Annual Report 2014 This report was prepared by: Vicki Doherty, Consortium Manager; Karen Raabe, Project Officer, Communications; and Maria Garrett, Project Officer, Evaluation and Research September 2014
Gippsland Region Palliative Care Consortium c/- West Gippsland Healthcare Group 41 Landsborough St, Warragul 3820 September 2014
Copies of this report and more information is available from www.grpcc.com.au or by phoning 03 5623 0684. Gippsland Region Palliative Care Consortium
Defi nitions and abbreviations
ACAS ...... Aged Care Assessment Service
ACCHOs ...... Aboriginal Community Controlled Health Organisations
ACP...... Advance Care Planning
BCCHS ...... Bass Coast Community Health Service
BCRH...... Bass Coast Regional Health
BRHS ...... Bairnsdale Regional Health Service
BSPCC ...... Brisbane South Palliative Care Consortium
CGHS...... Central Gippsland Health Service
CHCB...... Calvary Health Care Bethlehem
CMG ...... Consortium Management Group
CPG ...... Clinical Practice Group
DHS...... Department of Human Services
DH ...... Department of Health
EOLCP ...... End of Life Care Pathway
GLCH ...... Gippsland Lakes Community Health
GML ...... Gippsland Medicare Local
GP ...... General Practitioner
GRICS ...... Gippsland Regional Integrated Cancer Services
GRPCC...... Gippsland Region Palliative Care Consortium
GSHS...... Gippsland Southern Health Service
KRHS ...... Kooweerup Regional Health Service
LCHS ...... Latrobe Community Health Service
LRH ...... Latrobe Regional Hospital
MH ...... Monash Health
MND ...... Motor Neurone Disease
NP ...... Nurse Practitioner
NPC...... Nurse Practitioner Candidate
ODHS...... Omeo and District Health Service
ORH ...... Orbost Regional Health
PACRN ...... Palliative Aged Care Resource Nurse
PCCN...... Palliative Care Clinical Network
PCV ...... Palliative Care Victoria
PEPA...... Program of Experience in the Palliative Approach
PH ...... Peninsula Health
RACFs ...... Residential aged care facilities
SDF ...... Service Delivery Framework
SGH ...... South Gippsland Hospital
SPCSs Specialist Palliative Care Services - refers to government funded palliative care community and inpatient services.
VACCHO ...... Victorian Aboriginal Community Controlled Health Organisation
VPCSS ...... Victoria Palliative Care Satisfaction Survey
WGHG...... West Gippsland Healthcare Group
YDS ...... Yarram and District Health Service
Page 1 Contents
Chair’s Report 4
Manager’s Report 6
Policy context 7
About Gippsland 9
Strategic direction 1: Informing & involving clients and carers 12 Victorian Palliative Care Satisfaction Survey 13 Information for Clients and Carers 14 Aboriginal Palliative Care 14 Local partnerships 15
Strategic Direction 2: Caring for carers 16 After-hours Palliative Care Support 17 Respite care 18 Carer education sessions 18 6th Annual Gippsland Palliative Care Conference – Life and Death Matters: Carers need care too! 19
Strategic Direction 3: Working together to ensure people die in their place of choice 20 Palliative Aged Care Link Nurse Project 21 Palliative Approach Training for personal and direct care workers 23 PEPA workshops for health professionals and disability workers 24 Residential In-reach (RIR) Regional Managers Group 24 Victorian Palliative Care Consortia Aged Care Network 24 National roll out of revised Palliative Approach Toolkit 25 Palliative care in disability accommodation services 25
Strategic Direction 4: Providing specialist palliative care when and where it is needed 26 Specialist Palliative Care Consultancy Service 27 Primary and secondary consults by visiting palliative medicine specialists 28 Support for nurse practitioner candidates - palliative care 30 GRPCC partnership with the McCabe Centre for Law and Cancer 31 Motor Neurone Disease 31 Pastoral Care Project 32
Page 2 Gippsland Region Palliative Care Consortium
Strategic Direction 5: Coordinating care across settings 33 Links with Aged Care Assessment Service 34 After-hours Palliative Care Project 34 Palliative Aged Care Link Nurse Project 34 Telehealth 34 Developing a model of community palliative care 35
Strategic Direction 6: Providing quality care supported by evidence 36 Training and Education 37 Program of Experience in the Palliative Approach (PEPA) 39 6th Annual Gippsland Palliative Care Conference – Life and Death Matters: Carers need care too! 39 Impeccable Assessment Skills in Palliative Care Practice 39 Twilight Seminar Series 40 Communication Skills Training Program 40 The Introduction to Palliative Care Short Course 41 Telephone Triage Training 42 Palliative Care Scholarship Program 42 Palliative Care Volunteers 42
Strategic Direction 7: Ensuring support from communities 44 Volunteer Community Capacity Building Project 45 Developing community capacity in Gippsland: The role of the Gippsland Region Palliative Care Consortium 45
Future Directions 46
Organisational Structure 48 Consortium Management Group 49 Consortium Executive 49 Clinical Practice Group 49 Consortium Team 50 Representation on other relevant committees 51 Accreditation status of Member Agencies 51
Financial Statement 52
Page 3 Chair’s Report
...the GRPCC supported e Victorian Palliative Care Satisfaction Survey1 (VPCSS) provides a number of initiatives to valuable feedback from palliative care clients and their carers to help the Gippsland Region Palliative Care Consortium (GRPCC) and its member improve carer training, services improve service delivery. I am very pleased to report that for the including implementing third year in a row, the VPCSS top performing item for the Gippsland the Carer’s Kit in three region was ‘satisfaction with the level of respect shown towards you as an individual’. It is very encouraging to see that while services have faced services and supporting a many challenges this year, that sta continue to treat clients and their Carer Education Program families with respect, dignity and compassion. at Latrobe Community I am also pleased to advise that the top area brochures for (1) GRPCC stakeholders and to improve from the 2013 survey, ‘carers’ (2) the Gippsland community. Health Services (LCHS)... satisfaction of the level of training provided e GRPCC has also made signi cant to carry out speci c care functions (such as progress on developing and implementing a massaging, moving or bathing the patient’) model for palliative a er-hours care: increased from a mean score of 3.71 in 2013 to 3.78. In 2013-14, the GRPCC supported Over 100 nurses who take a er-hours a number of initiatives to improve carer phone calls from palliative clients and training, including implementing the Carer’s carers have been trained in palliative Kit in three services and supporting a Carer care triage; Education Program at Latrobe Community Many carers have been trained and Health Services (LCHS). supported to care for their loved ones at home; and e top areas for improvement in 2014 were satisfaction with ongoing support for Numerous guidelines and protocols (1) funeral arrangements and (2) support have been developed and implemented services (eg. counsellors, psychologists, to improve client care and anticipate social workers and pastoral care). It is timely issues out of hours, including the that, in late 2013-14, the GRPCC engaged Anticipatory Prescribing Guidelines and specialist palliative care social workers and Palliative Care Client Summary. bereavement counsellors to assist services to e GRPCC has also focused its e orts provide psychosocial care. this year on addressing Strategic Direction Ensuring information and resources are 3: Ensuring people die in their place of choice. available and accessible assists to inform Nearly 150 palliative aged care link and involve clients and carers in palliative nurses from residential aged care care. Consistent with the future directions facilities (RACFs) have been trained; for 2013-14, the GRPCC implemented its Over 80 direct care workers have been communication strategy which included the trained in the palliative approach; and launch of a new website www.grpcc.com. au, developing and distributing a monthly Partnerships and networks have been GRPCC e-News and monthly Palliative Aged formed and supported to ensure care is Care e-News, and developing two information coordinated and e cient.
1 Victorian Palliative Care Satisfaction Survey (VPCSS), Gippsland Region Report June 2014, Department of Health and UltraFeedback
Page 4 Gippsland Region Palliative Care Consortium
Due to the work of the GRPCC in 2013-14, I’m very excited to advise of the work being Over 100 nurses who take 57% of RACFs in Gippsland now use end-of- undertaken in partnership with Gippsland after-hours phone calls life care pathways (EOLCP) (compared 26% Lakes Community Health on building in 2012-13), 74% of RACFs now use Advance community capacity to deal with death, from palliative clients and Care Plans (ACP) (compared to 26%) and dying and grief. e project, “Making the carers have been trained aged care nurses are now more con dent in last chapter re ect the whole book”, intends providing a palliative approach to care. to assist discussions about deciding what is in palliative care triage... Moreover, in 2013-14 signi cant work has important to us and what that means for end been undertaken in disability supported of life care. To date, a group of volunteers accommodation services to raise awareness have formed a steering committee and about palliative care and the palliative engaged a lm maker to make a short lm approach. is approach has led to two to be used as a resource to stimulate these clients being referred to specialist palliative discussions. Please watch out for this lm care in 2013-14 (compared to 0 in 2012-13) soon: it is sure to make you laugh, cry and as well as an article proclaiming the work of think about your end of life wishes. the GRPCC in the Department of Human Services Disability Accommodation Services It is with some sadness that I write this Practice Update, Edition No. 35, July 2014. report as outgoing Chair of the GRPCC. I To meet demand, the GRPCC increased have seen many changes across the palliative the number of palliative medicine specialist care sector over the years and feel humbled visits to the region and introduced a visiting to have participated in such an important psychosocial program. Other highlights program in Gippsland. I thank the Victorian include: Government for its ongoing commitment to improving palliative care service in our At multi-disciplinary meetings General community. I would like to thank the GRPCC Practitioner (GP) attendances increased in 2013-14 (indicating greater engagement); member services for their commitment to a shared vision for palliative care in Gippsland Eighty-six primary consultations were and working so collaboratively together to provided to clients, compared with 36 in improve the quality and care of palliative Jan-June 2013; clients and carers in our community. I Nearly 600 multidisciplinary case would also like to extend my thanks to Vicki discussions, including a palliative Doherty and her team. ere is a lot of hard medicine specialist were held; and work going on behind the scenes and their Four nurse practitioner candidates contributions have helped us achieve our (NPCs) were supported to be employed, great outcomes. mentored by a nurse practitioner (NP), Lastly, my thanks to Amanda Cameron, supervised by palliative medicine Director of Nursing, Midwifery and Clinical specialists to undertake clinical Services at Latrobe Regional Hospital placements at palliative care units in 57% of RACFs in for taking on the Acting Chair role until metropolitan Melbourne. December 2014. I leave the GRPCC in good Gippsland now use end- e GRPCC Clinical Practice Group hands and look forward to hearing about its of-life care pathways had a very productive year in 2013-14 and achievements in the future. developed seven clinical practice guidelines. (EOLCP) (compared to Some of these GRPCC guidelines have been adopted by much larger and better resourced 26% in 2012-13), 74% palliative care services in Melbourne. I’m of RACFs now use ACP very proud to see that the work of the GRPCC Anne Curtin is having such statewide signi cance. Chariman , GPRCC (compared to 26%)...
Page 5 Manager’s Report
In Gippsland, palliative care is largely provided by a generalist workforce. Accordingly, a major focus of the GRPCC in 2013-14 has been up-skilling the generalist workforce. In addition to the education provided by palliative medicine specialists when they visit the region, the GRPCC undertook a number of education initiatives to improve the care provided to clients and carers, including:
ten Palliative Aged Care Link Nurse partnership with the McCabe Centre for Law implementing genograms as part of care Workshops; and Cancer and coordinated a medico-legal planning; and presentation on ACP to the GP practice. While nine Victorian Cancer Clinicians improving Aboriginal Palliative Care. the workshop provided best practice education Communication Program Workshops; and was evaluated extremely positively, a Much of the work on these initiatives will six Palliative Care Telephone Triage major win was the relationship that has been be undertaken in 2014-15 and so will be Workshops; forged between this practice and the specialist reported on next year. palliative care service. is relationship six Palliative Care Volunteers Workshops; In June 2014, the GRPCC engaged the ultimately increases the quality and timeliness La Trobe University Palliative Care Unit four Impeccable Assessment in of care for clients and carers. (LTUPCU) to review the work of the GRPCC Palliative Care Practice Workshops; e GRPCC recognises that a number over the past ve years. e main aim of this three Personal Care and Direct Care of government local areas in Gippsland research project is to determine whether the Workers Palliative Approach Workshops; are increasing at a greater rate than the rest GRPCC has impacted on the capacity of member services to deliver palliative care in two Pharmaceuticals in Palliative Care of Victoria. e demographic pro le of the Gippsland region. e results of the project Twilight Seminars; Gippsland with higher than state averages of persons aged over 65 years and people with will be used to understand how the GRPCC has one Annual Gippsland Region Palliative disabilities, will also pose many challenges contributed to organisational capacity building Care Conference; and to services in the future as the demand for in the Gippsland region, and whether the consortium is an e ective means for supporting one Advance Care Planning Seminar. palliative care services will no doubt increase. erefore, the GRPCC has undertaken and improving the provision of palliative care In 2013-14, there were 1,422 attendances signi cant work around assisting palliative services in the region. A nal report on this at training coordinated and provided by the care services in Gippsland to develop a best project will be presented to the Consortium GRPCC compared with 770 in 2012-13. practice model of community palliative Management Group in November 2014. is increase in attendance was due to the care to meet the demands of the future. I would like to thank Anne Curtin for her GRPCC’s commitment to providing education Recommendations from this report will be leadership and commitment to palliative locally, providing greater accessibility and provided to the Consortium Management care over the last ten years as Chair of the better targeted education for the Gippsland Group in early September 2014 and the GRPCC, and for her support of my team community. All training evaluated extremely GRPCC aims to assist member services to and I over the last three years. Lastly, I positively and many sessions provided a implement them. would like to thank my talented, dedicated statistically signi cant increase in participant’s and hard-working team of project o cers In late 2013-14, the GRPCC also provided con dence to provide palliative care. and clinicians: Carol Barbeler, Anny Byrne, funding to member services to implement a Judy Coombe, Maria Garrett, Irene Murphy, Forging relationships and engaging GPs number of Palliative Care Quality Initiatives. Karen Raabe, Mary Ross-Heazlewood and has always been a challenge for palliative care ese included: services, however the GRPCC made signi cant Melissa Spargo. It is exciting to see all of inroads in 2013-14. e GRPCC NP Mentor, participating in the Palliative Care the work we have achieved over the past NPCs and palliative medicine specialists Outcomes Collaborative; 12 months in this report and thank you for making it possible. visited a number of GP Clinics in the region to participating in the National Standards raise the pro le of palliative care and provide Assessment Program; education. One GP practice that had not been providing Carer’s Education Workshops; particularly engaged with specialist palliative care services was keen to learn about Advance implementing the Pathway for Improving Vicki Doherty Care Planning (ACP). e GRPCC formed a the Care of the Dying; GRPCC Manager
Page 6 Gippsland Region Palliative Care Consortium
Policy context
Page 7 Manager’s Report Policy context
e Victorian Government’s policy Strengthening palliative care: Policy and strategic directions 2011–20152, released in August 2011, guides the work of government-funded specialist palliative care services, palliative care consortia, statewide specialist services and the Palliative Care Clinical Network in Victoria over the next few years.
e policy’s vision is to ensure that 4. Providing specialist care when and “Victorians with a life-threatening illness where it is needed and their families and carers have access to a 5. Coordinating care across settings high-quality palliative care service system that fosters innovation, promotes evidence-based 6. Providing quality care supported by practice and provides coordinated care and evidence support that is responsive to their needs.”3 7. Ensuring support from communities. e policy identi es seven strategic directions For the purposes of clarity and accountability, with associated priorities. e strategic the structure of this Annual Report and other directions for 2011-2015 are: documents including the GRPCC Strategic 1. Informing and involving clients and carers Plan 2012-2015 and annual operational plans are based on these seven strategic directions. 2. Caring for carers 3. Working together to ensure people die Figure 1: GRPCC Organisational Structure in their place of choice
2 Victorian Government Department of Health (2011), Strengthening palliative care: Policy and strategic directions 2011 – 2015. 3 Ibid, pg. 6
Page 8 Gippsland Region Palliative Care Consortium
About Gippsland
Page 9 About Gippsland
Geography in Victoria as a whole). Gippsland has a higher than average percentage of Aboriginal e Gippsland region is extremely diverse population while the number of immigrants covering an area of 41,375 square kilometres is the lowest for all regions. Gippsland has (18.3% of Victoria), from metropolitan the highest rate of family violence incidents, Melbourne to the New South Wales border low income individuals, and rental stress of in the east. e distance from Mallacoota in all regions6. the east to Melbourne CBD is approximately Gippsland has two local government areas 516km. In 2011, the resident population in with the highest growth rates in Victoria: Gippsland was 259,271 persons or 4.6% of Bass Coast Shire and Baw Baw Shire. Victoria’s total population4 (Table 1). e During peak holiday periods, Bass Coast’s projected change in population is 1.4% per population exceeds 60,000 and 29% of the annum, resulting in an estimated resident resident population is over the age of 60. 5 population of 342,246 persons in 2031 . e total population is forecast to increase from 30,233 to 48,833 by 2013, an average Population annual change in population of 2.4%. Baw Baw Shire is a major exurban growth area for Population growth in Gippsland has been the south-eastern suburbs of Melbourne, the below average since 2001 but growth to 2021 focus of which is on Drouin and Warragul. is expected to be close to that of Victoria Baw Baw’s population is forecast to increase as a whole. e percentage of Gippsland’s from 43,389 to 74,676 by 2013, representing population aged 65 plus is higher than an average annual change in population of average. By 2021, persons over 65 years 2.8%7. Victoria in comparison is estimated of age are expected to make up 18.2% of to have an average annual change of 1.7% Gippsland’s population (compared to 14.0% during the same period (2011-2031)8.
