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Author: Quentin bngonline

Working with visiting health practitioners

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Implementing strong communication and coordination processes with visiting health practitioners is key to ensuring consistency of care within your residential aged care facility.

Clients in residential aged care have high medical needs, and are reliant on the expert medical services that are delivered by external professionals. However, in the hustle and bustle of daily operations, it is easy for wires to get crossed. For this reason, robust processes must be in place to ensure a smooth continuum of care between visiting doctors and RACF staff.

Your organisation should have a policy in place that outlines:

  • Processes to check the registration or professional status of visiting practitioners;
  • Agreements and protocols regarding the delivery of clinical care, including medication management;
  • Processes to monitor outcomes of clinical care delivered by visiting practitioners; 
  • Processes to support effective communication between the workforce and visiting
    practitioners; and
  • Clearly delineated roles and responsibilities for both the organisation, and for visiting health practitioners.

We have developed a policy template that addresses these key areas.  Find it in the Reading Room:

  • Policy: Arrangements for visiting health practitioners

Conducting client risk assessments

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Taking a person-centred approach is a key theme of the NDIS Practice Standards, and undertaking an individual risk assessment for each participant is part of this process.

Under Division 3 of the NDIS Practice Standards, Provision of Supports,  providers are required to demonstrate the following:

“In collaboration with each participant, a risk assessment is completed and documented for each participant’s support plan, then appropriate strategies to treat known risks are planned and implemented.”

This assessment should take place at the Support Planning stage, where a client’s individual circumstances and needs are being considered.

We have developed two risk assessment templates to help you undertake this assessment. These templates are designed to be easily filled out, and consider risks to both clients and staff. The templates cover common risk areas including client history and circumstances, physical risks associated with assisting a client in their home and WHS concerns.

You can easily add additional rows and content to adapt the templates to the specific risks and service environments that are relevant to your organisation.

Find our templates in the Reading Room:

  • Template: Client risk assessment 
  • Template: Client risk assessment (home visits)

Unannounced assessment contacts

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What is an assessment contact?

An assessment contact is a regulatory activity conducted by the Aged Care Quality Commission to monitor the quality of care provided by an Aged Care service. It includes any contact between a regulatory official and a provider of aged care services that is not a site audit, review audit or a quality review. It can take the form of phone discussions, emails or a visit to the site.

The purpose of an assessment contact is for the Commission to gain a greater understanding of the provider’s performance against the Quality Standards, and identify which providers need additional assistance in meeting the standards.

There are two types of assessment contact; announced and unannounced. Even for announced assessments there is no minimum timeframe for notice that the Commission must give before undertaking the assessment.

Focus of unannounced assessment contacts

The focus of unannounced assessment contacts will be determined by the Commission’s consideration of:

  •  areas of risk identified for the service;
  • areas previously notified for improvement and subject to a timetable for improvement;
  • requirements of the Quality Standards that have high prevalence of non-compliance across the sector;
  • current sector-wide strategies of the Commission such as a focus on infection control; and
  • other relevant information provided to the Commission.

Focus for September Quarter 2019

For the period of 1 July 2019 to 1 September 2019, the Commission has announced that assessment contacts will focus on:

  • Standard 1 – Consumer dignity and choice; and/or
  • Standard 6 – Feedback and complaints.

How to be prepared for an assessment contact

The Commission has advised that its assessors will include the following questions in their interview with the person in charge of the service:

  1. Have there been any adverse findings by another regulatory agency or oversight body in the last 12 months? (e.g. Healthcare complaints commission or similar, Food safety authority, Workcover, etc).
  2. What trends do your complaints data show you?
  3. How many consumers are receiving pressure area care
  4. Have there been any medication incidents in the past 6 months where a consumer required hospitalisation or attention by a medical officer?
  5. How many consumers have had falls and required medical attention in the past 3 months?
  6. How many consumers at the service are currently receiving psychotropic medications? (To be captured as a rate or percent of total consumers at the service.)
  7. How many consumers are restrained in order to manage risks to themselves or others at the service? (To be captured as a rate or percent of total consumers at the service.)
  8. Can you tell me about incidents in the past 6 months where a consumer or staff member has required medical attention as a result of challenging behaviour from a consumer?

