National Palliative Care Standards – Global Homework Experts

National
Palliative Care
Standards
5TH EDITION – 2018

2 National Palliative Care Standards – 5th Edition
Acknowledgements
Palliative Care Australia (PCA) would like to acknowledge the people and organisations who contributed to
developing the 5
th edition of the National Palliative Care Standards (the Standards).
Special thanks to the members of the Standards Review Group for their leadership and commitment in the review of
the 2005 National Palliative Care Standards. Their contribution has been instrumental in creating standards that are
based on the experiences of consumers, their carers and family; and which reflect concepts and principles to inform
service delivery and development, as well as support assessment against other quality standards.
Standards Review Group
Dr Meera Agar
Ingham Institute Applied Medical Research
University Technology Sydney
Mr Andrew Allsop (Chair)
Silver Chain Hospice Care Service, WA
Ms Liz Callaghan
CEO, Palliative Care Australia
Ms Kerri-Anne Dooley
Home Instead Senior Care, Qld
Dr Judi Greaves
Palliative Care Researcher
Ms Sue Hanson
Little Company of Mary Health Care Ltd
Assoc. Prof Marianne Phillips
Paediatric Palliative Care Australia & New Zealand and
Princess Margaret Hospital for Children, WA
Ms Claudia Virdun
University Technology Sydney (UTS), NSW
Ms Kate Weyman
St Vincents Hospital, Sydney
PCA would also like to acknowledge the invaluable and generous contributions of all of those who have provided
expert feedback through consultation and ongoing service involvement. Their involvement has been, and continues
to be, the critical success factor for the Standards. Additional thanks go to:
Ms Enyonam Glover
University of Wollongong, Medical Student
Ms Megan Nutt, Ms Rebecca Storen & Ms Kate ReedCox
Palliative Care Australia
Dr Samar Aoun & Assoc. Prof Lauren Breen
Curtin University, WA
Prof Peter Hudson
St. Vincent’s Hospital, Victoria
Queen’s University, Belfast, United Kingdom
University of Melbourne, Victoria
Dr Pippa Blackburn, Ms Sabina Clapham & Ms Karen
Quinsey
Palliative Care Outcomes Collaboration, Australian
Health Services Research Institute (AHSRI)
Dr Conrad Kobel, Mr Darcy Morris, Ms Cristina
Thompson & Dr Kate Williams
Centre for Health Service Development, Australian
Health Services Research Institute (AHSRI)
The National Palliative Care Standards were updated in November 2018 to include mapping of the NSQHS Standards
(2
nd edition) and provide additional information for applying the Standards to underserved population groups.
This version replaces the document that was released in February 2018.
Recommended citation
Palliative Care Australia 2018, National Palliative Care Standards 5th edn, PCA, Canberra
National Palliative Care Standards – 5th Edition 3
Contents
Chair’s Foreword 4
Introduction 5
Development of the National Palliative Care Standards 5th Edition 6
Mapping of the Standards 6
Core Values of the National Palliative Care Standards 7
The National Palliative Care Standards – Overview 8
How to Use the Standards 9
Applying the Standards to Underserved Population Groups 10
Standard 1: Assessment of needs 13
Standard 2: Developing the care plan 14
Standard 3: Caring for carers 15
Standard 4: Providing care 16
Standard 5: Transitions within and between services 17
Standard 6: Grief support 18
Standard 7: Service culture 19
Standard 8: Quality improvement 20
Standard 9: Staff qualifications and training 21
Mapping of the Standards to the NSQHC Standards (2nd edn) 22
Standard 1 22
Standard 2 23
Standard 3 24
Standard 4 25
Standard 5 26
Standard 6 27
Standard 7 28
Standard 8 28
Standard 9 29
Mapping of the National Palliative Care Standards against Standards from other relevant agencies 30
References 42

4 National Palliative Care Standards – 5th Edition
Chair’s Foreword
Palliative Care Australia (PCA) is delighted to provide the community with
the 5
th edition of the National Palliative Care Standards. The enthusiasm
with which the review and consultation process was received indicates
the importance of articulating the components of quality palliative care
which are reflected in the 5
th edition of the Standards.
Much has changed within the speciality of palliative care since the first
National Standards were written in 1994, with the current edition having
a strong focus on the provision of care that is person-centred and ageappropriate. The person, their family and carers are a unit that experience
palliative care, but each of these have individual needs that should also be
recognised.
Furthermore, providing quality palliative care relies upon a committed
team of professionals and volunteers who assist the person, their family
and carers. The aim of the 5
th edition of the Standards is to articulate
a vision for the provision of holistic, individualised, sensitive and best
practice palliative care as we approach new and demanding challenges in
the health sector.
PCA is extremely grateful for the collaboration and work of a large group
of people in bringing these Standards to fruition. PCA commends these
Standards to you as a tool to assist in the delivery of quality care for all
Australians at the end of life.
Andrew Allsop
Chair, Standards Review Group
President’s Foreword
On behalf of Palliative Care Australia (PCA) would like to thank Andrew
Allsop and the members of the Standards Review Group for their
commitment to ensuring this 5
th Edition of the National Palliative Care
Standards are contemporary and encompass all aspects of high-quality
palliative care.
PCA looks forward to continuing to support services to deliver bestpractice palliative care that is person and family centred. On behalf of the
Board of PCA, I commend these Standards to you and encourage you to
adopt them in your practice. Together, we will work towards achieving our
vision of quality palliative care for all.
Dr Jane Fischer
President Palliative Care Australia
National Palliative Care Standards – 5th Edition 5
Introduction
These Standards (5th edn) have been updated following consultation with the palliative care community and other
stakeholders. Much has changed within palliative care over the past decade, including expansion of the evidence
base for clinical care, re-design of service delivery models of care to meet changing community expectations
and needs, and changes to the language used to describe those we care for.
Most importantly there is increasing
recognition that caring for people who are approaching and reaching the end of life is everybody’s business –
everybody in health, aged and community care has a role to play.
Palliative Care Australia (PCA) defines palliative care in
the contemporary Australian context as:
Palliative care is person and family-centred care
provided for a person with an active, progressive,
advanced disease, who has little or no prospect of cure
and who is expected to die, and for whom the primary
goal is to optimise the quality of life.
PCA considers that the following elements are integral
to understanding this definition of palliative care:
» Palliative care should be strongly responsive to the
needs, preferences and values of people, their families
and carers. A person and family-centred approach to
palliative care is based on effective communication,
shared decision-making and personal autonomy.
» Palliative care should be available to all people
living with an active, progressive, advanced disease,
regardless of the diagnosis.
» Palliative care affirms life while recognising that dying
is an inevitable part of life. This means that palliative
care is provided during the time that the person is
living with a life-limiting illness, but it is not directed
at either bringing forward or delaying death.
These Standards clearly articulate and promote a vision
for compassionate and appropriate specialist palliative
care. The Standards recognise the importance of care
that is person-centred and age-appropriate. In particular
they point to the requirement for specific attention to
the needs of people who may be especially vulnerable
or at risk.
The Standards need to be relevant to those specialist
palliative care services with a sole practitioner, as
well as larger services that are more resourced with
comprehensive research and teaching roles – and to
everything in between. They are generally normative
standards but also incorporate aspirational components
to support those services with growing capacity and
capability.
This 5
th edition of the Standards has been developed to
reflect the significant changes that have occurred since
2005 and to continue to support specialist palliative
care services as they work to ensure that the people
they service have access to the highest quality of care
as they approach and reach the end of life.

6 National Palliative Care Standards – 5th Edition
Development of the National Palliative Care
Standards 5
th Edition
PCA began the Standards revision process in 2013. At
this time the palliative care community felt strongly that
any revision to the Standards should be done carefully,
with deep consideration and input from the sector, and
in reference to current evidence to ensure the 5
th edition
of the Standards adequately reflect the evolution
of palliative care. As such, PCA took the decision
to recommence the review process when adequate
resources could be allocated towards this important
piece of work.
The revision of the Standards was recommenced in
2015 with the establishment of the Standards Review
Group, who have presided over the ongoing revision
and consultation process. This panel of palliative care
clinicians, researchers and executives closely examined
the 4th edition of the Standards to identify their
strengths, limitations, gaps and areas of duplication.
This group developed the first draft for review.
There were two consultation rounds for the draft 5
th
edition of the Standards. Firstly feedback was sought
from PCAs National Policy Advisory Committee (NPAC),
Member Organisations and Affiliate Members from May
to August 2017.
The second round of consultation involved an online
survey in September 2017, culminating in receipt of 55
responses from palliative care services who previously
engaged with the National Standards Assessment
Program (NSAP), people or organisations with a vested
interest in the Standards, and affiliated government
bodies. Where necessary, additional specialist feedback
was sought from experts in a particular area.
In summary, a rigorous and extensive consultation
process has supported the development of the 5
th
edition of the Standards. PCA is grateful for the wide
interest and input it has received in the revision process
and hopes that you find value in the 5
th edition of these
Standards.
Mapping of the Standards
There is a growing number of standards that relate to
the care of people approaching and reaching the end
of life. Some are relevant to all services while others are
specifically targeted at components of the health, aged
and community care systems, for example aged care
or acute care hospitals. These Standards are designed
to complement other standards programmes. To assist
services to identify these intersections and avoid
duplication of effort, PCA have undertaken internal
mapping of these Standards against standards of the
agencies listed below:
» The Australian Commission on Safety and Quality in
Health Care (ACSQHC) National Safety and Quality
Health Service (NSQHS) Standards (Version 2)
1
» The ACSQHC National Consensus Statement:
Essential Elements for Safe and High-Quality End-ofLife Care
2
» The ACSQHC National Consensus Statement:
Essential Elements for Safe and High-Quality
Paediatric End-of-Life Care
3
» The Accreditation Standards, as identified in the
Quality of Care Principles 2014 and administered by
the Australian Aged Care Quality Agency (AACQA)
4
» The previous version of Palliative Care Australia’s
Standards for Providing Quality Palliative Care for all
Australians (2005)
5
PCA will continue to work with key stakeholders as
newer versions of any relevant standards are released.

National Palliative Care Standards – 5th Edition 7
Core Values of the
National Palliative Care Standards
Quality palliative care is provided by professionals who:
» Endeavour to maintain the dignity of the person, their
family and carers,
» Work with the strengths and limitations of the
person, their family and carers to empower them in
managing their own situation;
» Act with compassion towards the person, their family
and carers,
» Consider equity in the accessibility of services and in
the allocation of resources;
» Demonstrate respect for the person, their family and
carers;
» Advocate on behalf of the expressed wishes of the
person, their family, carers and communities;
» Are committed to the pursuit of excellence in the
provision of care and support;
» Are accountable to the person, their family, carers
and the community.
In order to ensure high quality, person-focused and
evidence-based services are available to meet peoples’
needs, primary care and specialist providers, as well as,
other professionals should also:
» Follow established practice standards and
requirements for quality management such as
leadership and governance, human resource
management, safe practice, information
management, and continuous quality improvement;
» Adhere to professional and organisational codes of
practice and ethics;
» Reflect on and evaluate current practice, and
incorporate new evidence into protocols, policies and
procedures;
» Participate in continuing professional development in
the knowledge, attitudes, and skills required to deliver
quality palliative care.