Table 1 – Selected indicators for Gippsland compared to Victoria, 2011
Indicator Gippsland Victoria Resident Population 259,271 5,534,526 Population aged 65 or above 18.2% 14.0% Indigenous population 1.5% 0.7% Birthplace Australia 87.3% 72.3% Speak language other than English 4.7% 24.2% 20-24 year olds who completed year 10 or less 22.5% 12.0% Median individual gross weekly income $474 $562 Need assistance with core tasks 6.2% 5.0% Households on internet 73.1% 79.7% Dwellings that are rented 23.9% 27.2%
Source: Australian Bureau of Statistics online Table Builder using 2011 Census data
4 Australian Bureau of Statistics, 2012 - Estimated Resident Population at 30 June 2011 5 Department of Planning, Transport and Local Infrastructure, 2014 - Victoria in Future 2014 population projections for Latrobe/Gippsland region 6 2012 Local Government Area Pro les, Gippsland Region, State Government of Victoria, Department of Health, 2012, pg. 101 7 Department of Planning, Transport and Local Infrastructure, 2014 - Victoria in Future 2014 population projections for Bass Coast Shire and Baw Baw 8 Department of Planning, Transport and Local Infrastructure, 2014 - Victoria in Future 2014 population projections for Victoria
Page 10 Gippsland Region Palliative Care Consortium
Omeo District Health (ODH) East Gippsland
MELBOURNE Wellington Central-West Orbost Regional Health (ORH) Bairnsdale RHS Gippsland Gipplsand Lakes Community Health (GLCH) West Gippsland KooWeeRup Regional Healthcare Group Central Gippland Health Service (CGHS) (WGHG) Health Service (KRHS) Latrobe Regional Hospital (LRH) Latrobe Community Health Service (LCHS) Gippsland Southern Health Service (GSGS) Bass Coast Community Bass Coast Yarram & District Health Service (YDHS) Health Service Regional Health (BCRH) Country of Origin (BCCHS) South Gippsland Hospital (SGH) and Language South Gippsland
In the 2011 Census, 87.3% of people in Gippsland stated they were born in Australia. e next most common places of birth were ere are 11 designated palliative care Figure 2: Location of palliative care United Kingdom 4.9%, New Zealand 1.1%, inpatient beds in the region located at: services - Gippsland region. Netherlands 1.0%, Germany 0.7% and Italy BRHS – one bed 0.7%. In Gippsland, the most common languages other than English spoken at home BCRH – one bed were: Italian 0.9%, German 0.4%, Dutch CGHS – two beds 0.3%, Greek 0.3% and Mandarin 0.2%. GSHS – one bed Health Outcomes LRH – four beds
In terms of health outcomes, Gippsland rates WGHG – two beds the lowest of all regions on a number of health A review completed in 2013 and again in indicators, including smoking (highest rate in 2014 indicates that the number of registered the state), male life expectancy, psychological community palliative care clients at one distress, and rates of disability. e region has point in time in Gippsland rose by 22% from the highest rate of low birth weight babies 250 to 304 (see Figure 3). and children at developmental risk, and the highest rate of drug and alcohol clients. e rate of inpatient separations is the highest of all regions, while private hospital utilisation is the lowest. GP attendances are slightly below average, while emergency department presentations Figure 3: Number of community and primary care type presentations are the palliative care clients registered at one highest of all regions9. point in time (March-April 2013 and May- June 2014) Palliative Care Services
ere are nine funded specialist community 90 2013 palliative care services in the Gippsland 80 2014 region (Figure 2), based at: 70 BRHS BCCHS 60 BCRH CGHS 50 GLCH GSHS 40 LCHS WGHG 30 YDHS 20 Unfunded generalist palliative care services are also provided by KRHS, ODH, ORH and 10 SGH. ere are also a number of smaller bush
Number of registered pallaitive care clients 0 nursing services in the East Gippsland region. BRHS BCCHS BCRH CGHS SGPCS GLCH LCHS WGHG YDHS * Snapshot at the time of interviewing the palliative ccare coordinators in March-April 2013 and April 2014
9 Ibid, pg. 101
Page 11 Strategic direction 1: Informing & involving clients and carers
Page 12 Gippsland Region Palliative Care Consortium
Strategic Direction 1: Informing & involving clients and carers
Victorian Palliative Care and 33% (inpatient) the previous year. Items Satisfaction Survey were rated from 1 (very low) to 5 (very high).
Palliative Care Victoria has conducted the All respondents were asked, “How satis ed Victorian Palliative Care Satisfaction Survey were you with the overall standard of care (VPCSS)10 annually since 2010 and its ndings provided by the palliative care service?” help consortia identify improvements in service (Figure 4), with 64% responding with a very delivery for clients and carers. e 2014 survey high level of satisfaction while 28% were (conducted between February and May 2014) satis ed, leaving 8% not satis ed with the captured feedback from adult patients (25%), standard of care. carers (28%) and bereaved carers (27%) from both community and inpatient palliative care Carers had 100% satisfaction with the settings. ere were a total of 161 respondents standard of care compared with 97% for 1 = Very low across the region from 611 surveys distributed. bereaved carers and 91% for clients. e top Figure 4: Distribution of responses for the question, 2 e response rate was 32% (community) and performing and top items for improvement are “How satis ed were you with the overall standard of 13% (inpatient) compared to 30% (community) provided3 in Tables 2 and 3 respectively. care provided by the palliative care service?” 4 5 = Very high
1 = Very low Patient 2 3 Carer 4 Bereaved carer 5 = Very high Community Patient Inpatient Carer Bereaved carer TOTAL Community 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Inpatient TOTAL 0% Source: 10% VPCSS 20% 2014 30% Gippsland 40% Region, 50% July 2014 60% 70% 80% 90% 100%
Table 2: Top fi ve performing items for Gippsland Region 2014
Rank Area of improvement Mean 1 [Satisfaction with] the level of respect shown towards you as an 4.82 individual 2 [Satisfaction with response from] nurses 4.73 3 Overall satisfaction with the care delivered by your palliative care 4.66 team 4 [Satisfaction with] the way your religious and/or spiritual needs 4.66 are supported 5 [Satisfaction with] how well the team responds to your needs 4.64
Source: VPCSS 2014 Gippsland Region, July 2014
10 Victorian Palliative Care Satisfaction Survey (VPCSS), Gippsland Region Report June 2014, Department of Health and UltraFeedback
Page 13 Strategic direction 1: Informing & involving clients and carers
Information for Clients Table 3: Top fi ve priority to improve items for Gippsland Region 2014 and Carers Rank Area of improvement Mean e GRPCC undertook an extensive review of its communication e orts in recognition 1 [Satisfaction with ongoing support] planning ahead for funeral 3.38 of its mandate to provide user-friendly, arrangements (if applicable) evidence-based information for clients, 2 [Satisfaction with ongoing support] opportunities to talk with 3.15 carers and health professionals. e GRPCC other carers about your own situation (as a carer) launched a new website in January 2014 (www. 3 [Satisfaction with] quality of food 2.70 grpcc.com.au) that provides comprehensive 4 [Satisfaction with ongoing support] to minimize fi nancial burden 3.29 information about palliative care, palliative 5 [Satisfaction with] amount of peace and quiet 3.36 care services in Gippsland, education and training delivered by the GRPCC and links Source: VPCSS 2014 Gippsland Region, July 2014 to other key websites such as CareSearch, Carer’s Victoria, Alzheimers Australia, Motor Neurone Disease Australia and Very Special Aboriginal Palliative Care palliative care and the local Aboriginal Kids. Two regular eNewsletters were also Health Workers. introduced; one targeting Gippsland health e GRPCC has continued to work towards In July 2013, the GRPCC was presented with professionals and the other targeting nurses developing a regional plan for improving a message stick from Gippsland’s Aboriginal who have completed the Palliative Aged Care palliative care for Aboriginal people in line Community Controlled Health Organisations Link Nurse Training Program as well as their with Koolin Balit, the Victorian Government’s managers and other people working in aged Strategic Directions for Aboriginal Health (ACCHOs) at the Victorian ACCHO care across the region. Both eNewsletters 2012-2022. (VACCHO) member meeting. Traditionally, currently have 150 subscribers from across message sticks were passed between di erent During 2013-14, the GRPCC provided the region that have voluntarily ‘opted in’ to clans and language groups to establish funding to WGHG and to GLCH to support receive the updates following a marketing information and transmit messages. ey Aboriginal Palliative Care. e WGHG campaign advising stakeholders that the were o en used to invite neighbouring groups project aims to develop a culturally safe GRPCC is providing regular information in to corroborees, initiation ceremonies, right of clinical pathway for Aboriginal cancer this new format. Hard copies of the Life & entry to country and invitation to religious clients. WGHG subsequently made a Death Matters Newsletter are still produced, ritual for drawing tribal boundaries, sacred successful submission to the Department of however it is now distributed biannually as ceremonial places, totems and tracking Health for funding of $80,000 through the opposed to quarterly to minimise duplication animals throughout the land. Aboriginal Health Strengthening Clinical and wastage. Care and Pathways initiative. e project, is message stick is the story of the e GRPCC developed and distributed two Reconnect, aims to improve collaboration in journey of the VACCHO and Palliative Care Victoria (PCV) and will be passed around new information brochures: Palliative Care the area of clinical engagement with the local Gippsland’s member services for a month at Services in Gippsland and About the GRPCC. Aboriginal community. e project is due for a time. Each service can use the message stick e former provides a useful overview of completion by June 2015. how to access palliative care services in to engage their local ACCHO and Aboriginal the region and wider a eld, and lists the e GLCH project aims to introduce community to promote palliative care contact details of the GRPCC’s member palliative care into the local Aboriginal service provision. e message stick can also services. It is hoped that this brochure may community in a non-confronting way, by be used by palliative care services to make/ contribute to addressing one of the VPCSS developing and implementing a culturally strengthen connections with Aboriginal patient subsample top 5 areas to improve appropriate tool re ecting a genogram by Hospital Liaison O cers. In 2013-14, the – I knew where to enquire about palliative Aboriginal Health Workers, as part of the message stick toured parts of East Gippsland care. e brochures have been distributed existing annual health assessments program. and was used to raise the pro le of palliative to all palliative care services (CEO, DON, is process will also provide an opportunity care with Aboriginal Hospital Liaison O cer Quality Managers, Nurse Educators and to build relationships between mainstream and Aboriginal Health Workers. Volunteer Coordinators), aged care facilities and medical practices in Gippsland as well as the six Gippsland local governments and Gippsland-based Members of Parliament. It is important that the GRPCC continues to innovate and provide relevant, targeted information to clients, carers and health professionals in a range of formats.
Right: e GRPCC was presented with a message stick by Gippsland’s ACCHOs in July 2013.
Page 14 Gippsland Region Palliative Care Consortium
Local partnerships
e GRPCC was one of the major sponsors of a Palliative Care Community Information e GRPCC provided sponsorship and support for a community Day held in East Gippsland in May 2014. information day organised by the East Gippsland Palliative Care Network Organised by the East Gippsland Palliative Care Network, the forum is an annual event Group and held in Bairnsdale on Wednesday 28th May. e day was aimed at providing people in East Gippsland based on the theme of this year’s National Palliative Care Week, “Palliative with the opportunity to learn about care Care – everyone’s business, let’s work together”. options for all stages of palliative care. Around 100 people from across East Gippsland attended the day, listening to a range Speakers included representatives from local of speakers who presented on many di erent aspects of palliative care. ere were community-based care services, nancial and information tables from local healthcare providers and legal, social and other support support services, residential aged care facilities, agencies, including the GRPCC. e goal of the day was to start conversations and State Trustees, pastoral care and bereavement promote planning ahead within our local community. ere was a tangible level of counsellors from Calvary Health Care discussion and questions throughout the day and more than 60 legal aid ‘take control’ Bethlehem as well as the GRPCC. A total of 94 kits* were given out. community members attended the forum. e East Gippsland Palliative Care Network is a e sponsorship of the advertising and promotional material and the provision of voluntary network of local health professionals a guest speaker from the GRPCC was very much appreciated by the East Gippsland and community members and sponsors Palliative Care Network Group.” included the GRPCC, Bairnsdale Regional Health Service, Bupa Aged Care Eastwood and Margie Griffi ths, East Gippsland Palliative Care Network Group and the Bairnsdale RSL. Chief Pharmacist BRHS e East Gippsland Palliative Care Network Group is a small group of like-minded members who have an interest in community information sharing surrounding palliative care. Ron was a 64-year-old male with * Take control: A kit for making powers of attorney and guardianship, O ce of Public Advocate and le pleural mesothelioma. He Victoria Legal Aid, updated February 2014. lived with his wife of 40 years in a regional community close to the main town. Ron has adult children: Ron was not referred to the local palliative preference to die at home; his son lives locally and his two care service until late in his illness. He was worked with the local nursing team daughters relocated from the west initially assessed and followed up by the to ensure regular use of evidence to be closer to their parents. Ron Nurse Practitioner Candidate (NPC) who: palliative care assessment tools to and his wife have a very close and liaised with the specialist palliative care promote e ective pain assessment supportive network of friends in specialist and GP to promote e ective screening and management; their local community. pain regime/s. Specialist palliative care liaised with the Gippsland Asbestos reviewed Ron twice within six weeks; Ron nominated pain (uncontrolled Related Support Group (GARDS) who widespread chest wall and le shoulder liaised with the medical oncologist assisted Ron and his wife to lodge a pain that radiated to this abdomen) as to put in place a plan of action to compensation claim and provided his chief complaint, greatly impacting access the local hospital and specialist ongoing support. e NPC also on his quality of life. Ron’s pain was palliative care service in Melbourne as facilitated a GARDS education session di cult to control as it featured various there was the risk of a pain crisis; for clinical sta at her workplace. physiopathological components. He was receiving radiotherapy but was fed up and advocated on Ron’s and his family’s behalf Ron’s pain was controlled. He decided to demoralised with recurrent admissions to to the medical oncologist regarding the cease all active treatment and was cared for hospital because of refractory pain. cessation of active treatment and his and died at home, as he wished.
