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10 minutes with Bridget from Decision Assist

Bridgit Boland

Bridget is one of the 10 palliative care nurses who answers calls to the 24-hour Decision Assist advisory line (1300 668 908). Bridget is a clinical nurse specialist in palliative care, who has extensive experience in oncology. She brings 20 years’ experience to the role.

Who does the Decision Assist line support?

Most of the people who call are registered or enrolled nurses who work in residential aged care facilities. We also support general practitioners, allied health workers, and personal care workers. The service isn’t for the general public or recipients of aged care services; if they call, we refer them onto a more appropriate service.

How do professionals feel about asking for help?

Sometimes when nurses call, they say to me, this question is probably silly. I say to them that nothing is silly. The fact that someone calls this advisory line indicates that they are caring and are very good at what they do. In any palliative care unit, as well as aged care services, no-one works solo. It is reassuring and safe practice to ask someone else for an opinion. We understand that people sometimes call because they’re feeling stressed, vulnerable and isolated and we have a lot of empathy for that. We help put people at ease.

It’s similar with GPs. Often we’re just reassuring them, and it is great to be able to say that I wouldn’t be doing anything different in the palliative care unit at a major city teaching hospital to what you are doing for this lady in her residential aged care facility .

What support and advice do you offer?

That depends very much on who is making the call, but the most common queries are about symptom management and medication and there are some psychosocial issues we’ve helped with as well.

Nurses
Nine times out of 10, the nurses who call have pretty much worked through what they need to do for a care recipient, but they just need to be reassured that they’re giving the most appropriate care.

We get quite a few calls out of hours, including Saturdays and Sundays, when nurses have limited back-up. Sometimes nurses are dealing with a huge workload and are feeling pressured. They recognise that it is good practice to get a second opinion. We have a conversation where we come up with a plan together – it’s never me just telling them what they should do.

We had a case a while ago where a frail resident had been given their oral pain-control medication but wasn’t able to swallow it. The nurse found it three hours later in his pyjamas. We worked out that the resident had a patch that was still working, and so at that stage he wasn’t in pain. We then worked out that he’d been written up for an injection, if pain was worse than normal. The nurse decided to try to give him the tablet again, and if he couldn’t swallow it, she’d give him the injection.

Aside from clinical issues, we’ve had calls from nurses who are having difficulties with family. We’ve talked through scenarios, like a son who visits and wants to feed his mum, but she can’t eat. We’ve helped nurses with what to say when talking through the dying process with families who are experiencing various stages of grief.

We have one nurse who calls us fairly regularly and every time she rings it is a good call. She says that she doesn’t waste time second guessing herself anymore. If she is worried about something, she just rings us straight away.

GPs
GPs tend to ring us because a patient is declining, and they need to change their medication to keep them comfortable. Sometimes it is because patients can no longer swallow and the GP wants to know what patches or injections they can give them, or when medications for pain and sedation need to be streamlined. I often put these calls through to our on-call palliative medical consultant. Palliative care is quite a specialised area and many GPs do not get the opportunity to do a palliative care placement during their training, so the advice service has been very successful. One GP commented recently that he was “very impressed with Decision Assist and would continue to ring, as needed”.

I recommend the Decision Assist smartphone app, palliAGED, which has been designed to help GPs who are caring for older patients with palliative care needs who live at home or in residential care. They’re often very interested to hear about how palliAGED can help them deliver care pre-emptively, based on a plan. The app offers prescribing support for symptoms experienced in the terminal phase too.

Sometimes GPs call us about a few patients at once. We’ve found that we have the same GPs ringing back because they find the phone line such a helpful service.

Pharmacists

Pharmacists have called, typically on a weekend and usually from relatively isolated areas in the country. They’ve received a script from a nursing home but not had the drug in stock, and so have called us to see what could be used instead. The pharmacist has then asked the doctor to change their script and the patient has had a good outcome.

Personal care workers

The majority of the calls that I have received have been from nurses however we are also able to assist personal care workers. They might have questions related to washing, feeding, everyday living or dressings and we’re happy to help.

Are some questions too difficult for the advisory line?

If we are dealing with something complex, we would never give an answer just off the top of our heads. We have extensive up-to-date evidence-based guidelines we can refer to, and there’s always a medical consultant on duty. We have all the back-up we need to be giving sound, evidence-based advice.

Sometimes people want support with advance care planning or education, and we can transfer them to an advance care planning operator or the decision Assist training line, where they can access that information.

What do you enjoy about your work?

As a charge nurse I used to see palliative care patients coming in from the nursing homes if they got a urinary tract infection or chest infection. It broke my heart that they weren’t being nursed where they were living and people knew them well. It was traumatising for the patient and their families.

Over the past few years this has changed, and many more residents are receiving palliative care in their aged care facilities. That can be hard on staff if they haven’t provided palliative care before. But at the same time, when they know they’ve looked after someone well, the satisfaction they get is huge. I saw a huge need to offer support, and Decision Assist is doing a great job of delivering it.

I get so excited when the phone rings. When you hang up, you think ‘Well, at least I’ve helped somebody today’.


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