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Problem Statement

The Deteriorating Patient Forum provides oversight and expert advice around the safety, effectiveness and ongoing improvement of the deteriorating patient recognition and response systems. A major workstream for the forum this year has been goals of care.

Often the default culture for deteriorating patients is to do whatever is technically possible, rather than considering what is individually appropriate. Unsuitable or unwanted treatments can result in suffering for patients and families, moral distress for clinicians, and unnecessary use of resources for the organisation.

What are we trying to achieve?

Our aim is to enable a shared goal to be developed between the patient, their family and clinicians to guide the appropriate level of intervention, should the patient deteriorate.

To support this, a shared goals of care form is being developed that aims to:

  • understand the underlying values of the patient
  • clarify which treatments are suitable for the patient
  • communicate the shared goals of care plan.

We are also developing a policy to support this process.

What have we done?

We have looked at several national and international variations of the shared goals of care form, and created a draft version of the form that aligns with the work being led nationally by the Health and Quality Safety Commission.

The form will guide a conversation to establish the underlying values of the patient, which will be used to inform decisions about the resuscitation status and level of intervention appropriate for the patient.

We are putting together a recommendation paper to outline the additional resources and training required to support clinicians to develop the skillset to have these conversations.

What did we find?

A new form and updated policy will provide some guidance on developing shared goals of care plans. However, to make a meaningful change, staff training will be required on how to have high-quality discussions with patients about goals of care.

How did we make a difference?

We are in the early stages of the process at present.

Where to from here?

We are currently seeking feedback about the form. It will then go through a series of plan-do-study-act cycles, before being finalised and rolled out across the organisation.

Once completed, the policy will support this. The recommendation paper will be put forward to gain additional resources for training for clinicians.

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