POMSNAME: A simple innovation to improve the assessment and documentation of palliative care needs

POMSNAME: A simple innovation to improve the assessment and documentation of palliative care needs

An article written by Associate Professor Ann Dadich and Ms Kerrie Womsley

Assessing and documenting a patient’s palliative care needs and preferences are pivotal to quality care. Assessment and documentation can help to:

  • identify changes in needs and preferences
  • identify ways to improve the patient’s quality of life
  • improve communication between different individuals involved in the patient’s care, and
  • reduce duplicative or redundant efforts.

Furthermore, as the adage suggests, if it wasn’t documented, it didn’t happen – that is, if a clinician fails to document their assessment of a patient, there is no evidence that it happened.

Despite the importance of assessing and documenting palliative care needs and preferences, it can be challenging. This is because many palliative care assessment tools are complex and lengthy, which can be burdensome for patients, carers, and clinicians. Furthermore, given that some assessment tools require clinicians to use them in a fixed way, they can fail to accommodate the opportunistic and conversational ways of building rapport with a patient, which are pivotal to palliative care. This is noteworthy because death can be a taboo topic.

It is therefore important to provide clinicians with different evidence-based resources that are user-friendly and flexible to accommodate different forms of expertise and different approaches to patient care.

To guide – rather than dictate – palliative care assessment and documentation, we created an aide-mémoire for clinicians who support patients requiring palliative care. This is because an aide-mémoire can help us to remember specific information, tasks, or details.

Informed by relevant literature, the aide-mémoire reminded clinicians to enquire about a patient’s pain, orientation and oral health, mobility, their social situation, nausea, appetite, medication, and elimination. To ensure that clinicians could readily access this tool, the aide-mémoire was produced on a placard that could be worn on a lanyard or keychain.

We invited community health nurses in a public community health centre who delivered palliative care to use the aide-mémoire. To support them, we provided formal and informal training. The formal training included in-service workshops. The informal training included mentoring, role modelling, as well as the weekly case review meetings. During these meetings, the senior nurses opportunistically reminded generalist clinicians of the importance of the domains. Given the importance of continued support, the training was offered regularly and in different ways to help the aide-mémoire become business-as-usual.

To determine whether the aide-mémoire changed how palliative care needs were assessed and documented, we evaluated patient case notes from September 1, 2015, to November 30, 2019. This extended period helped us to consider the short-term, medium-term, and long-term effects.

Overall, the assessment and documentation of patients’ palliative care needs improved with the introduction of the aide-mémoire. The patient notes demonstrated greater reference to most domains, even in the long-term.

These findings are important. They demonstrate the sustained impact of an inexpensive resource – an aide-mémoire – which was informed by relevant literature and supported by formal and informal training. Furthermore, given that palliative care is everyone’s business, the findings demonstrate a viable way to promote quality palliative care among clinicians with generalist expertise.

Given the value of the aide-mémoire, it was endorsed by the South Western Sydney Local Health District Primary and Community Health Quality and Safety Committee for use throughout the primary and community health services within the district. Furthermore, we were awarded a Quality Award to recognise this innovation within the local health district.

As an inexpensive innovation, POMSNAME represents an important way to improve the quality of palliative care assessment and documentation. If you would like to learn more about this aide-mémoire and consider how it might benefit your service, you are very welcome to contact us.
 

Further reading

Dadich A, Gliniecka M, Cull M, Womsley K. POMSNAME: an aide-mémoire to improve the assessment and documentation of palliative care - a longitudinal project. BMC Palliat Care. 2023 Oct 21;22(1):157.

Brilliant Palliative Care and the Brilliance Project – ongoing research to answer the question ‘What is brilliant care at the end of life?’


Authors


Ann Dadich

Associate Professor

Western Sydney University, School of Business


 


Kerrie Womsley

Clinical Nurse Consultant

Illawarra Shoalhaven Local Health District

 

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1 comments on article "POMSNAME: A simple innovation to improve the assessment and documentation of palliative care needs"

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Irene Whippy

We would like to learn more about the

aide-mémoire.

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The views and opinions expressed in Palliative Perspectives are those of the authors and are not necessarily supported by CareSearch, Flinders University and/or the Australian Government Department of Health and Aged Care.