8 National Palliative Care Standards – 5th Edition
The National Palliative Care Standards –
Overview
Standard 1 Initial and ongoing assessment incorporates the person’s physical, psychological, cultural, social
and spiritual experiences and needs.
Standard 2 The person, their family and carers work in partnership with the team to communicate, plan, set
goals of care and support informed decisions about the care plan.
Standard 3 The person’s family and carers needs are assessed and directly inform provision of appropriate
support and guidance about their role.
Standard 4 The provision of care is based on the assessed needs of the person, informed by evidence and is
consistent with the values, goals and preferences of the person as documented in their care plan.
Standard 5 Care is integrated across the person’s experience to ensure seamless transitions within and
between services.
Standard 6 Families and carers have access to bereavement support services and are provided with
information about loss and grief.
Standard 7 The service has a philosophy, values, culture, structure and environment that supports the
delivery of person-centred palliative care and end-of-life care.
Standard 8 Services are engaged in quality improvement and research to improve service provision and
development.
Standard 9 Staff and volunteers are appropriately qualified, are engaged in continuing professional
development and are supported in their roles.

National Palliative Care Standards – 5th Edition 9
How to Use the Standards
The Standards have been developed to be used by specialist palliative care services to support the delivery of high
quality palliative care for the person receiving care (the person), their family and carers. Implementation of the
Standards should occur in accordance with the
Privacy Act 1988, associated Australian Privacy Principles and other
relevant local and national health policies.
The Standards are divided into two categories (as shown in Figure 1):
» Care Standards (Standard 1 to 6) which describe the systems and enablers necessary to deliver high quality
clinical care, and
» Governance Standards (Standard 7 to 9), which describe expectation in regards to quality management, quality
improvement and benchmarking.
The Standards are self-assessed by tools and resources available under PCA’s Palliative Care Self-Assessment
(PaCSA), formerly the National Standards Assessment Programme (NSAP).
Figure 1: The National Palliative Care Standards
Assessment of
needs
Developing the
care plan
Caring for
carers
Providing care
Transitions
within and
between
services
Grief support
Standard 1 Standard 2 Standard 3 Standard 4 Standard 5 Standard 6
Service culture Quality
improvement
Staff
qualifications
and training
Standard 7 Standard 8 Standard 9
The table following describes the purpose of each of the components of the Standards.
Standard Contains the specific Standard. There are 9 standards.
Intent of the Standard A series of statements that provide further detail and explanation to assist with interpretation.
Standard elements The quality components of the Standard to which services are encouraged to aspire.
10 National Palliative Care Standards – 5th Edition
The provision of effective palliative care should directly benefit the individual, but also support the family as a
preventive health initiative, which can have long term implications for family functioning, mental health, education
and employment.
Providing palliative care is complex and can include a number of people who are invested in the caring process.
For health professionals, the complexities include a collaborative decision-making approach that encompasses the
wishes of the individual, family and the clinicians involved. At a systems level, palliative care should be available to all
individuals and their families who are living with life-limiting illnesses or conditions on a needs basis. This requires a
collaborative approach between clinicians from a range of disciplines, specialties in the paediatric and adult sector
and colleagues in the palliative care sector. In addition, it also requires support from Commonwealth and State and
Territory Governments with their responsibility for the planning and provision of the workforce and the services.
6,7
Children with a life-limiting conditions
Caring for infants (including the perinatal period),
children and adolescents (referred to as child or
children) with a life-limiting condition can have unique
characteristics that differentiate it from the provision
of care for adults. The needs of the child, and their
family, vary considerably based on their developmental
stage and the range of conditions seen can lead to a
variety of illness trajectories that can make predicting a
prognosis difficult.
8 The way in which children process
information, the methods for assessing and managing
their pain and other symptoms and their ability and
willingness to participate in decision making all needs
to be considered. Children may remain under the care
of their primary treating team, receiving care aimed at
a cure in parallel with support from specialist paediatric
palliative care through a consultative model. Paediatric
palliative care embraces the physical, emotional, social
and spiritual elements from the point of diagnosis or
recognition through to death and beyond. It focuses
on enhancement of quality of life for the child and
support for the family and includes the management
of distressing symptoms, provision of short breaks and
care through death and bereavement.
9
Aboriginal and Torres Strait Islander people
For Aboriginal and Torres Strait Islander people, the
time before, during and after passing often have a
number of customary practices. These practices may
be sacred and may not be widely discussed outside
of the community.
10 The time surrounding the end of
someone’s life is precious and needs to be respected
and approached in a safe and responsive manner.
Directly referring to ‘death’ and ‘dying’ may make
people uncomfortable and instead alternative terms
can be considered such as finishing up, passed on and
not going to get better. It is important to talk to the
key family members and/or decision makers about
what they would like to know. In doing so, relevant
information on the symptoms experienced by the
person with a life-limiting illness, including pain, and the
options to manage these symptoms, can be provided.
The family may express specific preferences, such as
use of traditional medicine, space to accommodate
more than one person to stay overnight and room
for multiple visitors at once.
11 Supporting people to
observe their traditions at the end of someone’s life
can assist the person with a life-limiting illness as well
as help their family and community with their grief and
bereavement.
12
Applying the Standards to Underserved
Population Groups

National Palliative Care Standards – 5th Edition 11
People living with a mental illness
For people living with a mental illness there is a known
association with experiencing comorbidities and
poor physical health outcomes. This combination of
pathologies can result in people being underserved
by the relevant specialties. People living with a mental
illness may not want to engage with medical staff and
so often do not receive diagnosis until late in an illness
trajectory, this may be further complicated by the
person’s legal decision making capacity.
13 They may also
have poorly met social, housing, income and support
needs. Consideration should be given to partnership
models between palliative care and mental health
services.
14
People living with dementia
A person living with dementia can require different
care to people with other life-limiting illnesses; in
part because of the long, unpredictable course
of the disease, issues regarding decision-making
capacity, challenges with communication and a lack
of community understanding of the condition. People
living with dementia may struggle to access palliative
care, especially if they are culturally and/or linguistically
diverse or may have challenging behavioural
symptoms.
15 Managing the needs of people with a lifelimiting illness, who may not be able to make decisions
on their own behalf requires careful attention to the
decision-making and care delivery process to ensure
that the needs of the person remains the primary focus.
Services may need to work collaboratively to deliver
appropriate care to the person living with dementia in
a range of care settings, including in the home and in
residential aged care.
16
People living in residential aged care
It is important that older people are supported to
receive high quality palliative care in the setting of their
choice, whether that be in their own home, in residential
aged care, in hospital or in a dedicated hospice service.
17
For many people a residential aged care facility is
their home and it is important they have access to the
same range of community and inpatient based services
available to people residing in their own homes. This
includes access to appropriate and adequate levels
of support from general practitioners and access to
consultative support and/or direct care from specialist
palliative care services on a needs basis.
People who live in prison custody
Each year a small number of people die anticipated
deaths whilst in prison custody. In 2014-15 of the deaths
of people in prison custody, natural causes accounted
for 71% of the known causes of death
18 (i.e. 41 people
of a total of 58 people), with one third being related
to heart disease.
19 However, there is only limited
information available on the end-of-life related care and
decision making preferences of this population.
20 The
need for delivery of palliative care in prison custody is
likely to increase given the increasing number of people
in prison custody who are 65 years and older, noting
that many people in prison custody are considered
older from 50 years (and 45 years for Aboriginal and
Torres Strait Islander people) given their experience of
accelerated ageing due to, for example, poor health.
21
People who live in supported accommodation
Provision of palliative care for people who live in
supported accommodation (e.g. disability residential
services) is likely to require coordination of care
between different services and different sectors
including disability and health. The staff engaged to
support people living with a disability in residential
services generally will not have additional health care
training, unless they are supporting a person with a
specific need, but they may be able to support palliative
care through the provision of information about the
person.
22 For some people living with a disability,
additional support may be required to assist them in
understanding a diagnosis and prognosis, which can
also complicate symptom management. Staff may
also need to be aware of non-verbal or alternative
communication strategies to assist them in the provision
of care.
23
People experiencing homelessness
Some people who are at risk of, or experiencing
homelessness may require access to palliative care. It
is important that services are flexible enough to meet
the needs of these highly underserved populations,
especially given people may move around and not have
a fixed location or address. If the person loses capacity
to make decisions, the staff at, for example, a hostile
or a health professional may be placed in a position of
having to make decisions for the person. Partnership
models between health and community services should
be in place to ensure that the needs of people can be
appropriately met.
24
12 National Palliative Care Standards – 5th Edition
Culturally and linguistically diverse communities
Differences in beliefs, values, and traditional health
care practices may be of particular relevance for
people at the end of their life. Quality, appropriate and
comprehensive care is culturally sensitive and requires
health professionals to understand each person’s
view of the situation and their expectations regarding
decision making and type of care. Some people may
be unfamiliar with the concept of palliative care and
the services available to them, including access to
interpreters and the funding/ payment method of
these services. Flexible models of care may assist in
considering how to best support local communities, as
well as to support people to access care that not only
considers their culture and language but also recognises
their individualised needs as well.
25
Lesbian, gay, bisexual, transgender and intersex
people
Although there have been increasing levels of social
acceptance and legislative improvements, LGBTI people
continue to experience prejudice and discrimination
in healthcare settings and often feel compelled to
hide their sexuality, gender identity or intersex status
for fear of negative responses. Many LGBTI people
have experienced discrimination, stigma, rejection,
criminalisation, exclusion, medical abuses, persecution
and isolation. Palliative care services must provide a
safe environment where LGBTI people with life-limiting
illnesses can live and die with equity, respect and
dignity, and without fear of prejudice and discrimination.
Their self-designated family and chosen carer(s) should
be treated with the same level of dignity and respect,
as they can often fall secondary to biological relatives
through assumed rights.
26
National Palliative Care Standards – 5th Edition 13
Standard 1: Assessment of needs
Initial and ongoing assessment incorporates the person’s physical, psychological, cultural,
social and spiritual experiences and needs.
Intent of the standard
The person, their family and carers are actively involved in the initial and ongoing person-centred assessment, which
focuses on their physical, psychological, cultural, social and spiritual needs.
A comprehensive and holistic assessment of the person’s needs and preferences is established on presentation and
in early consultations, with assessment guided by the person. As more than one clinician may be involved, care is
taken to ensure that assessment is coordinated and the information gathered is communicated effectively among
the treating team. Reassessment should occur regularly, particularly at changes in the phase of care. This includes
identifying when the person is imminently dying and incorporating assessment of the specific needs associated with
this phase.
The life experiences of the person, their family and carers will influence their preferences as they approach and reach
the end of their life. Their life may be influenced by age, culture, religion, ethnicity or experience. Some people will
have very deep attachments to such aspects– others less so. Consideration of the physical, psychological, cultural,
social and spiritual experiences and needs of the person is an integral part of the initial and ongoing assessment.
The person’s care plan, and any changes that may occur to it, are directly informed by comprehensive and holistic
assessments.
To meet this Standard, the health service is expected to ensure:
1.1. The initial and ongoing assessments are carried out by qualified interdisciplinary personnel.
1.2. The assessment is coordinated to reduce the burden of duplication on the person, family and carers.
1.3. Clinical assessment tools are informed by the best available evidence and identify those approaching the
end of life as well as those that are imminently dying.
1.4. The person’s needs are reassessed on a regular basis.
1.5. Initial and ongoing assessments are documented in the person’s clinical record.
1.6. Ongoing assessments are used to inform the care plan and any subsequent changes to it.

