Lessons from the pandemic: how Standards have evolved

We’re now two years into the pandemic, and the care and support sector has had to make some major adjustments to their service delivery in response to the COVID-19 crisis.

A number of standards have been amended or updated with significant new changes, to provide guidance on improving and standardising infection control processes, as well as ensuring that there are processes to manage workforce capacity and disaster readiness.

We’ve updated our self-assessments in SPP to reflect these changes, and thought it would be helpful to summarise the core themes that have emerged across the different major standards.  

Core infection control and disaster response themes

The core themes that have appeared consistently in standards updates include:

  • ensuring the workforce has the capacity, skills, training and equipment to implement infection prevention and control systems,
  • planning for and sourcing an alternative workforce in the event of disruptions,
  • developing, testing and reviewing an emergency and disaster management plan,
  • reporting to the governing body on infection control processes and implementation/testing of the emergency and disaster management plan,
  • testing, fitting and training in the use of PPE,
  • training in hand hygiene, respiratory hygiene and cough etiquette,
  • implementing stringent processes for communicating relevant information to family, patients and carers,
  • undertaking routine environmental cleaning,
  • ensuring workplace policies and procedures are in line with the relevant state or territory public health requirements,
  • managing movement of staff between areas and supporting staff required to isolate, and
  • procedures for waste management including safe storage and disposal of clinical waste.

These are some key areas that service providers should be addressing to ensure they are on top of their compliance requirements. Providers should check that they are familiar with any updates to standards that apply to their organisation. SPP can assist you with this, as we always update the modules on our platform in response to changes to standards.

Here are the main standards that have been updated to incorporate infection control requirements so far:

The updated Standards

National Safety and Quality Health Service Standards (NSQHS)

Changes to the NSQHS were introduced in May 2021 and include requirements to:

  • plan for public health and pandemic risks,
  • ensure the workforce has the capacity, skills, training and equipment to implement infection prevention and control systems,
  • test, fit, train workers and use PPE, and
  • ensure policies and procedures are in line with the relevant state or territory public health requirements.

NDIS Practice Standards

In November 2021 the NDIS Commission released a number of changes to these standards, to address:

  • planning for alternative workforce arrangements in the event of disruptions,
  • developing, testing, and reviewing emergency and disaster management plans,
  • implementing infection prevention and control precautions throughout all settings,
  • ongoing training on and supplies of PPE for workers, and
  • waste management including safe disposal of clinical waste.

QIC Health and Community Service Standards

In February this year, an updated version of the QIC Standards was released, with updates addressing infection control requirements including:

  • staff training in hand hygiene,
  • infection prevention management program aligning with state and territory guidelines,
  • regular cleaning of the environment, and
  • waste management.

Australian Community Industry Standard

The Australian Community Industry Standard was also updated towards the end of last year to include the following infection prevention and control requirements:

  • workplace preparation for pandemic,
  • workforce response to pandemic consistent with advice from health authorities, and
  • implementing and documenting an outbreak management plan.

RACGP Standards for General Practitioners

The RACGP Standards have seen a number of updates throughout 2021 and more recently in 2022, with the most recent update being in February 2022. The updated requirements address:

  • increased requirements around telehealth consultations (e.g. ensuring privacy etc.),
  • managing the risk of cross infection during a home visit,
  • updated processes for isolating patients and traceability processes for identifying patients who have used instruments,
  • establishing protocols for managing outbreaks of infectious disease in line with local, state and national guidance, and
  • environmental cleaning.

Aged Care Quality Standards

While the Aged Care Quality Standards haven’t been updated with new infection control requirements, the Aged Care Quality and Safety Commission has released a number of resources to guide providers in their implementation of infection control requirements. 

Resources to help you

We’ve developed and updated a number of resources in our platform to assist providers to manage infection control requirements under the standards that apply to them, as well as implement best practice processes. Here are some examples of how we can help:

  • a module for the “First 24 hours – managing COVID-19 in a residential aged care facility”,
  • a module to guide organisations to implement COVID-safe operations based on recommendations from Safe Work Australia,
  • a module to guide organisations through the components they should address in developing infection control / respiratory outbreak plan based on recommendations from various sources including the Department of Health, the Aged Care Quality and Safety Commission, and the NDIS Quality and Safeguards Commission,
  • resource templates including:
    • an outbreak management plan checklist,
    • an information sheet for employers on staff vaccination against COVID-19,
    • first 24 hours – managing COVID-19 in a Residential Aged Care facility checklist,
    • an emergency and disaster management plan,
    • emergency and disaster management procedures,
    • working from home policy,
    • working from home agreement,
    • client risk assessment.

Want to take a closer look at our Covid-19 resources?

2021 – that’s a wrap!

It has certainly been a busy year for service providers and compliance professionals in our sector. Providers have been truly tested by the challenges of the pandemic and a changing regulatory landscape. We invite you to reflect with us on the key developments of this past year.

