Hato Hone St John & Nelson Tasman Hospice Collaborate for the Community

In the context of our aging population with growing palliative care need, ambulance services have an increasingly important role in the delivery of palliative care. From 2016-2022 there has been a >700% rise in the palliative care caseload for Hato Hone St John nationally. Research shows that ambulance clinicians want further education and training in palliative and end-of-life care. In 2022 a project group was formed between Hato Hone St John and Nelson Tasman Hospice to strengthen the partnership between our two services, aiming to:

• Complement existing processes to improve patient access to palliative care and support in the home.
• Provide urgent palliative-care support when the patient’s usual palliative-care provider cannot respond.

• Avoid non-beneficial emergency department visits for palliative care patients.
• Improve education and training, enabling ambulance clinicians to become confident in supporting palliative-care patients and their whānau.

The first phase of this project has been the development of an Adult Palliative Care Ambulance Plan (APCAP). The APCAP documents individualised palliative care treatment, end-of-life decisions, patient preferences, and guidance on the use of APOs (Anticipatory Prescribed Orders) for symptom control.

A completed APCAP will be registered with Hato Hone St John Ambulance and uploaded, enabling a real-time automated alert to be provided to responding ambulance clinicians that an APCAP is in place.  The APCAP will reflect, but does not replace, the patient’s individual health care decisions documented in their Advance Care Plan (ACP) and/or Advance Directive (AD). Completion of an APCAP should be considered for any palliative patient being prescribed APOs. The APCAP requires Medical/Nurse Practitioner sign off but can be completed by any relevant clinician with the involvement of the patient and whānau.

Training sessions for all ambulance staff have been delivered throughout September. The APCAP is now available for use for all relevant palliative care patients across Nelson and Tasman, including those under the District Nursing primary palliative care service. A fillable PDF is available on Health Pathways under the Palliative Care Section  and on the Nelson Tasman Hospice website. Colleagues from Te Whatu Ora Nelson Marlborough, District Nursing, and General Practice have had input into the development of the APCAP.

“Strengthening partnerships between health providers can only improve outcomes for patients and their whānau with palliative care needs.” Nelson Tasman Hospice Medical Director Dr Jodie Battley says. “The APCAP further assists palliative care patients to receive care that aligns with their wishes and preferences.”

The next phase of the project will be focused on education and training for the ambulance service staff in specific palliative care fundamentals and internships for interested Hato Hone St John staff at Nelson Tasman Hospice.

Please direct any questions/concerns to Dr Jodie Battley: jodie.battley@nelsonhospice.org.nz