RespectingPatientChoices

NewsRespecting Patient ChoicesWINTER/SPRING 2004

The Community expansion is funded by theAustralian Government through the NationalPalliative Care Program

The local Health Service expansion is funded by theVictorian Government Department of HumanServices through the Hospital Admission RiskProgram (HARP)

RESPECTING PATIENT CHOICES PROGRAMAustin Hospital145 Studley Rd Heidelberg Vic 3084Tel 03 9496 5660Fax 03 9457 5405

© 2004 Austin Health

RespectingPatientChoices

The RPC Team

Eastern HealthAssoc Prof Graham SchmidtClinical Leader, RPC Eastern HealthAfter many years as Head of Gastroenterologyat Box Hill Hospital,Graham brings a wealth ofexperience and expertise to his role as ClinicalLeader. Graham particularly focuses on liaisonabout advance care planning with the medicalstaff and is keen to work more closely withGPs on the clinical and ethical issues involved.

Jennifer Evans BSW, BTheolProgram Manager, RPC Eastern HealthJennifer manages the implementation andexpansion of the program and the training andsupport of the RPC consultants. Jennifer hasmany years experience in health, welfare anddisability, and a long term interest in ethics,especially in regard to health and end-of-lifeissues.

Catherine RiskasCatherine handles all the documentationmaintenance, data input and workshoporganization for the program and comes froma background in administration and banking.

Northern HealthMike DorevitchDr Mike Dorevitch is a specialist geriatrician,gerontology researcher and medical adminis-trator. Issues concerning end of life decisionmaking and advanced care planning areparticularly relevant to his clinical practice. Hehas a keen interest in medical ethics and is amember of the Bundoora Extended CareEthics Committee. Mike is the ExecutiveSponsor of the Northern Health RPC Project.

Kim JeffsDr Kim Jeffs is the Clinical Leader for theRespecting Patient Choices project atNorthern Health. She recognises the impor-tance of advance care planning as a result ofher work as a Geriatrician. She is also anNHMRC post-graduate scholar investigatingdelirium at the Northern Clinical ResearchCentre and is currently enrolled in a Doctorof Medicine (MD) at The University ofMelbourne. She has previously completedresearch investigating Post Acute RespiratoryOutreach Services and Memory Clinics.

Gail RobertsMs Gail Roberts has undergraduate and postgraduate qualifications in counselling, healthlaw, health sociology and ethics, including aMaster of Arts (Health Studies). She has a long-standing interest in the relationship betweenthe law, technology, and ethics, and in thehealth consumer movement. Gail has abackground in nursing, socio-legal research,medical education and training, and inorganisational development and changemanagement in the field of general practice.Gail manages the development and imple-mentation of the RPC Project at NorthernHealth, as well as the training of RPCConsultants.

Janine SageMs Janine Sage provides administrativeassistance to the Project Manager of RPCat Northern Health in an array of areas,including information management, and in theorganisation of meetings, workshops andresources. Janine has worked at NorthernHealth for 14 years in a number of admin-istrative capacities, which greatly complementsthe experience of the RPC Team.

Austin HealthDr Bill Silvester MBBS FRACP FJFICMProgram DirectorAs an intensive care specialist, Bill has seenmany occasions when patients were on lifesupport machines which they may not havewanted if they had had an opportunity tospeak their mind beforehand. Bill’s work withthe Austin Health Patient Care EthicsCommittee on a new approach to askingpatients about their end-of-life care led to theProgram.

Liz Stickland RN BN Onc Cert MHAProgram ManagerLiz manages the implementation and expan-sion of the Program. She comes from manyyears experience in oncology nursing andwork in academic institutions.Her most recentpositions have been in project management.

Dr Karen Dettering MBBS MHlth Ethics FRACPAustin Health RPC Clinical LeaderKaren’s primary responsibility is to provideclinical leadership for the Program throughoutAustin Health. She is a respiratory physicianwith a particular interest in end of life decisionmaking, and care, and has a masters in healthethics.

Steve CowinAdministration AssistantSteve is responsible for the day-to-day officemanagement and the Program’s correspond-ence and organises resources, workshops,meetings and myriad of other activities. Stevehas worked in numerous positions at theAustin, including as a ward clerk and in theCatering Department.

Tracey Mander RN BN Grad Cert Onc MHAHARP Project OfficerTracey’s role in Respecting Patient Choices isto oversee the implementation of the Programinto four metropolitan health services inMelbourne – Austin Health, Eastern Health,Northern Health and St.Vincent’s Health. Herexperience prior to the Program has been inhaematology, oncology, palliative care, andmanagerial nursing. She also has an interest inethics.

