NSW Ambulance Authorised Palliative Care Plans
11 March 2015 Last updated:
30 March 2015
Authorised Palliative Care Plans were introduced across the state by NSW Ambulance to support paramedic decision making in meeting the needs of individual patients while respecting their palliative wishes.
NSW Ambulance applies this protocol to palliative and end of life care, when an ambulance responds to a patient with an endorsed Authorised Palliative Care Plan in place.
To support paramedic decision making in meeting the needs of individual patients while respecting their palliative care wishes when an ambulance responds to patients who have an Authorised Palliative Care Plan in place.
This project was presented at Rural Innovations Changing Healthcare (RICH) 2015.
- Supporting paramedic decision making
- Ensuring patient’s wishes and needs are documented and respected
- Improved communication between patient and treating clinicians.
- Initiative relating to plans for adults started in 2012-13
- Sustained: The initiative has been implemented, is sustained in standard business.
Initially the concepts of the Authorised Care Plans were developed in collaboration with Westmead Children’s Hospital to support the palliative care needs of children in their home. In 2012/13 Adult Authorised Palliative Care Plans were piloted at a Central Coast Residential Age Care Facility (RACF) and for community based patients in southern NSW under the care of the Amaranth Foundation.
The concept of the Authorised Palliative Care Plan is not only to support adult and paediatric palliative patients, but also to ensure respective family members and carers are fully conversed with the wishes of the patient.
This includes choices of care for example location of care, treatment decisions, medication administration, post death management arrangements or it may advise not to involve an ambulance attendance.
The opportunity exists for the treating clinician to discuss treatment and transport options with the patient, where these wishes are then documented by the treating clinician into an Authorised Palliative Care Plan and submitted to NSW Ambulance for review and endorsement.
There is the ability to flag that an Authorised Palliative Care Plan is in place at a specified address where if paramedics are responding via a Triple Zero (000) call they will be made aware there is an endorsed authorised care plan in place and are endorsed to follow the prescribed orders.
For example, an endorsed plan may advise the paramedic to administer additional pain medication, initiate therapy to assist the patient to be more comfortable in the home or withhold resuscitation activation. The option for hospital transfer remains available if that is the patient’s preferred choice at the time.
The NSW Ambulance Authorised Care Plans will continue to be available after the implementation of NSW Health Resuscitation Plans. Authorised Palliative Care Plans are more descriptive in what is expected of the paramedic throughout the patient’s palliative journey and support paramedics to vary their scope of practice through the endorsement process.
Note: NSW Ambulance has provided guidance to the paramedics in the use of the NSW Health Resuscitation Plans.
The Authorised Care Plans are now available statewide including across the Children’s Health Network.
The implementation of adult Authorised Palliative Care Plans followed a pilot conducted at a Residential Age Care Facility (RACF) and with community based palliative patients in southern NSW under the care of the Amaranth Foundation.
During the pilot period the team also:
- developed effective tools for patients, clinicians, carers and paramedics to use
- expanded the use of Paediatric Palliative Care Plans across the Children’s Health Network.
The results of the pilot showed:
|Number of Authorised Care Plans registered throughout the pilot period in 2012||214|
|Total calls to addresses with an Authorised Care in Plan registered in 2012||97|
|Total number of patients remaining at home ( not transported to the ED) 2012||42 (not all calls related to the palliative condition)|
The following is feedback from the RACF Pilot site:
- the Central Coast RACF pilot site implemented a process of case conferences for the patients with the staff when completing the Authorised Palliative Care plans
- the RACF implemented the plans at a secondary facility
- relationships between paramedics and the facility dramatically improved, specifically in relation to information exchange and clinical handover to the paramedics.
Even though plans are in place there still may remain the spontaneity of families or carers to continue to call ambulance if presented with unexpected symptoms or a crisis in their confidence to continue care. In this event, the role of paramedic is one of support for family and carers as well as providing care to the patient in a manner that respects the wishes of the patient.
Our partners in establishing and implementing Authorised Care Plans have been with Children’s Hospital Westmead and the Children’s Health Network, Medicare Locals, Amaranth Foundation, Veronica Residential Age Care Facility – Central Coast and the Local Health Districts.
Southern NSW Medicare Local and Sydney LHD have been active in supporting and advocating Authorised Care Plans including the development of communication brochures and a general practice information booklet.
NSW Health. 2013. Advance Care Planning - Making your wishes known. [webpage].
Manager Low Acuity Care, Clinical Services
Phone: 02 9779 3809
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