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End of Life Care at Bowral Hospital

Bowral Hospital
Project Added:
8 April 2015
Last updated:
9 June 2015

End of Life Care at Bowral Hospital


This program will provide better and more appropriate clinical care to the dying patient and their family, through improved education, end of life care policies, referral pathways, nursing resources and the use of volunteers as support for carers. 


To provide compassionate and dignified care to the patient who is dying, with appropriate support for the family during the last few days of life and following death.


  • Improved nursing care and documentation of key interventions for symptom management.
  • Improved assessment and documentation of spiritual and religious goals for patients identified as dying.
  • Improved delivery of information and support to the family during and following the patient’s death.
  • Improved collaboration with the palliative care consultant or clinical nurse specialist (grade 2) once the patient is identified as requiring end of life care.
  • Improved compliance with the policy for care of the body after death.

Project Status

Project status: Implementation: the initiative is ready for implementation, is currently being implemented, piloted or tested.

Project dates: June 2014 to June 2015. 


A documentation review and observation of 41 patients who required end of life care and died in Bowral & District Hospital between 2012 and 2014, raised issues in relation to:

  • documentation 
  • support for the patient and their family
  • interventions required or not required in the last days of life
  • after-death care of the patient’s body  
  • care and support after death for the family.


Improvements in the areas of documentation and support for the patient and their family were identified.

  • A comprehensive education plan connected to the care of the dying pathway was developed and implemented, to increase awareness of individual practice on patient care.
  • Six nurses nominated themselves as Resource Nurses, providing mentoring and twice-weekly in-services within the ward and high dependency unit.
  • Guidelines for end of life care during and after death have been completed, incorporating symptom management, communication and care of the body.
  • A policy review is underway, including a review of social work and palliative care referrals.
  • A review of the use of bereavement packs within Bowral & District Hospital is underway, to increase awareness of the family and their needs.
  • One bed area has been dedicated for palliative care patients and their family.
  • Volunteers have been engaged to provide support to staff and families of the patient, including visits where required. There has also been more active engagement in pastoral care services.

Implementation site

Bowral & District Hospital, South Western Sydney Local Health District (SWSLHD)


  • Carer representatives
  • Funeral director representative
  • Agency for Clinical Innovation’s Centre for Healthcare Redesign
  • Clinical Excellence Commission’s Clinical Leadership Program (CLP).


  • Quarterly data review of all patients who died and were identified as dying with some form of end of life care.
  • Audit and review of observations by senior staff on the condition of the deceased patient when transferred to the mortuary.
  • Feedback from consultations with a funeral service representative.
  • Feedback from consultations with families who are willing to be interviewed by hospital or volunteer staff, following the death of a loved one at Bowral & District Hospital.

Lessons Learnt 

The main challenge has been the engagement of clinical staff in the process, particularly in the busy ward environment.


Karen Kenmir
Acting Director of Nursing and Midwifery
Bowral & District Hospital
South Western Sydney Local Health District (SWSLHD)
Phone: 02 4861 0288

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