1. CMC presentation May 2016 EVOLVE Dr Simon Allan Director of Palliative Care Arohanui Hospice President Chapter of Palliative Medicine

2. EVOLVE-why and how?  We need to capture the enthusiasm of our members regarding the contribution they have made  Clearly they feel strongly about these low value items  The evidence base is persuasive  Colleges need to assist with the dissemination and promotion of items but also provide some helpful ways to support Special Societies in leading this  The cat is out of the bag- regulatory, insurance, funding implications abound.

3. Naughty Palliative Medicine!  It could be argued that 3 of our items were addressed to Consultant colleagues!  Two items include ourselves and our nurses  PC is bottom of the cliff and the retrospective view point can be critical in regard to others care to date in the patient journey  However these are evidence based points which we would love for out colleagues to see and reflect on for their practice

4. Palliative Care top 5 1. Do not delay discussion and referral to PC for a patient with serious illness because they are pursuing disease directed treatment 2. Do not delay conversations around prognosis, wishes values and EOL (and ACP) including failing to complete resuscitation plans/orders in patients with advanced disease of any type.

5. Palliative Care top 5 3. Do not use oxygen therapy to treat non- hypoxic dyspnoea in the absence of anxiety and more generally, routine oxygen at end of life. 4. Do not use percutaneous feeding tubes in patients with advanced dementia; instead use oral assisted feeding 5. Do not prescribe medication without conducting a drug regimen review in cases of polypharmacy in order to avoid adverse medication interactions.

6. Palliative Care  PC is at the bottom of the cliff and quite good with retrospectoscopes!  However we know that our colleagues do not like having hard discussions  There is a prevailing tendency to treat  Doing stuff without communicating and adequately consulting  There is an attitude which is not respectful of fully informing the patient and families  Communication skills should be a paramount professional quality for a doctor  NZ has a very good set of tools and training for advance care planning- how to better engage this?  Item 1-3 largely are around communication, taking the time to communicate and not keep on “doing”  The Chapter could survey colleagues regarding items 4&5 on our list after a PR exercise- i.e. post EVOLVE audits

7. Doctors training and planning  Doctors and care plans  Ceiling of care planning  Advance care planning  Family meetings- who is delegated, does anyone get trained?  College role in inculcating such skills  MinCEx  Case based discussions

8. Compliance and CME  We are increasingly required to demonstrate compliance – NZMC, credentialing, accreditation  To what extent are these monitoring tools aligned against vital aspects of learning and application of professional qualities to practice  Could EVOLVE items be included in areas of compliance/ monitoring?  College CME- holiday in Budapest or attention to evidence value change in practice

9. EVOLVE Conclusion  EVOLVE is a helpful way for doctors to tackle quality issues in Health  EVOVLE needs “legs” at various levels  Professional and College first  Regulatory, compliance, funding, policy, insurance, DHB are all possible areas for application