Maria Mann RN BN Grad Cert Crit CareHARP Project OfficerMaria is facilitating the Program across AustinHealth. With nursing experience in criticalcare, palliative care, spinal care, HIV and livertransplant co-ordination and research, shebrings a diverse range of skills to the Program.

Meagan-Jane Adams RN BN Grad Cert Crit CareCommonwealth Project OfficerMeagan’s role is to facilitate, train and supportpilot facilities in the community to implementthe Program in their own organisations.Crucial to the success of implementation is thesupport of GPs to the pilot sites, which isanother aspect to Meagan’s work. In Phase 2of the Commonwealth Project, Meagan andSuzanne will be taking the Project to interstatepilot sites. Meagan comes from an intensivecare nursing background with an interest inadvancing medical treatment vs futile care.Thispassion has led to her involvement in theproject.

Suzanne O’Callaghan BA(hons) Grad Dip EdGrad Dip Info Serv M Women’s HealthCommonwealth Project OfficerSuzanne is also responsible for taking theRespecting Patient Choices Program to thepilot facilities in the community, as wellsupporting the education of GPs in the pilotareas. Joining the Program from the HIV andhepatitis consumer health information centreat The Alfred, her experience includes enablingpeople to make informed treatment andlifestyle decisions, education and communityliaison.

Respecting Patient Choices Programat Northern Health

Northern Health will commence the rollout of itsRespecting Patient Choices Project from September2004. The Project rollout will be initiated in fivemedical areas (including the Ian Brand NursingHome) across two of its four campuses: the acutesetting of The Northern Hospital (TNH) and thesub-acute setting of the Bundoora Extended CareCentre (BECC).

The Northern Health Respecting Patient Choices Project is designed to link community-based healthprofessionals with both the acute and sub-acutesettings to facilitate smooth communicationbetween all those whose patients have an advancecare plan (ACP). The culturally and linguisticallydiverse community in the Northern Healthcatchment adds another layer of complexity to theProject, necessitating a carefully detailed rollout withcommunity input.

The set up phase of the Project is almost completeand the initial Respecting Patient Choices

Consultant Training workshops are planned forSeptember and October in 2004. A launch ofthe Respecting Patient Choices project is scheduledto coincide with the first training of RespectingPatient Choices Consultants, on Monday 13thSeptember at 2pm at The Northern Hospital.Over 50 health care professionals from NorthernHealth have expressed interest in training, includingmedical, nursing, social work staff and pastoralcare staff.

So far, over 400 Northern Health staff, healthconsumers and community health professionals haveattended education sessions about the RespectingPatient Choices Project.

The Project is providing further education aboutACP to other relevant areas of TNH and BECC witha view to ensuring that advance care planningbecomes a sustainable, quality patient care initiativethat complements the delivery of health careservices by Northern Health.

L–R: Ms Janine Sage, Ms Gail Roberts, Dr Mike Dorevitch, Dr Kim Jeffs

Respecting Patient Choices News WINTER/SPRING 2004 32

GP Information Kit

The GP Working Group have completed the GPinformation Kit for GPs involved in the Communityextension of the Respecting Patient Choices Program atAustin Health.This kit has been sent to all GPs that havepatients in the Residential Aged Care Facilitiesparticipating in the community extension of theRespecting Patient Choices Program. This extension isfunded by the Australian Government Department ofHealth and Ageing.

The purpose of this information kit is to:• Inform GPs about the Respecting Patient Choices

Program and their role in the Program• Promote a health outcome that is positive for the

patient• Provide support for GP to consult patients on wishes

for care• Assist GPs to participate in the advance care planning

process• Assist GPs to complete advance care planning

documentation

The Information kit covers:• The Respecting Patient Choices Program• Advance care planning and end of life care in Victoria• Steps to develop an Advance Care Plan • Using an Advance Care Plan

• Sources of information• Examples of documents

— Medical Enduring Power of Attorney form— Advance Care Plan— Advance Care Plan for people who do not have

legal capacity to make medical decisions— Refusal of Treatment Certificate for a Competent

Person— Refusal of Treatment Certificate for an Incompetent

Person• GP tools

— GP quick reference card: Steps to advance careplanning & assessing competence

— Advance care planning discussion guide• Office of the Public Advocate Fact Sheets

— Medical/dental treatments for patients who cannotconsent

— Enduring Power of Attorney (Medical Treatment)— Refusal of medical treatment

Another version of the GP Information Kit will bedeveloped for all GPs that would like more informationabout the advance care planning process.These GPs wouldinclude any GPs in participating sites implementing theRespecting Patient Choices Program under the DHSHARP funding. That is Eastern Health, Northern Healthand St Vincent’s Health.

