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PROGRAM OF EXPERIENCE IN THE PALLIATIVE APPROACH (PEPA) The Program of Experience in the Palliative Approach (PEPA) is an initiative of the Australian Government Department of Health and Ageing’s National Palliative Care Program. PEPA aims to improve the quality, availability and access to palliative care for people who are dying and their families. To achieve this aim, PEPA provides workforce placements and structured learning experiences to develop the capacity of health care professionals to deliver a palliative care approach. PEPA has been developed and implemented in two parts. PEPA 1 commenced in 2003 and provides placements for nurses and allied health professionals from primary health settings within specialist palliative care services to gain knowledge, skills and experience in the palliative approach to care. PEPA 2 commenced in 2005 and involves: (a) clinical placements with specialist palliative care services and structured learning experiences for GPs and rural and remote medical officers, and (b) clinical placements for specialist palliative care staff to develop skills in selected medical specialities. Over 750 health care practitioners, one-third from rural settings, have gained knowledge, skills and experience by completing a PEPA placement. PEPA is being evaluated using pre and post-placement participant, employer and palliative care host site surveys. Interviews are also being conducted with a sample of participants, employers and host site personnel to collect indepth descriptive data. To date, respondents to the evaluation have reported increased confidence in caring for people with life limiting illness. This enhanced confidence is related to participants’ perceived improved assessment skills, abilities to identify and implement interventions and abilities to communicate with patients, and the formation of links with a specialist palliative care service if assistance is required. For example, one participant has commented that: ‘(I am) more confident to discuss issues with the family and doctor attending to the client…’ and have ‘more contacts to access necessary information about care and other resources.’ The formation of links between primary health care providers and specialist palliative care services is an important component of PEPA. Participants have indicated that ongoing contact with the host site has assisted their practice in areas such as the management of complex clinical and psychosocial issues. Some host sites have reported that the networks formed with primary care providers have enhanced referral pathways and assisted them to gain an insight into the issues that the primary health providers face. The following responses from participants provide examples of host site assistance following the placement: • We asked the palliative care team to review a resident who had difficult pain relief problems. They gave us both support and advice to enhance care delivery. • Client in end stage motor neurone disease - assistance and advice regarding management at home now that client can’t self care anymore (gave advice about) equipment and carer support. Other examples provided suggest PEPA is achieving its goals in terms of enhancing the capacity of primary health care providers to provide a palliative approach to care. For example, respondents have reported: • Open discussions with staff, residents, family and GPs (on) how to treat residents with life limiting illness. When a resident had been admitted to hospital we were told that this person had not long to live. With the assistance of the palliative care consultant in the hospital and from the community we were able to have this resident cared for in her own room and surrounded by the people she loved. Since the PEPA program we have had two cases like this and it has been a great experience for the staff, the residents and the families. • Improved competence with use of pain relieving medication – this has also been helpful in managing non-malignant pain arthritis and osteoporotic fractures. Able to avoid referral to hospital emergency department. Further information on PEPA is available at www.pepaeducation.com PCA Staff PCA’s team consists of (left to right): Nicky Reavell, Project Officer; Catherine Kennedy, National Office Manager; Anna Picker, Project Officer, Karen Cooper, Project Manager, Donna Daniell, Acting Executive Director, Cindee Richardson, Project Manager; Dylan Malloch, Marketing and Communications Officer; Camilla Rowland, National Projects Manager; Fiona Couchman, Policy Officer; Stephanie Bradford, Administrative Assistant. 10
FEDERAL GRANTS PROGRAM UPDATE As part of the Strengthening Cancer Care initiative, the Federal Government announced funding of $23.1 million over four years (2005/06 through to 2008/09) for a Local Palliative Care Grants Program (LPCGP) in the 2005/06 Federal Budget. The LPCGP is aimed at helping local groups such as churches, charitable hospices and aged care providers to better provide support to people requiring palliative care and their families. The Government intents that the LPCGP will build on the achievements to date of the National Palliative Care Program. The funding will be distributed through four rounds. These will be: 1. fit-out of and equipment for premises for palliative patients 2. pastoral care, counselling and support for people needing palliative care and their families 3. step-down and transition-to-home support Round two of the funding - pastoral care, counselling and support - is also completed. Funding has been approved for thirty-two projects. The total amount of funding for these 32 projects is $3 million and the amount for individual projects ranges from $30,000 to $120,000 (GST exclusive). The projects will be implemented from March 2006 to March 2009. One organisation which has received funding through round two of the LPCGP is the Centre for Palliative Care in Fitzroy, Victoria. The CPC is an academic unit located within St Vincent’s Health, with formal affiliations to Melbourne University via the Department of Medicine at St Vincent’s and the School of Nursing. It concerns itself with undergraduate and postgraduate teaching, professional development, and research relevant to the fostering, promotion and critical study of palliative care. Round two of the funding will enable the Centre for Palliative Care to Implement and evaluate a family caregiver education program in an attempt to lessen caregiver burden. The proposed education program focuses on preparing caregivers for the role of supporting a relative or friend who is receiving palliative 4. care plans for patients who are living at home, including support for health professionals to enable patients to stay at home. Funding round one of the Local Palliative Care Grants Program - fit out and equipping premises and transition to home support - has now been completed. Funding has been approved for fifty-five projects: The total amount of funding for these 55 projects is $4 million and the amount for individual projects ranges from $30,000 and $100,000 (GST exclusive). The projects will be implemented over the period December 2005 to December 2006. One organisation which has received funding through round one of the grants program is the Bear Cottage Children’s Hospice in Manly, NSW. Bear Cottage was initiated by The Children’s Hospital at Westmead in 1988 and the location within St Patrick’s Estate was found in 1995 and provided the opportunity to create a ‘beach house’ style facility. This is an ideal location for children with life limiting illnesses and their families to holiday and seek respite. The centre was built at a cost of 10 million, and was entirely funded by the community. Round one of the funding will be providing Bear Cottage with the means to upgrade their existing transport services, thereby allowing improved hospice access. Bear Cottage Community Relations Manager Scott Wallsberger says that the LPCGP will be of significant assistance to Bear Cottage. “By providing us with the funds through the grants program, Bear Cottage will be able to modify our existing vehicle. This will allow improved vehicle access to the hospice and thereby increase the standard of palliative care we are able to provide,” said Mr Wallsberger. The staff at the Centre for Palliative Care, Melbourne University care at home. In addition to providing caregivers with practical and medical information, the sessions will include strategies for meeting common emotional and spiritual needs. The program will highlight key elements of pastoral care and prepare family caregivers for bereavement. The foundation for the education program has been developed from a rigorous evidence based approach that incorporated input from family caregivers and multidisciplinary palliative care health professionals. The outcomes of the program will be comprehensively evaluated so that recommendations can be made for wider implementation. Applications for the third funding round - care planning - closed at 5pm on 13 January 2006. The assessment process for these applications has commenced, and it is anticipated that all applicants will be advised of the outcome of this process by the end of March 2006. It is anticipated that the fourth funding round (a second release of fit out and equipping premises and transition to home support) will be advertised in the first half of 2007. 11
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