Palliative care services are delivered in a variety of settings across Australia to enable people living with life limiting illnesses to have appropriate, timely, and compassionate quality care. Palliative Care Australia (PCA) is the peak body for palliative care representing all those who work towards high quality palliative care for all Australians. Working with the government, it sets the standard by which services can be assessed. Historically this was done through the original National Standards Assessment Program (NSAP), for participating palliative care services to self-assess against the National Palliative Care Standards (2nd ed.) 2005.
While enjoying initial success, there was a high attrition rate with time poor services finding the workload of NSAP too burdensome. Recognising that key changes needed to be made, NSAP activity ceased and a formal evaluation was commissioned by PCA with The Centre for International Economics in 2015. Summary findings of the evaluation recommended transition from the rigid cycle completion model to a more fluid, individualised online program that allows self-assessment to generate a quality improvement action plan for the service. The program also would promote behaviours that are scrutinized by the National Safety and Quality in Healthcare Standards (NSQHCS) while providing a platform in which services can share benefits of self-reflection in quality improvements.
Funded by the Australian government, the National Palliative Care Standards were updated and released in early 2018 (5th ed.). The nine Standards are the backbone of the redesign of the self-assessment program, so they underwent a mapping process by the Australian Commission on Safety and Quality Health Care (ACSQHC) to align with the newly released NSQHCS (2nd ed.). With the recruitment of a National Clinical Advisor with a specialist palliative care background to lead the project, an expert steering committee was formed and the Palliative Care Self Assessment program or PaCSA, was created.
Initially a survey was done of the specialist palliative care services who had engaged with NSAP to prioritise their quality improvement objectives and service development needs. This better informed the objectives of the PaCSA portal design. A software company was engaged to design a portal to enable services to assess themselves against each element within each Standard, with a quality improvement action plan automatically generated at the end of the process.
Services will be supported in this process with access to quality improvement tools for patient and family/carer surveys, documentation audit tool, evidence gathering information and links to evidence based resources in palliative care, quality improvement and service development. These can be accessed at any time giving services flexibility to set their own goals. PaCSA also has the capability for services to upload stories to demonstrate quality improvement activities for each Standard that they can select to be available within their own services or to the PaCSA community, to improve peer to peer learning. In working with CareSearch, these stories will be included as part of a wider network of grey literature.
The portal was tested by the steering committee and with the specialist palliative care team at Clare Holland House, Calvary Health Care ACT. Based on feedback from these consultations, modifications were made to include videos to better highlight the goals and objectives of quality improvement of each Standard using PaCSA. The quality improvement action plan was also changed to be alive document allowing services to access it any time in the 24-month cycle to add in information, building on their evidence and increasing the efficiency of repeated assessments each subsequent time. PCA encourages services using the portal to provide feedback to the PaCSA team to identify areas for improvement in future versions.
PaCSA will be available for all services delivering palliative care from the 20th of May 2019 with the formal launch during National Palliative Care Week. Services, through a process of continual quality improvement and sector engagement, will be strengthened in their ability to meet organisational needs, community needs and above all, provide improved patient outcomes.
Services can register to use PaCSA at https://pacsa.force.com/Pacsa/s/login/SelfRegister
For further information on PaCSA email pacsa@palliativecare.org.au
Kate Reed-Cox, Palliative Care Nurse Practitioner (MN) and National Clinical Advisor for Palliative Care Australia (PCA)