Child safety

In the child safety space, progress has been underway over the last couple of years to implement the recommendations of the Royal Commission into Institutional Responses to Child Sexual Abuse. We published a blog post on this topic in March of this year.

On 1 July 2021, the new Victorian Child Safe Standards were released, bringing these standards into alignment with the National Principles for Child Safe Organisations. Our mapped self-assessment for the Victorian Child Safe Standards is available on SPP.

NSW followed in a similar vein and in November 2021, legislation passed in NSW Parliament mandating compliance with the NSW Child Safe Standards by certain ‘child safe organisations’. The NSW Child Safe Standards, which also map to the National Principles, can be accessed in SPP.

At present, Australian Catholic Safeguarding Ltd is finalising the Second Edition of the National Catholic Safeguarding Standards, and we expect to be providing assessment modules of these standards early in the New Year.

Aged care

The Royal Commission into Aged Care Quality and Safety was the focal point for aged care this year, with some regulatory changes already implemented and others underway.

The Serious Incident Response Scheme (SIRS) brought in new compliance requirements for residential aged care providers in April. Our Incident Management Procedures (Aged Care SIRS) Policy can help get you up to speed on this. In correlation with SIRS, the Aged Care Quality Standards were updated to include a requirement on incident management, and our ACQS self-assessments have been updated accordingly.

Rules around use of restrictive practices changed, with shift in terminology from ‘restraints’ to ‘restrictive practices’, bringing aged care into alignment with disability regulation. Our updated Use of Restrictive Practices (Aged Care) Policy reflects this.

This year we released an educative version of the Aged Care Quality Standards on SPP, based on the Commission’s Guidance and Resources for Providers document, and which walks providers through their requirements in greater depth. We have also released the Board Governance Toolkit, a comprehensive suite of resources designed specifically to support board members to fulfil their responsibilities under the Aged Care Quality Standards.

Disability

In late 2021, the NDIS Practice Standards saw their biggest overhaul since their inception. The NDIS Quality and Safeguards Commission identified emergency and disaster management and mealtime management/swallowing problems as key focal areas for additional guidance and regulation, and brought in three new Practice Standards to reflect this. In addition, a number of Quality Indicators were added and amended, reflecting a focus on infection control, staff training, individualised risk assessments and insurance requirements. Our blog post will flesh this out for you.

All changes to the NDIS Practice Standards are available for completion in SPP, and you can choose from mapped or stand-alone modules, depending on your organisation’s needs.

Health care

The National Safety and Quality Healthcare Service Standards (Second edition) were updated in 2021, to include new requirements around infection control. We added two new modules to our NSQHS self-assessment on SPP to address the new Standard 3 – Preventing and Controlling Infections.

The Australian Commission on Safety and Quality in Health Care has also begun releasing a number of new standards, aiming to ensure a consistent approach to safe and high-quality health care across different service environments. In 2021, we added self-assessment modules for the National Safety and Quality Digital Mental Health Standards and the National Safety and Quality Primary and Community Healthcare Standards to SPP, and we will be closely tracking the development of the National Safety and Quality Mental Health Standards for Community Managed Organisations.

During 2021 we also released three new modules for the RACGP Standards for general practices (5th edition). We worked closely together with the RACGP to ensure that all of the standards, criteria and indicators in each module are reflected in detail in SPP’s self-assessments.

ISO

ISO standards are popular accreditations amongst our users, and this year we were pleased to add ISO 27001 Information Security Management Systems to SPP. ISO 27001 is an internationally recognised standard that requires organisations to implement an Information Security Management System (ISMS). The Australian federal government requires ISO 27001 certification for all providers of employment skills training and disability employment services, and a number of health and community service providers also choose to follow this standard.

All the best for the holiday period!

The past 12 months have definitely been jam-packed, and we expect 2022 will be just as busy.

We thank you all for your continued collaboration, and from everyone in the BNG team, we wish you a safe and happy holiday season.

See you next year!

Need to get on top of your compliance work?

Access a broad selection of Standards in SPP.

Royal Commission Series: new governance standard

Over the past few weeks, we have been highlighting a number of the Royal Commission’s recommendations, as well as updating you on resources that can help you implement best practices.

Our focus today is on Recommendation 90: New governance standard.

The Royal Commission’s executive summary of its final report emphasised the need to ensure high standards of governance within aged care providers:

“Provider governance and management directly impact on all aspects of aged care. Deficiencies in the governance and leadership of some approved providers have resulted in shortfalls in the quality and safety of care.

“Governance arrangements provide for the systems by which an organisation is controlled and operates, and the mechanisms by which the organisation and its people are held to account. They are set by the leaders of an organisation, in particular the board or governing body. They are implemented by executive leaders and workers who report to those executive leaders. They involve everyone in an organisation.”