North East Valley Division GPEducation SessionThe North East Valley Division of General Practice joinedwith the Respecting Patient Choices Program at AustinHealth, to encourage GPs to participate in a ContinuingProfessional Development (CPD) activity in June. The aimof the session was to introduce the Respecting PatientChoices Program to GPs.

This education session attempted to achieve four mainoutcomes. First, was the need to inform GPs about theRespecting Patient Choices Team and its program ofadvanced care planning. Second, to present the medico –legal implications of advance care planning using theRespecting Patient Choices Program model, process anddocumentation.Third, was to define the role of the GP inrelation to the community extension of the RespectingPatient Choices Program and also for GPs that do nothave residents in the Community Extension Residential

Aged Care Facilities, and four, to illustrate the likelyscenarios where RPC would apply via a number of casestudies.

The session attracted interested participants from thedivision (3), GPs (20), practice managers (2), that bydivisional standards is regarded as very good attendance.

Written evaluations indicated that the sesion was of aparticularly high standard and that it was very wellreceived. The session is on a par with the well-receivedCPDs offered in recent times by virtue of the very goodfeedback received. There was significant alignmentbetween participants’ written answers to key learningquestions and key learning objectives delineated whenplanning the session

Respecting Patient Choices Programat Eastern HealthEastern Health is taking a multi-faceted approach tointroducing the Respecting Patient Choices program.Within the Acute setting of Box Hill Hospital, the mainfocus is on three general medical wards which also coverrespiratory, stroke and cardiology patients. However, staffin the Emergency Department. Short Stay Unit and TransitLounge have also been educated about advance careplanning in order to start the process and flag patients forfurther follow-up in the wards or community. SpecialistCardiac Failure and Urology nurses who can see patientsboth in the wards and at home, as well as aged caremanagers from a number of community based organiza-tions have been trained as Respecting Patient ChoicesConsultants to allow for the introduction of advance careplanning along the continuum of a patient’s journey.

A good example of the benefits of this approach is Mrs Twho, while a patient in Box Hill Hospital was introducedto the program by the social worker/Respecting PatientChoices Consultant. On her discharge Mrs T was referredto the Healthy at Home Program for follow-up of herhealth issues, but who also had staff trained as RespectingPatient Choices Consultants.The Healthy at Home CareManager/Respecting Patient Choices Consultant was thenable to assist Mrs T and her family to complete an AdvanceCare Plan (ACP) over a few visits. On completion, a copyof the ACP was forwarded to the Respecting Patient

Choices Office for inclusion on her hospital file and anAlert placed on the Patient data base, completing the loop.Mrs T’s husband and family were thus also introduced tothe program and Mr T completed his own Advance CarePlan.

Given that approximately 25% of patients with four ormore admissions to hospital come in from aged residentialcare, such facilities are an important area to be offered theprogram. Currently, Eastern Health is providing trainingand support to two residential care facilities, Millwardand Strathdon. Residents have responded very positivelyand especially appreciate discussing these issues with staffwhom they know so well.

Advance care planning education is offered on a continualbasis to doctors within Box Hill Hospital, with GPeducation anticipated to rollout over the next six months.General education has also been provided to key staffat the other Eastern Health hospitals (Maroondah andAngliss) to enable recognition of any Advance Care Plansof patients who may attend there as well as Box Hill.

Resources permitting, the intent is to expand the programwithin Box Hill Hospital and other community basedorganizations, with a focus on Peter James Centre, theEastern Health sub-acute facility next.

New Sub-committee EstablishedThe Respecting Patient Choices Program has established an Ethico-Legal Sub Committee of the National Reference Group.The committee comprises a number of lawyers and ethicists from Victoria and currently the Victorian and South AustralianPublic Advocates are represented.As the Respecting Patient Choices Program extends to the various states/territories inAustralia membership will expand to include the relevant Public Advocate or other relevant representatives from eachstate/territory.

The committee has been established to provide ethical and legal guidance to the Respecting Patient Choices Program tothe National Reference Group of the Program.

Two meetings have been held in June and the next meeting is scheduled for August 2004.The committee have reviewedthe Advance Care Plan for competent persons and will be providing legal and ethical guidance on the development of anAdvance Care Plan for people who do not have the legal capacity to make medical decisions.