Summary
Wheatbelt Specialist Palliative Care Nurse Manager Brett Hayes writes about the Western Australian service using videoconferencing to train carers to manage breakthrough symptoms in rural areas.
Recently we used the caring@home package to teach carers at home how to administer subcutaneous medication. What was different about this occasion was that we did it using video conferencing.
Wheatbelt Specialist Palliative Care provides a service for inpatient and community patients across 154,000 square kilometres for 24 hospitals and in the community across 43 local government shires. We work Monday to Friday within business hours, have three permanent clinical staff and a visiting consultant once a month. There are 180 patients that we are aware of in the region and as you can imagine, due to distance, it's very difficult to physically visit them all.
In 2016, we developed a TelePalliative care project with the main aim of seeing more patients. Using video conferencing (VC) we can now connect to more people in their own home, providing support from our central office. This has led to increased patient surveillance and more timely interventions which has led to an increase in planned home deaths.
Recently we used VC and the caring@home package to teach carers to administer subcutaneous medication at home. While on a home visit - we always visit our terminal patients at least once - our clinical nurse set up a VC with myself and the carer. While the nurse assessed the patient, I used the caring@home package to train the carer, who was the patient's son. The carer had a caring@home carers package in their home and I had one in my office. We went through the package together step-by-step and I watched as the carer rehearsed giving subcutaneous medication and became confident with the task.
The next day I had a call from the patient's daughter. Unfortunately the patient's son had found the task of watching his mother die more confronting that anticipated and was no longer able to help. The daughter was wanting to fulfill her mother’s desire to die at home but needed educating. I initiated a VC and again used the caring@home package to teach her how to competently administer subcutaneous medication.
I find the caring@home carers packages to be very user friendly and adaptable to VC providing that there is a package at each end. In this instance, we VCed every day with the carer, giving advice and support until her mother passed away at home. This was a fantastic outcome for the family who wanted to fulfil their mother's wishes in this way. This was made easier with help from the very adaptable caring@home package. I anticipate that this new procedure will become standard practice for our team.