14 National Palliative Care Standards – 5th Edition
Standard 2: Developing the care plan
The person, their family and carers work in partnership with the team to communicate, plan,
set goals of care and support informed decisions about the care plan.
Intent of the Standard
The person should be an active partner in their care planning as they approach and reach the end of life.
Where the person is not able to participate in care planning or decision-making it is important that a substitute
decision-maker or legal guardian is identified in accordance with the person’s goals and preferences and relevant
legislation and/or policies.
Comprehensive assessment provides the foundation for care planning. Each re-assessment should inform a reevaluation of the care plan. In addition, the person should be supported to consider and document their future care
goals and preferences (for example in an Advance Care Plan, Goals of Care or Advance Care Directive). The person’s
future care goals and care plan are documented in their clinical record, and communicated to all involved in the
delivery of care.
Recognising that every person is unique, that their experiences as they approach the end-of-life will be different
and that the agreed goals of care may change over time is crucial to the delivery of care that is respectful,
compassionate and maintains dignity.
To meet this Standard, the health service is expected to ensure:
2.1. Care planning is informed by the assessment process and reflects a person-centred, holistic approach that
incorporates cultural, spiritual, physical, psychological and social needs.
2.2. The person, their family and carers are provided with up to date information appropriate to meet their
needs and support informed participation in care planning and decision-making.
2.3. Systems are in place to identify a substitute decision maker if a person does not have the capacity to make
decisions for themselves.
2.4. The person is supported to consider, document and update their future care goals, including in an advance
care plan.
2.5. A system is in place for receiving, storing, accessing and sharing existing advance care plans.
2.6. Specific attention is paid to the needs of people who may be vulnerable or at risk, to support
communication, goal setting and care planning. This includes, but is not limited to Aboriginal and Torres
Strait Islanders, asylum seekers, people who have experienced torture and trauma, people who are
experiencing homelessness; people living with mental ilness, intellectual disabilities or dementia; paediatric
populations or people from ethnically and culturally diverse backgrounds.
2.7. Initial and ongoing discussions informing the care plan are documented and readily available to guide care
delivery.
2.8. The expectations and preferences of the person, their family and carers for the type and place of care are
discussed, negotiated and an agreed plan is documented.
2.9. The care plan is reviewed and updated regularly, on the basis of re-assessments of the person’s condition,
needs, and preferences, and in consultation with the person, their family and carers. Changes to the care
plan are documented.
2.10. Care plans incorporate management for emergency and out-of-hours support, including certification of
death and plans for the care and collection of the body where this is required after hours.

National Palliative Care Standards – 5th Edition 15
Standard 3: Caring for carers
The needs and preferences of the person’s family and carers are assessed, and directly
inform provision of appropriate support and guidance about their role.
Intent of the Standard
The person’s family and carers play an important role in providing physical, emotional, social and spiritual support
and care. It is very important that services value this role, appreciate its importance, and support the person’s family
and carers by working with them to understand the level of care that they are willing and able to provide.
The needs and preferences of the family and carers, including their need for information, should be assessed
independently from that of the person and aim to assist them to better fulfil their caring role and reduce associated
stress. Support may include facilitating access to equipment, nursing support, respite, counselling, information about
financial support and any other services that may be required.
It is important that the family and carers are provided with a clear plan for the management of out-of-hours
concerns or unexpected events in relation to the care of the person.
It is important to recognise that carers are often but not always family members and that a person may have more
than one carer, each one requiring assessment, information and support.
Moreover a person may want specific family members or friends who are not their identified carers to be
involved in and informed about their care. Clear identification of these individuals is necessary to enable effective
communication and avoid distress caused by inadequate communication.
To meet this Standard, the health service is expected to ensure:
3.1. At least one carer is identified for each person as far as possible and their specific needs, including their
need for information, are assessed and documented.
3.2. The service works with the family and carers to understand their needs and desired level of involvement in
care. The potential benefits and risks around assisting with care are discussed with the person, their family
and carers and there is ongoing assessment of their willingness and ability to participate in the provision of
care.
3.3. There are systems in place to ensure that the person’s nominated family and carers are supported to
participate in the provision of health care in accordance with the preferences of the person, their family and
carers (taking into account privacy requirements).
3.4. The family and carers are provided with up to date information and resources that are adapted to meet
their needs and that inform their participation in care planning and delivery. This may include information
about accessing respite services, equipment, financial support and other services, as well as encouraging
the involvement of personal support networks and self-care.
3.5. The family and carers are provided with a clear plan for emergency and out-of-hours events.
3.6. Depending on the location of care and the person’s needs and preferences, the family and carers are
educated on how to safely assist with care, including managing risk, manual handling and activities of daily
living.
3.7. The family and carers are provided with information about the signs and symptoms of approaching death
and the steps to take following death, in a way that is appropriate for their age, culture and social situation.

16 National Palliative Care Standards – 5th Edition
Standard 4: Providing care
The provision of care is based on the assessed needs of the person, informed by evidence,
and is consistent with the values, goals and preferences of the person as documented in their
care plan.
Intent of the Standard
Care is based on current and comprehensive clinical assessment, delivered in accordance with the person’s
expressed values, goals of care and preferences as evidenced in their care plan, and informed by the best available
evidence. Effective care enables the person to live as well as possible, to the end of their life.
Distress caused by symptoms (physical, psychosocial or spiritual) is actively pre-empted, and when it occurs, the
response is timely and effective. This includes prompt response to needs, regularly reviewing the effectiveness of
treatment, and ensuring the person, their family and carers have timely access to specialist palliative care at all
times. The dignity of the person is prioritised at all times through a person-centred approach to their overall care.
It may not always be possible to provide care that matches a person’s preferences. Where the person’s preferences
cannot be met, the service is expected to explain the reasons for this to them, their family and carers, and to discuss
acceptable alternatives.
To meet this Standard, the health service is expected to ensure:
4.1. Care is delivered promptly, in accordance with the changing needs of the person, their family and carers,
their documented care plan and their goals and preferences.
4.2. The service takes practical steps to keep abreast with new and emerging evidence, and uses the best
available evidence to inform clinical practice.
4.3. Where care cannot be delivered in accordance with the goals and preferences of the person, this is
discussed with the person, their family, and carers, and an agreed alternative plan is documented and
communicated.
4.4. There are protocols and procedures in place for the escalation of care where required, based on assessed
needs.
4.5. The service aims to actively pre-empt distress to the best of their ability but when it occurs, the response
to it is timely, appropriate and effective, and actions are documented.
4.6. The effectiveness of care is measured according to established indicators and outcomes.

National Palliative Care Standards – 5th Edition 17
Standard 5: Transitions within and between
services
Care is integrated across the person’s experience to ensure seamless transitions within and
between services.
Intent of the Standard
People may receive care from multiple services throughout the course of thei illness, and particularly as they
approach and reach the end of life. Understanding the values, goals and preferences of the person, their family
and carers and communicating these effectively during movements within and between care settings will support
delivery of effective, person-centred coordinated care.
Oral communication between care providers should be supported by sufficient written information on the person’s
condition, their care plan and goals of care to ensure seamless care and to avoid the provision of ineffective care or
care that does not align with the person’s preferences.
Specialist palliative care services have a role to play throughout a person’s palliative care experience, working
directly with the person, their family and carers and in partnership with other care providers where appropriate,
to coordinate and deliver care. When working in partnership with other services, clear strategies for referral,
communication and designated areas of responsibility are essential.
All services providing palliative care should make information available to local and wider health communities about
the populations they serve, and how their service can be accessed. This information should promote equitable
access to the service. Specialist palliative care services should have clear admission criteria that are transparent and
non-discriminatory in nature.
To meet this Standard, the health service is expected to ensure:
5.1. There are policies and procedures in place that support and promote continuity of care across settings and
throughout the course of the person’s illness.
5.2. The service has in place effective communication systems to support integrated care, including processes
for communicating information about the care plan, goals of care, prognosis and death of the person
within and between services.
5.3. Care plans demonstrate appropriate actions to support seamless transition between care settings.
5.4. Specialist palliative care services’ admission criteria are clear, applied consistently, and communicated to
the local health and wider community, and result in equitable access to services based on clinical need.
5.5. Referrals from the specialist palliative care service are made to appropriate specialists or services that are
able to meet the identified physical, social and spiritual needs of the person, their family and carers (for
example acute pain services, mental health services, bereavement counsellors).
5.6. Discharging a person from a specialist palliative care service should allow adequate time for services to be
put in place prior to discharge, and include a formal handover to ensure continuity of care and minimise
risk. Plans should be discussed with the person, their family and carers to ensure that their needs and
preferences are accommodated, and that they understand that the person may enter the service again if
and when their needs change.
5.7. Services assist local community-based service providers to build their capability to help people to be cared
for in their home, where this aligns with the person’s preferences.
5.8. Policies for prioritising and responding to referrals in a timely manner are documented and audited
regularly to identify improvement opportunities.
5.9. The organisation has mechanisms in place to assess unmet needs, and uses this information to develop
plans for future improvement of the service.