Strategic Direction 1: Informing and involving clients and carers Strategic Direction 2: Caring for carers Strategic Direction 3: Working together to ensure people die in their place of choice Strategic Direction 4: Providing specialist palliative care when and where it is needed Strategic Direction 5: Coordinating care across settings Strategic Direction 6: Providing quality care supported by evidence
Page 15 Strategic Direction 2: Caring for carers
Page 16 Gippsland Region Palliative Care Consortium
Strategic Direction 2: Caring for carers
After-hours Palliative provide a er-hours care providers with all would recommend the Care Support relevant up to date information. For a full training to others. list of initiatives, see Table 4. In 2011-12, the Victorian Department of Health Workshop evaluations highlighted the provided recurrent funding to improve a er- 2. Guidelines for a er-hours service need for additional resources to support hours support for palliative care clients. e provision are being sourced / developed the decision making by nurses. ree main Department has also released the A er-hours by the GRPCC, see Table 4. Resources needs were: Palliative Care Framework (the Framework) to will include Symptom Management assist palliative care consortia in implementing Guidelines that are intended as a reference guidelines to support clinical decision an a er-hours model within their region. to be suitable for use by generalist nurses. making; ese are currently under review by the For community palliative care clients, the up to date, relevant client information GRPCC Clinical Practice Group. minimum level of service includes telephone available a er-hours; and advice and a nursing visit if appropriate. 3. Six telephone triage training workshops protocols and procedures within health Background data collection and planning was were held during the rst half of 2014 with services. conducted in 2012-13 and recommendations 110 nurses from across Gippsland attending. based on this work have been implemented e sessions were delivered by Robin An A er-Hours Palliative Care Proposal during 2013-14: Tchernomoro of LearnPRN P/L and Carol – Phase 2 was approved by the Consortium Barbeler, GRPCC’s Palliative Aged Care 1. Tools to assist with best practice care Management Group. e proposal describes Resource Nurse. Evaluations show that planning have been sourced / developed the current situation for a er-hours the training was very well received: by the GRPCC. A main initiative is the palliative care in Gippsland compared to the Client Summary Palliative Care that is being over 98% agreed that the Framework and proposed GRPCC actions piloted. It is expected to be useful as a care workshop met their expectations, was to address identi ed gaps. A copy of the full planning tool as well as for communication well presented and was relevant to proposal is on the GRPCC website (www. between palliative care providers, e.g. to their work; and grpcc.com.au). Table 4 provides a summary.
Table 4: After-hours Palliative Care Framework key elements and GRPCC actions to address identifi ed regional gaps
Key Element Actions by the GRPCC 1 Best Practice Care Planning Promote the use of PCCN endorsed tools A Client Summary Palliative Care – being piloted Symptom Management Information Sheets – under review Carer’s Safety and Information Kit pilot completed in 2014 Carer Group Education pilot completed in 2014 Anticipatory prescribing guidelines - endorsed 2 Client information system The Client Summary Palliative Care provides a uniform data set Scoping implementation of palliative care software 3 After-hours telephone triage Six Telephone triage training sessions offered to all relevant staff Resources: – WA Cancer and Palliative Care Network Evidence based clinical guidelines for adults in the terminal phase – Symptom Management Guidelines for health professionals - under review – Telephone Triage Protocols (under development) 4 After-hours nursing visit See resources above Verifi cation of Death guideline – endorsed 5 After-hours medical support Monash Health and Peninsula Palliative Care Unit are providing after-hours palliative medicine advice to health care workers in Bass Coast, South Gippsland and Baw Baw Shires GRPCC scoping palliative medicine support for Latrobe Valley, Central and East Gippsland 6 Activity following an The Client Summary Palliative Care incorporates a form for capturing data about phone after-hours contact calls – being piloted
Page 17 Strategic Direction 2: Caring for carers
Figure 5: Gippsland funded palliative care Goal of care in care plan services (n=9) and their use of speci c care planning components, 2013 and 2014 MDT discussion with palliative care specialist (i.e. NP/C or medicine specialist) available All carers and 93% of health professionals Family meeting for all clients thought the Carer’s Kit 2013 was a useful resource... Advance care planning offered 2014
Copy of care plan to carer/client
0% 20% 40% 60% 80% 100%
e GRPCC sought updated information A pilot of the Carer’s Safety and Information Kit Residential aged care facilities (RACF), from all community palliative care services (originally developed by the Loddon Mallee with an Aged Care Assessment Service in 2014 to learn about any changes to service Palliative Care Consortium) was completed (ACAS) assessment; and delivery (Figure 5) and to get feedback about at LCHS, GLCH and GSHS during Jan-Apr Palliative care services (and volunteers). GRPCC initiatives. We found: 2014. A total of 31 kits were handed out and Respite beds are accessible in all local All services support the work by the evaluations by both health professionals and government areas of Gippsland. All RACFs GRPCC to upskill local nurses who carers were completed. All carers and 93% of manage their own respite bookings, and provide telephone triage for palliative health professionals thought it was a useful most have repeat bookings from community- care clients and carers. One service was resource and all health professionals thought open to using a metropolitan based it should become part of the regular resources based clients. Respite is booked ahead across palliative care service for telephone provided to palliative care clients / carers. All the annual calendar, and planned discharge triage in the future. carers agreed that the kit helped them feel on allocated days is essential. Some RACFs more con dent as carers. It is recommended will o er additional respite beds days if beds All services agree that documents to that the GRPCC facilitate the roll out of the are not occupied (with funding approval). support clinical decision-making by kit to all interested community palliative care nurses (e.g. symptom management Local health services and the NCRP are able services in Gippsland a er a review of the kit guidelines, anticipatory prescribing to contact RACFs individually for emergency contents based on suggested improvements guidelines and telephone triage respite. However, most respite beds are and based on a recent review by the Loddon protocols) would be very valuable. booked to near capacity ahead of time. Mallee Palliative Care Consortium. Six of nine services are currently A survey of GRPCC member services shows During 2014-15, work to nalise the working to make changes to their care that eight of 14 services (57%) have sta planning processes, in three cases as a Gippsland A er-Hours Palliative Care Model will education about respite care, while six of 14 result of National Standards Assessment continue and components of the Model will be services (43%) have respite education for clients Program (NSAP) recommendations. implemented across palliative care services. and carers included in their policies / procedures.
Respite care Carer education sessions
In 2013-14, the GRPCC investigated how Caring for a loved one dying at home can respite could be accessed in Gippsland and be isolating and overwhelming. Funded also mapped where respite beds were available through a GRPCC quality initiative, three in RACFs. e provision of respite in the carer group education sessions were held at palliative care environment in Gippsland is LCHS in Morwell in 2013-14. e program provided through the following agencies: was developed and validated by the Centre for Palliative Care. Each program runs for Home and Community Care (HACC) - three weeks, and respite and transport were with each shire having their own agency provided so that carers could attend. e who manages the program; program was facilitated by the Pastoral Care National Carer Respite Program (NCRP) Nurse and was presented by various allied – for short term, episodic care; health practitioners and volunteers ensuring
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Caring often comes at a cost. Carers have poorer health and wellbeing than non-carers...
a multidisciplinary approach. e program for my daughter who died. I can’t light a e Conference was held on Friday 26th included time for group discussion and candle because my husband is on oxygen and Saturday 27th July and opened with resulted in a number of allied health referrals so I pick a ower from the garden. I was a Gala Dinner followed by the plenary and carer initiated volunteer matching. To worried what people might think when sessions the following day. Professor Samar date 13 carers, three volunteers and three they come in and see it. Now I know it’s Aoun, Professor of Palliative Care at the sta have attended the program. OK to have it there and that it doesn’t School of Nursing and Midwifery at Curtin matter what other people think.” – a lady University, delivered the keynote address at According to the evaluations, the most useful caring for her husband whose daughter the Gala Dinner. Professor Michael Ashby, topics were the GPs presentation (“gave an idea died of cancer a few years before. Director of Palliative Care, Royal Hobart of typical progression – days/decline); Carer’s Hospital and Southern Tasmania Area safety kit (“excellent resource of the services e carers have also developed an informal Health Service was the keynote speaker for available”); understanding the physical process carer support group and work is currently the Plenary, and the conference program of expiration over a period of time and what to being undertaken to support this. A carer- included presentations from three carers do when someone dies at home. initiated monthly support group has also and one volunteer. Attendance was down been recommended and work is currently Comments by attendees provided on the on the previous year with the Gala Dinner being undertaken to support this. Two more evaluation forms: attracting 40 people compared to 63 in programs are being organised for 2014-15. 2013. e plenary/concurrent sessions were “At rst I didn’t know how I was going attended by 61 people compared to 92 in to nd the time to come to this group but 6th Annual Gippsland 2013. Evaluations indicated that the speakers I am so glad that I did.” Palliative Care Conference were overall of very high standard and the “Coming into the group I thought I – Life and Death Matters: carers presentations were very well received. needed counselling but now I know I Carers need care too! Refer to Strategic Direction 6: Providing am OK. I do know that counselling is In line with Strategic Direction 2, the theme quality care supported by evidence for available if I need it and I know how to of the 6th Annual Gippsland Palliative Care more information on the Conference and access it but I am OK.” Conference was caring for carers. its evaluation. “I know somebody who is also looking a er her husband and palliative care are involved. I am going to tell her to make sure she does this course.” Why did the carer cross the road? “I have a picture and ower at home is was the title of Sue Binzer’s presentation at the 6th Annual Gippsland Palliative Conference. According to Sue, the title came about because she tried to nd jokes about carers online but without any luck. No-one jokes about a carer! However, without laughter, Sue said she wouldn’t have made it to the other side. ere are around 2.6 million unpaid carers in Australia – around 12% of the ere was an population. Caring o en comes at a cost. Carers have poorer health and wellbeing than obvious growth in the non-carers. Caring responsibilities can also adversely impact upon family nances due participants from the to the costs involved in caring, and because of reduced opportunities to work and save. beginning of the course to For health professionals from all disciplines, self-care is also important to reduce the risk of burnout and stress. the completion. From the initial introduction where Sue was a carer for her parents, husband and two friends over a seven-year period. participants were reluctant e position description for a carer is not appealing; the outcome is not what you want, but it can be a role that any one of us may have to take on at one time in our lives. to share and disclose information to the nal So why do you do it? For most it is because we love our family and close friends, but session where they were all for some it can be seen mainly as an obligation. Sue went on to thank all who gave her crucial support she needed in her role as a carer; it was a very long list and she gave openly talking about death many personal and heartfelt examples. and dying.” Sue’s conclusion was that without all this support, carers won’t have the strength to do Michelle Davy, Organiser their very important job and they will be forced to hand it over to health professionals. and co-presenter of Carer e value of carer’s contribution to the economy is a staggering $40.2 billion dollars a education sessions year – we must encourage caring in society, both for our own sake and the economy.
Page 19 Strategic Direction 3: Working together to ensure people die in their place of choice
Page 20 Gippsland Region Palliative Care Consortium
Strategic Direction 3: Working together to ensure people die in their place of choice
Palliative Aged Care Link Figure 6: Aged Care Link Nurse’s increase in Nurse Project con dence post compared to pre training (all di erences signi cant p<0.01), n=95 In 2011-12, the Victorian Department of Health provided funding for four years to facilitate end Discussing death and the dying with of life care pathways in residential aged care residents facilities (RACFs) to ensure that more people are supported to die in their place of choice. Discussing death and the dying with relatives e aim of the Palliative Aged Care Link Nurse Project is to assist RACFs to build their capacity Supporting residents and families to deliver a palliative approach to care. A when they become upset Palliative Aged Care Resource Nurse (PACRN) has been employed by the GRPCC since Recognising and responding October 2012 and a pilot of a two day training to pain in residents program for Residential Aged Care Facility Recognising and responding (RACF) nurses was undertaken during 2012- to nausea in residents 13. e trained nurses became known as the aged care link nurses who can then pass on their Recognising and responding to knowledge to other sta within their workplace. terminal restlessness/agitation During 2013-14, the two day training Recognising and responding to program to become a palliative aged care delirium in residents having a palliative approach or EOL care link nurse (link nurse) was o ered to nurses at all of the 53 facilities in Gippsland. By Assisting with completion of Advance Care Plans the end of June 2014, a total of 149 nurses had been trained; representing 92% of all Recognising when to commence Gippsland facilities (see Table 5). Eighty of End of Life Care Pathways these nurses were trained during 2013-14 (69 were trained in 2012-13). Assessing residents with limited or diminished communication skills Participants in the training completed pre- and post-training evaluations that measured Supporting my colleagues caring for residents having a palliative their con dence in key palliative care activities. approach or EOL care e percentage increase in con dence is Recognising and responding provided in Figure 6. e nurses’ con dence to expressions of grief in was signi cantly higher (p<0.01) post training residents and their relatives compared to pre training (Student’s t-test). 0% 5% 10% 15% 20% 25% 30%
Table 5: Number of RACFs and link nurses trained in Gippsland as at end June 2014 Local Government Number No. of beds RACFs RACFs involved in link Percentage of facilities Link Area (LGA) of RACFs in LGA visited nurse training with link nurse Nurses Trained Bass Coast 8 477 8 7 88% 34* Baw Baw 6 419 6 6 100% 29 East Gippsland 11 570 11 10 91% 36 Latrobe 11 754 11 10 91% 27 South Gippsland 8 288 8 8 100% 34* Wellington 8 373 8 8 100% 23 TOTAL 52 2881 52 49 94% 149
* Combined link nurses trained
Page 21 Strategic Direction 3: Working together to ensure
Advance Care Planning Pre (ACP) offered Post
Figure 7: Impact of link nurses on RACFs in Gippsland, n=23 End of Life Care Pathway (EOLCP)
Increase in con dence post training was Education by link nurses also analysed by sub-region (East Gippsland/ Wellington, South Gippsland/Bass Coast, and Baw Baw/Latrobe) and there were some consistencies and some variations in the Referrals to palliative care palliative care activities that showed the most increase in con dence post training (Table 6). Comments by attendees provided on the 0% 20% 40% 60% 80% evaluation forms:
“I gained a lot from the open discussion and Following the completion of the link nurse meetings; and case studies. e review of pharmacology training program across the region, the focus of referring to palliative care services for (related to case studies) was most bene cial. support for the palliative approach in residential Ethical debate was a ‘healthy’ discussion.” complex care needs. aged care has shi ed from upskilling individual “Great day, so valuable, new knowledge link nurses, to assisting the link nurses to transfer At six to 12 months post aged care link nurse and sound refresher. Taking back heaps and their skills and knowledge into organisational training, services were contacted to collect cannot wait to pass on in mini education practice. Prior to the aged care link nurse post training data to measure early impacts sessions for sta .” project commencing, baseline information was of the palliative approach key processes that “A very well structured day with great collected from RACFs relating to their current were introduced in the training. By the end of speakers and information.” use of the following palliative care activities: June 2014, 23 of 49 facilities had been audited (47%) and Figure 7 shows that changes in “My awareness and understanding of all advance care plans (ACP); their practices have occurred. aspects of palliative care are improving and end-of-life care pathways (EOLCP); increasing all the time. I would be happy to ACP is now used by 74% of services do the same topics again in a few years…” palliative care case conferences/family compared to 22% pre training. However,
Table 6: Top three items for Aged Care Link Nurse’s increase in confi dence post training by subregion
% Increase in Region Palliative Care Activity confi dence East Gippsland/Wellington, n=27 Recognising when to commence End of Life Care Pathways 27 (EOLCP) Recognising and responding to delirium in residents having a 27 palliative approach or EOL care Assisting a resident and their family to discuss and complete Advance 20 Care Plans (ACP) South Gippsland/Bass Coast, n=19 Discussing death and the dying process with residents 32 Recognising when to commence End of Life Care Pathways 31 (EOLCP) Recognising and responding to delirium in residents having a 27 palliative approach or EOL care Baw Baw/Latrobe, n=38 Recognising when to commence End of Life Care Pathways 30 (EOLCP) Assisting a resident and their family to discuss and complete Advance 27 Care Plans (ACP) Recognising and responding to delirium in residents having a 23 palliative approach or EOL care
Page 22 Gippsland Region Palliative Care Consortium
there is still a reluctance to undertake the necessary discussions with family and the GP Table 7: PACRN supported education sessions in RACFS during 2013-14 to complete this activity. Similarly, the use of EOLCP in RACFs has increased from 26% pre LGA Topic Number of Audience training to 57% a er training. Furthermore, sessions 57% of RACFs referred at least one resident Baw Baw Pain 1 PCA/EN/RN to palliative care in 2013-14, compared with Latrobe Palliative Approach 2 PCA/EN/RN 0% in 2012-13. Additional work is needed to improve the skills and knowledge of all sta Pain 1 PCA/EN/RN involved in care of residents at end of life. is Wellington Palliative Approach 2 PCA / EN / RN / training is planned for 2014-15. Environmental staff / Administration A family meeting/discussion to review Nutrition & Hydration 1 PCA/EN resident care needs is a requirement of the Aged Care Standards on an annual or more Pain 1 PCA/EN frequent basis. e key process of palliative care case conference introduced as a part of the aged care link nurse training is aimed at Palliative Approach Training and providing support to nurses in residential identifying the need for shared planning of care for personal and direct care care. To complement this, direct care workers and common goals when a palliative approach workers also need the opportunity to improve their is required. e need to communicate knowledge and con dence in providing care e ectively and in a timely manner with the Irrespective of their place of residence, and recognising changes in people who are resident, family, GP and sta is emphasised as individuals having a palliative approach to having a palliative approach. In 2013-14, the a part of this process. RACFs are encouraged to care will have frequent contact with direct GRPCC successfully obtained additional formalise case conferences / meetings as a part care workers, who provide much of their funding through the PEPA program to provide of their palliative approach procedure. daily care. Direct care workers (personal education to direct care workers. e GRPCC With the introduction of the Residential carers, community care workers, disability delivered three PEPA workshops across the In-reach (RIR) service to Gippsland, access support workers) are in an ideal position to region, commencing in November 2013, to acute services for RACF residents has recognise and report changes in residents and concluding in May 2014. Workshops improved. Currently the RIR service is in its were conducted in Bairnsdale, Leongatha and clients who have life limiting conditions. initial stage, but RACFs using these services and Warragul with a total of 81 participants have reported anecdotally a decrease in the e Palliative Aged Care Link Nurse from both residential and community based need to transfer to accident and emergency Program has focused on building capacity organisations (Table 8). departments. Multiple factors impact on decision making to transfer a resident from Table 8: PEPA Extension - Palliative Approach Workshops for Personal the RACF to acute health services, so objective Care Assistants and Direct Care Workers measurement of ‘inappropriate transfer to acute services’ is not feasible nor appropriate. LGA Topic Audience Number of participants e PACRN continues to provide support to link nurses and residential care facilities. South Gippsland Palliative Approach Personal Care Assistants 26 (PCA) / EN / RN During 2013-14, 24 follow up visits to RACFs were provided. Highlights of assistance Baw Baw Palliative Approach PCA 35 provided either at a visit or over the phone East Gippsland Palliative Approach PCA/EN/RN 20 include (number if applicable):
provision of teaching material, resources and support in delivering both formal and informal education sessions (see Table 7) 11
providing education sessions to all sta and acting as a mentor when link nurses are teaching 6 assistance to service providers in referrals and working collaboratively with RACFs (i.e. residential in-reach, 6 palliative care services, Dementia Behaviour Management Advisory Service) provision of printed resources for facilities to develop a lending library to support both relatives, residents, and sta in 5 promoting communication and family meeting assistance in reviewing policies and procedures related to palliative care in residential aged care 4 distribution of a periodic GRPCC Palliative Aged Care Link Nurse e-newsletter (current distribution is 146 link nurses, 2 RACF managers and other interested health professionals who have signed up to receive the e-newsletter) provision of review workshops for link nurses to network and discuss common goals and challenges in a palliative approach *
* Preparation only in 2013-14. To be implemented in 2014-15.
