Getting Started

Having a dedicated working group within your organisation can provide the foundation governance structure to support palliative care and advance care planning for older people and their families.

The purpose of the working group is to:

1. Identify and support palliative care champions (see Action 2).
2. Develop and review policies and procedures to support palliative care and advance care planning (see Action 3).
3. Ensure standards relevant to palliative care and advance care planning are met using resources to support the ELDAC Care Model from the Clinical Elements of the RAC Toolkit (see Action 4).
4. Identify workforce development needs specific to palliative care and advance care planning (see Action 5)
5. Engage and monitor quality improvement activities through audit.
6. Identify and engage with key stakeholders such as specialist palliative care services, acute care outreach support teams, dementia specialists and Primary Health Networks (PHN).

Who might be invited/involved to the working group?

• An older person and/or family or carers representative
• Care director or manager
• Registered nurse/enrolled nurse
• Care worker
• Hotel services representative
• Allied health representative
• Pastoral or spiritual care representative
• General practitioner
• PHN representative
• Specialist palliative care representative
• Pharmacist.

The number of people engaged in the working group will depend on the size of the organisation. The working group should meet regularly, develop a standard agenda and meeting minutes with action items that are recorded. If your service is part of a larger organisation then coordination between working groups on organisational-wide issues, such as policies and procedures, is recommended. In instances where an existing governance structure supports palliative care and advance care planning across the organisation a separate working party may not be required.

The role of the palliative care and advance care planning champions may include to:

• Act as an ambassador for palliative care and advance care planning.
• Promote and review how palliative care and advance care planning is being provided in line with the ELDAC Care Model and the Clinical elements of the RAC Toolkit.
• Participate in the working group.
• Act as a resource for other team members, the older person, and their family and carers.
• Assist with or coordinate palliative care and advance care planning quality improvement activities that inform the working group.

Who?

Local champions should be identified that can support the organisation working group. Champions may be any team member within the organisation and can be grouped by clinical champions who have a direct clinical role (e.g. registered nurses, enrolled nurses, care workers, allied health and pastoral care) and non-clinical champions (e.g. hotel staff and volunteers).

How many?

The number of champions needed is up to the working group and will depend on the geographical structure of the organisation, model of care, and profile of the older persons’ being provided care. While there is no specific number required, it is recommended to have enough champions to ensure coverage across shifts, weekdays, weekends and holidays. The working group members and champions in the organisation can be acknowledged by displaying photos and names on a notice board, which can be viewed by older people, families and carers, General Practitioners or external providers.

The working group should meet with the clinical governance person/section of the organisation to review policies and procedures aligned to standards that support palliative care and advance care planning. Within a larger organisation it is critical that the organisation-wide policies and procedures are agreed upon and implemented. A policy sets the principles for the direction of the organisation and a procedure should be a series of steps that are completed to support the policy. Areas where a policy and/or procedure may be useful include:

• Advance care planning
• Palliative and End-of-Life Care
• Medication Management including Pain management
• Care of the family during and after the death of the older person
• Bereavement Care
• Voluntary assisted dying
• Verification of death
• Care of the body after death.

Policies and procedures should be linked to evidence and quality standards. palliAGED provides the latest evidence on palliative care and advance care planning for older people.

The Clinical Care section of the RAC Toolkit identifies eight elements of care. As part of this clinical action, the working group with assistance from champions, should review existing clinical forms, tools, and care management practices against these clinical elements and how they support standards relevant to palliative care and advance care planning. This action should be completed regardless of the type of system your organisation utilises (e.g. electronic, hard copy, or a combination of both). The Quality Improvement section of this toolkit provides the interactive ELDAC Advance Care Planning and Palliative Care Organisational Audit (pdf) that can assist with achieving this action. If updates to forms, tools, or care practices are required, the working group should discuss the timeframes to achieve these revisions and how these will be introduced and communicated to the team, older persons’ and families and carers.

To create and foster a positive culture to support palliative care and advance care planning a workforce training and education strategy is needed. Some key points for the working group are to:

• Consider the core educational units/capabilities in palliative care and advance care planning that are expected both of all team members and specific team members relevant to scope of practice?
• Identify internal learning structures such as learning management systems that support the workforce to participate in education and training on palliative care and advance care planning within the organisation?
• Identify key external providers engaged in palliative care and advance care planning workforce training and delivery?

For individuals within the organisation the ELDAC Assess your Knowledge section of this toolkit provides opportunity for individual team members to identify their personal learning needs, set a learning plan and link to ELDAC and other resources.