life & death matters From the Chair Inside this issue:

Transcription

1 Newsletter No.28, Spring 2015, life & death matters Inside this issue: From the Chair 1-2 GRPCC Team 2-3 Clinical Practice Group Communication Skills Program La Trobe University Palliative Care Unit Research Project Quality Initiatives 5 The Dreamers and Talking about it 5 Nurse Practitioner Mentor Advance care planning education: supporting rural and regional General Practitioners A Palliative Approach in the Aged Care and Disability environments On the Couch with Carol Barbeler GRPCC staff and contact details From the Chair As we come to the end of the Strengthening Palliative Care: Policy and Strategic Directions , I would like to take this opportunity to reflect on the work of the GRPCC over the past five years. In 2012, the GRPCC undertook some new projects and I m pleased to report that there have been a significant number of achievements since that time, which has facilitated the delivery of palliative care services across Gippsland. A brief summary of our achievements are listed below: Strategic Direction 1: Information for clients and carers - Developed and maintained a new userfriendly website; - Produced and distributed 24 palliative care e-newsletters; - Produced and distributed nine Life and Death Matters newsletters; - Produced four annual reports; and Developed and distributed two brochures on palliative care in Gippsland. Strategic Direction 2: Caring for Carers -Developed a number of evidence-based tools to assist in providing after-hours palliative care; -Trained 137 nurses in telephone triage; - Hosted a regional conference on Caring for Carers; and - Mapped and published respite options for clients and carers in Gippsland. Strategic Direction 3: Working together to ensure people die in their place of choice - Trained 216 aged care link nurses across Gippsland; - Significantly improved the number of residential aged care facilities (RACFs) providing advance care planning, end of life care pathways, palliative care education and the number of referrals to palliative care; - Trained 81 personal care assistants (PCAs) in the palliative approach; - Established Resident and Relative Resource Libraries in every RACF in Gippsland; - Trained 139 nurses Vicki Farthing, Chair, GRPCC. and 99 PCAs in the Palliative Approach to End of Life Care; - Trained 70 nurses and 50 PCAs in the Palliative Approach to Advanced Dementia; - Trained 70 nurses and 15 PCAs in Pain Management in Older People in the Palliative Care Environment; and Engaged with Disability Supported Accommodation Services to improve the palliative approach for their clients. Strategic Direction 4: Providing specialist palliative care when and where it is needed - Since January 2013, 1,770 cases have been discussed at a multidisciplinary team meeting attended by a palliative medicine consultant; Since January 2013, 175 clients have had a primary consultation with a palliative medicine consultant; - There are now two palliative care nurse practitioners (NP) and two NP candidates working in the region; and - A palliative care social worker and bereavement support counsellor has been providing support and primary consultations for clients in South Gippsland and Bass Coast. Strategic Direction 5: Coordinating care across settings - Developed an evidence-based Model of Community Palliative Care; (Continued on page 2)

2 Newsletter No.28, Spring 2015 life & death matters Page 2 From the Chair (Continued from page 1) - Improved the interface between the acute and community settings, and RACFs by supporting the NP and NPCs to provide in-reach services; - Established links with Aged Care Assessment Services, National Carers Respite Service and Carers Victoria; and - Coordinated palliative medicine consultant visits to general practices. Strategic Direction 6: Providing quality care supported by evidence - Implemented the National Standards Assessment Program across the region; - Implemented Palliative Care Clinical Network endorsed tools across the region; - Supported implementation of Palliative Care Outcomes Collaborative tools across the region; - Hosted three regional conferences for health professionals and the community; - Developed and implemented 14 palliative care clinical practice guidelines and tools; - In conjunction with Monash University, developed and delivered three Introduction to Palliative Care short courses for generalist clinicians; - Delivered or coordinated over 250 education sessions for clinicians in Gippsland. Strategic Direction 7: Ensuring support from communities - Facilitated training of over 50 palliative care volunteers; Supported community information days on palliative care; - In collaboration with Gippsland Lakes Community Health, empowered volunteers to assist the community to deal with death, dying and grief; and - Participated in many media campaigns about palliative care. The Victorian Government is currently considering palliative care policy moving forward from In anticipation of the new policy, the GRPCC recently held a planning day, attended by key staff from member organisations to workshop the Gippsland regional priorities for the next three years. These priorities will form the basis of the next Gippsland regional palliative care strategic plan. Vicki Farthing Chair, GRPCC GRPCC Team The GRPCC team (back l to r) Carol Barbeler, Anne Curtain, Vicki Doherty, Irene Murphy (front l to r) Mary Ross- Heazlewood, Anny Byrne, Melissa Spargo and Karen Raabe (Maria Garrett not pictured) Over the past 12 months there have been a number of changes to the GRPCC team. While the number of staff has reduced, the remaining GRPCC team are working hard at supporting our member services and the Gippsland region as a whole. Irene Murphy, Regional Nurse Practitioner Mentor, has been working very closely with the Nurse Practitioner Candidates and recently endorsed Nurse Practitioner to ensure their clients are receiving the best care possible. Irene has also instrumental in drafting many of the evidence based guidelines and protocols for the Clinical Practice Group. Carol Barbeler, Palliative Aged Care Resource Nurse and Disability Support, has been busy running lots of education sessions for nurses and personal care workers working with older people and also visiting Residential Aged Care Facilities across Gippsland and offering support. Project Officer, Anny Byrne, has conducted a large number of Communication Skills workshops for clinicians in the region, including a number of GP s, which have been very well received. Anny has also been busy coordinating the (Continues page 3)