Page 23 Strategic Direction 3: Working together to ensure
Participant registrations PEPA workshops for health provide collegial support to members in professionals and disability instigating this new program across Gippsland. were signifi cantly higher workers RIR aims to provide acute assessment and in 2013-14 compared treatment in residential aged care facilities for e GRPCC assists the Department of Health residents, in preference to transferring them with 2012-13 (Table to promote PEPA workshops in the region. to Emergency Departments. In 2012-13, Alzheimer’s Australia and Robyn 9) indicating a greater Allan, a professional educator were funded to provide these workshops across Victoria. Victorian Palliative Care awareness of the Consortia Aged Care program through the Two workshops for both health professionals Network and disability support workers were held promotion undertaken in Gippsland in 2013-14. Participant e GRPCC established the Victorian Palliative Care Consortia Aged Care Network by the GRPCC... registrations were signi cantly higher in 2013- 14 compared with 2012-13 (Table 9) indicating (VPCCACN) in late 2012 and provides a greater awareness of the program through the ongoing secretariat support to this network. promotion undertaken by the GRPCC. Now in its second year of existence, this network group continues to provide support to consortia members who hold the aged Residential In-reach (RIR) care portfolio. ere has been a signi cant Regional Managers Group change in membership of this group in is group was formed by the PACRN to 2014 as members have le their positions and been replaced, and where consortia have commenced programs in regions. e Table 9: Number of PEPA workshop registrations purpose of this group is to provide support and Target Audience 2012-13 registration 2013-14 registration networking opportunities to new members, as numbers numbers well as providing a collective forum for guests Healthcare workers 22 66 and stakeholders to interact and network. Disability support workers 14 29 A portal for sharing of documents was instigated by the GRPCC on Caresearch (www.caresearch.com.au). e portal continues to be populated with documents, anks to the GRPCC for giving our nursing sta the opportunity and access is arranged for new members. e to participate in the Palliative Aged Care Link Nurse program. collegial support that the Network provides to members fosters the sharing of innovative Being a low care stand-alone facility, our residents would usually be transferred to approaches to both barriers and enablers high care as their care needs increased or to a hospital a er an acute event; and o en to a palliative approach in residential these residents would not return to our facility for their end of life care. Over the past care. Each person that participates in the ten years we have provided palliative care, to some residents in certain circumstances, to Network brings skills and knowledge, and a high standard with the support of the local GP and District Nursing Service. is was the opportunity to participate in planning, only possible as the one educated sta member made herself available 24/7 for palliative sharing and problem solving approaches to and end of life care. palliative care for older people. Since participating in the Palliative Aged Care Link Nurse program, our low care stand-alone facility has provided palliative and end of life care to 90% of our residents Below: Caresearch portal at www.caresearch.com.au with some residents choosing to relocate closer to their family as their health declined. All Link Nurses report increased con dence in providing a high standard of palliative and end of life care and improved understanding of family and carer needs. ey feel better supported within the facility by each other and found the kit (Palliative Aged Care Resource Kit) and literature provided, a great resource. We look forward to attending further education sessions facilitated by the Gippsland Region Palliative Care Consortium.”
Hayley Chambers Facility Manager/Registered Nurse Melaleuca Lodge, Cowes
Page 24 Gippsland Region Palliative Care Consortium
National roll out of revised Palliative care in disability periods was also introduced. In 2013-14 there Palliative Approach Toolkit accommodation services were two referrals from disability supported accommodation services to palliative care e Brisbane South Palliative Care e GRPCC received funding from the Collaborative (BSPCC) in collaboration Department of Health in 2011-12 for four services compared to none in 2012-13. with the University of Queensland / Blue years to develop and implement a strategy to Life-limiting illness in people with Care is leading the roll out of the revised enhance palliative care capacity in disability disabilities has an e ect on the client, their Palliative Approach Toolkit, funded by federal accommodation services consistent with family, and their carers, and the GRPCC Department of Social Services. e GRPCC is the Disability Residential Services Palliative has a role in providing support to carers as assisting BSPCC by conducting workshops in Care guide. Across Gippsland, there are local regional areas in Gippsland. e focus 24 government-funded houses and ve they assist their clients in the last period of of these workshops will be to review the key community services (Mirridong Services their life. In both the aged care and disability processes of a palliative approach and to allow Inc, Noweyung, EW Tipping Foundation Inc, sector, aside from education, support, and RACF to apply for a copy of the revised toolkit. Yooralla and Scope (Vic) Ltd) that manage a building capacity to deliver person centred total of 18 houses. e GRPCC, in its initial roll out of the aged care, there is also an important role for the care link nurse training, funded a modi ed Education and support is also being o ered palliative aged care and disability resource palliative approach toolkit for RACFs that in the disability sector. During 2013-14, nurse to ensure that RACFs and disability were involved in the training. In 2012, it was sta working in individual group homes services are aware of the support available to announced that the Department of Social were o ered the opportunity to discuss them from their local community palliative Services would fund a national roll out of the ageing in their clients, and the concepts and care service. Providing this knowledge of toolkit. Across Victoria, the BSPCC has also approaches that are appropriate for people how and when it is appropriate to refer to a been working in collaboration with the VPCC with disabilities. Support for carers who have palliative care service has and will continue to Aged Care Network to facilitate a coordinated actively advocated for their clients to achieve be an important part of a palliative approach approach to workshops and the roll out. the best quality of life possible for long to care for people with life limiting illnesses.
e Program of Experience in the Palliative Approach (PEPA) program provided additional BreastScreen Victoria diagnosed a resident of one of Gippsland’s funding for the aged care and disability sector disability group homes with breast cancer during a rou tine for palliative approach training. e focus in mammogram. e house supervisor identi ed that her team would the second half of 2014 will be on end of life bene t from learning more about the resident’s condition and the care, and the use of pathways. treatments she was to undergo, such as chemotherapy, surgery and radiation. e operations manager organised for the GRPCC’s Palliative Aged Care and Disability Resource Nurse to meet with the sta team and the resident’s family.
According to the house supervisor, the nurse answered all their questions about what to expect as the resident underwent her individual journey with cancer and how they could best support the resident. According to the house supervisor “the session settled the sta ng team and provided a shared The family and staffi ng understanding of the likely progress of the condition”. group ‘sang the “Everyone has their own opinions and experiences about cancer and it praises’ of the GRPCC provided a forum for people to air their concerns and have them addressed.” nurse who provides e family and sta ng group ‘sang the praises’ of the GRPCC nurse who provides support, education and guidance for disability and residential aged support, education and care workers and health professionals across Gippsland. e house supervisor guidance for disability noted that “the resident has her medical team, but the Palliative Aged Care and and residential aged Disability Resource Nurse provided support and advice to the sta ng group and family.” care workers and health professionals across Reported in the Department of Human Services Disability Accommodation Services Practice Update, Edition No. 35, July 2014. Gippsland...
Page 25 Strategic Direction 4: Providing specialist palliative care when and where it is needed
Page 26 Gippsland Region Palliative Care Consortium
Strategic Direction 4: Providing specialist palliative care when and where it is needed
Specialist Palliative Care 2. Implement a consistent data collection Consultancy Service method across the region to improve reporting; e GRPCC has continued to work according to A Specialist Palliative Care 3. Continue to encourage GP participation in Consultancy Service Plan for Gippsland 2011- MDT meetings and case management; and 2015. During 2013-14, work within Phase 2 4. Begin the recruitment process for palliative of the Specialist palliative care consultancy medicine consultant/s to the region. service implementation strategy (Figure 8) has continued and included: While many telehealth initiatives have been implemented (videoconferencing of MDT primary and secondary consults by meetings, video-recording of education visiting palliative medicine specialists; sessions), there continues to be many education by visiting palliative medicine challenges in building telehealth capacity. specialists; e GRPCC is continuing to partner with the Gippsland Health Alliance to resolve support for Nurse Practitioner Candidates these issues. (NPC) by the NP mentor; and A region wide data collection by local strategies to increase involvement by palliative care services about the visiting GPs in multidisciplinary team (MDT) palliative medicine specialist service was meetings and case management. implemented in January 2013 and this report Calvary Health Care Bethlehem (CHCB), includes the rst full nancial year of data. Monash Health (MH) and Peninsula Health GP participation was addressed (see Figure (PH) continue to provide visiting palliative 9) and work towards a resident palliative medicine specialist services to Gippsland. medicine specialist is underway, including Figure 8: Specialist palliative care a business case for a resident palliative consultancy service implementation Recommendations in a progress report titled, medicine specialist to be based in the region. strategy Specialist Palliative Care Consultancy Service Program 2007-12 – Interim report were to: 1. Continue to improve telehealth capabilities in collaboration with visiting palliative medicine specialists;
PHASE 3 Resident specialist palliative PHASE 2 care consultancy service Specialist palliative care 2013-15 consultancy enhancement PHASE 1 Palliative medicine specialist/s 2011-13 Secondary consultation living in Gippsland and providing Visiting specialists providing primary and secondary consults, 2008-11 primary and secondary consults, and education. Visiting specialists providing and education. Nurse Practitioners endorsed in secondary consults and Nurse Practitioner/Candidates in each sub-region providing key education. each sub-region. triage and clinical leadership roles. Visting specialists credentialed GP participation in muti GPs active in MDT meetings and and primary consults begins. disciplinary teams (MDT) meetings case management; and NPC program begins. and case management. increasingly skilled in palliative care.
Page 27 Strategic Direction 4: Providing specialist palliative care when and where it is needed
70% 2012-13 2013-14 60% Figure 9: Proportion of MDT meetings in Gippsland with involvement by GPs, allied 50% health and NP/C, Jan-Jun 2013 and 2013-14 40%
30% Primary and secondary consults by visiting 20% palliative medicine specialists 10% Visits to Gippsland by palliative medicine 0% specialists were increased during 2013-14 as %GPs %NP/C % Allied Health follows:
South Gippsland was visited twice per counsellor met with stakeholders at LCHS, professionals attending MDT meetings in month (rather than once) from May 2014; LRH, CGHS and BRHS and provided the region was six, ranging from two at education sessions which were well attended WGHG to ten at Foster. e average number MDT meetings at Korumburra by allied health professionals. of patients discussed at each meeting was commenced in May 2014; six, ranging from three at BCRH to 10 at Regular MDT meetings with involvement by Leongatha and BCCHS. Bass Coast was visited twice per month palliative medicine specialists and NP/Cs were (rather than once), from February 2014; provided across the region in nine locations Due to capacity, CGHS and WGHG were unable to maintain a constant involvement Latrobe Valley was visited three times per (Table 10). e MDT meeting format is di erent in MDT meetings throughout the year. month (rather than twice), from April 2014. by sub-region and includes teleconference or In addition, BRHS/GLCH replaced a videoconferencing (if available). In addition, involvement by psychosocial number of meetings with secondary phone specialists was introduced in 2013-14 to e number of MDTs has remained stable consultations. ese issues have either address an identi ed gap in the region. A at 94 meetings in 2013-14 compared to 99 already been addressed or there are plans to bereavement counsellor and a pastoral care in 2012-13. e average number of health address them in 2014-15.
