Emergency Planning and Management

What we know

A palliative care emergency is a sudden and life-threatening change in a person’s condition. In this scenario, handovers of care are particularly important to reduce risk of receiving inappropriate treatment. Planning ahead for possible emergencies is good practice and can improve the quality and safety of care. Documentation of care preferences or the nomination of a substitute decision-maker can help to ensure that a person receives care in line with their wishes.

Go to Evidence Summary

What can I do?

Suggest that the family consider advance care planning. Planning for future care and Talking about goals, values, and preferences can help guide discussions and decisions around advance care planning.

Use this form (928kb pdf) to help you prepare and conduct a conversation with a GP when you are concerned about a resident’s health.

Remember that extended care paramedics and Nurse Practitioners may be able to provide care that could avoid a hospital admission.

When people decide to be cared for at home, ensure that they (person, family, carers) have a care plan which includes decisions that includes what to do in an emergency.

Make available the fact sheet about advance care planning for individuals (200kb pdf) and the factsheet for substitute decision-makers (200kb pdf) so that people in your care and their families can prepare for the future and document choices or preferences.

Advance care planning information can be uploaded to My Health Record.

Ensure that the Advance Care Plan (ACP) or Advance Care Directive (ACD) can be found quickly and easily. Make sure the contact details are up to date for the next-of-kin, the substitute decision-maker and the person to contact in case of an emergency; these may not be the same person.

When someone is transferred in an emergency, make sure that the current care plan and documents such as an ACD goes with them.

After a health emergency or a hospital admissison, review the care plan. A family meeting may be helpful.

What can I learn?

Take the opportunity to update your skills on symptom management for respiratory distress, pain and gastrointestinal issues.

Reymond L, Cooper K, Parker D, Chapman M. End-of-life care: Proactive clinical management of older Australians in the community. Australian Family Physician. 2016;45:76-8

Burkett E, Scott I. CARE-PACT: A new paradigm of care for acutely unwell residents in aged care facilities. Australian Family Physician. 2015;44(4):204-9.

The policy on end-of-life and palliative care in the Emergency Department (557kb pdf) - Australasian College for Emergency Medicine (ACEM).

Read the factsheet about advance care planning for care workers (202kb pdf).

The general public, health care professionals, care workers and students can do modules available at ACP Learning - a website to support online learning for all those interested in learning more about advance care planning.

Check out the ACP Learning resource library.

What can my organisation do?

Recommend palliAGEDnurse for nurses working in residential, community or primary care.

Upskill staff to manage symptoms that might otherwise indicate the need for an acute care admission.

Prepare staff and services for the recognition of impeding death to avoid sense of emergency/panic if unprepared.

Consider developing an emergency care pathway that might reduce the need for acute care admissions. Review after-hours emergency procedures.

Prepare staff to be comfortable and confident with communication at a time of an emergency; they know how to pass on 'bad news' and are sensitive to how people may receive 'bad news'.

Train staff to introduce discussion around advance care planning and offer contact details of people who can provide assistance in completing the paperwork.

Ensure there is a process of integrating an Advance Care Plan (ACP) or Advance Care Directive (ACD) into notes/records and the goals of care.

Make sure that a copy of the ACD is readily available in notes or records; an electronic version may assist accessibility by various people and organisations which provide care.

Page updated 25 May 2018