The 2nd edition of the NSQHS came into effect at the start of this year, addressing the gaps identified in the first edition including mental health and cognitive impairment, health literacy, end-of-life care, and Aboriginal and Torres Strait Islander health.
Standard 5, focusing around complying with and demonstrating compliance to Comprehensive Care, is thus far proving to be one of the most challenging for hospitals and health service providers to meet. The struggle lies in developing a Comprehensive Care plan which meets all risk assessment and care standards.
The Standard also demands the engagement of the health provider with the patient in the planning process to elicit a better understanding of their needs and goals and minimise ambiguity of care preferences.
Dr Ian Scott, Director of Internal Medicine and Clinical Epidemiology at the Princess Alexandra Hospital, has shared some of Metro South’s strategies in providing comprehensive end-of-life care.
In his presentation to Criterion Conference’s Implementing the 2nd Edition of the NSQHS Standards last year, Dr Scott’s statistics highlight the gaps in care for elderly patients:
- The number of Australians aged 65 and over will double by 2050
- 75% of us have not had end of life discussions
- 60% think we don’t talk about death enough
- Over 70% of us die in hospital though most of us would prefer to die at home
- Less than 10% of us die with an advance care plan
- 1 in 3 patients will receive non-beneficial medical interventions in the last 6 months of life
- More than 1 in 10 admissions for end of life care will be subject to futile interventions
Advance care planning, the “process of making decisions about future health care for patients in consultation with clinicians, family members and important others”, is undertaken with the goal of ensuring patients’ wishes are respected- even in the instance they were to lose their decision-making capacity.
The prime goal, Dr Scott explains, is to iteratively identify and facilitate what patients consider important in end-of-life care:
- Managing symptoms
- Avoiding prolonged dying
- Achieving a sense of control
- Relieving burdens placed on the family
- Strengthening relationships
- Communicating future wishes
The benefits of ACP include reduced stress, anxiety and depression in surviving family members, improved patient satisfaction and quality of life, and fewer in-hospital deaths and ICU admissions.
Key ACP discussions should include an assessment of the understanding of the disease and its prognosis, the patients’ preferences for information-sharing and decision-making, and definition of their concerns, goals of care and acceptable levels of function.
Dr Scott cites a survey, States Worse Than Death, which found a large portion of people to believe there are several unacceptable levels of function. More than 50% of those surveyed believe bowel and bladder incontinence and/ or having to rely on a breathing machine to live is worse than death, closely followed by the inability to get out of bed.
In response to Standard 5, Metro South Health introduced an ACP Statement of Choices with page 1 pictured below:
The key indicators it is time to initiate an ACP can include:
- New diagnoses of life-limiting conditions
- Severe, irreversible deterioration in health status
- Loss of response to, or complications from, disease-specific treatments
- Frequent unplanned hospitalisations
- Transfers from or to RACFs
- Assessing appropriateness of high-risk surgery
- Potentially inappropriate poly-pharmacy
- Determining hospice eligibility
- Expressed wish of patient/ family to discuss ACP
Learn more about how your hospital or healthcare facility can drive quality improvement through Standard 5 at Criterion Conference’s Implementing Comprehensive Care conference, taking place on 14th – 16th October 2019, in Sydney.
Hear directly from Dr Ian Scott and other senior healthcare professionals at the forefront of embedding Comprehensive Care and address the challenges specific to delivery in your organisation.