Guidelines for a Palliative Approach in Residential Aged Care

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Schedule 1 MEDICAL POWER OF ATTORNEY CONSENT TO MEDICAL TREATMENT AND PALLIATIVE CARE ACT 1995 1. I,_ ____________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ (insert name, address and occupation) appoint the following person(s) to be my medical agent(s): a._____________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ b._____________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ c._____________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ (Set out name, address and occupation of the agent. If 2 or more agents are appointed, the order of appointment must be indicated by placing the numbers 1,2,3…beside each name. This indicates that, if the first is not available the second is to be consulted, if the first and second are not available, the third is to be consulted and so on. It should be noted that a medical power of attorney cannot provide for the joint exercise of power. (See Section 8 (6) of the Consent to Medical Treatment and Palliative Care Act 1995) 2. I authorise my medical agent to make decisions about my medical treatment if I should be unable to do so myself. 3. I require my agent to observe the following conditions and directions in exercising, or in relation to the exercise of, the powers conferred by this power of attorney: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ (here set out any conditions to which the power is subject and any directions to the agent) 4. This is an enduring power of attorney made under the: Consent to Medical Treatment and Palliative Care Act 1995 ______________________________________________________________________________ (Signature of the person appointing the agent) DATED the ______________day of ____________________________20_____ Guidelines for a Palliative Approach in Residential Aged Care 249
Acceptance of Power of Attorney 1. I,_ ____________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 2. I,_ ____________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 3. I,_ ____________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ (here set out name(s), address(es) and occupation(s) of medical agents(s)) accept appointment as a medical agent under this medical power of attorney and undertake to exercise the powers conferred honestly, in accordance with the conditions and directions set out above, and, subject to that, in what I genuinely believe to be my principal’s best interests. ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ (Signature(s) of the medical agent(s)) Witness’s certificate I, _____________________________________________________________________________ (here set out name and address of the witness and the qualifications of authorised witness) certify: (a) that the grantor and grantee of the power of attorney signed it freely and voluntarily in my presence; and (b) both appeared to understand the effect of the power ______________________________________________________________________________ (Signature of JP, solicitor, member of clergy, pharmacist; or proclaimed bank manager, postal manager or police officer.) DATED the ______________day of ____________________________20_____ 250 Guidelines for a Palliative Approach in Residential Aged Care
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Guidelines for a Palliative Approac
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NHMRC APPROVAL These guidelines wer
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4 ADVANCE CARE PLANNING 55 4.1 Impl
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16 MANAGEMENT’S ROLE IN IMPLEMENT
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17 Ann and Mr Wells’ family Helpi
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IMPORTANT NOTICE On 8 December 2005
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achieved for these guidelines from
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facets of a palliative approach are
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Additional levels of evidence The N
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Guidelines Ref No. Evidence level A
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Guidelines Ref No. Evidence Cachexi
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Guidelines Ref No. Evidence Anxiety
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Guidelines Ref No. Evidence 70. Und
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1.1.1 Aims The aims of the systemat
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Table 1: Search terms Terms Aborigi
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1.1.5 Exclusion Criteria Although t
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in the methodology that may invalid
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To ensure the reliability of the re
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1.2.2 Methodology When the first re
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1.4.2 Method When feedback was requ
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Several Working Party members conve
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or disagreed with each stakeholder
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All the feedback received was colla
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CHAPTER 2 A PALLIATIVE APPROACH A s
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• Profound weakness • Trouble s
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• Has the resident had a recent d
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in the RACF rather than transferrin
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palliative care teams is more appro
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or ageing progression (see Table 4)
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Table 7: A practical model of socia
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Vignette 2: Robert’s story Robert
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CHAPTER 4 ADVANCE CARE PLANNING Car
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efore discussing the advance care p
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• A change in their health status
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CHAPTER 5 ADVANCED DEMENTIA Advance
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A study was conducted to investigat
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5.3.2 Acute illness One study found
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Vignette 5: Anna’s story Anna was
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(see Fainsinger, Miller and Bruera
