Teamwork

To achieve teamwork and coordination of care, all members of the healthcare team must talk to each other. The healthcare team includes:

Teamwork

the patient and their substitute decision-maker, family and carers
YOU and your colleagues
acute care clinicians
care providers in community and aged care
Aboriginal liaison or health workers
general practitioner
district nursing
community palliative care
palliative care consultancy service
- metropolitan hospital-based palliative care consultancy team
- regional palliative care consultancy team.

In end of life care, an effective team:

enables all disciplines, including graduate and junior clinicians and appropriately trained volunteers, to engage with the broader team, voice concerns, and act on the expressed preferences and consent of the patient
has experienced team members providing supervision, leadership, support, mentorship and teaching to develop the skills and capacity of inexperienced team members
recognises, values and supports carers.

Policies and procedures demonstrate the importance of carers of patients in their last 12 months of life. Policies and procedures ensure:

staff are skilled in therapeutic communication
family meetings support care and discharge planning. A family meeting may include the treating team, allied health, the palliative care consultancy service, the patient and family.
referrals to allied health, such as pastoral care, counselling or social work, are supported
care for families and carers extends to the period after the patient has died.

Reviewed 19 April 2024