MONTHLY UPDATES

Just in Case Box

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Sept 2016 – UPDATE

The JiCB initiative began its implementation phase in July with the education of hospice@HOME staff and the afterhours teams within hospice@HOME, including GPAssist who are providing the telephone wrap around after hours service for JiCB patients.  This was completed mid-July, which was then followed by a roll out of state-wide nursing and GP education about the project guidelines and procedures.  Please note that education is not mandatory for either GP’s or nurses, however it is encouraged for a better understanding of how to use and access the JiCB.  Please see attached flyers for further information about GP and nursing education opportunities.   For interest, there are DEMO JiCB’s kept in all regional hospice@HOME offices for anyone to access for their own information.

The Just in Case Box Reference Group had their second meeting in August.   Dr Siyan Baxter (Manager of State Research, The District Nurses) attended as a guest to work with the input and direction of the group on JiCB evaluation.  With the limited amount of time we have left to evaluate the initiative, we had to be realistic about what outcomes we can evaluate. The Reference Group felt that there should be a focus on patient/carer experiences, an economic evaluation and the experiences of the multidisciplinary team.  As a result, the JiCB Steering Committee have chosen a validation survey called ‘Support Team Assessment Schedule’ (STAS) as the tool to be using for the evaluation of patient, carer and multidisciplinary team experiences.  There is further information attached about the STAS and there will be further information also provided on the JiCB FAQ page.  Some of the other examples of evaluation outcome measures are length of time the JiCB was in the home before use, place of death, reasons for transfer (if applicable), length of hospital stay, and use of ED and ambulance services.

The Reference Group continue to provide the initiative with valuable engagement and stakeholder perspectives which we are extremely grateful.

There are currently 2 Just in Case Box’s that have been prescribed and are in patient’s homes in the south of the state.  Communication between service providers got off to a rocky start, however, as part of our commitment to continuous quality improvement, we have amended implementation processes with the input of the JiCB Reference Group and will continue to work with all the patients participants of care to ensure that we identify linkages between clinical groups to ensure seamless care across all streams.

With hospice@HOME staff changes in the North and North West of the state there was a short decrease in clinical leadership for the initiative, however, we have recently re-formed  the project team and will shortly start working with GPs to implement Just in Case Box’s in those regions.

We have also recently updated and reprinted the Guidelines, the September 2016 version is now accessible on the website at Just in Case Box Guidelines (Sept 2016)

As always, please contact hospice@HOME with any questions.

May 2016 – UPDATE

Just in Case Box Forum

Thanks to all those who attended the Just in Case Box forum in Hobart on Thursday 28th April 2016. The forum was opened and facilitated by Dr Kelly Shaw whose expertise and professionalism was greatly appreciated.

Fiona Onslow, Director of State-wide Operations for The District Nurses, led a minutes silence to remember the 20th anniversary of the Port Arthur tragedy and then talked to the development of the Just in Case Box over the last two years.

This was then followed by four expert speakers from within Tasmania and also interstate. If you couldn’t make it on the day, highlights of the speaker’s presentations will be posted on the hospice@HOME Just in Case Box page soon so you don’t miss out!

We’d like to express our sincere thanks to all the speakers who took time out of their busy schedules to come and present to us. We feel very honoured and humbled to be in the presence of such amazing end of life researchers and professionals.

After lunch, we farewelled some of our interstate guests and got down to work. With representation from a wide variety of professional disciplines and from all corners of the state, the facilitated discussions generated some fantastic conversation. Participants were asked to consider “in 3 years from now (after implementation) what does success look like for the Just in Case Box?”

Some of the thoughts were;

  • It had been a limited roll out with a state-wide consistent approach
  • The GP had led the care and the initiative was implemented in sites that were ‘champions’
  • A shared plan of care was well communicated
  • A Goals of Care was undertaken for each patient
  • Risks had been well identified and managed
  • There was a medical (GP) assessment prior to commencing starting a Just in Case Box
  • The medications were prescribed by the patients GP
  • There was a medical order when the prescribed medications were needed to be used
  • Research/evaluation questions and findings had been well communicated to stakeholders

 

Participants were then asked “in 3 years from now (after implementation) what does failure look like for the Just in Case Box?”

I think there was a unanimous agreement that front page Mercury or Examiner would be the ultimate failure! “Family forced to keep dying relative at home in pain and suffering!”

Thanks to all those who attended and participated in the discussions. The Just in Case Box Steering Committee and Reference Group will be given a full report of the forum to consider stakeholder suggestions.

Reference Group

We have started sending invitations for an external reference group which has been established in response to our consultations. The reference group will be an excellent channel to assist us in communicating information to and from stakeholder groups who may be impacted by, or impacted on by the initiative. There is state-wide representation and professionals from across the health spectrum.

Once again, thank you for your interest in the Just in Case Box initiative and I look forward to updating you again in June 2016.

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June 2016 – UPDATE

Hi all and welcome to June’s Just in Case Box update!

I will be emailing you each month to update you on the progress of the initiative as we transition into implementation phase. If you do not want to be included in these emails, please let me know and I will remove you from the mailing list.

Just in Case Box Reference Group

Last month, we were still in the process of sending out invitations for an external reference group. We received overwhelming interest in the reference group and thank you to all who were keen to be involved. Unfortunately, we had to limit size in order to keep the group manageable but despite that it still is a group of 17! However, I’m happy to update that we have now convened the group which has representation from all relevant professional groups and across all regions. The Just in Case Box Reference Group held its inaugural meeting on the 6th June 2016. They worked through the report that was developed following the Just in Case Box Forum in April 2016 which provided the platform for some excellent discussions and perspectives. Thank you! The next meeting is in August 2016.

GP/RN Education

A free online, self-directed learning package has been developed for Registered Nurses. It will be available to all RNs on our website soon. There will be access to online presentations, reading and a quiz which when completed the RN will receive a Certificate of Completion worth 3CPD points. An extra 1CPD point can also be obtained by completing a short reflective activity following an interaction with a patient who has a Just in Case Box. Again, we will issue a Certificate of Completion for inclusion in the RNs professional portfolio. All the hospice@HOME after hours RNs (and those brokered by GPAssist to provide 1800HOSPICE service) will commence the Just in Case Box self-directed learning package next week and must have completed it by 17th July 2016. It will also be available online via the hospice@HOME website for Community Health Nurses across the state next week.

We will be liaising with the regional GP liaison officers over the coming weeks about a possible role in peer support for GPs and we will also be looking into an online resource prior to mid-July 2016.

Thank you for your interest in the Just in Case Box initiative and I look forward to providing another update in July.

The Just in Case Box is comprehensive.  Safety aspects are considered, including when medications can be given for example ‘within working hours’ with direct consultation with physician or any time according to patient plan                                                                                                                  – Nurse Practitioner

 

There’s a real focus on patient care with a sense of control for patient and family                                                                                                                                 – Palliative Care Social Worker