Table 10: Multidisciplinary (MDT) meetings in Gippsland with involvement by visiting palliative medicine specialists, 2013-14
Meetings Frequency No. of Average no. Average Meetings Meetings with Allied Consultancy of meetings of patient no. of with GP with NP/C Health Location LGA service meetings held discussions attendees attendance attendance attendance BCCHS Bass PH Monthly 8 10 7 13% 75% 88% Coast
BCRH Bass PH Monthly 8 3 9 88% 88% Coast
BRHS/ East CHCB Fortnightly 11 5 4 55% 9% GLCH Gippsland
CGHS1 Wellington CHCB Fortnightly 12 4 3
GSHS – South PH Monthly 9 7 9 100% 22% Foster2 Gippsland
GSHS – South PH Monthly 2 5 10 100% 100% Korumburra2 Gippsland
GSHS – South PH Fortnightly3 11 10 5 36% 82% Leongatha2 Gippsland
LCHS Latrobe CHCB Fortnightly 23 6 8 96% 83% 35%
WGHG Baw Baw MH Fortnightly 10 6 2 10% 90%
Region Region 94 6 6 49% 43% 38%
1 e CGHS MDT is extended to YDHS via teleconference as required. 2 South Gippsland Palliative Care Service (funded through GSHS) covers the South Gippsland LGA. Meetings have been held in three locations since May 2014, when meetings in Korumburra commenced. 3 Fortnightly from May 2014, previously monthly.
Page 28 Gippsland Region Palliative Care Consortium
ere was a slight overall increase in GP which led to palliative medicine specialists not a visiting palliative medicine specialist in attendance at MDT meetings in 2013-14 being able to access the meetings, dropping Gippsland; totalling 646 (client) consultations. compared to 2012-13 (see Figure 9 and Table 10 out of meetings and not being able to fully In comparison, there were 334 client for data by meeting). However, the proportion participate. Recommendations were also made consultations across the region in Jan-Jun of meetings attended by NP/Cs and allied health for more formal processes at the meeting, 2013. Client information data was not collected professionals was less in 2013-14 compared with the chair being more proactive in on the primary consultations undertaken at to Jan-Jun 2013. Reasons for reduced NP/C seeking feedback from the palliative medicine William Buckland Radiotherapy Centre. attendance include restructure of the service in specialists. Issues with videoconferencing have Client information shows that 41% of Bass Coast and South Gippsland and a period continued and the GRPCC is partnering with discussions were for newly registered clients without an NPC available in East Gippsland. the Gippsland Health Alliance to improve the videoconferencing facilities and processes. with the local palliative care service, while 49% In addition to the palliative care MDT meetings were review consultations and the remaining Primary consultations are now available detailed in Table 10 the GRPCC also funds a 10% were for bereaved clients (Figure 10). across Gippsland, both in the inpatient, palliative medicine specialist to participate in ese gures were all similar to those for 2012- outpatient and community settings, except the fortnightly Gippsland Regional Integrated 13. Phase of care was also collected and 34% in Baw Baw. During 2013-14, a visiting Cancer Services (GRICS) Lung Tumour Stream of clients were in the stable phase at the time palliative medicine specialist provided a total MDT meetings. In 2013-14, there were a total of discussion, while 26% were in the unstable of 86 primary consultations to clients across of 141 patient discussions at these meetings. A phase, 28% in the deteriorating phase, 2% in the Gippsland compared to 36 Jan-Jun 2013. recommended referral to the local palliative care terminal phase and 11% in the bereaved phase service was made for 14 patients. Secondary phone consultation with the (see Figure 11). e most common issue facing GRICS and the GRPCC undertook an palliative medicine specialist has continued to palliative care clients in Gippsland in 2013- evaluation of the palliative medicine component be o ered across the region to GPs, nurses and 14 was pain (41%), followed by psychological specialists in both the community and acute of the MDT meetings in late 2013. e needs (24%) and fatigue (24%). See Figure setting. e amount of time spent on secondary evaluation found that palliative medicine advice 12 which also includes a comparison with consultations has not changed signi cantly and referrals were suboptimal considering data from Jan-Jun 2013. Understanding the since 2012-13, however the data is incomplete. patients’ diagnoses and prognoses presented. most common symptoms faced by clients and Further investigation found that there had During 2013-14, there were a total of 560 carers assists the GRPCC to target appropriate been many di culties with videoconferencing client discussions at MDT meetings with education to sta .
Stable Unstable
Deteriorating Terminal Bereaved
Bereaved New Review 100%
100% 90% 90% 80% 80% 70% 70% 60% 60% 50% 50% 40% 40% 30% 30% 20% 20% 10% 10% 0% 0% 2012-13 2013-14 2012-13 2013-14
Figure 10: Proportion of clients (discussed at MDT meetings or as a Figure 11: Proportion of clients (discussed at MDT meetings or as a primary primary consult) in Gippsland by category, Jan-Jun 2013, n=379 and consult) in Gippsland by phase of care, Jan-Jun 2013, n=377 and 2013-14, 2013-14, n=612 n=609
Page 29 Strategic Direction 4: Providing specialist palliative care when and where it is needed
50% 2012-13 2013-14 45%
40%
35%
30%
25%
20%
15%
10%
5%
0% Pain Fatigue Nausea/ Agitation Bowels Breathlessness Social Psychological Spritual Other vomiting needs needs needs issue
Figure 12: Symptoms and issues among clients For further details about education, see Lisa Macdonald at GLCH). Lisa Macdonald in Gippsland (discussed at MDT meetings or Strategic Direction 6: Providing Quality was appointed to the position of NPC at as a primary consult), Jan-Jun 2013, n=379, Care Supported by Evidence. GLCH in February 2014 for a period of 2013-14, n=624 twelve months to replace Nicola Gorwell Support for nurse who took leave from the position. For details of the NPC’s work see Table 11. practitioner candidates - palliative care e GRPCC’s Nurse Practitioner Mentor, Irene Murphy, continued to provide e GRPCC provided funding to three lead mentorship, support and clinical guidance services to support the employment of four and advice to the NPCs as they move towards nurse practitioner candidates (NPCs) during their endorsement. 2013-14 (Jenny Turra at LCHS, Maryann A number of key milestones were delivered Bills and Kate Richardson at WGHG and by the Nurse Practitioner Mentor in 2013-14, including the: completion of the GRPCC Nurse Practitioner Candidate Palliative Care: Calvary Health Care Bethlehem has enjoyed a close working Professional and Educational Candidacy Framework. is document provides relationship with GRPCC for a number of years and has worked to the framework for all the professional, help support and develop palliative care in the La Trobe Valley, Central clinical leadership, knowledge acquisition, and East Gippsland. Our specialists provide clinical input and support skills and attributes required to meet and nd working with other health professionals in Gippsland very the Australian Nursing and Midwifery rewarding. is is greatly assisted by the e orts of GRPCC to organise Council (ANMC 2014) National and liaise with the various services and health professionals we come Competency Standards for endorsement into contact with. Calvary Health Care Bethlehem looks forward to an as a Nurse Practitioner; ongoing relationship with the GRPCC that will continue to enhance development of the Terms of Reference and develop palliative care in Gippsland. for the Palliative Care Nurse Practitioner Candidacy Program Steering Committee Scott King and convening of meetings; Clinical Director to Palliative Medicine Calvary Health Care Bethlehem introduction of Learning Modules in
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Symptom Management in Palliative Care GRPCC partnership with West Gippsland Healthcare Group holds the (Pilot Project) to facilitate knowledge the McCabe Centre for Law position and provides a regional support and skills development in symptom and Cancer service. Support is provided in liaison management for the district nurses at with the MND regional advisor through: In an exciting new initiative, the GRPCC LCHS that builds on evidence-based education sessions, telephone support and partnered with the McCabe Centre for Law practice. ( e GRPCC’s intention is to personal contact as required. roll out the Learning Modules to other and Cancer (McCabe Centre) to develop district nursing services in the Gippsland an education program to build knowledge Key activities delivered in 2013-2014 included: and expertise in ACP and associated subregions, following the completion of attendance at regular MND Victoria the pilot and its subsequent evaluation); communication skills to better support meetings; patients in decision-making at the end of development of the Nurse Practitioner life. e program is speci cally targeted ongoing liaison with MND Regional Endorsement portfolio guidelines for to general practitioners however nurses advisor; the GRPCC; working in palliative and aged care will provision of telephone support to all provision of clinical support and also be included. Mayne Pharma provided Gippsland palliative care services as consultancy to district nursing sta in sponsorship covering the catering costs. the Gippsland subregions; required; e education program will be delivered in organisation of clinical supervision and two-parts: the rst part provided participants provision of information on MND to mentorship for Maryann Bills and Kate with an introduction to the McCabe Centre palliative care clients living with MND, Richardson at Monash Medical Centre and a general overview of ACP and relevant carers and health professionals and McCulloch House under the tutelage of case studies by Dr Barbara Hayes, palliative community care providers; Drs Jackson, William and Franco; care physician and ACP expert; and the facilitation of ongoing multidisciplinary second part will include a presentation by organisation of a clinical placement for team meetings for management & client the O ce of Public Advocate and a more Lisa Macdonald and Nicola Gorwell at care via videoconference link in client detailed presentation of the legal aspects of Calvary Health Care Bethlehem under home with specialist MDT at Calvary ACP by the McCabe Centre. e rst session the supervision of Drs King and Burke; Health Care Bethlehem; was held in May 2014 at the Inglis Medical delivery of a series of four capacity building Centre in Sale and attended by ve GPs, four ongoing liaison with local Palliative workshops, Impeccable Assessment Skills nurses and the Centre’s Care Coordinator. care teams and MND Palliative care in Palliative Care Practice, targeting nursing e evaluations rated the seminar highly specialists at Calvary Health Care; sta involved in palliative care delivery; and the second session is scheduled for education to sta on MND at Palliative delivery of a Twilight Seminar Series August 2014. e intention is to roll out the Care Secondary Consultation Meetings; for senior nursing sta and general education program across Gippsland during and practitioners involved in palliative care 2014-15 via direct attendance and webcast. delivery. e inaugural seminar was involvement in the ‘Walk for D feet’ on the use of pharmaceuticals use in Motor Neurone Disease MND community fundraising event palliative care and was held in Traralgon held in Warragul, December 2013. (July 2013) and Inverloch (November e Motor Neurone Disease (MND) Shared 2013); and Care Worker role is funded by the Victorian A survey of member services show that Department of Health through MND a total of nine sta from three services establishment of an innovative Victoria. e palliative care team leader from attended MND training during 2013-14. partnership with the McCabe Centre for Law and Cancer to assist Gippsland general practitioners build knowledge Table 11: Nurse practitioner candidates (palliative care) in Gippsland supported by GRPCC, 2013-14 and expertise in Advance Care Planning (ACP) to better support patients in Number decision-making at end of life. e two- Month of MDT Number part seminar was held at Inglis Medical Host Consultancy of NPC meetings of patients organisation LGA service appointment attended referred# Centre in Sale in May with the second GLCH East CHCB Aug 2011 6 111 session scheduled for August 2014. Gippsland For further details about the Impeccable LCHS Latrobe CHCB Feb 2011 19 61 Assessment Skills in Palliative Care Practice WGHG* Baw Baw MH Feb 2013 9 81 workshops, Twilight Seminar Series and the * WGHG hosted two NPCs during 2013-14, but individual data is not available as they shared referral Advance Care Planning Seminar refer to load and MDT meeting attendance Table 13. #GLCH and WGHG NPCs had direct or indirect involvement with all clients referred to the SPCSs in 2013-2014
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The involvement of the NPC and the palliative care specialist enabled Jenny to remain at home, Pastoral Care Project “Introduction to Spiritual Care: an education resource”. e resource will where she died peacefully In 2013-14, the GRPCC continued to be available nationally to all providers of partner with Spiritual Health Victoria surrounded by her family residential aged care, and therefore to the (SHV), formerly known as the Healthcare sta and volunteers who support people on the farm she loved... Chaplaincy Council of Victoria. in aged care. e resource will equip all e GRPCC provided support to those working in the sector to identify the SHV to produce an Education Package, spiritual needs of residents and to respond to these appropriately. It has the potential to be of bene t to all people, regardless of faith, gender, or cultural background, who use or are employed by residential aged care services in Australia including those who are I have enormous regard and respect for the work done providing palliative care to the aged. by the GRPCC. e GRPCC sta are a dynamic and dedicated e GRPCC also partnered with SHV team who continually strive towards the common goal of to provide a Clinical Pastoral Education promoting and improving palliative care in our region. unit in Gippsland. is course is generally provided in Melbourne which makes it My ongoing involvement with the GRPCC, through the Clinical Practice di cult for rural participants to access and Advisory Group and role as Motor Neurone Disease Shared Care Worker is a in turn negatively impacts on the availability positive experience that provides a framework for building leadership capacity. of trained pastoral carers in the region. e e support I receive from the Consortium as nurse practitioner candidate GRPCC assisted with the student selection fosters the clinical and professional con dence that I require to in uence process, provided support for students and quality palliative care delivery in our service. assisted with clinical placement. Students will complete their studies and placement in Maryann Bills, NPC and Palliative Care Team Leader, WGHG November 2014.
Jenny was 59 years old and diagnosed with Motor Neurone Disease (MND). Jenny lived in rural town with her husband and was very involved in the local community. She worked locally as a health professional and helped her husband manage the family farm. Jenny had a close and supportive relationship with her adult children and grandchildren who reside interstate and visited their parents o en. e nurse practitioner candidate (NPC) initially assessed Jenny and met with her regularly. From the outset of their relationship, Jenny was very clear about her feelings on two very important issues: wanting to have an Advance Care Plan developed in partnership with her family; and wanting to remain and die at home with her family. e NPC worked with Jenny and her husband to build his con dence to care for his wife at home and liaised with MND Association of Victoria to obtain the necessary equipment to enable Jenny to stay at home. Jenny was referred early to the local palliative care service and the NPC was instrumental in making sure that there was a coordination and collaboration with the many health care providers involved in supporting Jenny and her family. e involvement of the NPC and the palliative care specialist enabled Jenny to remain at home, where she died peacefully surrounded by her family on the farm she loved.
