Category: “Models of Care & Novel Partnerships”
Poster Presentation
Title Streamlining complex palliative care discharges within a newly developed palliative care team in comprehensive care cancer setting.
Background Whilst most people express a wish to die at home, many remain in acute hospital settings for end of life care. The narrow window of opportunity for deteriorating patients to be safely discharged home to die remains an ambiguous goal for many. There are often multiple levels of complexity impacting on communication, goal of care, patient and carer education and ethical decision making.
Aim To identify key principals of complex discharge planning. To identify an effective, timely & safe discharge pathway for the patients, clinicians & community palliative care team.
Method Identify key barriers, via a case review, to terminal phase in home setting. Data collected from medical records and staff involved in discharge planning.
Results Analysis of the data identified key issues impacting on the complexity of discharge planning for end of life at home including limited documentation, symptom control & psychological patient and carer distress. Targeted education programs for nurses resulted in increasing levels of confidence and empowered nursing staff in discharge process. Established flowsheets to and educate nursing staff with different geographical locations & discharge community palliative care paperwork.
Conclusion This research assesses the importance of commencing discussions of patients wishes and preference early in their disease trajectory. The nursing staff become more confident with paperwork included in the discharge process. Working collaboratively with the community palliative care teams to ensure a patient has a safe and timely transition home.