Australian Residential Aged Care End-of-Life Care Pathway (RAC EoLCP) 

Summary of key points

The term ‘end of life pathway’ is widely understood to mean a best practice clinical document that guides planning and delivery of palliative care during the last few days of a person’s life. There has been widespread support for the use of pathways, based largely on documentation audits. However, until recently, there has been a lack of evidence that the use of end of life pathways actually improves palliative patient outcomes. [1]

The Department of Health and Ageing (DoHA) funded the Brisbane South Palliative Care Collaborative (BSPCC) to produce an end of life pathway tailored for use within Australian residential aged care facilities (RACFs). The pathway - known as the Residential Aged Care End of Life Care Pathway (RAC EoLCP) - when implemented in conjunction with a supportive framework has been evaluated as improving outcomes for dying residents as well as the quality of palliative care provided by RACFs. RACF clinical staff report that the RAC EoLCP is easy to use and has improved their confidence in delivering palliative care.

The RAC EoLCP is now being utilised by other DoHA funded Aged Care and Palliative Care projects, as well as within other facilities.

Background

In 2006, as part of the Local Palliative Care Grants Program, DoHA funded BSPCC to develop, pilot and evaluate an end of life care pathway within a supportive framework that would improve equity of access to quality palliative care for residents dying in aged care facilities.

The RAC EoLCP was produced by adapting existing pathways, including the Liverpool Care Pathway [2] and incorporates evidence and consensus-based best clinical management and care coordination for dying residents. Components of the supportive framework included:

• Establishment of dedicated Palliative Care Link Nurses within RACFs
• Creation of palliative care educational resources for RACF clinical staff
• Establishment of RACF Medication Imprest Systems that allow for timely access to drugs commonly used at the end of life
• Mechanisms to link RACF staff with Specialist Palliative Care colleagues to improve complex case management
• Mechanisms to facilitate GP support to provide end of life care “in-place”

The project was completed in 2009 and an evaluation report provided to DoHA later that year. [3]

Evaluation of the pathway project (across 299 deaths) has provided some of the first evidence internationally that the use of palliative care pathways improves resident outcomes of care. Some important evaluation findings include:

• Dying residents commenced on the RAC EoLCP were significantly less likely to be transferred to hospital, so more able to die “in-place” in the familiar environment of their RACF with carers known to them.
• RACF staff reported significant improvements in the quality of palliative care provided by their facility. Aspects of improved care included access to specialist palliative care services, information provided to residents and families, care coordination, symptom management and inclusion of relatives in care decision making.
• Improvements in care were supported by family survey responses.

Conclusion

The RAC EoLCP, when implemented within a supportive framework, results in improved outcomes for dying residents as well as the quality of palliative care provided by Australian RACFs. On the basis of this evidence it is recommended that the RAC EoLCP be made available to as many Australian RACFs as possible.

RAC EoLCP Investigator Contact

Investigators

• Prof Liz Reymond MBBS (Hons) FRACGP FAChPM PhD
• Ms Fiona Israel RN MCouns
• Dr Margaret Charles PhD, MAPS
• Brisbane South Palliative Care Collaborative    bspcc@health.qld.gov.au

RAC EoLCP Document

The RAC EoLCP document is licensed under a Creative Commons licence. There is no cost associated with downloading or using the RAC EoLCP document however you must agree to the terms of the licence.

To view a copy of the RAC EoLCP click here

To view permissions/licensing page and download the RAC EoLCP please use this hyperlink http://www.health.qld.gov.au/pahospital/services/pal_care.asp

References

1. Chan R, Webster J. End-of-life care pathways for improving outcomes in caring for the dying. Cochrane Database of Systematic Reviews 2009, Issue 4.   Art. No.:  CD008006. DOI:10.1002/14651858.CD008006.
2. UK Department of Health, National End of Life Care Programme. Liverpool Care Pathway. Available at http://www.endoflifecare.nhs.uk/eolc/lcp.htm.  Accessed 4 September 2009. 
3. Reymond L, Israel F, Charles M, Thomson J, End Stage Care Pathway for Patients in Residential Aged Care Facilities’ Final Report, Department of Health & Ageing, Local Palliative Care Grants Program: Care Planning sub-program April 2009

This page was created on 8 March 2010
Last updated 29 June 2011.