The evolution and where we are now: Palliative care needs rounds resulting in better living and dying in residential aged care

Nikki Johnston OAM1, Julianne Samara1, Liz Forbat2,3, Wai-Man Liu4, Jane Koerner3, Michael Chapman4,5, Lawrence Lam6

1Calvary, 2Stirling, 3ACU, 4ANU, 5Canberra Health, 6UTS


Access to Specialist palliative care for aged care residents is often inadequate and inconsistent across Australia. Ability for staff to care for residents in their last month’s needs improvement and residents experience high levels of unnecessary hospitalisation. This points to an urgent clinical priority to manage residents’ complex needs in the aged care setting. We developed and tested a new approach to provide specialist palliative care in aged care, called Palliative Care Needs Rounds.

We conducted a mixed method pilot study in 2015. We then went on to conducting a stepped wedge randomised control study in 12 facilities, with 1700 residents. The primary outcome was hospitalisations, with secondary outcomes focused on dying in preferred place, quality of death/dying, and staff confidence. Qualitative interviews captured feedback from staff on the implementation of the model of care.

Palliative Care Needs Rounds led to statistically significant reductions in residents’ length of stay in hospital alongside substantial decreases in the number of admissions. Symptom management during death and dying were significantly improved, alongside improvements in dying in preferred place. Staff confidence to look after people approaching end of life also improved. Interview data indicated that staff found Palliative Care Needs Rounds helpful, particularly in learning to identify dying and ensuring anticipatory plans are in place for residents.

Palliative Care Needs Rounds improve residents’ quality of care and death. Palliative Care Needs Rounds can be implemented easily by senior nurses, drawing on a published checklist describing how to conduct them. Palliative Care Needs Rounds deliver key targets in the Australian national palliative care strategy and therefore this methodologically robust trial offers evidence of an effective mechanism to improve care.


Nikki is the inaugural winner of the Health Minister’s Award for Nursing Trailblazers presented on 9 April 2019.

Nikki became a registered nurse in 1989 and a Nurse Practitioner in 2008.

Currently working for Calvary, Clare Holland House campus Canberra, Nikki believes all Australia’s deserve equity of access to quality care nearing the end of life, regardless of their age, diagnosis or where they live.

Nikki’s research team have successfully tested a model integrating specialist palliative care into residential aged care. They have been recognised internationally for their approach that led to reduced avoidable hospital transfer’s, reduced length of hospital stays and normalising dying while increasing the capacity of staff to care for residents in their last months of life.

She was recognised in the 2019 Australia Day Honors as a recipient of a Medal of the Order of Australia for her contribution to nursing, also in 2019 Nikki won the inaugural national health ministers award for nursing trailblazers and the Australian collage of Nurse Practitioners mentor of the year award. Her team won two national awards, the Palliative Care Australia award for team innovation in palliative care and the Hesta nursing award for team excellence.

Nikki is the only nurse who sits on the ACT health minister’s clinical leadership forum with 5 doctors. She is a member of the Australian Collage of Nurse Practitioners, the Australian Collage of Nursing and Palliative Care Nurses Australia.