Reviewing and consolidating aged care guidance
A blog post written by Professor Jennifer Tieman, CareSearch Director, College of Nursing and Health Sciences, Flinders University
When palliAGED was launched three years ago, it offered a new approach to guidance for aged care around palliative care and end of life. This approach explicitly acknowledges the central role of evidence in guiding care but also recognises the importance of the aged care context in applying this evidence. Context is now critically important as people are living longer than ever before, electing where possible to age in the place of their choosing, and dying older.
The last five years has seen major change in policy directions and in aged care regulation. There are new Aged Care Quality Standards detailing among many expectations the use of evidence to inform person-centred decision making and care provision. The sector is also being challenged by a number of major reviews including the current Royal Commission into Aged Care Quality and Safety. At the same time, the evidence base for palliative care has expanded. A simple search in PubMed for 'aged care AND palliative' restricted to the last 5 years retrieves 9,204 articles. In the five-year period before that there were 6,555 articles, or 30% fewer. Such changes speak to the importance of contemporary guidance that reflects the current systems and processes specific to Australia and incorporation of new evidence to inform practice. They also speak to the demands being placed on aged care staff and resources. It follows that simplifying access to the most useful evidence and guidance can help to keep the focus on providing best practice care.
For CareSearch and for palliAGED, ensuring that guidance is current, relevant and informed by the best evidence is a core part of our work. We do this not only by updating evidence relating to care and practice issues but by reviewing the current role and suitability of our resources. Over the last 10 years CareSearch has partnered with many different groups and been involved in creating a range of products, resources and tools. Building in time to assess the continuing currency and relevance of these products is an important part of our quality processes.
During the 2017-2020 project period, there has been an active review process of any associated aged care resources. The aim was to consolidate resources for the sector while ensuring currency and relevance. As a result, content brought across from the Decision Assist project has been revised and updated for inclusion in palliAGED. The palliAGED Symptoms and Medicines guidance for terminal care being one resource resulting from this activity. The continuing role of the Residential Aged Care Hub released in CareSearch in 2011 has also been reviewed. This was one of the first web resources in Australia that focused on palliative care in aged care and at that time was a key repository of clinical guidance, resources for care and practice, and information for residents and families. However, as it was built on the 2006 APRAC evidence, which were the first guidelines addressing palliative care in aged care, by 2017 when palliAGED was launched the RAC Hub was referring to evidence that was over a decade old. It was also reflecting an aged care system that had changed in terms of resident needs, funding, standards and demand. Closing this Hub was an important step in updating and consolidating aged care resources. It also provided the opportunity to create new sections within palliAGED and new resources including the palliAGED Practice Tip Sheets for careworkers and nurses. These resources complement the palliAGED Evidence and Practice centres and bring all of this guidance together in the one place.
The Palliative Approach (PA) Toolkit currently hosted by CareSearch was another seminal aged care resource in need of review. Initial development and pilot-testing of the PA Toolkit model of care was undertaken by Professor Deb Parker (UQ/BlueCare) in 2009-2010 using the APRAC Guidelines. A national rollout of the PA Toolkit led by Professor Liz Reymond (Brisbane South Palliative Care Collaborative) was completed between 2012 and 2015. In early 2015, CareSearch entered into an agreement within Brisbane South to support sustainable access to the PA Toolkit resources via a web-based presence until 2017 with a subsequent agreement ensuring access during 2017-2020. By 2020, it was clear that a review was needed as the guidance had dated and no longer reflected the current context or evidence base for care. As a result, the PA Toolkit is being retired on 30 June 2020. As with the RAC Hub closure, the pending retirement has led to a review of alternatives for the content, a plan for new content within palliAGED and CareSearch, and the release of new palliAGED resources including a range of interactive forms for use by aged care.
Our 2017-2020 review focus has shown that it is not sufficient to create new resources and content. Any activity must include a framework for ongoing review, and options and processes for regeneration, consolidation and, where necessary, closure. In this way, we can provide reassurance to the sector as to the quality and continuing relevance of palliative care resources for aged care. It also helps us to respond to the varied and changing contexts in which care is provided, as we work with the sector to ensure easy access to the best and most relevant information available.
Professor Jennifer Tieman, CareSearch Director, College of Nursing and Health Sciences, Flinders University