Advance Care Planning and End of Life Care Newsletter - September 2016 as PDFWelcome to the quarterly Advance Care Planning and End of Life Newsletter, which is jointly published by the Agency for Clinical Innovation (ACI), Clinical Excellence Commission (CEC) and the NSW Ministry of Health.

The newsletter provides updates on ACI, CEC and Ministry Advance Care Planning and End of Life projects and a guest spot for a local health district (LHD), specialty health network (SHN) or pillar to provide information on their Advance Care Planning and End of Life Care initiatives. LHDs, SHNs or pillars wishing to provide an update in Issue 4 should email:

In this edition

Update: The Clinical Excellence Commission's End of Life program 'The Last Days of Life'

The CEC End of Life program facilitated the development of a ‘Last Days of Life’ toolkit which is currently being piloted in NSW. The toolkit aims to ensure all dying patients receive optimal symptom control, have social, spiritual and cultural needs addressed, and bereavement support for families and carers occurs.

The various charts, guidelines and flowcharts have been developed by groups of expert clinicians and consumer advisors. This was achieved through consensus opinion and the review of current literature alongside current best practice from across NSW, Australia and Internationally. The resources are not intended to replace either local Specialist Palliative Care guidelines or consult advice given by Specialist Palliative Care clinicians. The tools piloted are:

  • Initiating Last Days of Life Management Plan: identify the dying patient and commence individualised management planning
  • Comfort Observation and Symptom Assessment (COSA) chart: tailored individual symptom and comfort assessment
  • Symptom Management Medication Guide/Flowcharts: starting doses and escalation recommendations for the 5 main symptoms in the last days of life
  • Accelerated Transition Die at Home plan: facilitates safe, seamless transition from hospital to community for patients to die at home
  • Communication tools: provide information and support to the patient and their family/carers on care and treatment in the last days of life.

The Last Days of Life Toolkit pilot program

Twenty seven facility/clinical units’ across 10 local health districts nominated to join the pilot. These include large and medium metropolitan hospitals as well as rural sites with aged care, medical, surgical, and Intensive care units participating. The pilot commenced in August 2016 for duration of 6 months.

Where does the Last Days of Life Toolkit fit with the state-wide End of Life strategic plan?

The Last Days of Life Toolkit is part of the NSW strategic plan to improve palliative and end of life care for all patients in NSW. The tools have been designed for use by generalist medical and nursing staff caring for dying patients in all in-patient hospital settings. They are as evidence-based as possible, and are in keeping with NSW Health policy and ACQSHC National Standard requirements.

More information

For more information contact:
Bernadette King, Program Lead
Phone: (02) 9269 5522

Agency for Clinical Innovation's update

Quality care for ELDERLY patients: NSW ED leadership forum

On 5 August 2016, Dr Magnolia Cardona-Morrell, The Simpson Centre for Health Services Research, South Western Sydney Clinical School presented to the NSW ED Leadership Forum on Non-beneficial treatments at the end of life: extent, causes, potential solutions and future research (video).

The NSW ED Leadership Forum is an Emergency Care Institute initiative that was established to bring together ED Executive / Leadership Teams to discuss topics of interest relating to emergency care. Dr Cardona-Morrell’s presentation was followed by a panel discussion on Challenging decisions in elderly emergency patient care (video).

The panel included Professor Ken Hillman, Professor of Intensive Care, Liverpool Hospital, University of New South Wales, Professor Gideon Caplan, Director of Geriatric Medicine, Prince of Wales Hospital and Conjoint Associate Professor, University of New South Wales and Ms Jacqueline Hewitt, Aged Care Emergency Clinical Nurse Consultant, Patient Flow Unit, Rankin Park Campus.

More information

For more information contact:
Heather Davey, A/Manager, ACI Palliative Care Network
Phone: (02) 9464 4666

Clinical Excellence Commission's project update

The CEC’s End of Life program aims to provide clinicians with the support and tools to ensure safe, quality end of life care for patients in NSW public health organisations.

Admitted patient death screening

The admitted patient death screening tool standardises screening of all in-patient deaths and includes indicators on the quality of dying. The tool is used by more than 90% of facilities with the current focus being on improving data and how data can be used for reporting/improvement at local and organisational level.

AMBER care bundle

The program that encourages talking openly about preferences and plans for end of life is available for facilities where end of life management could be improved.

The CEC have been working with eHealth, the Ministry of Health and the Agency for Clinical Innovation to include the AMBER care bundle in the emr2 Advance Care Plan package. The emr2 Advance Care Plan package is intended to be released over the next few months.

More information

For more information contact the CEC's End of Life Program
Phone: (02) 9269 5596

NSW Ministry of Health's update

SHAPE wins international award

Congratulations to the Health Education & Training Institute (HETI) for receiving the Brandon Hall ‘Best use of Blended Learning - Gold Award’ for SHAPE (Supporting Health professionals in Advance Care Planning and End-of-life) Conversations.

SHAPE was developed in conjunction with the Office of the Chief Health Officer and provides a step by step communication guide for conducting effective end of life conversations with patients, families and carers. The prestigious Brandon Hall Awards recognise organisations that have successfully developed education programs that have achieved measurable results. The Awards attract entrants from around the world.

More information

For more information contact:
Phone: (02) 9391 9110


2016 National Advance Care Planning Conference

The 2016 National Advance Care Planning Conference will be held at the Melbourne Convention & Exhibition Centre from the 15 to 17 November 2016. Registration closes on 7 November 2016.

More information

For more information contact:
Phone: 03 9496 5660

Current as at: Friday 9 August 2019
Contact page owner: Health and Social Policy