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Dame Cicely Saunders first describe
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Table 8: Common myths about pain ma
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6.2.4 Breakthrough pain The term
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Pain can lead to behavioural change
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Vignette 7: Mrs Harris’ story Mrs
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examined the addition of paracetamo
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provision and storage of drugs, whe
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successfully tested predominantly w
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The reasons for malnutrition in old
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The diets of residents should also
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To assist in such a discussion, a d
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appear until dehydration is far adv
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Guideline: Hydration 24. Recommenda
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6.7 NAUSEA AND VOMITING Nausea is t
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• Do you have any problem control
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6.9.1 Assessment A thorough oral as
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6.10 SKIN INTEGRITY The major skin
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Wounds can occur in residents for a
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Brocklehurst and colleagues (1999)
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medication treatment along with non
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• CAM therapies may be culturally
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word games, the present day, and fa
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CHAPTER 7 PSYCHOLOGICAL SUPPORT A r
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7.1.1 Death statements and depressi
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the factor structure of the CSDD. I
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7.2.2 Management Non-pharmacologica
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Table 17: Distinguishing delirium f
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is recognised that in many rural an
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important [305] (Level QE). Familie
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8.4 FAMILY INVOLVEMENT The role of
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CHAPTER 9 SOCIAL SUPPORT, INTIMACY
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Rather than denying the existence o
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9.2.2 Management Imaginative progra
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Guideline: Social Support Social Su
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include lack of information about t
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CHAPTER 11 CULTURAL ISSUES Australi
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11.2 Assessment The best approach t
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CHAPTER 12 SPIRITUAL SUPPORT Dein a
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Vignette 13: Jack’s story Jack wa
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Guideline: Spiritual Support 68. A
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interpersonal and leadership skills
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CHAPTER 14 END-OF-LIFE (TERMINAL) C
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mood (61%), constipation (59%) and
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e relevant, and may even worsen sym
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Treatment involves changes in posit
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14.5 PREPARING FOR IMMINENT DEATH
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education of the aged care team and
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Table 21: Grief, loss and bereaveme
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• excessively avoiding tasks remi
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Vignette 18: Reflections When provi
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may have been able to contribute to
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CHAPTER 16 Management’s role in i
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REFERENCES 1. World Health Organiza
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31. Hanson, L. C., Danis, M. & Garr
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60. World Health Organization Quali
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89. McCarthy, M., Addington-Hall, J
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121. Saunders, C. M. (1998). Forewo
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150. Sindrup, S. H. & Jensen, T. S.
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177. Berry, E. M. & Marcus, E.-L. (
Page 212 and 213: 208. Robinson, S. B. & Rosher, R. B
Page 214 and 215: 237. Brocklehurst, J., Dickinson, E
Page 216 and 217: 265. Barraclough, J. (1997). ABC of
Page 218 and 219: 295. Brown, T. M. & Boyle, M. F. (2
Page 220 and 221: 328. Kristjanson, L. J., Leis, A.,
Page 222 and 223: 360. McGrath, P., Vun, M. & McLeod,
Page 224 and 225: 392. Saunders, C. M. & Baines, M. J
Page 226 and 227: 424. Rawlings, D. & Glynn, T. (2002
Page 228 and 229: Glossary acetaminophen Acetaminophe
Page 230 and 231: coordinator of volunteers coping A
Page 232 and 233: geropsychologist A geropsychologist
Page 234 and 235: opioids Opioid is a specific term u
Page 236: specialised palliative team A speci
Page 239 and 240: Ms Wendy Shiels Dr Jane Sims Dr Chr
Page 242: APPENDIX B The Australian Governmen
Page 245 and 246: APRAC GUIDELINES: EVIDENCE EVALUATI
Page 247 and 248: APRAC GUIDELINES: EVIDENCE EVALUATI
Page 250 and 251: APPENDIX F: Summary of the frequenc
Page 252: APPENDIX G: An example of how the g
Page 256 and 257: APPENDIX I: Resource list PALLIATIV
Page 258 and 259: Psychological Challenge Depression
Page 260 and 261: APPENDIX J: Examples of advance dir
Page 264: APPENDIX K An example of a Genogram
Page 268 and 269: INDEX Abbey Pain Scale 64, 71, 78 A
Page 270 and 271: evidence levels 5, 6, 20, 21, 22 ev
Page 272: andomized controlled trials 5, 21 R
Page 275 and 276: Palliative Care Australia PO Box 24
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