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Recognition of the importance of end-of-life care will enable improvements in the quality of care delivered to patients and their families. Australia is experiencing an increasing number of deaths, (many expected), with an aging population who are living longer, often with multimorbidity. This makes end of life care a priority. The last year of someone's life takes place in a complex healthcare system, with increasing pressures on care delivery, placing the spotlight on health service providers to ensure that teams and individuals are supported and enabled to provide such care. Two rapid literature reviews identified best practice principles and processes for delivering safe and high-quality end-of-life care in acute care, aged care and community settings. The reviews identified that end-of-life care is experienced within the whole health and social care system, including hospital admissions interspersed with care in the community, outpatient and emergency department visits and potentially admission to a hospice. Much of this last year of life is spent at home, which may be a personal residence, an aged care facility, prison, supported accommodation or even on the streets. Transitions across settings requires seamless care, as well as organisational readiness to deliver safe and culturally appropriate care. This is more important now with end-of-life care subject to quality assurance mechanisms within the National Safety and Quality Health Service Standards (2nd edn): Comprehensive care. This requires all sectors to work collaboratively when caring for someone at the end of their life in order to see positive changes in care outcomes. [ABSTRACT FROM AUTHOR]

Abstract: Healthcare professionals working in hospitals are likely to care for people in their last year of life. Many of these people will be older, frail and at high risk of adverse events. The management of medicines forms a large part of the care of this population. The interdisciplinary healthcare team can identify patients who are near the end of their life and, in partnership with the patient (or substitute decision maker) and family, plan to achieve their goals of care. Pharmacists can contribute to quality outcomes through their specialist knowledge of the unique medication issues at the end of life. This is particularly important in the context of the frail older person with comorbidities that may complicate medication management. Effective medication management and team collaboration can relieve suffering and bring comfort to the dying patient and their family. This article outlines considerations for hospital‐based clinicians treating the older person approaching the end of their life. [ABSTRACT FROM AUTHOR]

The role of the hospice is well established in providing quality care for the dying. With the drive for greater emphasis on community-based palliative care, there is a need to enable elements (especially medicines management practices) from the inpatient hospice model to be more readily available in the community environment. This paper describes the incorporation of an advanced practice pharmacist into a large metropolitan palliative care service. The focus of this appointment has been to develop strategic engagement with primary care providers to better support medicines management for people registered within a metropolitan palliative care service. Through the development of education programs, participation in quality improvement activities and by supporting the ambulatory palliative care team, the advanced practice pharmacist has engaged the community pharmacist as part of the broader palliative care team. There are challenges and opportunities for pharmacists to assist in providing improved palliative care services delivery within the Australian healthcare system. [ABSTRACT FROM AUTHOR]

Background: For most people, the last 12 months of life are spent living in the community, with the support of family and friends for a number of caregiving functions. Previous research has found that managing medicines is challenging for caregivers. Currently there is little information describing which caregivers may struggle with tasks associated with managing a loved one's medicines. Aim: The aim of this study was to identify factors that flag caregivers who are likely to experience problems when managing someone else's medications. Setting/Participants: The annual South Australian Health Omnibus Survey provides a face-to-face, cross-sectional, whole-of-population view of health care. Structured interviews, including questions covering palliative care and end-of-life care, were conducted with 14,625 residents in their own homes. Results: Of the 1068 respondents who had provided care for someone who died of a terminal illness in the last five years, 7.4% identified that additional support with medicine management would have been beneficial. In addition, three factors were predictive of the need for additional support in managing medicines: aged <65 years; lower household income; and living in a metropolitan region. Conclusion: The findings of this study provide insights to inform the development of palliative care service models to support informal caregivers in the management of medications for people with a life-limiting illness.

During the terminal phase, access to medicines is critical for people wishing to spend their last days of life at home. Yet, access to medicines can be problematic. The aim of this study was to report the perspectives of specialist and generalist health professionals (HPs) on the issues of community access to medicines for this vulnerable group. A qualitative descriptive study design investigated the views of HPs working in palliative care roles in South Australia. Nurses, doctors and pharmacists described their experiences of accessing medicines for management of terminal phase symptoms during semi-structured focus group discussions. Content analysis identified six themes including: 'Medication Supply', 'Education and Training', 'Caregiver Burden', 'Safety', 'Funding' and 'Clinical Governance'. Future projects should aim to address these themes when developing strategies for the management of people wishing to die at home.

A preterm infant born to a woman with chronic lead poisoning was found to have the highest blood lead level recorded for a surviving neonate. Parenteral calcium disodium edetate, but not oral succimer, was effective in reducing the infant's lead burden in the neonatal period. An exposure assessment revealed the mother's long-term ingestion of lead-contaminated herbal tablets as the source.