3 GRPCC Team (continued from page 2) Page 3 Palliative Care Specialist visits to Gippsland. Project Officer, Maria Garrett has been working on the After Hours Palliative Care Project and has overseen the creation of some fantastic tools including the Tools to Assist After-Hours Telephone Triage of Community Palliative Care Clients and the Client Summary Palliative Care. Maria s role also includes evaluating all the work that the GRPCC undertakes, ensuring we know what is and what is not working. Sadly Maria will be leaving the GRPCC at the end of September, her expertise and knowledge will be greatly missed. Vicki Doherty, Manager and Melissa Spargo, Administrative Assistant have been working hard to ensure the smooth running of all facets of the GRPCC. In the past 12 months we have also said goodbye to two very valuable members of the GRPCC team. Mary Ross- Heazlewood has been a Project Officer for the GRPCC since Mary s portfolio was Clinical Practice and Education and during her time with the GRPCC, she set up the Clinical Practice Group and the Operational Reference Group as well as coordinating the Introduction to Palliative Care Monash University Short Course. Karen Raabe, Project Officer commenced with the GRPCC in 2012 to undertake corporate communications and regional volunteer coordination. Karen introduced the GRPCC enewsletters and relaunched the GRPCC website as well as coordinating palliative care volunteer training. One of Karen s greatest achievements was orchestrating the very successful 2014 conference. The departure of Mary and Karen has certainly left a gap in the GRPCC but the remaining members of the team are working hard to support our member services. Clinical Practice Group The Clinical Practice Group (CPG) is a GRPCC working group chaired by Cheryl Bush, Executive Manager Clinical & Nursing Services at Gippsland Lakes Community Health (GLCH). The CPG was established to enhance the provision of quality palliative care through the development of common clinical policies and procedures for adoption by member services. The CPG convenes monthly to discuss the needs of palliative care services in the region and to develop guidelines and protocols to improve care for clients and carers. In 2015 alone, the CPG has endorsed a number of tools including; -Palliative Care Access & Management Flow Chart for GPs Referral Pathway, - Opioid Conversion Guidelines, - Verification & Certification of Death Guidelines, - Prioritizing & Responding to Referrals, - Responding to After-hours Phone Calls, and - Client Summary Palliative Care. These tools and many more can be found on the GRPCC website ( under Education & Resources. The CPG is currently seeking expressions of interest from GPs and Allied Health staff that have expertise in palliative care and would like to contribute to the CPG. If you are interested and would like a copy of the CPG terms of reference, please contact Irene Murphy on or at irene.murphy@wghg.com.au

