Palliative Care in Southern NSW

GPs involved in palliative care in Southern NSW now have the option of closing the after hours gap for their palliative care patients. In consultation with the patient and their family, the GP may elect to complete a NSW Ambulance Authorised Palliative Care Plan. 

Once endorsed by NSW Ambulance, this plan specifically authorises NSW Ambulance paramedics to deliver individually tailored treatment based on the GPs advice as documented in the plan. In the event of a Triple Zero (000) call-out by the patient, the NSW Ambulance Authorised Palliative Care Plan may be initiated. This may include administration of medications and other actions to relieve and manage symptoms in the home.

Individuals with palliative care needs often access care through their local family GP and community palliative care nurse. Families and carers also have an important role in supporting individuals with palliative care needs in the home, particularly in the after hours period when health service providers may be more difficult to contact. 

It is understood that families and carers are often well prepared with education and support, including medication regimes to help manage breakthrough pain and other symptoms in the after hours period. It is also understood that on occasion, things don’t work and more help is needed. 

According to a survey conducted in 2011, 76 per cent of Australians would prefer to die in their own homes. However, the most recent statistics on palliative care indicate that in 2009 –10, 51 per cent of Australians who died that year did so within a hospital setting (AHHA).

In the after hours period when sudden changes in health may lead to uncertainty, NSW Ambulance Triple Zero (000) service is commonly a first response. In the absence of detailed clinical knowledge about the patient, the paramedic’s response is protocol based and transfer to the hospital emergency department is generally required. This transfer is often not the optimal outcome in these situations and may be avoidable. For a patient with palliative care needs, transfer may be avoidable if the paramedic has access to an authorised palliative care plan.

This plan allows the paramedic responding to a Triple Zero (000) call to respect the palliative care wishes of the patient and follow the GP’s advice.