18 National Palliative Care Standards – 5th Edition
Standard 6: Grief support
Families and carers have access to bereavement support services and are provided with
information about loss and grief.
Intent of the Standard
Grief is a normal emotional reaction to loss, but the course and consequences of bereavement will vary for each
individual. Personal and social circumstances may place some family members and/or carers at increased risk of
experiencing problems in the lead up to and aftermath of a person’s death. These may be emotional or psychosocial
problems, or more practical issues such as financial insecurity or risk of homelessness. The loss of a child or a
violent death can create particular vulnerability and expected need for more support for families and carers. Early
identification and referral can improve experience and outcomes for at risk people.
Support for family members and carers in preparing for the death and in understanding the process of dying, as well
as bereavement support at designated timeframes after a death may assist in reducing physical and psychosocial
morbidity associated with loss and grief. There should be multiple opportunities for bereaved persons to self-identify
their requirement for bereavement support.
While the majority of people will integrate loss into their life with the support of family, friends and community, some
people will experience more intense and persistent symptoms of distress or adverse psychological outcomes such as
Prolonged Grief Disorder, Post Traumatic Stress Disorder and increased risk of self-harm.
27,28,29 Although systematic,
predictive screening of all recently bereaved people is not recommended, the use of standardised, validated tools
to diagnose prolonged grief in those who have persistent signs and symptoms can assist in appropriate referral for
treatment. Structured screening and assessment is both indicated and effective in these situations.
Services should develop partnerships with a range of community organisations able to support people who are
anticipating or living with loss. Specialist palliative care services should employ staff with appropriate training
and skills to support families and carers in their experience of loss and grief. Services must also have mechanisms
in place to identify people who are at risk of, or who are experiencing a complex response to bereavement, and
facilitate access to experts in grief, loss and bereavement management where possible. The timeliness of tailored
support and consistency of relationship between the service and the bereaved are vital to building rapport and trust
with the service’s ability to help after death.
To meet this Standard, the health service is expected to ensure:
6.1. Culturally appropriate information and resources about loss and grief and bereavement support services is
routinely provided to families and carers before and after the death.
6.2. The service provides education about loss, grief and bereavement to staff, volunteers and other community
providers.
6.3. The service employs a structured assessment of bereavement that addresses emotional, behavioural, social,
spiritual and physical domains.
6.4. The risk assessment process begins on intake to the palliative care service and continues throughout the
service’s involvement with the person and beyond.
6.5. The service uses validated tools to assess for signs and symptoms of persistent and intense distress in
bereaved persons.
6.6. The service develops strategies and referral pathways, in partnerships with other providers in the
community, to assist families and carers in feeling more prepared for the death and to accommodate grief
into their lives after bereavement.
6.7. Referrals to bereavement, specialist mental health and/or counselling professionals are made when
clinically indicated.
6.8. The organisation has mechanisms in place for the specialist palliative care team to access education,
training and supervision to meet the loss, grief and bereavement needs of the family and carers.

National Palliative Care Standards – 5th Edition 19
Standard 7: Service culture
The service has a philosophy, values, culture, structure and environment that supports the
delivery of person-centred palliative care.
Intent of the Standard
Specialist palliative care services are leaders in the delivery of high quality palliative care for people with complex
needs, or for people whose needs exceed the expertise of local care providers. It is important that specialist
palliative care services have a clearly stated philosophy, set of values and culture that guide the delivery of high
quality palliative care.
Services should seek opportunities to influence the delivery of palliative care in other settings, through collaboration
and partnerships. In particular, partnership should be sought with services that provide support to Aboriginal and
Torres Strait Islander and other cultural populations.
To meet this Standard, the health service is expected to ensure:
7.1. The values and culture of the service explicitly support the provision of person-centred palliative care.
7.2. The philosophy and objectives of the service are documented and incorporated into clinical practice
guidelines, policies and procedures.
7.3. The care setting provides an appropriate environment to support people reaching the end of their lives,
their family and carers.
7.4. Services understand the community they serve, and use this information to both provide optimal specialist
palliative care services and influence wider health, aged and social care systems that meet the needs of
that community.

20 National Palliative Care Standards – 5th Edition
Standard 8: Quality improvement
Services are engaged in quality improvement and research to improve service provision and
development.
Intent of the Standard
In order to maintain and continuously improve the high standard of palliative care delivery in Australia, it is important
for services to engage in quality improvement and lead or participate in research. The specialist palliative care
service should engage in research and quality improvement activities aimed at developing new evidence to inform
practice. Where relevant, these activities should contribute to the quality improvement approach of the broader
health service in which the specialist palliative care service is located.
All services are expected to embed quality improvement activities into their daily practice, working systematically
through a cyclical quality improvement process. Services are expected to identify areas for improvement through
thorough risk assessment processes, quality audits, and standards reviews, and to implement actions relevant to
improving performance in identified areas. Improvement actions and outcomes should be evaluated to determine
whether interventions or changes have been effective. It is expected that people using and interacting with the
service are provided with opportunity to give feedback on the service received and to identify opportunities for
improvement.
To meet this Standard, the health service is expected to ensure:
8.1. An ongoing quality improvement process is implemented to review clinical performance and outcomes,
and to identify, implement and evaluate improvement activities.
8.2. Data about the effectiveness of palliative care delivery is collected, reviewed and reported locally.
8.3. System failures are systematically identified and investigated, and there are opportunities to learn from
error.
8.4. The service engages in robust and rigorous clinical audit review.
8.5. The service is accredited to ensure achievement of governance and safety requirements.
8.6. The service participates in benchmarking processes to compare its service delivery over time and/or with
external organisations.
8.7. The service supports staff to lead or participate in palliative care research wherever possible.
8.8. Specialist palliative care services support other services providing care to people at the end-of-life to
improve the quality of that care.
8.9. The person, their family and carers and the community are provided with opportunities to provide input
into the evaluation of the service via formal and informal feedback mechanisms.

National Palliative Care Standards – 5th Edition 21
Standard 9: Staff qualifications and training
Staff and volunteers are appropriately qualified, are engaged in continuing professional
development and are supported in their roles
Intent of the Standard
A defining feature of a specialist palliative care service is the employment of staff that have recognised qualifications
or credentialing in palliative care. All services are expected to support their staff, both with respect to their ongoing
professional development and in coping with the daily demands of working with people, their family and carers who
require specialist palliative care.
Services must ensure that volunteer services are coordinated and supervised appropriately, and volunteers receive
appropriate and regular training and support to fulfil their roles safely and competently.
To meet this Standard, the health service is expected to ensure:
9.1. The service employs a multidisciplinary team of health professionals with recognised qualifications,
credentialing and experience to meet the physical, psychological, social, cultural and spiritual needs of the
person, their family and carers.
9.2. Staff in clinical leadership and management positions have recognised qualifications and experience in
relevant fields.
9.3. A formal assessment of palliative care education and training is undertaken for all members of the health
service to identify professional development requirements.
9.4. Staff and volunteers receive appropriate supervision and support in accordance with an established
professional development framework.
9.5. Staff undergo training to ensure delivery of culturally safe care.
9.6. Staff are trained in self-care strategies and advised on how to access personal support.
9.7. Volunteer programs are recognised, supported and managed in accordance with the relevant volunteer
standards.

22 National Palliative Care Standards – 5th Edition
These Standards set out to articulate and promote a vision for compassionate and appropriate palliative care, where
the NSQHS Standards aim to protect the public from harm and to improve the quality of health service provision.
The NSQHS Standards (2
nd edn) includes a number of actions that overtly focus on supporting safe and high-quality
end-of-life care (Actions 5.15 to 5.20). There are also a range of other actions that are relevant to the delivery
of holistic and person-centred comprehensive care that includes palliative care. Consequently, health service
organisations that are working towards meeting the actions in these Standards may also be contributing to related
actions in the NSQHS Standards. Though the actions in the two sets of Standards are not always exactly equivalent,
it is worth health services considering where the actions within these two sets of Standards relate as outlined in the
table below.
STANDARD 1
Assessment of needs
Initial and ongoing assessment incorporates the person’s physical, psychological, cultural, social and spiritual
experiences and needs.
ELEMENT WITHIN THESE STANDARDS ACTION WITHIN NSQHC
STANDARDS
1.1 The initial and ongoing assessments are carried out by qualified
interdisciplinary personnel.
1.20; 1.23; 1.24
4.5; 4.6
5.5; 5.6; 5.7; 5.8; 5.10; 5.11; 5.14; 5.15;
5.21; 5.22; 5.24; 5.29; 5.30; 5.31;
5.33; 5.34
1.2 The assessment is coordinated to reduce the burden of duplication on the
person, family and carers.
2.10
5.5; 5.6; 5.7
6.3; 6.4; 6.7; 6.9
1.3 Clinical assessment tools are informed by the best available evidence and identify
those approaching the end of life as well as those that are imminently dying.
1.27
5.15
1.4 The person’s needs are reassessed on a regular basis. 2.6; 2.7
3.6
4.10
5.7; 5.10; 5.14
6.9
8.4; 8.5
1.5 Initial and ongoing assessments are documented in the person’s clinical record. 1.16
4.5; 4.6; 4.7; 4.8; 4.10
5.12; 5.13
6.4; 6.11
8.4; 8.5
1.6 Ongoing assessments are used to inform the care plan and any subsequent
changes to it.
2.10
4.6
5.13; 5.14; 5.15;
6.9; 6.11
Mapping of the Standards to the NSQHC
Standards (2nd edn)
The care of people recieving palliative care is guided by a number of different sets of standards including these
Standards and the National Safety and Quality Health Service (NSQHS) Standards (2
nd edn.).1
National Palliative Care Standards – 5th Edition 23
STANDARD 2
Developing the care plan
The person, their family and carers work in partnership with the team to communicate, plan, set goals of care and
support informed decisions about the care plan.
ELEMENT WITHIN THESE STANDARDS ACTION WITHIN NSQHC
STANDARDS
2.1 Care planning is informed by the assessment process and reflects a
person-centred, holistic approach that incorporates cultural, spiritual,
physical, psychological and social needs.
2.6; 2.7
5.4; 5.13; 5.14; 5.15; 5.20
2.2 The person, their family and carers are provided with up to date
information appropriate to meet their needs and support informed
participation in care planning and decision-making.
2.4; 2.6; 2.7; 2.8; 2.9; 2.10
4.11
5.13; 5.14;5.23; 5.26
6.9; 6.10
2.3 Systems are in place to identify a substitute decision maker if a person
does not have the capacity to make decisions for themselves.
2.5
2.4 The person is supported to consider, document and update their future
care goals, including in an advance care plan.
2.6; 2.7
5.9; 5.13; 5.14; 5.17
6.11
2.5 A system is in place for receiving, storing, accessing and sharing existing
advance care plans.
1.16; 1.17; 1.18
5.17
6.11
2.6 Specific attention is paid to the needs of people who may be vulnerable
or at risk, to support communication, goal setting and care planning.
This includes, but is not limited to Aboriginal and Torres Strait Islanders,
asylum seekers, people who have experienced torture and trauma, people
who are experiencing homelessness; people living with mental illness,
intellectual disabilities or dementia; paediatric populations or people from
ethnically and culturally diverse backgrounds.
1.15; 1.21
2.6; 2.7; 2.8; 2.10; 2.13
5.7; 5.8; 5.10; 5.11; 5.21; 5.22; 5.23;
5.24; 5.25; 5.26; 5.27; 5.28; 5.29;
5.30; 5.31; 5.34; 5.35; 5.36
6.7; 6.9
8.5
2.7 Initial and ongoing discussions informing the care plan are documented
and readily available to guide care delivery.
1.16
5.4; 5.8; 5.9; 5.12; 5.13; 5.17
6.1; 6.11
8.4; 8.5
2.8 The expectations and preferences of the person, their family and carers for
the type and place of care are discussed, negotiated and an agreed plan is
documented.
2.6; 2.7
5.4; 5.13; 5.20
2.9 The care plan is reviewed and updated regularly, on the basis of reassessments of the person’s condition, needs, and preferences, and in
consultation with the person, their family and carers. Changes to the care plan
are documented.
2.6; 2.7; 2.10
5.14
6.11
2.10 Care plans incorporate management for emergency and out-of-hours support,
including certification of death and plans for the care and collection of the
body where this is required after hours.
1.26
5.13; 5.20

