Our service is…
For people requiring education about a non- dialysis pathway of care
For any person in the renal service who wishes to undertake Advance Care Planning conversations +/- Directive completion
For people requiring symptom management (non-dialysis and dialysis)
For those approaching end of life, requiring integration of palliative approach to care (dialysis, non-dialysis and transplant)
For GP and community services support and access to Renal Services at Western Health
To support the Renal Service as a whole with information, education, mentoring and professional expertise in the area of Renal Supportive Care
Referral requirements
From GP and/or Nephrologist only.
See nephrology referral information on adult specialist referrals.
Introduction to supportive care philosophy and advance care planning information must be provided prior to referral. “Flagging' patients is not accepted
Triage
Clinical Nurse Consultant (CNC) – Conduct initial further information gathering and telephone assessment
CNC Decide need and direct flow to Medical/Nurse Practitioner (NP)/CNC Clinic or Home visit
MDT discussion
Discharge
Advance care planning conversations facilitated and documented +/- Directive completed
Symptoms stable demonstrated by Integrated Palliative Care Outcome Scale (IPOS) – Renal
Patient no longer wishes to attend
Referral to Palliative Care – Palliative Care becomes primary service, Supportive Care follows up with renal bereavement support alongside Palliative care services
Death