4 Newsletter No.28, Spring 2015 life & death matters Page 4 Victorian Cancer Clinicians Communication Skills Program The GRPCC, with support from Cancer Council Victoria facilitated 13 free communication skills workshops throughout Gippsland during The workshops are designed for groups of up to six health professionals and include facilitated role plays with an actor, in the context of Transition to Palliative Care. The workshops which are based on the Calgary Cambridge model provide a safe learning environment promoting individual learning and behaviour change. The sessions were facilitated by John Reeves, a Gippslandbased clinical psychologist, Anny Byrne, RN and GRPCC Project Officer, and Veronica Porcaro, a trained actor. In total, 77 professionals attended the 13 workshops and 100% of participants were either very satisfied or satisfied. All participants learned skills during the role play that will be useful in their work and over 97% agreed that the workshops increased confidence in their communication skills. When asked what part of the workshop was most useful, 79% of participants mentioned the role play. For more information on the communication skills workshops, or if you would like a copy of the full evaluation report, please contact Anny Byrne at anny.byrne@wghg.com.au or call I really appreciated the feedback and the opportunity to role play with the actor. I believe this creates an opportunity to practice new skills effectively La Trobe University Palliative Care Unit Research Project In late 2014, La Trobe University Palliative Care Unit (LTUPCU) was approached by the GRPCC to evaluate; the work of the GRPCC on the capacity of member services to deliver palliative care in the Gippsland region; the perceived value of the GRPCC to staff of member services; and the effectiveness of the GRPCC as a means for improving the provision of palliative care services in the region. Phase one of the project was entitled Developing capacity for palliative care in Gippsland: The role of the Gippsland Region Palliative Care Consortium. The results from this research demonstrated that capacity building in member organisations primarily focused on organisational capacity building. Wendy Dagher, Andrea Grindrod & Bruce Rumbold from LTUPCU, interviewed 31 people working within either the member services or GRPCC and consulted a range of documents produced over the last four years by the consortium. The findings highlighted the priority the GRPCC has placed on supporting its member services to build capacity in clinical service delivery, particularly in remote services who are very dependent on the GRPCC s support. The findings also indicate that the GRPCC is greatly valued by its member services with most respondents anticipating that palliative care service delivery would be negatively impacted if the GRPCC ceased to exist. Member services involvement with the GRPCC also resulted in positive impacts in other areas of health care, where staff had been able to adapt models and ways of practice, or transfer knowledge and skills. Overall, a regional consortium approach seems to be highly effective for building palliative care capacity in rural and regional areas. Phase two of the study focused on community capacity building in the Gippsland Region and is scheduled to be released shortly. Please visit the GRPCC website for view the full report.

5 Page 5 Quality Initiatives In , the GRPCC funded 19 quality initiatives across member services to support implementation of evidencebased resources. Expressions of interest were sought from member services and some of the supported initiatives included; - Introduction of Palliative Care Outcomes Collaboration (PCOC) tools, - support for National Standards Assessment Program (NSAP) process, - support for implementing A Model of Community Palliative Care, - support for Pathway for Improving the Care of the Dying (PICD), - Aboriginal Palliative Care projects, - Palliative Care Service Plan, - Hear me play - Carer support, - and Palliative/Advance Care Planning Project Nurse. The PICD is an end of life care pathway and aims to integrate the principles of palliative care into general hospital, community and aged care facilities. The overall aim of the PICD project is to improve clinical processes for the terminal stage of care of dying clients and to ensure better coordination of care for terminally ill clients. South Gippsland Hospital (SGH), Foster initially promoted PICD in Quality initiative funding allowed the service to educate health professionals and promote the use of the care plan across the service again in Surveys and auditing of patient histories shows that the majority of doctors, nurses and allied health staff continue to follow the principles of the PICD Care Plan. Pre and post results showed an increase in confidence with the process after the 2014 project and a 50% improvement in the documentation of care for the dying patient. Five services were funded to The Dreamers and Talking about it Photographer and visual artist Pippa Wischer asked forty people who are receiving palliative care questions about life, dreams and dying, photographing them while they answered these intimate and implement PCOC tools which offer an evidenced based standardised approach for clinical assessment of the palliative client. All implementation strategies involved education and formation of working groups to bring stakeholders within the service together. Gippsland Lakes Community Health (GLCH) used the funding to also implement genograms across the palliative care service together with the PCOC tools. GLCH educated 43 nurses who are directly involved in the delivery of palliative care in East Gippsland. The participants received handouts and electronic versions for the genogram, Carer Support Needs Assessment Tool (CSNAT) and PCOC. Participants also received training in drawing a genogram as well as assistance with practical application from Nicola Gorwell, Nurse Practitioner Candidate (GLCH). A modified genogram suitable for Aboriginal clients was also developed. complex questions. The result was a unique book and subsequent art exhibition featuring photographic portraits of people with a life-limiting illness and their reflections on life, death and dreams. Palliative Care Victoria with support from the GRPCC proudly hosted the Dreamers Exhibition at the Latrobe Regional Gallery from 14 February 15 March 2015 during which time 1,400 people viewed the exhibition. On opening night, cinematographer Vincent Lamberti interviewed Mardi Johnson and Carolyn Sandford (nee Johnson) and created a short film entitled Talking about it. The film captures Mardi and Carolyn s thoughts on dying and coping with death, it also includes some very special footage of Bruce Johnson shortly before his death which was kindly provided by Mardi. Please visit the GRPCC website at to view this inspirational and thought provoking video. Sue and I have felt privileged to be Champions for the PICD. To have the funding to help educate and promote the PICD Care Plan for the Nurses, Allied Health and Medical Staff again has been an honour for both of us'. The PCOC and genogram provides us with a consistent approach to the assessment of our palliative clients and we know it is considered best practice. The PCOC gives a very succinct snapshot about where the client is on the disease trajectory and the genogram provides all the relevant information about their home environment. Previously you d have to ask a lot of questions, but now it s much simpler