24 National Palliative Care Standards – 5th Edition
STANDARD 3
Caring for carers
The needs and preferences of the person’s family and carers are assessed, and directly inform provision of
appropriate support and guidance about their role.
ELEMENT WITHIN THESE STANDARDS ACTION WITHIN NSQHC
STANDARDS
3.1 At least one carer is identified for each person as far as possible and their
specific needs, including their need for information, are assessed and
documented.
2.6; 2.7; 2.10
5.13
6.3; 6.9
3.2 The service works with the family and carers to understand their needs and
desired level of involvement in care. The potential benefits and risks around
assisting with care are discussed with the person, their family and carers and
there is ongoing assessment of their willingness and ability to participate in the
provision of care.
2.6; 2.7; 2.10
5.13; 5.14; 5.20
6.9; 6.10
3.3 There are systems in place to ensure that the person’s nominated family
and carers are supported to participate in the provision of health care in
accordance with the preferences of the person, their family and carers (taking
into account privacy requirements).
2.6; 2.7; 2.8; 2.10
5.13; 5.14; 5.20
6.8; 6.9; 6.10
8.6; 8.7
3.4 The family and carers are provided with up to date information and resources
that are adapted to meet their needs and that inform their participation in
care planning and delivery. This may include information about accessing
respite services, equipment, financial support and other services, as well as
encouraging the involvement of personal support networks and self-care.
2.8; 2.10
5.20; 5.23; 5.25; 5.26
6.9
3.5 The family and carers are provided with a clear plan for emergency and outof-hours events.
2.6; 2.7; 2.10
6.9
8.6; 8.7
3.6 Depending on the location of care and the person’s needs and preferences,
the family and carers are educated on how to safely assist with care, including
managing risk, manual handling and activities of daily living.
2.6; 2.7; 2.10
3.7 The family and carers are provided with information about the signs and
symptoms of approaching death and the steps to take following death, in a
way that is appropriate for their age, culture and social situation.
2.8; 2.9; 2.10
5.20
6.9

National Palliative Care Standards – 5th Edition 25
STANDARD 4
Providing care
The provision of care is based on the assessed needs of the person, informed by evidence, and is consistent with the
values, goals and preferences of the person as documented in their care plan.
ELEMENT WITHIN THESE STANDARDS ACTION WITHIN NSQHC
STANDARDS
4.1 Care is delivered promptly, in accordance with the changing needs of the
person, their family and carers, their documented care plan and their goals
and preferences.
2.6; 2.7
5.3; 5.14; 5.208.10; 8.11; 8.12; 8.13
4.2 The service takes practical steps to keep abreast with new and emerging
evidence, and uses the best available evidence to inform clinical practice.
1.27; 1.28
4.3 Where care cannot be delivered in accordance with the goals and preferences
of the person, this is discussed with the person, their family, and carers, and an
agreed alternative plan is documented and communicated.
2.6; 2.7;
5.13; 5.20
6.3; 6.9; 6.10; 6.11
4.4 There are protocols and procedures in place for the escalation of care where
required, based on assessed needs.
8.6; 8.7; 8.8; 8.9
4.5 The service aims to actively pre-empt distress to the best of their ability but
when it occurs, the response to it is timely, appropriate and effective, and
actions are documented.
1.302.6; 2.7; 2.10
5.16; 5.20; 5.30; 5.31; 5.32; 5.33;
5.34
8.6; 8.10; 8.12; 8.13
4.6 The effectiveness of care is measured according to established indicators and
outcomes.
1.8; 1.28
5.14; 5.19

26 National Palliative Care Standards – 5th Edition
STANDARD 5
Transitions within and between services
Care is integrated across the person’s experience to ensure seamless transitions within and between services.
ELEMENT WITHIN THESE STANDARDS ACTION WITHIN NSQHC
STANDARDS
5.1 There are policies and procedures in place that support and promote
continuity of care across settings and throughout the course of the person’s
illness.
5.4; 5.5; 5.6; 5.20
5.2 The service has in place effective communication systems to support
integrated care, including processes for communicating information about
the care plan, goals of care, prognosis and death of the person within and
between services.
1.16
2.10
3.7
5.4; 5.5; 5.20
6.4; 6.7; 6.8; 6.9; 6.10; 6.11
5.3 Care plans demonstrate appropriate actions to support seamless transition
between care settings.
5.13; 5.14
6.4; 6.8; 6.9
5.4 Specialist palliative care services’ admission criteria are clear, applied
consistently, and communicated to the local health and wider community, and
result in equitable access to services based on clinical need.
5.5 Referrals from the specialist palliative care service are made to appropriate
specialists or services that are able to meet the identified physical, social and
spiritual needs of the person, their family and carers (for example acute pain
services, mental health services, bereavement counsellors).
5.4; 5.13; 5.20
6.4;
8.12; 8.13
5.6 Discharging a person from a specialist palliative care service should allow
adequate time for services to be put in place prior to discharge, and include a
formal handover to ensure continuity of care and minimise risk. Plans should
be discussed with the person, their family and carers to ensure that their needs
and preferences are accommodated, and that they understand that the person
may enter the service again if and when their needs change.
2.6; 2.7; 2.10
5.13; 5.20
6.4; 6.8; 6.9; 6.10; 6.11
5.7 Services assist local community-based service providers to build their
capability to help people to be cared for in their home, where this aligns with
the person’s preferences.
5.8 Policies for prioritising and responding to referrals in a timely manner are
documented and audited regularly to identify improvement opportunities.
1.7; 1.8
5.9 The organisation has mechanisms in place to assess unmet needs, and uses
this information to develop plans for future improvement of the service.
1.8; 1.9; 1.10; 1.11; 1.13; 1.14
2.11; 2.13
5.19

National Palliative Care Standards – 5th Edition 27
STANDARD 6
Grief support
Families and carers have access to bereavement support services and are provided with information about loss and
grief.
ELEMENT WITHIN THESE STANDARDS ACTION WITHIN NSQHC
STANDARDS
6.1 Culturally appropriate information and resources about loss, grief and
bereavement support services is routinely provided to families and carers
before and after the death.
1.15; 1.21
2.8; 2.10
5.20
6.2 The service provides education about loss, grief and bereavement to staff,
volunteers and other community providers.
1.20
5.18; 5.20
6.3 The service employs a structured assessment of bereavement that addresses
emotional, behavioural, social, spiritual and physical domains.
6.4 The risk assessment process begins on intake to the palliative care service and
continues throughout the service’s involvement with the person and beyond.
5.10; 5.11; 5.14
6.4; 6.9
6.5 The service uses validated tools to assess for signs and symptoms of
persistent and intense distress in bereaved persons.
1.27
5.7; 5.10; 5.11; 5.20
8.6
6.6 The service develops strategies and referral pathways, in partnerships with
other providers in the community, to assist families and carers in feeling
more prepared for the death and to accommodate grief into their lives after
bereavement.
2.10
5.20
6.7 Referrals to bereavement, specialist mental health and/or counselling
professionals are made when clinically indicated.
2.10
5.4; 5.5; 5.6; 5.13
6.4;
8.10; 8.12
6.8 The organisation has mechanisms in place for the specialist palliative care
team to access education, training and supervision to meet the loss, grief and
bereavement needs of the family and carers.
1.20; 1.21; 1.22; 1.25; 1.26
5.16; 5.18

28 National Palliative Care Standards – 5th Edition
STANDARD 7
Service culture
The service has a philosophy, values, culture, structure and environment that supports the delivery of person-centred
palliative care and end-of-life care.
ELEMENT WITHIN THESE STANDARDS ACTION WITHIN NSQHC
STANDARDS
7.1 The values and culture of the service explicitly support the provision of
person-centred palliative care.
1.1; 1.2
2.1; 2.2
5.3
7.2 The philosophy and objectives of the service are documented and
incorporated into clinical practice guidelines, policies and procedures.
1.1
2.1; 2.2
7.3 The care setting provides an appropriate environment to support people
reaching the end of their lives, their family and carers.
1.29; 1.30; 1.32; 1.33
5.4
7.4 Services understand the community they serve, and use this information to
both provide optimal specialist palliative care services and influence wider
health, aged and social care systems that meet the needs of that community.
1.2; 1.4; 1.15
2.11; 2.13
STANDARD 8
Quality improvement
Services are engaged in quality improvement and research to improve service provision and development.
ELEMENT WITHIN THESE STANDARDS ACTION WITHIN NSQHC
STANDARDS
8.1 An ongoing quality improvement process is implemented to review clinical
performance and outcomes, and to identify, implement and evaluate
improvement activities.
1.8; 1.9; 1.10; 1.11; 1.12; 1.13; 1.14; 1.22;
1.28
2.11
5.19
8.2 Data about the effectiveness of palliative care delivery is collected, reviewed
and reported locally.
1.8; 1.9
5.19
8.3 System failures are systematically identified and investigated, and there are
opportunities to learn from error.
1.11; 1.12; 1.13; 1.14
5.19
8.4 The service engages in robust and rigorous clinical audit review. 1.28
5.19
8.5 The service is accredited to ensure achievement of governance and safety
requirements.
8.6 The service participates in benchmarking processes to compare its service
delivery over time and/or with external organisations.
1.28
8.7 The service supports staff to lead or participate in palliative care research
wherever possible.
8.8 Specialist palliative care services support other services providing care to
people at the end-of-life to improve the quality of that care.
5.16;5.20
6.4
8.9 The person, their family and carers and the community are provided with
opportunities to provide input into the evaluation of the service via formal and
informal feedback mechanisms.
1.8; 1.13; 1.14
2.11; 2.12; 2.13

National Palliative Care Standards – 5th Edition 29
STANDARD 9
Staff qualifications and training
Staff and volunteers are appropriately qualified, are engaged in continuing professional development and are
supported in their roles.
NPC ELEMENT ACTION WITHIN NSQHC
STANDARDS
9.1 The service employs a multidisciplinary team of health professionals with
recognised qualifications, credentialing and experience to meet the physical,
psychological, social, cultural and spiritual needs of the person, their family
and carers.
1.20; 1.21; 1.23; 1.24; 1.25; 1.26
4.4
5.5; 5.16
8.10; 8.11
9.2 Staff in clinical leadership and management positions have recognised
qualifications and experience in relevant fields.
9.3 A formal assessment of palliative care education and training is undertaken
for all members of the health service to identify professional development
requirements.
1.20; 1.22
9.4 Staff and volunteers receive appropriate supervision and support in
accordance with an established professional development framework.
1.25; 1.26
5.16; 5.18
9.5 Staff undergo training to ensure delivery of culturally safe care. 1.20; 1.21
9.6 Staff are trained in self-care strategies and advised on how to access personal
support.
5.18
9.7 Volunteer programs are recognised, supported and managed in accordance
with the relevant volunteer standards.

