Education

'The Illawarra Shoalhaven Story': How Allied Health Implemented PCOC.m4a

We acknowledge that the country for Aboriginal peoples is an interconnected set of ancient and sophisticated relationships. From Sydney to the Southern Highlands to the South Coast, from fresh water to bitter water to salt, we pay our respects to leaders past and present.

This video is a collaboration between the Illawarra Shoalhaven Local Health District and the Palliative Care Outcomes Collaboration. In this video, we talk about how multidisciplinary teams can use PCOC tools to support better patient and care outcomes in palliative care. The following video is video one in a series of 3.

Hi there, I'm delighted. to support the Illawarra Shoalhaven Palliative Care Allied Health Team to share the experience of a multidisciplinary team approach to using PCOC.

Established in 2005, PCOC is a quality improvement program funded by the Commonwealth Department of Health. The program's overall aim is to improve palliative care outcomes. Services participating in PCOC use standardised assessment tools to measure and improve patient, and their family and carer outcomes.

PCOC collects information from participating services across Australia about palliative care outcomes, where this information is then analysed and sent as reports to services every six months. Services use this information to better understand if the care they provide is effective to facilitate service-to-service benchmarking.

Services use the five PCOC-validated clinical assessment tools to measure and improve an individual's symptoms. Clinical teams use the information gathered from the assessments to provide appropriate and holistic care. An important part of the PCOC assessment approach is involving individuals and their family and carers in decisions about their care.

The five PCOC assessment tools include:

• the Palliative Care Phases;
• Resource Utilisation Group – Activities of Daily Living (also known as RUG ADL);
• the Australian Modified Karnofsky Performance Status (also known as AKPS);
• the Palliative Care Problem Severity Score (known as PCPSS); and
• the PCOC Symptom Assessment Scale (or SAS). Some palliative care services are using the Edmonton Symptom Assessment System or ESAS, which includes the assessment of non-physical symptoms. Starting from 2025, PCOC will begin transitioning from SAS to ESAS, which we will elaborate on in video three of this series.

These evidence-based tools are designed to be used together and will help determine the palliative care phase and the needs of the individual. This then helps inform the nature of clinical response required.

So, what are the benefits of using the PCOC assessment tools? There are a number of ways that tools support person-centred care. These include:

• The use of the PCOC common clinical language to facilitate communication between palliative care clinicians and providers across all teams and settings;
• Identifying the resources needed to provide the necessary support for individuals to maintain their independence and quality of life.
• Involving people and their family and carers in decisions about plans of care, to meet the person's individual needs.
• Services can use the PCOC assessment tools to provide a holistic evaluation of the person's palliative care needs.

I’m the Allied Health Clinician Team Leader for our Specialist community palliative care service.

PCOC is used throughout our service as a way of clinically handing over information and escalating and monitoring care.

I'm the Palliative Care Allied Health Educator.

At Illawarra and Shoalhaven Local Health District, we made it mandatory for all Specialist Palliative Care Allied Health staff working in the community to complete every component of the PCOC assessment.

We have social workers, psychologists, physiotherapists, dieticians, occupational therapists, and speech pathologists all completing the five components of the PCOC assessment at every encounter.

In this video, we'll outline how we implemented this change and embedded it into our Allied Health Model of Care sustainably. We want to encourage all specialist palliative care services to include Allied Health in the application and response to PCOC assessments.

So, why did we embed PCOC into routine practice for Allied Health? Well, firstly, we noticed a gap. Allied Health often sees clients in between routine nursing assessments, and there were multiple occasions when the person had become unwell or symptoms had changed and required urgent action. However, this was not recorded in our data; follow-up was sometimes missed; and there was no common language between Allied Health and nursing.

All members of the MDT are contributing to the clinical care of the person and when everyone is completing PCOC assessments, it provides a more holistic patient journey where every episode of being unstable or deteriorating can be readily captured and responded to in a timely way.

Here we are showing some comments from clients and their family and carers that have been part of the PCOC assessment process.

“The social worker came out to see me and also checked in on my breathing. They talked me through what a nine out of 10 was like compared to a five out of 10. I was scoring it wrong and I didn't realise. Because it was a nine out of 10, they arranged for the doctor to change my medications, and the physio came out to see me.”

“I noticed that everyone in the palliative care team was checking in on the same problems. My breathing, my pain, sleep, even my bowel movements. It's good to know that everyone, even my OT, is watching out for these things.”

We have developed a poster in collaboration with PCOC to provide some step-by-step ideas for other services on what they may need to consider when implementing PCOC assessments for all Allied Health disciplines.

Firstly explain the why with your team – acknowledge it may take time to adopt this into standard practice, but it is an important component of the person’s journey. Provide site-specific examples of when care escalation had been missed or when Allied Health have identified certain needs.

Having a clinical leader in the team who understands PCOC well and will support and advocate decision-making, is crucial. If you are implementing PCOC across multiple disciplines, you need coordination and consistency! They need to ensure that all disciplines are doing the assessments correctly and at the right times.

PCOC assessments may not be standard practice for every discipline. You need to have an education plan and discipline specific examples.

Our service utilised the ‘PCOC education guide’, which includes completing PCOC Essentials Online and attending a PCOC Fundamentals webinar.

We then followed this up with team education on how to practically complete the assessments, how to word questions and incorporate this into their current discipline assessments.

It is also embedded into our orientation plan for every new Allied Health staff member.

Ensure that all staff have access to the PCOC lanyards, recording sheets, and the SAS ruler. These tools not only help the clinician but also provide clients and carers with a visual to. rate distress associated with their symptoms.

It's important to understand and clearly establish when a PCOC assessment is required by Allied Health. Typically, it is one assessment within a 24-hour period, so if a community nurse has completed a PCOC that day with the client, the Allied Health team member may only need to check in with the person and see if anything else has changed, rather than completing a whole new PCOC assessment again.

Ensure they are aware of what escalation pathways are required from Allied Health, the importance of the response timeframes from PCOC, and which member of the MDT was required for the escalation.

We want to encourage every Allied Health professional working in specialist palliative care to complete the full PCOC assessments. We are all capable of implementing the whole assessment into standard practice. This means we can provide a much more comprehensive picture of the needs of the person and their families.

For our service setting, a clear expectation that this would be mandatory for Allied Health, helped to make this change occur. We also had a very clear timeline for implementation. Our soft, go-live date, which was when all staff were just having a go in the clinical field, and so they were able to practice, make mistakes, forget to do an assessment and gain some feedback. After this, the hard go-live date was when all disciplines were expected to be completing the assessments and recording this in the person's file. There will be challenges and questions throughout, so it is very useful to have drop-in sessions between team members to share tips and feedback.

This concludes video one of this three-part video series. We thank the Palliative Care Allied Health team for their time and ongoing support for PCOC patients and their families. We would also like to thank the PCOC consumer representatives for their valuable input.