Chaired by Dr Will Cairns OAM, introduces some of the early discussions about #palliativecare - identified key issues - continuity of care, caring for new patients with new conditions, caring for #COVID19 patients and also #palliativecare colleagues #21OPCC
Communication and international collaboration vital for management of #palliativecare during pandemic #21OPCC
Vital for #palliativecare providers to document their experiences of #COVID19 #21OPCC
First up is Dr Anjali Raghavan, from @Austin_Health talking about 'Rapid transfer from ICU to PCU so families can be present during COVID lockdown' #21OPCC
@Austin_Health Dr Raghavan began her journey in #palliativecare at the beginning of 2020, just as #COVID19 pandemic began #21OPCC
End-of-life care has always been an important part of intensive care medicine #21OPCC
Pillars of #palliativecare open communication are vital to reducing stress at end-of-life. #21OPCC
Increasing role for transfer from ICU to PCU during pandemic - little research about this, which is the motivation for this project #21OPCC
12 patients transferred from ICU to PCU over 5 month period.
Mean length of stay in ICU was approx 9 days #21OPCC
Decisions to move to PCU were discussed with family members within 24 hours of decision #21OPCC
Consistent handover by consultive #palliativecare teams to inpatient #palliativecare team.
Approx 1/3 transferred out of hours. #21OPCC
Time from transfer from ICU to death was variable, between 35 min and 6 days. #21OPCC
The limited available data about families experience of this time, during the pandemic, indicates mixed emotions, gratitude, distress, anger (directed at experience of health care prior to this time), #COVID19 added to stress #21OPCC
Research identified potential areas for improvement of the transfer process - planning and communication, and in transition from active to supportive management #21OPCC
Jia Yin Tay and Rachel Everitt talk about 'COVID19 end-of-life care: symptoms and supportive therapy use in an Australian hospital' #21OPCC
#COVID19 significant impact on healthcare worldwide. Aim of study to describe clinical characteristics, symptomatology, medications and use of supportive therapies in patients who died from #COVID19 in a Victorian hospital #21OPCC
58 patients died from #COVID19 during the study time-period. Average age 87 years old. #21OPCC
Hypertension and dementia most common comorbidities in the cohort. #21OPCC #COVID19
Most common end-of-life care symptoms in the people included in the study incl breathlessness, pain, and agitation #21OPCC
90% of patients required opioids for pain management in final days #21OPCC
Respiratory secretion less common in #COVID19 terminal phase when compared to non-COVID patients.
Breathlessness most prevalent symptom. #21OPCC
Interesting - Cough not a very prevalent symptom in the terminal phase, even though it is one of most common symptoms in acute phase of the virus. #COVID19 #21OPCC
Only 8 out of the 58 patients were referred to #palliativecare consultancy in the last days of life - is important to find out what barriers exist and how the #palliativecare role can be expanded in future #COVID19 #21OPCC
Interesting comments in the chat asking how specialist #palliativecare referrals can be improved #21OPCC
Michelle Wood from Banksia Palliative Care is up next to talk about 'Unsung heroes: providing front-line, face-to-face community palliative care during a pandemic lockdown' #21OPCC
Michelle asks us to think about where we were when we first heard about #COVID19 #21OPCC
Banksia Pall Care is a 24-hour service, providing specialist service at no cost. Referrals to #palliativecare increased during 2020/21 #COVID19, as well as admissions and deaths #21OPCC
Michelle discusses the challenges of delivering expert community #palliativecare through a pandemic #21OPCC
Challenges incl = adapting, learning about #COVID19, social distancing, risk management, lockdowns.
The management team have been v supportive. #21OPCC
Supplies of basic equipment was a huge challenge for them #COVID19 #21OPCC
Michelle tells a story about how they were getting PPE supplies from a local tattooist, as their usual suppliers were unable to provide them with equipment.
Everyone chipping in to help each other - great community effort during #COVID19 #21OPCC
"Clients didn't want to go to hospital, with the fear of isolation and dying alone" during the pandemic #COVID19 - 21OPCC
Very difficult to manage symptoms over telehealth, had to visit in homes #21OPCC
Staff were phenomenal in adapting to daily changes in restrictions. Michelle very grateful for her team #21OPCC
How to provide #palliativecare during a pandemic - Take a really deep breath, gather with your colleagues, put your heads down and make a difference in a lot of people's lives - Michelle #21OPCC
Jennifer Philip is the final presenter in this session, 'Palliative Care and COVID-19'. She is talking about 'Outpatient palliative care telehealth during #COVID19 and beyond: a mixed method evaluation' #21OPCC
The study to evaluate telehealth during #COVID19 was conducted in Victoria during 2020 and 15 weeks of lockdown, conducted survey and qualitative interviews with patients and clinicians. #21OPCC
The study found that many of the telehealth consults were about provision of pain management, the remaining were general follow-up #21OPCC
Telehealth during #COVID19 improved continuity of care and enhanced relationships #21OPCC
Telehealth during #COVID19 has also been beneficial for joint consultations, incl GP, specialist and #palliativecare #21OPCC
Loss of physicality of usual #palliativecare delivery .
A mix of telehealth and in-person appointments might work well in future #21OPCC
Q&A 'COVID19 and Palliative care session' #21OPCC
Q for Anjali - was there urgency for the transfers from ICU to PCU?
A - natural progression of events
Q for Jia and Rachel - interested to hear that #COVID19 patients had relatively low doses of medications?
A - Became unwell quite quickly, initiating doses at levels used to taking in aged care setting #21OPCC
Q - do you think patients comfortable at end of life?
A - medication playing catch up. Distress quite common #21OPCC
From Anjuli - visitor restrictions in ICU very strict, no visitors allowed. But, slightly more relaxed in palliative care units #21OPCC
Q for Michelle - why do you think number of referrals increased so much in 2020?
A - more referrals came from oncologists. Suspect it may be because the team at Banksia were active and other healthcare services may not have been. More referrals also from aged care #21OPCC
A from Michelle cont...- team at Banksia were active in the community, and able to provide hands-on support #21OPCC #COVID19
Sorry, missed Q for Jenny...
A - community services under the pump, telehealth doesn't need to be an either or. Gradual transition. #21OPCC