30 National Palliative Care Standards – 5th Edition
Mapping of the National Palliative Care
Standards against Standards from other
relevant agencies
To assist services to identify intersections and avoid duplication of effort, PCA has completed internal mapping of
the National Palliative Care Standards (5
thedn.) against the standards of various agencies.
The section below lists the relevant National Palliative Care Standard elements as it relates to these other standards.
Standard 1: Assessment of needs
National Palliative Care
Standards 2005
5
Std. 2 The holistic needs of the patient, their caregiver/s and family, re acknowledged in the
assessment and care planning processes, and strategies are developed to address those needs, in
line with their wishes.
Std. 3 Ongoing and comprehensive assessment and care planning are undertaken to meet the
needs and wishes of the patient, their caregiver/s and family.
National Consensus
Statement: Essential
elements for safe high
quality end of life care
2
EE 1 Patient-centred communication & shared decision making
• Action 1.4 “individual preferences & needs of all patients [etc]”
EE 3 Components of care
• Action 3.1 “The psychosocial, cultural & spiritual needs of patients, families & carers should be
assessed, and care should be provided in accordance with their wishes, values & needs.”
Accreditation Standards
(residential aged care)
4
Std. 2 Health & personal care
• 2.5 Specialised nursing needs “Care recipients’ specialised nursing care needs are identified and
met by appropriately qualified nursing staff.”
Std. 3 Care recipient lifestyle
• 3.8 Cultural & spiritual life “Individual interests, customs, beliefs and cultural and ethnic
backgrounds are valued and fostered.”
• 3.9 Choice & decision-making “Each care recipient (or his or her representative) participates in
decisions about the services the care recipient receives…”
National Consensus
Statement: Essential
elements for safe high
quality paediatric end of
life care
3
EE 1 Family-centred communication and shared decision-making
• Action 1.4 Clinicians should be respectful, sensitive and responsive to the preferences and needs
of individual children and their families, regardless of aspects of identity such as culture, religious
belief, gender or sexual preference.
EE 3 Components of care
• Action 3.1 Clinicians should assess the psychosocial, cultural and spiritual needs of the child.
Support should be offered for families who wish to include cultural or religious practices in the
care of the child, such as particular foods, singing, ceremonies or healing.
• Action 3.5 Clinicians should revisit the goals of care, treatment plan and any limitations of medical
treatment when significant changes in the child’s condition, preferences, or circumstances occur –
for example, when the child is in transition to the terminal phase.

National Palliative Care Standards – 5th Edition 31
Standard 2: Developing the care plan
National Palliative Care
Standards 2005
5
Std. 1 Care, decision-making and care planning are each based on a respect for the uniqueness of
the patient, their caregiver/s and family. The patient, their caregiver and family’s needs and wishes
are acknowledged and guide decision-making and care planning.
National Consensus
Statement: Essential
elements for safe high
quality end of life care
2
EE 1 Patient-centred communication & shared decision making
• Action 1.1 “Clinicians and patients should identify opportunities for proactive and pre-emptive endof-life care discussions”
• Action 1.2 “The clinical team should work with the patient, family and carers to identify [who] the
patient wishes to be involved in discussions about their care.”
• Action 1.3 “Culturally appropriate decision makers should be identified”
• Action 1.4 “Clinicians should seek to understand … be responsive to, the individual preferences &
needs of all patients [etc]”
• Action 1.6 “The patient [etc] should be provided with written information”
• Action 1.7 “Clinicians should work with patients, families & carers to ensure key [people] are
present during end-of-life discussions”
• Action 1.9 “Clinicians should … allow adequate time for those involved to absorb, process and
react to the information they are being given.”
• Action 1.8 “Clinicians should provide an honest and straight forward summary … Clinicians should
be compassionate and sensitive, use plain language, and avoid the use of medical jargon.”
• Action 1.11 “patients, families & carers … provided with sufficient support to make decisions”
EE 2 Teamwork & coordination of care
• Action 2.2 “The roles and responsibilities of different understood by all those involved in a
patient’s care, including the patient themselves, and their substitute decision-maker, family and
carers.”
• Action 2.3 “If there is disagreement or ambiguity … the range of views and the reasons for them
should be discussed with the patient [etc].”
EE 3 Components of care
• Action 3.5 The goals of care … should be appropriately discussed with the patient [etc].”
• Action3.7 “The goals of care, treatment plan and any limitations of medical treatment should be
revisited with the patient [etc]”
• Action 3.8 “Information about the advance care plan … the patient’s treatment preferences should
be readily available to all clinicians [etc]”
Accreditation Standards
(residential aged care)
4
Std. 1 Management systems, staffing and organisational development
• 1.8 Information systems “Effective information management systems are in place.”
Std. 3 Care recipient lifestyle
• 3.6 Privacy and dignity “Each care recipient’s right to privacy, dignity and confidentiality is
recognised and respected.”
• 3.8 Cultural & spiritual life “Individual interests, customs, beliefs and cultural and ethnic
backgrounds are valued and fostered.”
• 3.9 Choice & decision-making “Each care recipient (or his or her representative) participates in
decisions about the services the care recipient receives”

32 National Palliative Care Standards – 5th Edition
National Consensus
Statement: Essential
elements for safe high
quality paediatric end of
life care
3
EE 1 Family-centred communication and shared decision-making
• Action 1.1 The interdisciplinary team should identify the person/s with parental responsibility.
• Action 1.2 Clinicians should assess the capacity of the child to be involved in discussions and
decision-making about their care. This capacity may change across the illness trajectory and as
the child develops.
• Action 1.5 Clinicians, the child and their parents should identify opportunities for proactive and
pre-emptive end-of-life care discussions to increase the likelihood of delivering high-quality endof-life care aligned with the child and their parents’ values and preferences, and to reduce the
need for urgent, after-hours discussions in emergency situations.
• Action 1.13 Clinicians should check that the child and their parents have been provided with
sufficient support to make decisions. This includes support for children and parents who have
communication difficulties, cultural, spiritual or linguistic needs, or decision-making difficulties
associated with disability, mental illness or cognitive impairment.
• Action 1.14 Clinicians should clearly document the content of discussions and any agreed plan of
care in the patient clinical record. Any unresolved issues that require further follow-up should be
documented, along with a plan for follow-up.
EE 3 Components of care
• Action 3.2 Clinicians should inform families about the process and purpose of advance care
planning. This process should be undertaken using age-appropriate advance care planning
documents where available.
• Action 3.4 Clinicians should document the outcomes of the decision-making process in the child’s
clinical record. These outcomes include the goals of care, the agreed treatment plan…
• Action 3.5 Clinicians should revisit the goals of care, treatment plan and any limitations of medical
treatment when significant changes in the child’s condition, preferences, or circumstances occur –
for example, when the child is in transition to the terminal phase.
• Action 3.8 Information about the advance care plan, clinical treatment plan, goals of care, any
limitations of medical treatment, and the child and parents’ treatment preferences should be
readily available to all clinicians involved in the child’s care, including those involved in caring
for the child in emergencies, after hours, through ambulance services and, where relevant, in the
community.
EE 10 Systems to support high-quality care
• Action 10.1 The health service organisation should ensure that systems are in place to support
clinicians to work with children and their families to receive, prepare, review and/or update
age-appropriate advance care plans, according to the wishes of the child and their family. These
systems should align with NSQHS Standard 1 (Governance for safety and quality in health service
organisations) and Standard 9 (Recognising and responding to clinical deterioration in acute
health care).
• Action 10.5 The health service organisation should work with community care providers to ensure
that systems are in place for communicating and accessing advance care plans developed in
community care settings.

National Palliative Care Standards – 5th Edition 33
Standard 3: Caring for carers
National Palliative Care
Standards 2005
5
Std. 5 The primary caregiver/s is provided with information, support and guidance about their role
according to their needs and wishes.
Std. 8 Formal mechanisms are in place to ensure that the patient, their caregiver/s and family have
access to bereavement care, information and support services.
National Consensus
Statement: Essential
elements for safe high
quality end of life care
2
EE 1 Patient-centred communication & shared decision making
• Action 1.3 “Culturally appropriate decision makers should be identified”
• Action 1.4 “Clinicians should seek to understand … be responsive to, the individual preferences &
needs of all patients [etc]”
• Action 1.6 “The patient [etc] should be provided with written information”
• Action 1.7 “Clinicians should work with patients, families & carers to ensure key family members,
substitute decisions-makers & carers are present during end-of-life discussions”
• Action 1.11 “patients, families & carers … provided with sufficient support to make decisions”
EE 3 Components of care
• Action 3.1 “The psychosocial, cultural & spiritual needs of patients, families & carers should be
assessed, and care should be provided in accordance with their wishes, values & needs.”
• Action 3.5 “The goals of care … should be appropriately discussed with the patient, and their
substitute decision-maker, family and carers”
• Action 3.6 “The rationale for medical decisions should be clearly communicated with the patient,
family and carers.”
• Action 3.7 “The patient, substitute decision-maker, family and carers should be empowered to
request further discussion and a review of the plan at any time.”
• Action 3.9 “The patient, family and carers should not feel abandoned by the healthcare team”
• Action 3.12 “Family and carers should be supported to spend time with a dying patient in
accordance with their wishes”
• Action 3.13 “Bereaved family and carers should be provided with written information about how to
access bereavement support”
EE 5 Response to concerns
• Action 5.2 “The patient, substitute decision-maker, family and carers should understand the
triggers and process for requesting an urgent review, and the process for responding to their
request.”
• Action 5.3 “Processes should be in place to enable patients, substitute decision-makers, families,
carers … to escalate concern until a satisfactory resolution is achieved.”
EE 6 Leadership & governance
• Action 6.1 Patients, and their families and carers should be partners in the development and
governance of organisational systems for delivering end-of-life care.
Accreditation Standards
(residential aged care)
4
Std. 3 Care recipient lifestyle
3.6 Privacy and dignity “Each care recipient’s right to privacy, dignity and confidentiality is
recognised and respected.”
3.9 Choice and decision-making “Each care recipient (or his or her representative) participates
in decisions about the services the care recipient receives, and is enabled to exercise choice and
control over his or her lifestyle…”
National Consensus
Statement: Essential
elements for safe high
quality paediatric end of
life care
3
EE 1 Family – centred communication and decision-making
• Action 1.1 The interdisciplinary team should identify the person/s with parental responsibility.
• Action 1.4 Clinicians should be respectful, sensitive and responsive to the preferences and needs
of individual children and their families, regardless of aspects of identity such as culture, religious
belief, gender or sexual preference.
• Action 1.9 Clinicians should work with parents to ensure that key family members are present
during end-of-life discussions or that appropriate follow-up meetings are offered. This will ensure
that consistent messages are given about treatment options, their likelihood of success, risks and
prognosis.
EE 3 Components of care
• Action 3.9 … Clinicians should communicate openly about comfort care and what to expect in the
terminal phase.
• Action 3.15 Clinicians should support parents and families to care for their dying child, and provide
information about what to expect during the dying process.