Strategic Direction 1: Informing and involving clients and carers Strategic Direction 2: Caring for carers Strategic Direction 3: Working together to ensure people die in their place of choice Strategic Direction 4: Providing specialist palliative care when and where it is needed Strategic Direction 5: Coordinating care across settings
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Strategic Direction 5: Coordinating care across settings
Page 33 Strategic Direction 5: Coordinating care across settings
Strategic Direction 5: Coordinating care across settings
e GRPCC continues to integrate policies with ACAS so that clients and carers have and practices across hospital and community timely and a ordable access to respite. settings to ensure access to coordinated and consistent care at the end-of-life, through the After-hours Palliative Consortium Management Group (CMG), Care Project the Clinical Practice Group (CPG) as well as linkages with Gippsland Medicare Local. e Many components of the A er-Hours Palliative The GRPCC has also Nurse Practitioner Candidates in Central- Care Project will help improve care coordination. shared and made clinical West Gippsland, Eastern Gippsland and Baw e development of guidelines such as the Baw continue to strengthen linkages between Client Summary Palliative Care has the policies and guidelines acute, community palliative care services potential to be used widely as a tool for e ective available to the broader and RACFs in their local government areas. communication between service providers, including acute, community, residential aged In 2013-14 through the Palliative Aged care, local government and ACAS. In addition, palliative care sector on Care Project, the GRPCC completed training resources to guide telephone triage of phone the GRPCC website... of link nurses which incorporated end-of-life care pathways. e Pathway for Improving calls from palliative care clients and carers the Care of the Dying (PICD) has been a er-hours, including symptom management supported by the GRPCC to be implemented guidelines, will help achieve evidence based care across the acute, community and residential by all members of the health care team. Refer to aged care sector ensuring a consistent Strategic Direction 2: Caring for carers for more approach to end-of-life care. information on this project. e GRPCC has provided representation on the Palliative Care Clinical Network and Palliative Aged Care provided updates on work in the region to Link Nurse Project encourage partnerships with services outside Increased collaboration between stakeholders the region. e GRPCC has also shared and service providers in the care of RACF and made clinical policies and guidelines residents is one of the aims of the aged care available to the broader palliative care sector link nurse project. An increase in awareness on the GRPCC website. of service provision, entry criteria and referral processes has been the focus of education Links with Aged Care for RACFs, aged care link nurses and service Assessment Service providers to make coordination of care a primary concern in the care of the resident. e Aged Care Assessment Service (ACAS) is the gateway to providing timely, a ordable Refer to Strategic Direction 3: Working respite care. e GRPCC recognises that in together to ensure people die in their place of order to assist clients to be cared for at home, choice for more information on this project. referrals to ACAS need to be done in advance so that planned respite can be put in place. Telehealth In 2013-14, the GRPCC met with Gippsland ACAS to encourage formal links between Technology continues to be a challenge in Work is continuing ACAS and the region’s palliative care services Gippsland and the GRPCC has supported in order to achieve earlier referral to ACAS many services to use videoconferencing for on building telehealth for palliative care clients. MDT meetings and education. Issues include reliable connectivity, tra c congestion, local A survey of member health services show capacity in Gippsland capacity and drop outs. Many services resort that 11 of 14 services (79%) have policies and/ to using alternate so ware and web based through a partnership or procedures regarding referral to ACAS systems to circumvent these issues. with Gippsland Health while eight of 14 services (57%) have formal links with ACAS. e GRPCC will continue In 2013-14, the GRPCC initiated recording Alliance... to encourage services to develop formal links of palliative care education sessions to be
Page 34 Gippsland Region Palliative Care Consortium
made available to health professionals at a Rosa was a middle-aged woman diagnosed with oesophageal time that suited them. Work is continuing cancer with extensive lung involvement. Rosa lived alone and on building teleheath capacity in Gippsland was socially isolated. She had two children, one was adopted and through a partnership with Gippsland Health Alliance. the other had been placed in foster care. Rosa had a history of psychiatric illness, which included many years of incarceration. Developing a model of She had di culties engaging with health professionals and was community palliative care very distrustful; she was perceived as ‘di erent’ by some of them. Rosa had no known general practitioner and remained unwell In June 2014, the GRPCC commenced work on developing a model of community during her stay in the palliative care service. Following some palliative care. ere are nine funded preliminary debate, Rosa was admitted to the service as it was community palliative care services in seen as “duty of care” from the health service’s perspective. Gippsland with signi cant variations in their e nurse practitioner candidate (NPC) involvement was pivotal in nding provision of palliative care. e project will Rosa a GP she could trust. Rosa refused to verbally communicate from the explore the di erences and similarities of six beginning about any issues related to her progressive disease including death of these services with the aim of developing and dying. However, the NPC’s expert knowledge and communication skills a model that: resulted in Rosa gradually opening up in di erent ways. For example, she is practical, applicable to all nine funded would willingly discuss plans for her cats’ welfare for when she was no longer services and based on best-practice there. Rosa’s artwork and literature was prominent in her home and provided principles; an opening for the NPC to talk with Rosa in a non-confrontational, meaningful way, allowing the NPC to learn more about who Rosa and what was important to makes the most of available resources; her. Rosa died at her home. and e NPC also worked with her colleagues and other health professionals to promotes consistent care, language and improve overall understanding of relevant professional components including the: evaluation. Palliative care professionals from around the region will contribute to the project and Code of Ethics and Conduct for nurses; and the participating services are: West Gippsland Healthcare Group; Health Service’s policies and protocols related to duty of care and Bass Coast Community Health Service; professional responsibility and accountability. Bass Coast Regional Health; e NPC modeled and exhibited a collaborative and inclusive approach through: Bairnsdale Regional Health Service; e ective symptom management and care planning; Gippsland Lakes Community Health; and advocacy role involving relevant health professionals; La Trobe Community Health Service. promotion of continuity of care i.e. limiting the number of palliative care It is expected the model of care’s nurses visiting Rosa. (Rosa agreed to phone calls initially and when her recommendations may assist the community trust was gained, she agreed to regular visits for symptom assessment and palliative care services to better identify support); and service delivery gaps for a more exible and sustainable workforce structure. ese allied health involvement. recommendations aim to promote capability and capacity building to enhance and improve palliative care delivery to meet increasing Strategic Direction 1: Informing and involving clients and carers demand for palliative care services. Strategic Direction 4: Providing specialist palliative care when and e palliative care services can adopt and/ where it is needed or modify these recommendations, according to their particular context of care, to ensure Strategic Direction 6: Providing quality care supported by quality care delivery that can be assessed evidence against national standards and that is supported by a quality improvement culture.
Page 35 Strategic Direction 6: Providing quality care supported by evidence
Page 36 Gippsland Region Palliative Care Consortium
Strategic Direction 6: Providing quality care supported by evidence
rough the CPG, the GRPCC maintains (NSAP). Details by service are summarised in consistent clinical care protocols that are Table 12. e Table also shows use of PCCN informed by research and evidence (See endorsed tools, which have been promoted under Organisational Structure). All funded to member services through the CPG. An member services participate in the annual increase in the number of services utilising Victorian Palliative Care Survey (VPCSS) these can be seen compared to 2012-13. No and eight member services now participate in member service submits data to the Palliative the National Standards Assessment Program Care Outcomes Collaborative (PCOC).
Table 12: Quality initiatives undertaken by member services, 2013-14 compared to 2012-13 Member NSAP VPCSS PCCN Endorsed Tools* Service Problem Distress Initial Pain Carer Support FICA Spiritual Symptom Australia Liverpool Severity Management Assessment Needs History Tool Assessment Modifi ed Care Score (PCOC) Tool (NCCN) Tool Assessment Scale (PCOC) Karnofsky Pathway, e.g. Tool (CSNAT) Performance PICD Scale BRHS BCCHS BCRH CGHS GLCH GSHS KRHS^ LCHS LRH ODH^ ORH^ SGH^ WGHG YDHS Total 8 10 3 4 7 3 1 6 7 11 2013-14 Total 6 10 2 2 5 1 0 5 5 8 2012-13
= implemented ^ = unfunded generalist palliative care services *Table only includes tools used by at least one funded member service. For a full list of PCCN endorsed tools, see Department of Health, Clinical tools to assist with specialist palliative care provision, November 2012.
Training and Education and Death Matters: Carers need care too; Telephone Triage Training; e GRPCC delivered 88 palliative care Advance Care Planning Seminar (Part 1); Monash University Palliative Care Short education sessions during 2013-14 within Impeccable Assessment Skills in Palliative Course; and the following categories (Table 13): Care Practice; Sessions presented by visiting palliative Aged Care Link Nurse Training; Palliative Care for Year 4C medical students; medicine specialists. PEPA Palliative Approach Training for Pharmaceuticals in Palliative Care; Aged Care Link Nurse Training, including Personal and Direct Care Workers; Victorian Communication Skills Training evaluation, is reported under Strategic 6th Annual GRPCC Conference – Life Program (VCCCP); Direction 3.
Page 37 Strategic Direction 6: Providing quality care supported by evidence
Table 13: Attendance* at GRPCC education activities 2013-14 by category, topic and profession of attendees
Note: Number of attendees was recorded for each individual session so total numbers re ect number of attendances, not numbers of people across sessions. No. of Other Medical Allied Total Average Education activity GPs Nurses Other sessions Medical student Health no.1 score2 Aged Care 13 183 81 264 Aged Care Link Nurse Training - Day 1 4 74 74 Aged Care Link Nurse Training - Day 2 6 109 109 PEPA Palliative Approach Training for Personal 3 81 81 and Direct Care Workers Conference 2 48 4 3 12 118 Conference; Gala Dinner 1 21 2 2 6 48 Conference; Plenary sessions 1 27 2 1 6 70 GRPCC 25 327 11 34 6 384 Advance Care Planning seminar 1 5 5 10 4.5 Impeccable Assessment Skills in Palliative 4 73 2 75 Care Practice Palliative Care for Year 4C medical students 3 34 34 Pharmaceuticals in Palliative Care 2 85 4 2 92 Victorian Cancer Clinicians Communications 9 59 4 63 4.83 Program Telephone Triage Training 6 110 110 4.74 Other 1 25 25 Monash University Palliative Care Short 1 25 25 Course Visiting specialist 47 16 474 51 9 49 8 631 Constipation in palliative care 4 2 34 3 41 4.2 Delirium and terminal restlessness 1 14 14 4.5 Early referral and goal setting in palliative care 1 6 6 End stage respiratory disease 2 0 35 0 0 0 0 37 4.0 Goal setting and early referral to palliative care 2 26 4 31 4.2 Introduction to oncology for palliative care 1 8 8 4.6 Managing complex pain in palliative care 4 3 48 3 3 58 4.2 Management of complex pain and use of 1 10 5 2 17 4.5 adjuvants in palliative care Management of the paediatric patient 1 1 15 5 2 4 28 4.3 Motor Neurone Disease 1 5 7 1 15 4.0 Nausea, vomiting and acute bowel obstruction 7 1 56 3 8 70 4.8 Opioid conversion 3 2 25 7 1 36 4.4 Palliative Care 1 1 2 1 4 4.0 Palliative care emergencies 4 29 1 30 3.9 Paraneoplastic syndrome 1 12 7 1 20 4.0 Pharmacotherapy of nausea and vomiting 1 17 8 1 26 4.2 Prognostic indicators in palliative care 1 10 2 5 17 3.1 Psychosocial care in palliative care 7 6 90 3 15 5 123 4.1 Terminal restlessness and delirium in palliative 2 17 25 4.2 care Transition from acute to palliative care 1 15 3 2 5 25 4.2 Q & A: Unanswered questions from clinical 1 practice Grand Total 88 16 1062 66 (5%) 43 (3%) 58 101 1422 (1%) (75%) (4%) (7%)
1 e same participant may have attended di erent sessions. 2 e score is an average score for respondents agreement with the statement ‘ e education provided today will change/enhance my practice skills’ in ve categories (Strongly disagree = 1, Disagree=2, Unsure=3, Agree=4, Strongly Agree=5.) 3 e score is for the statement ‘Increased con dence in my communication skills’ (categories were the same, but questions were di erent as the evaluation was by Cancer Council Victoria) 3 e score is for the statement ‘My understanding of the topic has been enhanced’ (categories were the same, but questions were di erent as the evaluation was by LearnPRN Pty Ltd)
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Table 13: Attendance* at GRPCC education activities 2013-14 by category, topic and profession of attendees
Note: Number of attendees was recorded for each individual session so total numbers re ect number of attendances, not numbers of people across sessions. Figure 13: Comparison of overall assessments Entirely Partially Not at all No. of Other Medical Allied Total Average of the Gala Dinner and Plenary / Concurrent Education activity GPs Nurses Other 1 2 sessions Medical student Health no. score sessions, 6th annual conference, 2013 Fullfilled expectations - Dinner Aged Care 13 183 81 264 n=30 Aged Care Link Nurse Training - Day 1 4 74 74 Aged Care Link Nurse Training - Day 2 6 109 109 Fulfilled expectations - Plenary/Concurrent sessions PEPA Palliative Approach Training for Personal 3 81 81 Program of Experience in the n=40 and Direct Care Workers Palliative Approach (PEPA) Conference 2 48 4 3 12 118 Learning needs met - Dinner n=31 Conference; Gala Dinner 1 21 2 2 6 48 PEPA placements Conference; Plenary sessions 1 27 2 1 6 70 Learning need met - A survey of member services shows that two of Plenary/Concurrent sessions n=40 GRPCC 25 327 11 34 6 384 14 services provided PEPA placements in 2013- Advance Care Planning seminar 1 5 5 10 4.5 14. Five services had sta complete a PEPA Relevance to practice - Impeccable Assessment Skills in Palliative 4 73 2 75 placement in a di erent service, including Dinner n=31 Care Practice Peninsula Health, Frankston Hospital, Royal Palliative Care for Year 4C medical students 3 34 34 Melbourne Hospital, Melbourne City Mission, Relevance to practice - Pharmaceuticals in Palliative Care 2 85 4 2 92 Cabrini Health and GLCH. Plenary/Concurrent sessions n=40