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More from @CroakeyNews

10 Sep
To wrap up the final day of #21OPCC, here are ten key quotes that give an overview of topics discussed today.
“Cultural aspect of what death and dying mean. Other countries do that so much better than what we do in Australia.” - Prof Patsy Yates #21OPCC @pastyymates
"Aged care facilities want to provide great care - if funded appropriately, we can do that better, capacity can be built." - Peter Jenkin #21OPCC
Read 12 tweets
9 Sep
Another full day of interesting and insightful discussions about #palliativecare at #21OPCC. Following are ten key quotes for an overview of the second full day of presentations.
"When the doctor has time to sit and listen, this has a huge impact on the patient" - Dr Diana Ferreira @diana_mbhf - great insight from the patients' perspective as a cancer patient #21OPCC
"Death is not linear" - Dr Katrin Gerber @NAgeingRI #21OPCC
Read 11 tweets
9 Sep
Last plenaries for the day about to begin - I'll be tweeting from this one- What is needed for better outcomes for breakthrough cancer pain? #21OPCC
Session chaired by Prof Gregory Crawford from Uni of Adelaide, Prof Andrew Davies from Trinity College, Dublin, Emeritus Prof Maree Smith from Uni of Qld, @diana_mbhf a #palliativecare researcher & cancer patient, & Dr Jessica Lee from Concord Centre for Palliative Care #21OPCC
Prof Andrew Davies - longstanding interest in breakthrough pain, disappointing thing is we still seem to have a problem in terms of diagnosing the problem, assessing it, and providing adequate medications #21OPCC
Read 14 tweets
9 Sep
I will now be tweeting from the ''Collaboration and Integration session, chaired by Camilla Rowland #21OPCC
First presenter in this session is Judy Hollingworth talking about 'Palliative care practitioners and community advocates collaborate in a disadvantaged rural region' #21OPCC
After a lovely acknowledgement to country, Judy begins her story about collaboration and causation #21OPCC
Read 76 tweets
9 Sep
Welcome and acknowledgement to country by @didarmody
I acknowledge I am tweeting from Kaurna country and pay my respects to Elders past and present #21OPCC
.@didarmody reminds us to have a look at the art submitted for the art competition #21OPCC
International panel coming up! Incl #palliativecare experts @rachelcogs, Christian Ntizimira @ntizimira, Dr Katherine Pettus @kpettus, Dr Malama Tafuna’l from University of Otago, A/Prof Ghauri Aggarwal, and A/Prof @OdetteSpruyt #21OPCC
Read 47 tweets
8 Sep
A great day of presentations today at #21OPCC
If you missed any sessions, here are ten key quotes which give a brief overview of the day.
"Death is a social justice issue" - @NaheedD
#equityequityequity
"It's really hard to give palliative care {to people experiencing homelessness} if you're not advocating for housing" - also @NaheedD #21OPCC
"The most important thing to get right is how you finance your health system" - @yates_rob on Universal Healthcare Coverage reform #21OPCC
Read 10 tweets

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