34 National Palliative Care Standards – 5th Edition
Standard 4: Providing care
National Palliative Care
Standards 2005
5
Std. 2 The holistic needs of the patient, their caregiver/s and family, re acknowledged in the
assessment and care planning processes, and strategies are developed to address those needs, in
line with their wishes.
Std 3. Ongoing and comprehensive assessment and care planning are undertaken to meet the needs
and wishes of the patient, their caregiver/s and family.
Std. 6 The unique needs of dying patients are considered, their comfort maximized and their dignity
preserved.
National Consensus
Statement: Essential
elements for safe high
quality end of life care
2
EE 3 Components of care
• Action 3.1 “The psychosocial, cultural & spiritual needs of patients, families & carers should be
assessed, and care should be provided in accordance with their wishes, values & needs.”
EE 7 Education and training
• Action 7.5 Clinicians should receive ongoing education about disease-specific symptom
assessment and evidence-based symptom management relevant to their area of practice.
Accreditation Standards
(residential aged care)
4
Std. 2 Health & personal care
• 2.1 Continuous improvement “The organisation actively pursues continuous improvement.”
• 2.4 Clinical care “Care recipients receive appropriate clinical care.”
• 2.5 Specialised nursing care needs “Care recipients’ specialised nursing care needs are identified
and met by appropriately qualified nursing staff.”
• 2.6 Other health and related services “Care recipients are referred to appropriate health specialists
in accordance with the care recipient’s needs and preferences.”
• 2.9 Palliative care “The comfort and dignity of terminally ill care recipients is maintained.”
National Consensus
Statement: Essential
elements for safe high
quality paediatric end of
life care
3
EE 3 Components of care
• Action 3.9 Clinicians should manage physical symptoms in alignment with the child and their
parents’ wishes, and review treatment regularly.
EE 5 Response to concerns
• Action 5.1 Members of the interdisciplinary team should escalate concerns as required and in
line with relevant policies and procedures until a satisfactory resolution is achieved. This may
include accessing a second opinion if there are concerns that end-of-life care needs are not being
adequately recognised or addressed.
• Action 5.3 Clinicians should conduct an interdisciplinary review of the goals of care and the
treatment plan when concerns are raised that a child has unmet end-of-life care needs including
physical, psychosocial or spiritual distress. Plan and document required follow-up and ongoing
communication with the child, parents, and other clinicians.
• Action 5.4 Clinicians should know how to get rapid access to specialist paediatric palliative
care advice 24 hours a day and seven days a week. This may include access by telephone or
videoconference.
EE 10 Systems to support high-quality care
• Action 10.2 The health service organisation should ensure that systems are in place to provide
clinicians with access to essential palliative medications 24 hours a day and seven days a week.
These systems should align with NSQHS Standard 4 (Medication safety).
• Action 10.3 The health service organisation should ensure that systems are in place to provide
timely access to input from specialist paediatric palliative care clinicians, when required for
children with complex palliative care needs or as a supportive resource for other clinicians. This
may include off-site access via videoconferencing or teleconferencing.

National Palliative Care Standards – 5th Edition 35
Standard 5: Transitions within and between services
National Palliative Care
Standards 2005
5
Std. 4 Care is coordinated to minimise the burden on patient, their caregiver/s and family.
Std. 9 Community capacity to respond to the needs of people who have a life limiting illness, their
caregiver/s and family is built through effective collaboration and partnerships
Std. 10 Access to palliative care is available for all people based on clinical need and is independent
of diagnosis, age, cultural background or geography
National Consensus
Statement: Essential
elements for safe high
quality end of life care
2
EE 1 Patient-centred communication & shared decision making
• Action 1.6 “The patient, substitute decision-maker, family and carers should be provided with
written information about which clinician is responsible for leading and coordinating their care.
Whenever possible, this clinician should be directly involved in discussions about the patient’s endof-life care.”
• Action 1.13 “The content of the discussion and plan of care … should be communicated to all teams
involved in the patient’s care”
EE 2 Teamwork & coordination of care
EE 3 Components of care
• Action 3.8 Information about the advance care plan, clinical treatment plan, goals of care… should
be readily available to all clinicians involved in the patient’s care, including those involved in caring
for the patient in emergencies, after hours and, where relevant, in the community.
• Action 3.9 The patient, family and carers should not feel abandoned by the healthcare team…
• Action 3.14 Clinicians should explore and discuss alternatives to hospital-based care… this could
include the patient’s usual residence, a local hospital, a community or residential aged care facility,
or a hospice or other palliative care facility.
• Action 3.15 Clinicians should liaise with other relevant services and provide referral, as necessary
EE 5 Response to concerns
• Action 5.9 If the responder is not part of the clinical team, they should communicate with the
responsible medical officer … and the plan for follow-up or further review of the patient.
EE6 Leadership & governance
• Action 6.2 The health service executive should consider how best to allocate resources within the
context of the organisation’s strategic plan to support the delivery and effective functioning of
systems for providing end-of-life care.
• Action 6.3 A formal policy framework should exist, outlining the organisational approach to endof-life care. It should include…the interface with external services, such as community and social
care providers, residential aged care facilities and external hospice providers
• Action 6.9 Organisations should work with local community-based service providers to build
capacity for people to be cared for in their preferred place of death (e.g. at home).
EE 10. Systems to support high-quality care
• Action 10.4 Organisations should implement processes to improve communication between health
services at transitions of care.
Accreditation Standards
(residential aged care)
4
Std. 1 Management systems, staffing and organisational development
• 1.1 Continuous improvement “The organisation actively pursues continuous improvement.”
• 1.8 information systems “Effective information management systems are in place.”
Std. 2 Health & personal care
• 2.6 Other health and related services: Care recipients are referred to appropriate health specialists
in accordance with the care recipient’s needs and preferences.
• 2.9 Palliative care “The comfort and dignity of terminally ill care recipients is maintained.”
Std. 3 Care recipient lifestyle
• 3.8 Cultural and spiritual life “Individual interests, customs, beliefs and cultural and ethnic
backgrounds are valued and fostered.”

36 National Palliative Care Standards – 5th Edition
National Consensus
Statement: Essential
elements for safe high
quality paediatric end of
life care
3
EE 1 Family-centred communication and shared decision-making
• Action 1.7 Clinicians should provide parents with written information about which clinician is
responsible for leading and coordinating their child’s care. Whenever possible, this clinician should
be directly involved in discussions about the child’s end-of-life care.
• Action 1.15 Clinicians should communicate the content of the discussion and plan of care, including
any limitations of medical treatment, to all teams involved in the child’s care, including relevant
community care providers.
EE 2 Teamwork and coordination of care
EE 3 Components of care
• Action 3.8 Information about the advance care plan, clinical treatment plan, goals of care, any
limitations of medical treatment, and the child and parents’ treatment preferences should be
readily available to all clinicians involved in the child’s care…
• Action 3.9 The child and their parents should not feel abandoned by the healthcare team…
• Action 3.12 Clinicians should explore and discuss alternatives to hospital-based care, when possible
and appropriate, and as preferred by the child and their parents. This could include providing
appropriate referrals, equipment and support to deliver care in the family home, the child’s local
hospital, a hospice or other palliative care facility.
• Action 3.13 Clinicians should liaise with, and provide referral to, other relevant services as
necessary – for example, to children’s hospice, specialist inpatient or community palliative care
services.
EE 6 Leadership and governance
• Action 6.2 The health service executive should consider how best to allocate resources within the
context of the organisation’s strategic plan to support the delivery and effective functioning of
systems for providing paediatric end-of-life care.
• Action 6.3 The health service organisation should create a formal organisational policy framework
for paediatric end-of-life care which applies across the acute health service, including… the
interface with external services, such as community and social care providers, and external
hospice providers
• Action 6.8 The health service organisation should work with local community-based service
providers and families to build capacity for children to be cared for in the preferred place of care
(e.g. at home).
EE 10 Systems to support high-quality care
• Action 10.4 The health service organisation should implement processes to improve
communication between health services at transitions of care…

National Palliative Care Standards – 5th Edition 37
Standard 6: Grief support
National Palliative Care
Standards 2005
5
Std. 8 Formal mechanisms are in place to ensure that the patient, their caregiver/s and family have
access to bereavement care, information and support services.
National Consensus
Statement: Essential
elements for safe high
quality end of life care
2
EE 1 Family-centred communication and shared decision-making
• Action 1.3 In some cultures, mainstream assumptions about death and dying, and about patients
and families as decision-makers may not be correct. Culturally appropriate decisionmaker(s)
should be identified as early as possible so that strategies can be put in place for obtaining their
input into discussions about end-of-life care.
EE 3 Components of care
• Action 3.13 Bereaved family and carers should be provided with written information about how to
access bereavement support when they have left the health service.
Accreditation Standards
(residential aged care)
4
Std. 1 Management systems, staffing and organisational development
• 1.3 Education and staff development “Management and staff have appropriate knowledge and
skills to perform their roles effectively.”
Std. 2 Health & personal care
• 2.4 Clinical care “Care recipients receive appropriate clinical care.”
• 2.6 Other health and related services: Care recipients are referred to appropriate health specialists
in accordance with the care recipient’s needs and preferences.
Std. 3 Care recipient lifestyle
• 3.8 Cultural and spiritual life “Individual interests, customs, beliefs and cultural and ethnic
backgrounds are valued and fostered.”
National Consensus
Statement: Essential
elements for safe high
quality paediatric end of
life care
3
EE1 Family-centred communication and shared decision-making
• Action 1.10 In some cultures, mainstream assumptions about death and dying may not be correct.
Clinicians should work with parents to identify as early as possible any culturally appropriate
decision-makers to include in discussions about end-of-life care.
EE 3 Components of care
• Action 3.18 Clinicians should provide bereaved parents, siblings and other family members with
written information about how to access bereavement support from the time the child receives
a life-limiting diagnosis. This may include providing support to the child’s friends or, for an
adolescent, boyfriend or girlfriend.

