End-of-life care

Mandatory standards on end of life care from 2019

All hospitals and healthcare providers will need to have systems to support optimum end-of-life care under new national quality standards to be introduced in 2019.

Routine provision of advanced care plans, substitute decision makers and shared decision making will be key features of the revised National Safety and Quality Health Service (NSQHS) Standards that set minimum standards of care for health service organisations.

Developed by the  Australian Commission on Safety and Quality in Healthcare (ACSQH), the second version of standards has been updated to include specific requirements for end of life care that were absent from the first version implemented in 2013.

Under the new standards, healthcare organisations will be required to have systems in place to support the preparation and documentation of advanced care plans, directives and treatment limiting orders.

The standards aim to put into practice the recommendations on essential elements for safe and high-quality end-of-life care as contained in a national consensus statement developed by the ACSQH in 2015.

End of life care systems are among several new areas suggested for the second version of the standards, which have now been approved for implementation from 2019 after being put out for consultation to healthcare and consumer groups.

In its revision of the standards, the  Commission noted that end of life care remained patchy despite investment in palliative care services and initiatives such as  guidelines,  care pathways and advance care planning programs.

It said that until recently, there was no consensus on what was required to provide high-quality end-of-life care.

“Some health service organisations do not see that providing end-of-life care is their responsibility, and care is outsourced to medical emergency teams, palliative care teams and intensive care teams. For patients, this may mean that the care they receive is provided because they begin to deteriorate acutely. It may also mean that the care is provided by strangers, and is often provided after hours and in urgent circumstances. “

The commission said the new standards would help address the problem of treatment being continued long after it becomes apparent that a person was at the end of life.

“The introduction of mandatory standards that provide greater choice for people at the end of life, even with a small improvement, could reduce length of stay and the cost of unnecessary procedures, which has the potential to save millions of dollars annually,” it added.

According to the national consensus statement on end-of-life care,  healthcare teams have a responsibility to:

  • Provide timely and accurate information regarding the patient’s clinical condition and its severity or stage, the expected disease trajectory, the available treatments, and the likelihood of response to such treatments.
  • Clearly communicate information to support patients (or substitute decision-makers, families and carers) to make decisions about care, and to check that they understand the implications, consequences and risks associated with such decisions.
  • Invite patients to participate in the process of advance care planning, and create opportunities for patients to make decisions and to communicate their values, goals and wishes regarding their end-of-life care.
  • Offer support, expert opinion and advice so that patients (or substitute decision makers, families and carers) can participate in fully informed, shared (or supported) decision-making.
  • Identify existing advance care plans and provide care in accordance with the patient’s expressed wishes.
  • Document, communicate and hand over the agreed plan of care and any limitations of medical treatment to other clinicians involved in the patient’s care.

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