There are other factors to consider, depending on the type of services you provide.

Home service providers

The Commission’s assessors will include the following questions in their interview with the person in charge of the service:

  1. Have there been any adverse findings by another regulatory agency or oversight body in the last 12 months? (e.g. HealthCare Complaints Commission or similar, Food safety authority, WorkCover, etc).
  2. What trends do your complaints data show you?
  3. Has the service had unfilled shifts in the last month?
  4. Does the service have specific strategies to help staff to provide care to people living with dementia? If so, what are these?
  5. Does the service have a process to identify and respond to changes in the condition of consumers? If so, what are these?

Residential aged care

The key areas of risk for residential aged care providers may include:

  1. Risk areas identified in previous assessments
  2. The use of restraints
  3. A single Quality Standard, or a number of requirements of one or more of the Quality Standards
  4. Risk areas which were identified at the entry meeting.

For providers delivering multiple services, the Commission may wish to conduct multiple assessment contacts at the same time.

Notifying consumers

If the Commission has requested a site visit, there may be a requirement to notify consumers of the upcoming visit. The Commission has developed posters in a range of different languages that the provider can use to notify consumers, click here for more information.

Further reading

For a more detailed outline of assessment contacts and what they may entail, see the Commission’s website.

Clinical governance

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The Aged Care Quality Standards and the National Safety and Quality Health Service Standards include requirements for organisations to have a clinical governance framework, as well as policies to address infection control, antimicrobial stewardship and open disclosure processes.

It is a mandatory requirement for all Australian hospitals and day procedure services to be assessed through an independent accreditation process to determine whether they are in compliance with the National Safety and Quality Health Service Standards.

What is clinical governance?

The set of relationships and responsibilities between a health service organisation and its relevant stakeholders to guarantee good outcomes and continuously strive to improve clinical care for clients.

At its core, effective clinical governance fosters a culture within an organisation in which healthcare professionals of all levels routinely question: ‘Am I doing it right? How can I do better?’.

Purpose of clinical governance

The purpose of clinical governance is to ensure that everyone is accountable to clients and the community for delivering good clinical outcomes and meeting clinical indicators. It is an all-encompassing framework, and also includes infection prevention, antimicrobial stewardship and waste management.

Six key components of the Clinical Governance Framework

  1. Governance, leaderships and culture
  2. Partnering with clients
  3. Roles and responsibilities
  4. Client safety and quality improvement systems
  5. Clinical performance and effectiveness
  6. Safe environment for the delivery of care

Policies related to Clinical Governance can be found in the SPP Reading Room:

  • Info Sheet: Clinical Governance
  • Policy: Clinical Governance
  • Policy: Open Disclosure
  • Policy: Infection Prevention and Control
  • Policy: Antimicrobial Stewardship
  • Policy: Waste Management

 

Promoting emotional wellbeing in aged care

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Being involved in activities that promote enjoyment and a sense of purpose is essential for healthy ageing. Older people may be more susceptible to feelings of loneliness, isolation and sadness, and it important for aged care providers to remedy this by offering  a range of activities and services that are aligned with clients’ needs.

Some core principles aged care staff can folllow to promote emotional wellbeing are:

  1. Supporting autonomy and independence.
  2. Encouraging and fostering social connections within and external to the service.
  3. Focusing on strengths, abilities and improving capacity, rather than disabilities.
  4. Promoting personal responsibility.
  5. Providing person-centred services that are flexible and responsive.
  6. Creating relationships with the older person to explore their interests and strengths and to develop their goals.
  7. Respecting an older person’s decision-making ability and preferences.
  8. Working in partnership with other local services and agencies.
  9. Respecting privacy and dignity in relation to consulting friends, families, and service providers.

