1. MOVING FORWARD WITH CARE PLANNING Deanne Layton Quality and education Coordinator Mercy Palliative Care

2. Our three key messages Participation in NSAP Collaborative Improvement Project was beneficial in identifying strategies to implement change Small and steady change will lead to the end result Continuing to focus on the initial goal and don’t lose sight of what you are trying to achieve.

3. Mercy Palliative Care.  home based palliative care service serving western metropolitan region of Melbourne  This a geographical area of 1368 sq kms encompassing inner city and semi-rural areas  The catchment population is almost 700,000 growing at 4.4% pa  Cultural diversity  Socio-economic diversity  Age distribution of client population across the spectrum from birth to over 100yrs

4. NSAP Collaborative Improvement Project Occurred in 2011 and involved 20 palliative care services across Australia NSAP identified Assessment and Care Planning as an area of focus from the NSAP National Quality Report. Provided services with the framework to implement change. The framework provided was the Institute of Healthcare Improvement (IHI) Breakthrough series which involves using PDSA cycles Services were required to be in attendance at three learning sessions. Each service presented their project stories and the lessons learnt from these

5. Assessment and care planning at Mercy Palliative Care Documentation of bereavement risk and care planning identified by Mercy Palliative Care as area where processes could be reviewed and improved This was identified through auditing. Bereavement risk was not being identified and documented appropriately. PDSA cycle used to audit bereavement risk form, review of bereavement documentation, increasing awareness amongst staff of the need for the risk to be highlighted to the bereavement team and development of a new bereavement risk form. Staff consultation – discussions with staff who used the form to gain their feedback

6. What happened next? Further investigation led to need to improve multidisciplinary team meeting process – increased patient numbers and same meeting time July 2006 - 216 patients July 2011 - 305 patients Sunshine office July 2006 - 80 patients July 2011 – 121 Recognition that it was more difficult to have holistic patient discussions with the increasing patient numbers Also identified need to incorporate the PCOC (Palliative Care Outcomes Collaborative) assessments collected and incorporate these assessment tools into team meeting

7. How to move forward? The team meeting process was raised – difficult to know what to do. Participation in NSAP Improvement Collaborative drove the changes and presented a model by which to begin to change to improve holistic discussions of patients PDSA cycles - multidisciplinary team meeting review survey of staff - trial use of running sheet included plan, phase and problem severity score - Adjustment to use of running sheet – condensed recording data - Change to the actual structure – new patients and those seen that week - Grade three nurse to chair meeting

8. Did this create improvements? Improvement documentation of bereavement risk (35% to 80%) Improved staff satisfaction with multidisciplinary team meeting Longer holistic discussion of patient which allow identification of risk Integration of PCOC assessment tools and language into the team meeting’ More manageable team meeting times

9. Challenges to change Getting initial buy in from staff – agreeing there was an issue Reluctance to change long term practices Ask nursing staff to complete a running sheet. Achieving sustainability

10. NSAP Collaborative Improvement Project At this point Mercy Palliative Care presented their project story at the Learning Session This learning session covered strategies for sustainability and provided useful tips for maintaining the momentum Valuable experience was sharing of the stories – many organisations had faced similar challenges during their project Skills in managing change and project management will be valuable in the future

11. What next? Success at largest office after refining the process with PDSA cycles plan to roll out to other two offices Moved the system to one other office with varying results Factors contributing to this include - Quality Coordinator not on site - Patient numbers - buy in from management and staff

12. Addressing the new challenges More PDSA cycles -Trial patient running sheet Staff who had rotated offices proved to be champions Documentation working party formed Documentation education requested by staff Review and refocus of the team meeting review goals in the Management Meeting

13. Peer Mentor visit As part of the NSAP cycle a Peer Mentor visit occurred Visit from a Peer Mentor to assist in identifying opportunities for quality improvement Suggestions given to the service regarding the team meeting and moving forward More PDSA cycles to test these suggestions

14. Lessons learnt Moving the model across to another office was far more challenging than first thought Champions on site are a valuable contributor to sustainability Constant communication is needed with staff and managers to keep everyone focused on the initial goal “A jug fills drop by drop” - Buddha