission provides ongoing advice to the project.
End-of-Life Essentials is funded by the Australian Government Department of Health
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