Evaluation of the Encouraging Better Practice in Aged Care (ebpac) Initiative Final Report

Facilities with no plans to implement the toolkit

Interviewees who indicated that their facility had no plans to implement the CSI toolkit were asked six questions. These related to their understanding of the project, why they were not implementing the toolkit, barriers to implementation, the future needs of palliative care in RACFs and any other points they would like to add.

What is your understanding of the initiative and the purpose of the project?

Only four participants provided an answer to this question, of which two knew nothing about the toolkit and one wasn’t sure. Of those not planning to implement the toolkit there appears to be little understanding of the toolkit itself.

Why do you not intend to implement the Palliative Care Toolkit within your facility?

All participants in this group provided details about why they were not planning to implement the toolkit. The most common response was that facilities in this group felt they already had most, or all, of what the toolkit was offering. Some participants indicated that they had used some parts of the toolkit to cover gaps in their system or that it reinforced what they were already doing. One participant made the following statement:

We are currently using the gold standards framework along with four other local facilities. This has provided us access to a lot of education through the local specialist palliative care service. We attended the workshop to make sure that our model of care was on the right track and to check what resources were available. The workshop was very professionally run and the resources supporting the toolkit are fantastic. We particularly like the bereavement support booklet for staff.

The remaining participants indicated that either it was because they did not know about the program or that they had only sent one staff member and they had since left the organisation.

What do you see as the main barriers to implementation within your facility?

Once again, all participants provided a response to this question. Participants had different views on what the barriers were, including a lack of resources, lack of knowledge about the program and staff turnover. One participant indicated that a lack of staff was the main barrier:

The lack of registered nurses in some facilities - particularly in low care facilities. It is a great toolkit and would put facilities on the right path but it needs people to drive the change.

Another participant felt that the barriers were more systemic in nature:

Everyone needs to be on the same 'page' - at the moment the GPs seem to be lacking knowledge of current developments in palliative care. Like everyone in RACFs we are admitting residents at a later stage with more complex needs - palliative care is becoming increasingly relevant and we need to be able to do this well.

Do you see any future needs for palliative care in RACFs?

Only three participants in this group answered this question, of which two answered ‘Yes’ and one was ‘not sure’. Two participants provided feedback about this question with one participant noting that while there is a lot of palliative care education for nursing and care staff, GPs needed more training, as indicated in the following statement:

GPs tend to miss out and their prescribing regimes seem to be old fashioned - they need much more support.

A second participant felt that there were needs relating to pain assessment and access to specialist services.

Is there anything else that you would like to add?

Participants made several additional comments of which some were positive statements about the workshops and the resources in the toolkits. One participant noted that while they had used the toolkit in the past they now mainly used other resources. Another participant indicated the need for one-on-one education with all staff and the need for psychosocial support for all staff, including grounds people and cleaners, to deal with issues relating to bereavement.

10.1Facilities who are planning to implement the toolkit

There were eight participants who were planning to implement the toolkit. Participants were at various levels of planning. Some facilities had not yet done anything and indicating that implementation was something they would like to do. Other facilities had undertaken several planning tasks and one facility was about to start internal staff training in the first quarter of 2015. This participant, having completed a number of planning tasks and being about to implement the program, was analysed along with those who had commenced implementation as they were all able to answer many of the additional questions for this group. These seven participants were asked four additional questions.

What is your understanding of the initiative and the purpose of the project?

All seven participants analysed in this group answered this question. Of these only three were able to provide details on their understanding of the initiative. Their understanding was that the initiative was to help staff to better understand symptoms and palliative processes and therefore provide better care to residents, to provide a forum for discussion, education to nurses and to provide resources, through the toolkit, to support palliative care in RACFs.

Other responses addressed barriers to implementation such as lack of staff time, competing priorities, staff turnover and a perceived lack of need due to links with local specialist palliative care services and the local health district.

Other participants indicated that, as they were part of a larger organisation, it was organisational policy to roll-out the toolkit during 2015. They would be adopting the toolkit as a matter of organisational policy.

Have there been any changes to policies and procedures as a result of the project?

All participants in this group answered ‘No’ to this question and did not provide any details in relation to their answer.

What steps have you taken to implement the Palliative Care Toolkit?

Respondents to this question (n=6) did not identify a lot of activity towards planning for the implementation of the toolkit in the future. Half indicated that any planning or other activities towards implementing the toolkit would be happening at some time in the future. One participant stated that implementation was being discussed at a higher level within the organisation. Another participant indicated that a staff member had been identified to implement the initiative.

Two participants indicated that planning activities were taking place at their facility. For example one participant stated that there were two nurses currently working to implement the program.

Of those participants who indicated that they were planning to implement the program, only one had done significant work towards implementation. All other facilities in this group provided only a few details on their plans for implementation, such as assigning staff members to work on the implementation and investigating local training options.

Is there anything else that you would like to add?

Four participants in this group provided extra comments about the palliative care toolkit initiative. There was a wide variety of responses. One participant thought the toolkit was ‘a great resource’, while another stated they were frustrated at slow bureaucratic processes. A third participant reiterated the importance of palliative care in aged care and the need for greater awareness and early intervention. One participant felt there was not a great need for the toolkit, as summarised in the following comment:

I believe that we are already delivering quality palliative care - 2 patients in the last couple of months - we get great feedback from families. Our staff have attended many pall care in-services and are competent in this area.