This excerpt is directly from Natalie’s placement report :-
“Completing a PEPA placement at the Townsville University Hospital Palliative Care Centre was an invaluable start to my palliative studies at Monash. This placement and our initial Monash assignment formed the basis for my PEPA placement activity. On commencing the Monash assignment on palliative services available in our community and how they are accessed, I realised both myself and my colleagues had a knowledge gap in this area. Furthermore, the Four Corners program “A Good Death” highlighted to me the importance of early palliative care referral; an area that I had no knowledge of.
These two concepts became the basis for my PEPA project.
My objectives were to:
- increase colleague awareness on palliative services are available not only here in the hospital, but in the local and rural communities
- increase colleague awareness of the benefits of early referral to palliative care
- instil an awareness that ALL pharmacists can help facilitate a good death
I presented a twenty-five-minute PowerPoint presentation at the Townsville University Hospital, which eighteen pharmacists attended in person and others joined via Teams. I began my presentation by asking the group to think of a patient that they saw on the ward the day before and to ask themselves if they would be surprised if this patient was to die in the next twelve months. I wanted to highlight to them that access to palliative care is everybody’s concern and not just a job for the palliative team.
To establish that palliative care is associated with better patient care outcomes and timely access is paramount, I presented three studies to the group, with data showing that early referral resulted in greater palliative engagement and the benefits associated with this in terms of greater quality of life, general practitioner visits in the home, greater home opioid use and more patients dying in their home environment in the early referral group. I focused on a study that assessed time from referral to death in palliative oncology, organ failure and frailty patients. Oncology patients were found to receive much earlier referral to palliative services than the other two groups. Additionally, the organ failure and frailty patients were much more likely than the oncology patients to spend greater than one of the last two weeks of their life in an acute care setting. This likelihood was in fact more than double in the case of the organ failure group. This highlighted to the pharmacists that we as healthcare professions are not good at identifying these patients and providing early referral, which impacts on end of life for these patients. These are patients that pharmacists are seeing on the ward daily, and early identification of these patients may lead to better end of life outcomes.
I used the tool of Advanced Care Planning to help facilitate pharmacists identifying patients that may benefit from early referral. The goals of Advanced Care Planning are in line with those of early referral, as it gets patients to assess their goals of care and document their spiritual and religious beliefs and things that are important to them. It includes an Acute Resuscitation Plan (ARP) and most importantly it gets clinicians to evaluate the treatment plan, and hopefully ask “the surprise question”.
The Advanced Care Planning (ACP) Quick Guide is available on the Queensland Health intranet, and lists diseases/conditions and the individual triggers to instigate Advanced Care Planning. I discussed this document with the pharmacists and the triggers for ACP are points that they are familiar with and can easily identify. I detailed where to find this document should they want to refer to it for a particular patient. The inclusion of ACP and ARP statis is only a new feature on our electronic chart, so I showed the pharmacists where to find this. I stressed to them that I am not suggesting that they get involved in ACP, but rather identify patient’s who may benefit and discuss this with their multidisciplinary team, which will hopefully get the process towards early referral to palliative care in motion.
I covered the palliative services available in the Townsville hospital and in the local and rural communities and provided contact information for these teams. This information is saved along with my presentation in our pharmacy K drive and can be accessed from any computer in the hospital should anyone need to refer to it.
At the start of my presentation, I handed out a questionnaire to assess the pharmacist’s confidence across six different areas both before and after the presentation. I had 16 questionnaires returned, with an increase in confidence across all six areas, with the question regarding rural palliative service knowledge over doubling in score from before presentation. From this, I feel that the activity met the objectives stated.
I feel the PowerPoint presentation was a good means for delivering the information, as it facilitated a group discussion and questions at the end. If I was to do this activity again, I don’t think I would change anything in the content but would look into how I could find out who attended online via Teams and provide questionnaires for them to get a more accurate data set. I think a good follow up to this project would be to survey the staff again in a few months to see whether they have incorporated these concepts into their work and how often they initiate conversations around Advanced Care Planning. I will plan a follow up presentation in the future to assess this.
I believe this presentation will add an extra dimension to the way that pharmacists view patient’s trajectory, and hopefully facilitate greater Advanced Care Planning, leading to better early referral to palliative care, particularly in the non-oncology patient cohorts. I feel this presentation will help pharmacists not working in the palliative care centre play a role in facilitating a “good death”.”
Thanks Kristen for such a great activity outcome.