Victorian Cancer Clinicians Communications 9 59 4 63 4.83 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Program Reverse PEPA placement Telephone Triage Training 6 110 110 4.74 Carol Barbeler, the GRPCC’s Palliative Aged Other 1 25 25 6th Annual Gippsland Year 2013), Associate Professor Mark Boughey Care Resource Nurse undertook a reverse- Monash University Palliative Care Short 1 25 25 Palliative Care Conference (Director of Palliative Medicine, St Vincent’s and PEPA at Domain Aged Care, Bairnsdale Course – Life and Death Matters: Co-Deputy Director, Centre for Palliative Care), for three days in May 2014. Carol planned Visiting specialist 47 16 474 51 9 49 8 631 Carers need care too! Associate Professor Charlie Corke (Intensive a structured activity program that was also Care Specialist, Barwon Health), Professor Paul Constipation in palliative care 4 2 34 3 41 4.2 exible and responsive to the needs of care e theme of this year’s conference was Komesaro AM (Director, e Monash Centre Delirium and terminal restlessness 1 14 14 4.5 sta . e program included education, case caring for carers with Professor Samar Aoun for the Study of Ethics in Medicine and Society) Early referral and goal setting in palliative care 1 6 6 reviews and sta mentoring. delivering the keynote speech, Valuing Family and Dr Ranjana Srivastava (Medical Oncologist, Carers – the hidden patients, at the Gala End stage respiratory disease 2 0 35 0 0 0 0 37 4.0 Monash Health). Sta identi ed that communication was Dinner. e conference program included Goal setting and early referral to palliative care 2 26 4 31 4.2 an area requiring improvement, including presentations from three carers and one Introduction to oncology for palliative care 1 8 8 4.6 handover, written communication and volunteer and attracted a range of disciplines Impeccable Assessment Managing complex pain in palliative care 4 3 48 3 3 58 4.2 communication with families. Case reviews from across the Gippsland region. e Gala Skills in Palliative Care Management of complex pain and use of 1 10 5 2 17 4.5 of past residents were used to examine how Dinner was attended by 40 people, compared Practice adjuvants in palliative care communication could be improved. to 63 in 2012 (excluding GRPCC sta ), while e GRPCC delivered four Impeccable Management of the paediatric patient 1 1 15 5 2 4 28 4.3 the Plenary/Workshop sessions were attended In consultation with the sta , Carol also Assessment Skills in Palliative Care Practice Motor Neurone Disease 1 5 7 1 15 4.0 reviewed the RACF’s policies and procedures by 61 people this year compared to 92 last workshops across Gippsland during 2013. Nausea, vomiting and acute bowel obstruction 7 1 56 3 8 70 4.8 related to palliative and end-of-life care. year. A comparison of the degree to which the Gala Dinner and Plenary/Workshop e workshop presentations ran for four Opioid conversion 3 2 25 7 1 36 4.4 sessions ful lled participant’s expectations hours and included the following topics: Palliative Care 1 1 2 1 4 4.0 PEPA extension workshops and learning needs is provided in Figure 13. Cognitive assessment in palliative care; Palliative care emergencies 4 29 1 30 3.9 In 2013-14, the GRPCC successfully Planning for the 7th Annual Conference Paraneoplastic syndrome 1 12 7 1 20 4.0 Neurological assessment in palliative care; obtained additional funding through the commenced in early 2014 and in light of Pharmacotherapy of nausea and vomiting 1 17 8 1 26 4.2 PEPA program to provide education to direct 2013 attendances, it was decided to hold the Respiratory assessment in palliative care; Prognostic indicators in palliative care 1 10 2 5 17 3.1 care workers. Details of these workshops are conference at a new venue, the RACV Inverloch Abdominal assessment in palliative care; Psychosocial care in palliative care 7 6 90 3 15 5 123 4.1 provided under Strategic Direction 3. Resort, and invite a keynote international Physical, respiratory and abdominal Terminal restlessness and delirium in palliative 2 17 25 4.2 speaker, Dr Andrew Wilcock to attract a care Post-PEPA support broader audience. Dr Wilcock is the Director, examination skills; and Transition from acute to palliative care 1 15 3 2 5 25 4.2 palliativedrugs.com and Reader in Palliative Mindfulness and re ection presentation. In 2013-14, the GRPCC was provided with Medicine and Medical Oncology at University Q & A: Unanswered questions from clinical 1 Irene Murphy, GRPCC’s Nurse Practitioner practice funding to provide support to participants of Nottingham, United Kingdom. A number who had undertaken a PEPA placement in of other leading palliative care physicians Mentor, presented most topics. She was assisted Grand Total 88 16 1062 66 (5%) 43 (3%) 58 101 1422 (1%) (75%) (4%) (7%) previous years. is funding was used to and researchers also accepted the GRPCC’s by Jenny Turra, Nurse Practitioner Candidate support the 6th Annual Gippsland Palliative invitation to speak including Emeritus Professor (NPC), at Morwell, and Nicola Gorwell, 1 e same participant may have attended di erent sessions. Care Conference and all past PEPA placement Ian Maddocks AM ( rst Chair of Palliative Care, NPC, at Bairnsdale who both presented on 2 e score is an average score for respondents agreement with the statement ‘ e education provided today will change/enhance my practice skills’ in ve categories (Strongly disagree = 1, Disagree=2, Unsure=3, Agree=4, Strongly Agree=5.) participants were invited to attend. Flinders University and Senior Australian of the respiratory assessment in palliative care. 3 e score is for the statement ‘Increased con dence in my communication skills’ (categories were the same, but questions were di erent as the evaluation was by Cancer Council Victoria) 3 e score is for the statement ‘My understanding of the topic has been enhanced’ (categories were the same, but questions were di erent as the evaluation was by LearnPRN Pty Ltd)
Page 39 Strategic Direction 6: Providing quality care supported by evidence
Figure 14: Participant’s increase in self- reported competence post compared to pre Physical assessment Impeccable assessment in Palliative Care Practise training (all di erences signi cant Respiratory assessment p<0.01), n =35 Abdominal assessment
Cognitive assessment
Neurological assessment
0% 10% 20% 30% 40%
Four workshops were held with a total of Fundamentals of pharmacokinetics and 75 attendees and 63 evaluation forms were pharmacodynamics; completed (response rate 84%). e workshops Quality use of medicines; and were targeted at nurses who made up 61 of 63 completed evaluations with remaining two Choice of analgesics in palliative practice. completed by doctors. Mayne Pharma provided e seminars were well attended and very sponsorship, covering the cost of catering. well received with 97% of respondents rating e workshops were very well received. ey the overall quality as very good or good. e were rated as very good by 79% of respondents seminars were entirely relevant to 53% of and the workshops entirely met the learning respondent’s practice and 43% of respondents objectives of the majority of respondents and had their learning objectives entirely met. were relevant to their practice. Participants Mundipharma and Mayne Pharma provided also rated themselves as signi cantly more sponsorship, covering the catering costs. competent in the assessment skills covered by e GRPCC intends to continue the twilight the workshop a er attending. seminar format during 2014-15 and will Participants completed self-reported continue to work with Gippsland Medicare competence assessments pre-training and Local to engage the medical community post-training. e increase in competence and look at other ways of providing relevant post workshop compared to pre was seminars to prospective GPs through the statistically signi cant (p<0.01, Student’s Gippsland Medical School. t-test) (Figure 14). For Traralgon attendees, 13 provided generally positive comments about the seminar: Interesting and informative Twilight Seminar Series “Interesting and informative presentations presentations enjoyed e GRPCC introduced a twilight seminar enjoyed the case studies in QUM (Quality the case studies in series in July and November. e two and a half use of Medicines). All topics well delivered hour seminars were held from 6.30 – 9.00 pm within allocated timeframe.” QUM (Quality use of and included dinner. e inaugural seminar “Excellent from start to nish. anks for was on the use of pharmaceuticals in palliative a fabulous night.” Medicines)... care. One seminar was held in Traralgon and the other in Inverloch with a total of 92 “Can’t wait for the next time.” attendees, the majority of whom were nurses (92%), while doctors accounted for 4% and Communication Skills allied health professionals 2% of attendees. Training Program Speakers included Margie Gri ths, Chief In the palliative care setting, therapeutic Pharmacist BRHS; Linda Graudins, Senior communication is critical to identify patients’ Pharmacist, Centre for Medication Use and and families’ needs and goals of care. When Safety, Alfred Health; Scott King, Clinical patients and their families need to make Director Palliative Care, CHCB; and Irene di cult decisions and transition to palliative Murphy, GRPCC’s Nurse Practitioner care, e ective therapeutic communication Mentor. Topics included: skills can assist individuals to make informed Drug to body: Body to drug – decisions. erapeutic communication skills
Page 40 Gippsland Region Palliative Care Consortium
Figure 15: Evaluation of VCCCP workshops in Strongly Agree Agree Neutral Disagree Strongly Disagree Gippsland, Feb-Jun 2014, n=58
Increased confidence in my communication skills are not inherent; these skills must be learned Increased my knowledge about and included in formal curriculum. A communications with patients Communication Skills Master Class was held at the 5th Annual Gippsland Palliative Care Provided practical, relevant Conference in 2012 and positive evaluations information contributed to the scheduling of a series of communication skills workshops in 2013-14. Provided relevant case scenarios e GRPCC delivered a series of free communication skills training workshops throughout Gippsland supported by the Cancer Will be a benefit in my job Council Victoria, Victorian Cancer Clinicians 0% 20% 40% 60% 80% 100% Communication Program (VCCCP). John Reeves, a Gippsland-based clinical psychologist, and Anny Byrne, RN and a GRPCC Project knowledge and con dence in communicating The Introduction to Palliative O cer facilitated the sessions. An actor, with patients and would be of bene t in their Care Short Course Veronica Porcaro, was used to provide an job (Figure 15). e GRPCC will run another Since 2009, the GRPCC, in partnership with opportunity to practice role-play of imparted series of workshops in 2014-2015. communication skills. Each participant chose Monash University School of Nursing & the palliative care communication areas he/she Midwifery has delivered an education program nds most challenging and that he/she would aimed at building the capacity of generalist like to work on. healthcare professionals to provide a quality Year 4C Monash Medical palliative approach for clients. e program is Student feedback about A total of nine ve hour workshops on the topic tailored to local needs to ensure context and communication training ‘Transition to Palliative Care’ were provided relevance, and is delivered by a team of leading for nursing and allied health professionals. academic and clinical palliative care experts. Workshops were held in Leongatha, Sale, Whilst challenging and Warragul (2), Bairnsdale (2), Wonthaggi, Orbost confronting the role play was e program was not delivered in 2012-13 due and Traralgon. In addition, three workshops extremely valuable.” to a lack of numbers. During 2013-14 increased were held as part of the Palliative Care for e ort was placed on marketing the program “It truly was the gold standard in and the GRPCC o ered full participant funding Year 4C medical student education sessions at communication skills because of for a limited number of participants who are Leongatha (1) and Warragul (2). John and Veronica.” employed by member services. A total of 22 e workshops evaluated extremely “Role-plays were fantastic quality. people successfully applied for funding support favourably with 100% of participants agreeing It was great to have a fantastic and 25 participants (maximum capacity) that the workshops had increased their actress and a great communicator attended the course commencing June and for advice and tips.” nishing September 2014.
Past participants have reported increased con dence in working with clients, families According to John Reeves, the bene ts of the workshops are many, and other sta . Analysis of pre and post course evaluations has revealed statistically signi cant including a reduction in stress and anxiety, improved relationships and improvements in participants’ views, attitudes, interactions, and more accurate diagnoses. is last point is particularly and knowledge of the palliative approach. important as a more accurate diagnosis leads to better, understood and targeted treatments. John said that a recent participant described the workshop as “high impact, high drama, highly nerve-wracking and highly worthwhile.” John also added “It is wonderful to have the support of the Consortium to roll-out the program across Gippsland.” John Reeves, Clinical Psychologist Warragul
Page 41 Strategic Direction 6: Providing quality care supported by evidence
In 2013-14 a further eight scholarships were awarded to assist with professional development activities related to palliative care...
Telephone Triage Training met their expectations, 99% thought they Palliative Care were well presented and 100% thought they Scholarship Program e GRPCC facilitated six Palliative Care were relevant to their work. In addition, all Telephone Triage Training Workshops across e GRPCC is committed to building respondents would recommend the workshop Gippsland during March and June 2014. e palliative care workforce capacity and to others. workshops formed part of the Gippsland capability in Gippsland. e GRPCC A er-Hours Palliative Care Model and “My clients will be better supported to Palliative Care Scholarship Program was were promoted to all nurses who take a er- manage signs and symptoms at home” introduced in October 2012 and eight hours phone calls from palliative care clients scholarships were awarded in 2012-13 (two or carers. Participants included district “Increase my con dence in telephone triage” Medical Practitioner Scholarships and six nurses, palliative care nurses and a er-hours Evaluation comments stressed the need Nursing and Allied Health Scholarships). hospital coordinators. Robin Tchernomoro for supporting resources to be available to In 2013-14 a further eight scholarships were awarded to assist with professional of LearnPRN P/L delivered the six-hour long nurses a er-hours, in particular telephone workshops and a one-hour palliative care development activities related to palliative triage protocols, relevant patient information component was delivered by Carol Barbeler, care. All recipients were registered nurses. and symptom management guidelines. GRPCC’s Palliative Aged Care Resource e recipients of the scholarships are detailed Nurse. e workshops included telephone “Protocols are needed for triage of phone in Table 14. e Scholarship Program will triage principles, use of protocols and calls for all nurses regardless of level of continue in 2014-15. guidelines and used case studies as a way to experience to promote optimal outcomes show pitfalls and to highlight the importance for palliative care clients according to their Palliative Care Volunteers of communication skills. goals and wishes.” e GRPCC’s education e ort also focused A total of 110 nurses were trained, “Need more personal info on clients to on strengthening the region’s volunteer representing all nine funded community plan care etc” resources with a total of 19 prospective palliative care services in Gippsland as well volunteers completing a palliative care “ e need for us to review our practice of as two un-funded services. e workshops volunteer training program organised by were very well received with 100% of a er-hours triage as we have no guidelines the GRPCC and held in Leongatha during respondents agreeing that the workshop and only minimal knowledge of each patient. October and November. e participants came from four health services (WGHG, Table 14: GRPCC Palliative Care Scholarships 2013-14 LCHS, GSHS and YDHS) and the volunteer coordinator from WGHG and palliative Recipient Workplace Funded activity care administration o cer from GSHS Sarah Bone District Nurse /Palliative Attendance at the 7th Annual attended the program. e health services Care, BCRH Gippsland Palliative Care were responsible for delivering the rst two Conference modules of the Palliative Care Volunteer Rosie Steele RN District Nurse/Palliative Attendance at the 7th Annual Training Resource Kit (Introduction Care, BCRH Gippsland Palliative Care to palliative care and the palliative care Conference volunteer’s role). e GRPCC delivered the Debbie Wells RN District Nurse/Palliative Attendance at the 7th Annual remaining seven modules over six weeks. Care, BCRH Gippsland Palliative Care Conference Many of the participants car-pooled and drove over three hours (return trip) to attend Michelle Evans RN District Nurse/Palliative Attendance at the 7th Annual the training. ey stayed a er the sessions Care, BCRH Gippsland Palliative Care Conference and had lunch at the Leongatha RSL that had generously donated the use of a meeting Janene Hughes RN District Nurse/Palliative Attendance at the 7th Annual room for the training. e participants’ Care, BRHS Gippsland Palliative Care Conference enthusiasm and commitment was inspiring. Most sessions were held in the morning with Kat Swift Social Worker, WGHG Attendance at the Palliative Care one full day session and a farewell lunch held Victoria Biennial Conference at the end of the program. Janene Hughes RN District Nurse/Palliative Palliative Care Resource Nurse Care, BRHS Course, Banksia Palliative Care e GRPCC utlised the skills and experience of GSHS’ volunteer coordinator, Leslie Adams,
Page 42 Gippsland Region Palliative Care Consortium
Last October I was involved in delivering the Palliative who has a background in workplace and Care Volunteer training that was conducted in Leongatha. As a community training. Leslie facilitated the edgling coordinator of palliative care volunteers, being able to training program and delivered two modules work closely with the GRPCC was an invaluable experience. (Communication and Diversity). Michelle Davy, Pastoral Care Nurse at LCHS, delivered Here at GSHS, our palliative care team is larger than a lot of the other services the Spirituality and Responding to Loss and in Gippsland. With seven trainee volunteers from GSHS attending, we may Grief modules and Mary-Ross Heazlewood, have been able to run a course of our own; but by teaming up, through the the GRPCC’s Clinical and Education Project GRPCC, with other palliative care services, my volunteers and I had a much O cer and Clinical Nurse Consultant at GSHS richer experience. delivered the Illness and Care, and Death and rough this partnering, we had access to the resources and expertise of Dying modules. Presentations by Liz Crocker, palliative care professionals from across Gippsland, we also met volunteers and a Gippsland-based health psychologist and volunteer managers from several other palliative care services and discovered Catherine Matthews, an experienced palliative just how much we all have in common. care volunteer from GSHS, completed the training program and provided the participants I think that those six Tuesdays last year gave us a great opportunity to with an understanding of the importance of network, to share ideas and concerns, to challenge our own thinking and to self-care from both a professional and personal explore some new ways of being with people. By the end of the course we had perspective. all had some ‘aha…’ moments. We had shared some fears, some tears and lots of laughs. We had also survived the technical challenges that only happen when e GRPCC commenced planning for you run training in an RSL dining room! a second training program to be held in East Gippsland for prospective volunteers For me personally, it was an amazing experience to spend time with a group from CGHS, BRHS and GLCH as well as of 20 or so people, all committed to working in their communities and with the common goal of enabling their clients to live in dignity and comfort throughout smaller outlying district nursing facilities. It the palliative stage of their illness. It is only through the GRPCC’s work that this is intended that the program will be held in opportunity arose – so thank you GRPCC.” early 2015. Leslie Adams e GRPCC continues to represent Consumer Engagement Offi cer & Volunteer Program Coordinator the region on the Victorian Managers of Gippsland Southern Health Service, Korumburra and Leongatha Volunteers Network Meeting chaired by Palliative Care Victoria.
