Evaluation of The Just in Case Box project
Emma Curnin, Clinical Project Specialist, The District Nurses, Tasmania
The Just in Case Box (JiCB) was a four-year project implemented as part of hospice@HOME in Tasmania. Its purpose was to provide equitable access to timely symptom relief for people with a life limiting illness who expressed a preference to die at home. It formed part of the overall end-of-life plan and included the pre-emptive provision of subcutaneous medicines (recommended by the Australian and New Zealand Society of Palliative Medicine) and consumables.
The JiCB also used the original Caring Safely at Home (CSAH) resources from Queensland to provide a standardised and consistent resource to teach carers how to safely give subcutaneous medicines. These original resources have been updated for the caring@home project and will be released on 29 October 2018.
The experiences of those using the JiCB and CSAH was evaluated using semi-structured interviews. Thirty-nine patients, carers, community nurses, General Practitioners and community pharmacists participated in the evaluation.
In summary, most carers were very happy with the JiCB and the training they received. They felt confident enough to use the medicines, especially in an emergency or to relieve distress, which was enhanced through the education where they had practiced drawing up syringes under the supervision of a nurse. For those carers who administered medication, they were able to witness the relief that it provided to the patient, including reduced agitation and discomfort.
“The training (to draw up the syringes and provide top-ups as required) was a bit overwhelming at first: We were blown away. ‘Oh, what do we do? This is all too hard,’ but once we started using it everything was organised and worked very well. It seemed complicated until we got started, but it wasn’t complicated. The manual that goes with it, the pages are very well set out. It all took so much pressure off us and she was comfortable.” Carer
Most community nurses identified several advantages of the JiCB and education for the patient and carer. These were:
- taking away fear and anxiety
- providing reassurance and peace of mind
- knowing that everything is there that might be needed
- immediate access for comfort of uncontrolled symptoms
- keeping patients comfortable
- providing backup especially in remote locations if a nurse can’t get there quickly.
The major advantage identified by community nurses was that that they knew it would help keep the patient at home and prevent them having to go to hospital.
“It probably gives (the patient and carer) the feeling of being in the driver’s seat…..I’d say both the patient and the carers feel empowered, because they receive the education, they have an understanding.” Community Nurse
Overall, the JiCB and CSAH were found to be valuable tools in the face of increasing demand for high-quality, community-based end-of-life care.
hospice@HOME was funded through Better Access to Palliative Care, an initiative of the Australian Government. The evaluation was undertaken by and with thanks to KP Health. If you would like further information about the JiCB project please contact The District Nurses on (03) 6208 0500 or enquiries@thedistrictnurses.org.au