38 National Palliative Care Standards – 5th Edition
Standard 7: Service culture
National Palliative Care
Standards 2005
5
Std. 7 The service has an appropriate philosophy, values, culture, structure and environment for the
provision of competent and compassionate palliative care.
Std. 9 Community capacity to respond to the needs of people who have a life limiting illness, their
caregiver/s and family is built through effective collaboration and partnerships
National Consensus
Statement: Essential
elements for safe high
quality end of life care
2
Guiding principle 4. Recognising when a patient is approaching the end of their life is essential to
delivering appropriate, compassionate and timely end-of-life care.
EE 1 Patient-centred communication & shared decision making
• Action 1.8 “Clinicians should be compassionate and sensitive, use plain language, and avoid the use
of medical jargon.”
EE 3 Components of care
• Action 3.9 “Care, compassion, open and honest communication about what to expect, and the
comfort of the dying patient remain priorities.”
EE 6 Leadership and governance
• Action 6.3 A “formal policy framework should exist, outlining the organisational approach to endof-life care. It should include…”
• Action 6.8 “Organisations should have systems in place to ensure that essential resources required
for the provision of safe and high-quality end-oflife care (e.g. private space for family meetings,
equipment and medications) are always operational and available.”
• Action 6.9 “Organisations should work with local community-based service providers to build
capacity for people to be cared for in their preferred place of death (e.g. at home).”
EE 7 Education and training
• Action 7.6 Education should cover ethical and medico-legal issues, including the relevant
professional ethical frameworks, and the relevant legislation.
Accreditation Standards
(residential aged care)
4
Std. 1 Management systems, staffing and organisational development
• 1.5 Planning and leadership: The organisation has documented the residential care service’s vision,
values, philosophy, objectives and commitment to quality throughout the service.
• 1.6 Human resource management: There are appropriately skilled and qualified staff sufficient to
ensure that services are delivered in accordance with these standards and the residential care
service’s philosophy and objectives.
Std. 4 Physical environment and safe systems
• 4.4 Living environment “Management of the residential care service is actively working to provide a
safe and comfortable environment consistent with care recipients’ care needs.”
National Consensus
Statement: Essential
elements for safe high
quality paediatric end of
life care
3
Guiding principle 6 – Care of the dying is urgent care. Recognising when a child is approaching the
end of their life is essential to delivering appropriate, compassionate and timely end-of-life care.
EE 1 Patient-centred communication & shared decision making
• Action 1.11 “Clinicians should …Be compassionate and sensitive, use plain language, and avoid the
use of medical jargon.”
EE 6 Leadership and governance
• Action 6.3 The health service organisation should create a formal organisational policy framework
for paediatric end-of-life care which applies across the acute health service…
• Action 6.7 The health service organisation should develop systems to ensure that essential
resources required for the provision of safe and high-quality paediatric end-of-life care (e.g. private
space for family meetings, equipment and medications, memory making materials, access to toys
and education resources) are always operational and available.
• Action 6.8 The health service organisation should work with local community-based service
providers and families to build capacity for children to be cared for in the preferred place of care
(e.g. at home).
EE 7 Education and training
• Action 7.6 Education should cover ethical and medico-legal issues, including the relevant professional
ethical frameworks, and the relevant legislation in the state or territory of clinical practice.

National Palliative Care Standards – 5th Edition 39
Standard 8: Quality improvement
National Palliative Care
Standards 2005
5
Std. 11 The service is committed to quality improvement and research in clinical and management
practices.
National Consensus
Statement: Essential
elements for safe high
quality end of life care
2
EE 6 Leadership and governance
• Action 6.3 A formal policy framework should exist, outlining the organisational approach to end-oflife care. It should include…evaluation, audit and feedback processes, and reporting requirements.
EE 7 Education and training
• Action 7.3 Patients, families and carers should be invited to participate in providing education
about end-of-life care, since patient stories can be powerful tools for teaching. It is important that
patients, families and carers are adequately supported to share their experiences
EE 9 Evaluation, audit & feedback
• Action 9.1 Data about the effectiveness of processes and systems for delivering end-of-life care
should be collected, reviewed and reported locally (including over time).
• Action 9.2 Clinicians must lead evaluation and audit, and feed back aggregate, de-identified data to
their peers and colleagues.
• Action 9.3 Monitoring and evaluation strategies should be developed to capture feedback about
the quality of end-of-life care from multiple disciplines
• Action 9.7 All deaths should be routinely reviewed to determine whether the safety and quality of
the patient’s end-of-life care were acceptable, and how they could have been improved.
Accreditation Standards
(residential aged care)
4
Std. 1 Management systems, staffing and organisational development
• 1.1 Continuous improvement “The organisation actively pursues continuous improvement.” (also 2.1,
3.1, 4.1)
• 1.2 Regulatory compliance “The organisation’s management has systems in place to identify and
ensure compliance with all relevant legislation, regulatory requirements, professional standards and
guidelines.” (also 2.2, 3.2, 4.2)
• 1.4 Comments and Complaints “Each care recipient (or his or her representative) and other
interested parties have access to internal and external complaints mechanisms.”
National Consensus
Statement: Essential
elements for safe high
quality paediatric end of
life care
3
EE 6 Leadership and governance
• Action 6.3 A formal policy framework should exist, outlining the organisational approach to end-oflife care. It should include…evaluation, audit and feedback processes, and reporting requirements.
EE 7 Education and training
• Action 7.3 The health service organisation should invite children and families to participate in
providing education about paediatric end-of-life care, since patient stories can be powerful tools
for teaching. It is important that children and families are adequately supported to share their
experiences.
EE 9 Evaluation, audit and feedback
• Action 9.1 The health service organisation should collect, review and report locally (including over
time) data about the effectiveness of processes and systems for delivering paediatric end-of-life
care.
• Action 9.2 The health service organisation should ensure that clinicians lead evaluation and audit,
and feed back aggregate, de-identified data to their peers and colleagues.
• Action 9.3 The health service organisation should develop monitoring and evaluation strategies
to capture feedback about the quality of paediatric end-of-life care from multiple disciplines (e.g.
medicine, nursing, social work), as well as from children and their families.
• Action 9.7 The health service organisation should implement processes to routinely review the
safety and quality of all deaths and determine if end-of-life care could have been improved.

40 National Palliative Care Standards – 5th Edition
Standard 9: Staff qualifications and training
National Palliative Care
Standards 2005
5
Std. 12 Staff and volunteers are appropriately qualified for the level of service offered and
demonstrate ongoing participation in continuing professional development.
Std. 13 Staff and volunteers reflect on practice and initiate and maintain effective self-care strategies.
National Consensus
Statement: Essential
elements for safe high
quality end of life care
2
Guiding principle 7. Safe and high-quality end-of-life care requires the availability of appropriately
qualified, skilled and experienced interdisciplinary teams.
EE 6 Leadership and governance
• Action 6.3 A formal policy framework should exist, outlining the organisational approach to endof-life care. It should include…training and education requirements, access to professional clinical
supervision, and formal and informal debriefing, to suit the varied needs of clinicians, access to
support and debriefing for nonclinical staff
EE 7 Education & training
• Action 7.5 Clinicians should receive ongoing education about disease-specific symptom assessment
and evidence-based symptom management relevant to their area of practice.
• Action 7.7 Education should include specific competencies for providing culturally responsive endof-life care to Aboriginal and Torres Strait Islander people, and to people from other culturally and
linguistically diverse communities.
• Action 7.8 Education should include specific training for providing end-of-life care to people with
limited capacity to participate in decision-making – for example, those with mental illness, disability
or cognitive impairment.
• Action 7.9 Ongoing formal training in communication skills should be offered to clinicians at all
levels, as these skills are critical to the delivery of end-of-life care.
• Action 7.10 All members of the interdisciplinary team should receive education about how to
recognise and resolve feelings of moral distress and burnout in themselves and their colleagues.
They should also receive information about how to seek help, if required
EE 8 Supervision and support for interdisciplinary team members
Accreditation Standards
(residential aged care)
4
Std. 1 Management systems, staffing and organisational development
• 1.3 Education and staff development “Management and staff have appropriate knowledge and skills
to perform their roles effectively.” (also 2.3, 3.3, 4.3)
• 1.6 Human resource management “There are appropriately skilled and qualified staff sufficient to
ensure that services are delivered in accordance with these standards and the residential care
service’s philosophy and objectives.”
Std. 4 Physical Environment and Safe Systems
• 4.5 Occupational health and safety “Management is actively working to provide a safe working
environment that meets regulatory requirements.”

National Palliative Care Standards – 5th Edition 41
National Consensus
Statement: Essential
elements for safe high
quality paediatric end of
life care
3
Guiding principle 7 Safe and high-quality end-of-life care requires the availability of appropriately
qualified, skilled and experienced interdisciplinary teams.
EE 6 Leadership and governance
• Action 6.3 A formal policy framework should exist, outlining the organisational approach to endof-life care. It should include…training and education requirements, access to professional clinical
supervision, and formal and informal debriefing, to suit the varied needs of clinicians, access to
support and debriefing for nonclinical staff
EE 7 Education and training
• Action 7.5 The health service organisation should ensure that clinicians receive ongoing education
about disease-specific symptom assessment and evidence-based symptom management relevant
to their area of practice.
• Action 7.7 Education should include specific competencies for providing culturally responsive endof-life care to Aboriginal and Torres Strait Islander people, and to people from other culturally and
linguistically diverse communities.
• Action 7.8 Education should include specific training for providing end-of-life care to children
of different ages and developmental stages. This should include those with limited capacity to
participate in decision-making – for example, those with mental illness, disability or cognitive
impairment. This should include education about parental responsibility and making decisions in the
best interests of the child.
• Action 7.9 Ongoing formal training in communication skills should be offered to clinicians at all
levels, as these skills are critical to the delivery of end-of-life care.
• Action 7.10 All members of the interdisciplinary team should receive education about how to
recognise and resolve feelings of moral distress and burnout in themselves and their colleagues.
They should also receive information about how to seek help, if required.
EE 8 Supervision and support for interdisciplinary team members
42 National Palliative Care Standards – 5th Edition
References
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44 National Palliative Care Standards – 5th Edition
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