6 Newsletter No.28, Spring 2015 life & death matters Page 6 Nurse Practitioner Mentor Irene Murphy Nurse Practitioner Mentor GRPCC The GRPCC s Nurse Practitioner (NP) Mentor, Irene Murphy has continued to provide mentorship, support, clinical advice and guidance to the NP Candidates (NPCs) as they move towards endorsement. Irene has also been providing support to the NP at Latrobe Community Health Service (LCHS) as she progresses her role and scope of practice post endorsement. Some of the NP Mentor activities in the last six months have included: - Working with the Palliative Care NP Candidacy Program Steering Committee through bimonthly meetings; - Leading and participating in the GRPCC Clinical Practice Expert Group to progress palliative care vision and care delivery in the region as per the Department of Health Strengthening palliative care: Policy and strategic directions and in the development of evidence based tools and guidelines; -Development of the NP Endorsement portfolio and expert panel interview guidelines for the GRPCC; -Planning for the GLCH and WGHG NPCs submission of NP portfolios aimed for November 2015; -Provision of clinical support and consultancy to district nursing staff in the Gippsland sub regions, particularly in the absence of the sub regions NP and NPCs. Advance care planning education: supporting rural and regional General Practitioners The GRPCC in partnership with the McCabe Centre for Law and Cancer delivered a series of education sessions in advance care planning (ACP) for general practitioners (GPs) and other health professionals in the Gippsland region. The education sessions combined clinical insights on conversations about death and dying with education delivered by Dr Barbara Hayes (Palliative Care Physician, Clinical Leader, Advance Care Planning, Northern Health), Helen Rushford, (Coordinator, Advice and Education Service, Office of the Public Advocate), Irene Murphy, (Nurse Practitioner Mentor, Gippsland Region Palliative Care Consortium) and Dr Deborah Lawson (Legal Policy Advisor, McCabe Centre for Law and Cancer, Cancer Council Victoria). These sessions aimed to assist GPs and other health professionals to acquire knowledge and skills in - ACP processes and documentation; - enhance knowledge of the particular legal frameworks in Victoria; - where to seek further information to support and provide strategies for effective communication with patients at the end of life; and - to facilitate decision making. There may be opportunity to run more of these sessions in the region. If you are interested in taking part please contact Irene Murphy on or at irene.murphy@wghg.com.au Dr Deborah Lawson, recently presented on this initiative at the 5th International Society of Advance Care Planning and End of Life Care Conference on the 9-12 September 2015 in Munich, Germany. my knowledge has been enhanced in terms of exploring EOL issues with patients and also treatment options