The kinds of activities that an organisation can offer will depend on the size and resources of the service. Ideally, an organisation should provide, or facilitate access to services and activities relating to the following areas:

  • Physical activity
  • Purposeful activities
  • Music and arts
  • Animals and pet therapy
  • Social relationships and connections
  • Involving family members, carers and friends
  • Spirituality
  • Resilience and coping skills
  • Loss and grief support

For more detailed guidance on how your organisation can best promote emotional wellbeing for its clients, we have developed the following resources, available in the SPP Reading Room:

  • Information Sheet: Emotional Wellbeing in Aged Care
  • Policy: Promoting Emotional Wellbeing (Aged Care)

Nutrition, meals, hydration and hospitality

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Access to nutritious and tasty meals is central to client wellbeing and enjoyment – making it a key area for residential aged care and disability service providers to get right. 

Meeting the nutritional needs of older adults

There are a number of factors which can impact the nutritional needs and requirements of older adults, such as susceptibility to malnutrition, difficulties faced during food preparation, isolation and depression. Organisations need to consider these factors when preparing nutrition and meal plans for their clients. In addition to their nutritional needs, older clients may also require assistance to consume foods, for example if they have problems swallowing or using their hands.

Meeting the nutritional needs of people with a disability

Based on self-reported data, around forty-seven percent of people over the age of two with a disability eat less than the recommended serving of fruit and vegetables each day (Australian Institute of Health and Welfare). Food and beverages play an important role in the overall health and wellbeing of people with a disability. They can contribute to a person’s quality of life, help maintain a healthy body weight, protect against infection and reduce the risk of clients developing chronic health conditions.

Hospitality services

If an organisation outsources their catering to an external provider, they should consider the client’s nutritional needs, preferences and cultural considerations. This includes factoring in client input, choice and independence when choosing the catering service for your organisation.

Providers should also make several considerations when selecting laundry and cleaning service providers for aged care clients. Organisations should consider the chemicals services use, whether staff have undertaken cultural competency training and understand the importance of client dignity and independence, hygiene and infection control standards.

BNG has developed resources on nutrition, meals and hydration based on best practice nutrition guidelines. Additionally, our policy template on hospitality services is a great tool for organisations who outsource laundry, catering and cleaning services.

Find the following resources in the Reading Room:

  • Info Sheet: Nutrition, Meals and Hydration
  • Policy: Nutrition, Meals and Hydration
  •  Policy: Hospitality Services

Restrictive practices

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Restrictive practices are practices which involve the use of actions, methods and interventions that restrict the rights or freedom of a person with a disability. The main categories of restrictive practices are restraint (chemical, mechanical, physical or social) and seclusion.

There is a concern that restrictive practices are used as a ‘means of coercion, discipline, convenience, or retaliation by staff, family members or others providing support.’ If used in this manner, restrictive practices constitute a breach of a person’s human rights. Consequently, the use of restrictive practices in Australia has become a topic of concern, and recent focus among government bodies and policy makers has been on reforming policy and legislation in this area. The Australian Law Reform Commission has stated that the overall aim of reform is to reduce, and ultimately, eliminate the use of restrictive practices.

Each state and territory have their own rules regarding what restrictive practices can be used as part of a client’s treatment plan, however only five types of restrictive practices are permissible in Australia. To make it easier for NDIS providers to navigate these regulatory requirements, BNG have developed a suite of resources which are available in the SPP Reading Room:

  • Info Sheet: Eliminating Restrictive Practices
  • Policy: Eliminating Restrictive Practices (Disability)
  • Template: Restrictive practices reporting form
  • Template: Restrictive practices register

What’s in a best practice complaints management system?

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We recently gave a webinar on how to develop and implement a best practice complaints management system, and thought we’d summarise the key points in this short blog post. 

Complaints are a valuable feedback tool!

Receiving complaints can seem like a negative outcome for your service, but on the positive side, it can actually mean that you have a simple and accessible process for people to make complaints. Complaints are a valuable source of feedback on your services, and can help you identify areas in which your organisation can learn and improve.

