Palliative care in residential aged care: Implementing an evidence based model of care

In Australia 7% of persons aged 65 and over live in a residential aged care facility (RACF). This study was a 2 year national project implementing an evidence based model of palliative care in residential aged care. The project received $(A)1.4 million from the Australian Government Department of Health and Ageing under Enhancing Best Practice in Residential Aged Care program. The model of care included three key processes: 1.Advance Care Planning 2.Palliative Care Case Conferences 3.End of Life Care pathway. Nine RACF around Australia participated and in each RACF link nurses were trained to implement the model of care and act as champions of change within their RACF. Other staff received education on the model of care including monthly reviews with a specialist palliative care nurse. This paper reports on the resident outcome data. Data was collected on 83 residents who had died in the nine RACF12 months prior to the model of care implementation. A total of 73 residents received the new model of care. Chart audits were completed on the last month of care for residents in the pre and post sample. There were significant improvements in documentation of end of life (EOL) wishes (55.4 vs 72.6%, chisquare = 4.94, p<0.05), evidence that next of kin were involved in EOL discussions (71.1 vs 95.7%, chisqaure = 15.85, p<0.001), the use of palliative care case conferences (8.4 vs 94.5%, chisquare = 115.21, P<0.001) and an EOL care pathway (21.7 vs 84.6%, chisquare = 37.65, p < 0.001). There was a significant improvements in pain assessment (41.6 v 70.3%, chisquare =11.66, p=0.001), effectiveness of non-pharmacological treatments for pain (23.4 v 62.5%, chisquare =22.09, p<0.001), effective use of regular analgesia (56.7 v 64.5%, chisquare =0.82, p=0.37) and prn analgesia (62.1 v 77.6%, chisquare =3.47, p=0.06). Significant increases were also found for assessment of dysponea (2.4 v 44.4%, chisquare =18.58, p<0.001) and the use of nonpharmacological strategies for dysponea (31.7 v 57.1%, chisquare =4.42, p<0.05). An evidence based model of palliative care can improve the care provided for residents in RACF.