7 Page 7 A Palliative Approach in the Aged Care and Disability environments The first half of 2015 has been very busy with a range of education activities being offered across Gippsland. Education sessions on a Palliative Approach to Advanced Dementia and Pain Management for Older People in the Palliative Care Environment have been offered for nurses and carers in separate workshops, in several locations across the region. The GRPCC has also sponsored another two groups of aged care link nurse training, bringing the total number of nurses and allied health professionals who have completed this two day training program to more than 200 since it commenced in early The GRPCC has also delivered education to community care and disability support workers who care for people in the community. The Living Longer Living Better aged care reforms that commenced in 2012 are resulting in the delivery of more support and care at home, a focus on greater consumer choice and control, and a greater recognition of diversity and support to carers. Care and support workers providing care in clients homes are seeing a greater impact of ageing and comorbidities, and the concepts of a palliative approach were introduced and discussed with these workers employed across the Latrobe Valley. The second half of 2015 is seeing more of a focus on individual residential aged care facilities (RACFs), and disability accommodation and day program services. Some RACFs have taken advantage of assistance with developing an implementation plan for palliative approach activities, whilst others received facilitated education sessions or education material on key palliative approach activities. Several facilities have also requested informal group discussions on some common issues and concerns in palliative care and end of life care. Residential and day program disability support staff, supervisors, regional and program managers have also been involved in discussions relating to people with disabilities who are ageing, and the impact of comorbidities on their functional state. Much discussion has occurred on accessing service providers for these people in regional areas. Ongoing education and support is being offered to support workers in the disability field, as their clients enter later adulthood. If any of the education sessions or support activities briefly mentioned in this article are of interest to you, your organisation or facility, please don t hesitate to contact Carol Barbeler, Palliative Aged Care and Disability Resource on or at carol.barbeler@wghg.com.au For more information on the Living Longer Living Better reforms, follow the link to the Ageing and Aged Care Directory at the Department of Social Services. our-responsibilities/ ageing-and-agedcare/aged-carereform On the couch with Carol Barbeler What do you do for a living? Palliative Aged Care and Disability Resource Nurse for GRPCC What did you want to be when you grew up? Teacher Favourite holiday destination? Flinders Ranges What will be written on your headstone? Well, that was a life well lived!... Music at your funeral? Peter Gabriel and anything Coldplay What would your last outfit be? A nice dress, and of course, boots! Buried, cremated or snapfrozen? Buried What are you reading now? The Art of Happiness by His Holiness, the Dalai Lama What would you have for your last meal? Grilled Tasmanian Salmon with a light mustard cream sauce Which famous person would you like to invite to dinner? The Pope If you were an animal what would it be? A big chocolate Labrador that everyone loved What lessons has your work life taught you? Life is short... Live it today! Carol Barbeler, Palliative Aged Care and Disability Resource Nurse for GRPCC

8 Get the latest GRPCC news online The GRPCC logo features a Hardenbergia violacea, commonly known as false sarsaparilla, purple coral pea or happy wanderer. In Aboriginal culture the leaves and flowers were used to treat mouth ulcers, and brewed as a hot drink to treat chest infections. The flowers were also eaten for detoxification and cleansing purposes. Contacts: GRPCC Chair Vicki Farthing t: Consortium Manager Vicki Doherty m: e: vicki.doherty@wghg.com.au Administrative Assistant Melissa Spargo t: e: melissa.spargo@wghg.com.au Palliative Aged Care and Disability Resource Nurse Carol Barbeler t: m: e: carol.barbeler@wghg.com.au Nurse Practitioner Mentor Irene Murphy t: m: e: irene.murphy@wghg.com.au Project Officer Anny Byrne t: e: anny.byrne@wghg.com.au Office hours 8.30 am 4.30 pm Monday to Friday t: e: enquiries@grpcc.com.au w: The GRPCC distributes three regular enewsletters aimed at health professionals in the community, acute, aged care and disability settings. The enewletters have regular updates about GRPCC projects, upcoming education and training opportunities, and other useful information relating to palliative care practice across the region and broader afield. You can subscribe via just click on the Subscribe to our newsletters button and follow the prompts. The GRPCC is an alliance of 14 member services that provide inpatient and/or community palliative care services for the residents of Gippsland. The GRPCC s vision is that Gippslanders with a life-threatening illness and their families and carers will have access to a high quality service system, which is innovative and provides evidence-based coordinated care that is responsive to their individual needs. The Victorian Department of Health provides GRPCC with core operational funding. The newsletter life & death matters is produced biannually and distributed free of charge. To receive a copy of the newsletter, please your contact details to enquiries@grpcc.com.au or write to: Gippsland Palliative Care Consortium c/- West Gippsland Healthcare Group 41 Landsborough Street Warragul VIC 3820