To facilitate complaints and improve services, your organisation should have in place a complaints management system which:

  • Cultivates a positive complaints culture in the organisation;
  • Encourages and supports all complaints, feedback and suggestions;
  • Integrates person-centred principles (e.g. supporting people to make a complaint, keeping them informed of the process and outcomes, and considering their desired outcome);
  • Facilitates open communication with complainants, and within the organisation;
  • Ensures every complaint is reflected upon to improve what could be done better next time; and
  • Follows the principles of procedural fairness, impartiality and fairness.

The complaints management process

The following steps make up the complaints management process, from developing and documenting a policy and procedures, to investigating and reviewing the handling of a complaint.

  1. Develop, document and communicate the complaints policy and procedures. Make sure stakeholders are involved in the development of the policy, and it is understood by clients, staff and other stakeholders.
  2. Receive the complaint, listen to the complainant, clarify the issue/s and find out their desired outcome.
  3. Acknowledge the complaint and inform the complainant of how you will proceed.
  4. Assess the risk, priority level, and complainant’s desired outcome.
  5. Plan (if required) what information is needed for the investigation and how it will be obtained.
  6. Investigate (if required) the complaint, ensuring it is impartial, confidential and transparent.
  7. Respond to the complaint, explaining how you made the decision, and agree on a response with the complainant.
  8. Follow up with the complainant, see if they are satisfied with the response, and if not, refer them to the relevant external body for further support or investigation.
  9. Keep records in a secure and confidential location, for the specified retention period.
  10. Review data from complaints and analyse how the system could be improved.

Need help with these steps?

To guide your organisation through all of the above steps, we’ve recently updated our suite of complaints-related resources in the Reading Room, with new and updated information sheets, and template policies and registers.

  • Complaint submission form template
  • Complaint process tracking form template
  •  Complaint information sheet for clients template
  • Complaint acknowledgement letter template
  • Complaint response letter template
  • Child safe complaints management policy template
  • Complaints management policy template
  • Complaints register
  • Complaints management information sheet

Managing high impact and high prevalence risks

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The Aged Care Royal Commission identified in Volume 1 of the Interim Report, that during the last quarter of 2018-19, the second most common subject of complaints was falls prevention and management.

Minimising the number of falls and pressure injuries in care facilities is vital for client safety and quality of life. Aged care clients are particularly vulnerable to falls and pressure injuries, due to their reduced mobility. Hearing loss is also particularly common in aged care facilities. Leaving hearing loss unaddressed can have a negative impact on a client’s quality of life.

Aged Care service providers should have robust policies and procedures in place, which aim to prevent and reduce the rate of pressure injuries, falls and harm from hearing loss. They should also have procedures which delegate responsibilities and effectively manage incidents as they happen.

To help you address the risks posed by falls, pressure injuries and hearing loss, we’ve put together a collection of policies and info sheets which work towards best practice for preventing and addressing high impact and high prevalence injuries.

Pressure injuries

One of the most commonly occurring preventable conditions, pressure injuries affect 42% of people in RACFs. They can cause death, infection, cellulitis, reduced physical mobility and pain. Our pressure injuries policy includes procedures on:

  • Assessment
  • Prevention
  • Warning signs
  • Treatment

Falls-related injuries

These are one of the leading causes of mortality in older Australians. Considerations such as syncope, dizziness and vertigo, vision, footwear and environmental considerations should be taken into account when conducting a risk assessment and implementing falls management strategies. Our policy addresses:

  • Risk screening and assessment
  • Staff training
  • Management strategies
  • Responding to falls

Hearing loss

If uncorrected, hearing loss can lead to a reduced quality of life, and increase the risks of developing depression and dementia. 85% of Australians in RACFs experience some form of hearing loss. Providers should implement a comprehensive hearing loss policy to ensure that clients receive the highest quality of care. Our policy covers:

  • Assessment and Identification
  • Communication
  • Staff responsibilities
  • Staff training

These resources have been developed as a guideline for your organisation to implement robust policies which help to address high impact risks.

They are available in SPP’s Reading Room.