I was one of the many in the district (South Gippsland) who was fortunate enough to do this introductory course (Palliative Care Volunteer training October – November 2013) and found it fascinating and very comprehensive. What I got out of the course was a big reminder that nothing can be taken for granted and that listening is an incredibly powerful tool … even companionable silence can be beautiful. Over a period of eight weeks many topics and issues were covered and personal stories of experience were shared. It gave us all a great base of preparation to go out into the community to share the lives of those who have been classi ed as terminally ill – where end of life is a de nite. As a volunteer, we men and women, are prepared to regularly spend time with another to help the carers and family members share the load of what can present as a varied mix of emotions and experiences. I would hope that the dignity and respect of that individual and their family can be maintained and yet assist in a peaceful, ful lling way. My rst patient experience a er the course was a rich, although short experience. I supported a man who died of complications of his cancer. His wife and neighbours who were very kind and generous also supported him. I was able to visit him at home and in hospital. Although I knew him for a brief period of his life we enjoyed our conversations and I knew when he eventually became unconscious, that he knew that I was there too. To see another human being at peace and restful I am sure eased his passing. Sometimes I was with him when his wife could not be. It was a pleasure and a privilege to be able to support both of them to the end. Jenny McDonald Palliative Care Volunteer Gippsland Southern Health Service, Korumburra and Leongatha
Page 43 Strategic Direction 7: Ensuring support from communities
Page 44 Gippsland Region Palliative Care Consortium
Strategic Direction 7: The steering committee Ensuring support from communities engaged a fi lmmaker with connections to the local community to Volunteer Community supporting the transition of the project shoot a short fi lm that Capacity Building Project to a community organisation; and introduces the concept of Under the auspice of Palliative Care Victoria, promotion of project locally and broader the GRPCC in partnership with GLCH a e l d . Advance Care Planning received one-o funding for two years (2013- (ACP) through a series 14 and 2014-15) to develop and implement Developing community a volunteer project designed to increase capacity in Gippsland: of personal stories told community awareness and capacity to deal The role of the Gippsland by Gippsland Lakes with issues of dying, death and bereavement. Region Palliative Care e project is one of three within Victoria, Consortium Community Health and is the only regional based initiative. (GLCH) volunteers, clients In June 2014, the GRPCC engaged the e project, “Making the last chapter La Trobe University Palliative Care Unit and carers... re ect the whole book”, uses the analogy of (LTUPCU) to examine the contribution of writing the last chapter of a book to start a the GRPCC to increasing the capacity of its conversation on the importance of re ecting member organisations to provide palliative and sharing with family and friends the care services to the Gippsland community. essence of who we are and what is important contributed to organisational capacity to us so that it can be re ected into the last e GRPCC has overseen the building in the Gippsland region, and chapter of our life. e initiative involves implementation of many initiatives, and has whether the consortium is an e ective means using trained volunteer facilitators to deliver evaluated their e ectiveness and reported for supporting and improving the provision an education package that introduces the its achievements in Annual Reports to of palliative care services in the region. above concept in an interactive format. e the Minister for Health. ese speci c facilitators also discuss ways for individuals evaluations have informed the continuous e project will commence July 2014 and to convey the essence of who they are and improvement of various aspects of palliative LTUPCU will interview a wide range of sta what is important to them to others. care in the region. However, an independent involved in palliative care delivery across the study of the broader impacts on member region shortly. Publications produced by the Signi cant progress was made on the organisations’ capacity to deliver palliative GRPCC will be reviewed to ascertain their scoping and implementation of the project care services has not been undertaken. e ectiveness in assisting member services during 2013-14. Under the leadership of to develop organisational capacity. A nal GLCH, a local project steering committee e main aim of this research project is report will be presented to the Consortium was established consisting of key GLCH to investigate the in uence of the GRPCC Management Group in November 2014. sta and seven community members. on the capacity of member services to e steering committee is responsible for deliver palliative care in the Gippsland Below: A short lm that introduces the concept of guiding the project, developing resources region. e results of the project will be ACP through a series of personal stories told by that can be used by the volunteer facilitators, used to understand how the GRPCC has GLCH volunteers, clients and carers was created. and elicit the support of other local community groups to ensure the project’s sustainability. e steering committee engaged a lmmaker with connections to the local community to shoot a short lm that introduces the concept of ACP through a series of personal stories told by GLCH volunteers, clients and carers.
e next steps include:
nalising the education package for the volunteer facilitator role;
seeking expressions of Interest a local community group to adopt the project;
Page 45 Future Directions
Page 46 Gippsland Region Palliative Care Consortium
Future directions
e 2014-15 strategic directions of Working together to Providing quality care the GRPCC align with the Victorian 3 ensure people die in 6 supported by evidence their place of choice Government’s policy and will include: e GRPCC will continue to support e GRPCC will continue to work health professionals wishing to improve Informing and involving with government and non-government their skills and con dence in palliative 1 clients and carers funded disability accommodation care through the Scholarship Program. services to develop a palliative care e GRPCC will review and update the e GRPCC will continue to distribute education program for sta caring for Palliative Care Education Calendar, regular GRPCC and Aged Care residents. e GRPCC will also develop including the Annual Conference, a training program for SPCPs caring for e-Newsletters and the biannual Life & based on attendance and evaluations. Death Matters to stakeholders and the clients with an intellectual disability. e GRPCC will deliver another series community. e GRPCC will continue to roll out of Communication Skills Workshops the Palliative Aged Care Link Nurse e GRPCC will continue provide across the region. training across Gippsland. relevant and timely information e GRPCC will deliver another about palliative care services, support, e GRPCC will provide two series of series of Telephone Triage Training training and education through the workshops across the region on end of life Workshops across the region as part of GRPCC website – www.grpcc.com.au. care pathways for registered and enrolled the A er-Hours Palliative Care project. nurses as well as personal and direct care e GRPCC will assist member services workers as part of the PEPA program. e GRPCC will continue to support to roll out the Carer’s Kit as part of the Volunteer Coordinators and Managers A er-Hours Palliative Care Project. Providing specialist to provide training and support to In collaboration with GLCH, the GRPCC 4 care when and where volunteers. will complete the Building Culturally Safe it is needed e GRPCC will host the 7th Annual Aboriginal Palliative Care Capacity in e GRPCC will continue the roll Gippsland Palliative Care Conference, East Gippsland project. out of the Specialist Palliative Care Life and Death Matters: To treat or not Consultancy Service Plan for the region. to treat on 23-24 October 2014 at the In collaboration with WGHG, the RACV Inverloch Resort. GRPCC will complete the Reconnect e GRPCC will develop a business project. plan for recruiting a palliative medicine e GRPCC will continue to support specialist to the region. services to participate in PCOC, NSAP and implement PCCN endorsed tool. Caring for carers e GRPCC will continue to support 2 the provision of psychosocial care to Ensuring support from e GRPCC will assist services to health services. 7 communities implement all endorsed components e GRPCC will continue to support the e GRPCC will work in partnership of A er-hours model of care, including Nurse Practitioner Program in the region. with GLCH to implement the “Making the Carer’s Kit, Client Summary e GRPCC will assist member services the last chapter re ect the whole book” Palliative Care and Anticipatory to implement recommendations from project. Prescribing Guidelines. the Model of Community Palliative e GRPCC will consider Care project. e GRPCC will distribute information recommendations arising from to services on access to respite services Coordinate care the La Trobe University Palliative in Gippsland. across settings Care Unit research to be nalised 5 in November 2014, and implement Once the PCCN has developed new e GRPCC will continue to partner recommendations where applicable. respite criteria, the GRPCC will inform with GHA to implement telehealth member services and undertake e GRPCC will continue to use the solutions in Gippsland. biannual audits to ensure compliance. media to raise community awareness e GRPCC will continue to promote about palliative care initiatives and linkages between SPCSs and RACFs. issues of dying, death and bereavement.
Page 47 Organisational Structure
e GRPCC is one of eight regional specialist palliative care services (SPCPs) in Latrobe Community Health Service consortia in Victoria and provides each departmental region as well as other (LCHS) leadership to its member services by: stakeholders from health and community Latrobe Regional Hospital (LRH) services in a non-voting capacity. West Gippsland Healthcare Group undertaking regional planning; e voting member services of the GRPCC are: (WGHG) coordinating palliative care service Bairnsdale Regional Health Service Yarram and District Health Service provision; (BRHS) (YDHS). advising the Department of Health Bass Coast Community Health Service Non-voting GRPCC member services for about future service development and (BCCHS) 2013-14: funding; and Gippsland Medicare Local Limited managing the service delivery Bass Coast Regional Health (BCRH) (GML) framework and undertaking Central Gippsland Health Service communication, capacity building and (CGHS) Kooweerup Regional Health Service clinical service improvement initiatives (KRHS) in conjunction with the Palliative Care Gippsland Lakes Community Health Omeo District Health (ODH) Clinical Network. (GLCH) Orbost Regional Health (ORH) Palliative care consortia comprise voting Gippsland Southern Health Service members from all government-funded (GSHS) South Gippsland Hospital (SGH).
In 2013-14, the CMG membership comprised:
Member Service Representative Title BRHS Bernadette Hammond Director of Nursing BCCHS Ormond Pearson Chief Executive Offi cer BCRH Ward Steet Director of Community Services CGHS Mandy Pusmucans Director of Community Services DH Jennifer Doultree Aged Care Team Leader (ex-offi cio) GLCH Cheryl Bush Executive Manager, Clinical and Nursing Services GML Pam Odgers Program Coordinator GRPCC Vicki Doherty Consortium Manager GSHS Neil Langstaff Director of Nursing KRHS Margaret Bakonyi Deputy Director of Nursing LCHS Rachel Strauss Executive Director of Ambulatory Care LRH Amanda Cameron Director of Nursing, A/g Chair, GRPCC from June ODH Louise Vu illermin CEO & Director of Nursing, until April Frank Megens CEO & Director of Nursing, from May ORH Debbie Hall Director of Nursing SGH Anna Stefani Director of Nursing WGHG Anne Curtin Director of Nursing, Chair, GRPCC until May Kathy Kinrade Director of Nursing, from May YDHS Robert Barker Director of Nursing
Page 48 Gippsland Region Palliative Care Consortium
Consortium Consortium Executive Clinical Practice Group Management Group e role of the Consortium Executive is e role of the Clinical Practice Group e role of the Consortium Management to ensure the Consortium regional plan is (CPG) is to ensure that decisions made Group (CMG) is to drive the implementation delivered; provide support to the consortium by the Consortium are based on good of the Victorian Government’s policy in manager; ensure nancial accountability is clinical practice; facilitate collective the region. e CMG is responsible for achieved and to undertake sta recruitment problem solving in the implementation monitoring and reviewing the implementation and performance management. of the Victorian Government’s policy at a of the policy, facilitating the integration of care clinical level; and develop resources that e Department of Health requires for people with a life-threatening illness, as promote good clinical practice. e CPG Consortia Executive to meet at least twice per well as supporting carers and families across is a mandated skills-based advisory group annum. In 2013-14, the GRPCC Executive the service system. e consortium manager and includes representation from member met seven times and comprised: is part of the CMG in a non-voting capacity services, community organisations, general and a Department of Health (DH) regional Consortium Chair – Anne Curtin practitioners, nurse practitioners (NPs), NP representative attends in an ex-o cio capacity. (WGHG) until May 2014; Amanda candidates (NPCs) and metropolitan-based Cameron (LRH) appointed Acting palliative medicine specialists. e Department of Health mandates that the Chair June 2014 Consortium members meet at least six times per annum. In 2013-14, the CMG met seven Consortium Manager – Vicki Doherty times. Members are expected to attend 75 Fund holder – Mandy Pusmucans per cent of meetings. e attendance of each (CGHS) member service is outlined in Table 15. Other voting members – Cheryl Bush (GLCH) Table 15: Attendance by member services representatives at CMG meetings 2013-14 During 2013-14, the CPG met nine times, updated its terms of reference and Member Attendance Attendance worked on the following clinical guidelines: service (%) BRHS 5 71 Name Status Review Date BCCHS 0 0 Opioid Conversion Guidelines Endorsed Aug 2015 BCRH 3 43 Syringe Driver Compatibility Endorsed Nov 2015 CGHS 5 71 Oxygen Use in Palliative Care Endorsed Oct 2015 Verifi cation and Certifi cation of Death Endorsed Feb 2015 DH 7 100 Management of Breathlessness Endorsed Oct 2015 GML 0 0 Guidelines GLCH 7 100 MDT Meeting Process and Endorsed GRPCC 7 100 Documentation GSHS 1 14 Anticipatory Prescribing of Endorsed May 2016 Medications KRHS 1 14 Prioritising and Responding to Active LCHS 6 86 Referrals LRH 6 86 Palliative Care Client Summary Active; pilot in progress ODH 3 43 Symptom Management Guidelines Under development ORH 3 43 Bereavement Support Audit Tool* Under development SGH 3 43 Carer Symptom Management Guide Under development WGHG 7 100 Responding to After-Hour Phone Calls Under development YDHS 3 43 * A survey completed by member services show that three of 14 are using the Bereavement Support Standards (DH, Nov 2012)
Page 49 Organisational Structure
In 2013-14, the CPG membership comprised: Cheryl Bush (Chair) Executive Manager, Clinical and Nursing Services, GLCH Dr Jane Fischer Palliative Care Physician, Calvary Health Care Bethlehem Dr Brian McDonald Palliative Care Physician, Peninsula Health Dr Joy Linton General Practitioner, South Region Dr Liz Wearne General Practitioner, Eastern Region Resigned May 2014 Irene Murphy NP Mentor, GRPCC Jenny Turra Palliative Care NPC, Central Gippsland Maryann Bills Palliative Care NPC, WGHG and MND Shared Care Worker Kate Richardson Palliative Care NPC, WGHG Joined April 2014 Lisa Macdonald Palliative Care NPC, GLCH Joined April 2014 Kiona Smith Oncology NPC, LRH Megan Daly Palliative Care NPC, KRHS Sarah Bone Registered Nurse, BCRH Joined April 2014 Elise Clegg Registered Nurse, Tyers Ward, LRH Pam Odgers Gippsland Medicare Local Inc. Vicki Doherty Consortium Manager, GRPCC Mary Ross-Heazlewood Project Offi cer, Clinical Practice and Education, GRPCC and Clinical Nurse Consultant, South Gippsland Palliative Care Anny Byrne Project Offi cer, GRPCC Carol Barbeler Palliative Aged Care Resource Nurse, GRPCC
Consortium Team In 2013-14, the GRPCC team comprised:
e Consortium team assist with the Consortium Manager Vicki Doherty implementation of the GRPCC’s work by Administration Offi cer Judy Coombe (until Mar) delivering an extensive education program; Melissa Spargo (from May) managing a range of projects as determined Project Offi cers: by the government’s policy directions; providing regional volunteer support; and Specialist Palliative Care Service Consultancy Anny Byrne initiating targeted communication activities Program and Scholarship Program that raise stakeholder and community After-hours Palliative Care Project, Research and Maria Garrett awareness of the GRPCC and palliative care Evaluation services in Gippsland. Corporate Communications and Regional Karen Raabe Volunteer Coordination Clinical Practice and Education Mary Ross-Heazlewood Palliative Aged Care Resource Nurse and Disability Carol Barbeler Support Regional Nurse Practitioner Mentor Irene Murphy Motor Neurone Disease Shared Care Workers Maryann Bills and Toine Bovill
Page 50 Gippsland Region Palliative Care Consortium
Representation on other relevant committees
e GRPCC is represented on a number of statewide committees as detailed below.
Committee GRPCC Representative Palliative Care Clinical Network Mary Ross-Heazlewood Palliative Care Victoria Interdisciplinary Mary Ross-Heazlewood Research, Education and Advanced Practice Special Interest Group Victorian Managers of Volunteers Network Karen Raabe Victorian Palliative Care Consortia Chairs Anne Curtin Victorian Palliative Care Consortia Managers Vicki Doherty (Chair 2013-14) Victorian Palliative Care Consortia Aged Care Carol Barbeler Network
Accreditation status of A survey of member health services Member Agencies shows that there are some formal working relationships with palliative care organisations All member agencies are currently accredited outside Gippsland; Peninsula Hospice with the Australian Council on Healthcare Standards (ACHS) with the exception of Bass (GSHS), South Eastern Palliative Care Coast Community Health Service, Gippsland (KRHS) and McCulloch House (WGHG). Lakes Community Health and Latrobe Contact with a visiting specialist palliative Community Health Service that are accredited care service is not included and neither are with the Quality Improvement Council. any formal relationships within Gippsland.
Page 51 Financial Statement
Gippsland Region Palliative Care Consortium Financial Statement 2013-14
Revenue $ Regional Consultancy Service 701,173 After-hours 152,550 Consortia 121,776 PEPA 38,125 MND 18,000 PCV Community Capacity Building 28,750 Carried forward 2012-13 1,055,175 Total 2,115,549 *Revenue does not include funding provided by the Commonwealth, Consortium and Sponsorship.
Expenditure $ Salaries, wages and on-costs 511,894 Consultancy services 662,207 Training and staff development 263,994 Quality assurance activities 357,728 Administration, printing and sundries 73,954 Travel costs 73,773 Equipment and repairs 86,668 Total 2,030,218
Surplus (Defi cit) 85,331
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C/- West Gippsland Healthcare Group Landsborough Street Warragul VIC 3820 Tel: 03 5362 0684 Fax: 03 5622 6488 Email: [email protected] Web: www.grpcc.com.au