Improving Medication Safety for Clients and their Carers in the Rural Palliative Care Home Setting Project commenced January 2008 in response to an error involving a carer administered medication. Clinicians identified that no formalised process existed within NSW for carer medication administration despite a widespread practice of carers administering subcutaneous medications at home, especially in the last few days of life. It was recognised that formalised protocols and standardised training for carers were required to ensure patient safety.
The need to respect patient and carer choices is emphasised throughout care while providing effective symptom control in the palliative care home setting. The project consisted of evaluating a carer's preparedness to administer subcutaneous medications and provided education and structured support to the carer to administer these medications. A culture of medication safety emerged that was welcomed and embraced by patients, carers and families and the clinicians. The project developed a legal and ethical framework on which to base these standardised practices.
This project was an initiative of a health promoting palliative care service as per Allan Kellehear's 1999 model with service delivery strategies based on the five major ‘action’ principles of the Ottawa Charter. The outcomes demonstrated that carers were trained to safely administer subcutaneous medication and there were no medication errors.
Additional outcomes included improvements in After-Hours Occupational Health and Safety for staff, and improved the end of life decision-making abilities and processes for patients, carers and families enabling choice in place of care.
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