In the Royal Commission’s view, the existing governance requirements under the Aged Care Quality Standards “do not provide a sufficiently strong basis for the governance and leadership of aged care providers.”

The Commission's recommendations

Recommendation 90 sets out a proposal for more robust governance requirements to be introduced, to drive improvements to the aged care system.  Key components of the recommendation include requirements that providers:

  • Have governing body members who possess the appropriate mix of skills, experience and knowledge of governance responsibilities, to ensure the delivery of safe and high-quality care by the provider;
  • Have a care governance committee, to monitor and ensure accountability for the quality of all care provided;
  • Seek and receive regular feedback from consumers, their representatives and staff, on the quality and safety of the services they deliver, and ways in which the services could be improved;
  • Have an integrated complaints management system, including regular reporting to the governing body about complaints, any patterns, and underlying reasons for the complaints;
  • Have effective risk management practices in place covering care risks and also financial and other organisation risks;
  • Give particular consideration to ensuring continuity of care in the event of default by contractors or subcontractors; and
  • Have a governing body representative provide an annual attestation that the governing body has satisfied itself that the provider has structures, systems and processes in place to deliver safe and high-quality care.

How can BNG help?

SPP’s existing self-assessment for the Aged Care Quality Standards is an excellent way for providers to better understand the core components of a comprehensive approach to governance.

The self-assessment goes well beyond just listing the requirements of the standards.  It guides providers through the core approaches and processes they should implement in order to achieve best practice across their organisation, and in the area of governance it includes detailed, educative, best practice modules covering topics such as:

  • Organisational structure and accountabilities; governing body recruitment, induction and training; and reporting;
  • Clinical governance;
  • Risk management systems;
  • Financial controls and management; and
  • Performance monitoring and evaluation, and quality improvement.

It also includes modules on client and community feedback and complaints.

All of the modules include downloadable resources such as policy templates, to help providers develop their own policies and procedures.

Towards Best Practice: Clinical Governance self-assessment

We also have a separate self-assessment for Clinical Governance, which is based on guidance from the Aged Care Quality and Safety Commission. It addresses clinical governance at a more granular level and details the processes that should be in place for a clinical governance framework. The self-assessment outlines the roles and responsibilities of all individuals involved in care including the governing body, senior executive team, operational manager, the workforce, health practitioners and consumers.

Resources

We have many resources which will assist providers to implement a comprehensive approach to governance across their organisation, including a whole resource topic on “Governance and Management”.  You can find this section in the Reading Room under the heading “SPP Resources by Topic”.

You can also search for other resources using the search bar in the Reading Room. A number of our resources address Recommendation 90, including information sheets and policies covering:

  • Client Feedback;
  • Quality Management and Continuous Quality Improvement;
  • Complaints Management; and
  • Risk Management.

While the governance requirements are yet to be formally implemented, your organisation can get ahead by working through our self-assessments and implementing best practice policies and procedures across the organisation.  

To access these resources, and hundreds more, log in to SPP.

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You can access these governance resources and many more in the SPP platform. 

Royal Commission Series: recommendation 99 calls for ‘protection for whistleblowers’

An issue highlighted by the recent Royal Commission into Aged Care Quality and Safety is the lack of systemic support for whistleblowers within the aged care system. In her overview of the Royal Commission’s Final Report: Care, Dignity and Respect, Commissioner Lynelle Briggs AO states:

It is a sad fact that many older people, their families and care workers are reluctant to speak up about the quality and safety of care because of the fear of reprisal from providers or their staff members”.

Current problems in the sector

Commissioner Briggs speaks of the need to make more transparent the complaints process and to strengthen whistleblower protections, using the following witness statement from Gwenda Darling, who gave evidence at the Brisbane Hearing, as an example:

After my first experience of having my service cut off by the provider after complaining, I’ve been a bit fearful that I could lose my package if I complain. The providers have a lot of power. I had to really fight hard to get my package reinstated. I felt hopeless and disempowered after that experience and it felt like there was no point raising issues or complaining.”

Similarly, an aged care nurse shared in a public submission to the Royal Commission that she had “learned over the years not to say anything for fear of repercussions from management”. Staff and consumers within an organisation may worry that they are in a vulnerable position, and therefore feel afraid to voice any concerns they have.

The Australian Medical Association submitted to the Royal Commission that legislated safeguards may help employees to speak up, which may “lead to earlier identification of concerns and to the improvement of services provided to older people in aged care”.

The Royal Commission, in its final report, ultimately recommends that a new Act be introduced, containing comprehensive whistleblower protections for all involved parties.

Recommendation 99 reads:

The new Act should contain comprehensive whistleblower protections for:

a)    a person receiving aged care, their family, carer, independent advocate or significant other

b)    an employee, officer, contractor, or member of the governing body of an approved provider

who makes a complaint or reports a suspected breach of the Quality Standards or another requirement of or under the Act.

What can providers do now?

Since the publication of the Royal Commission’s final report, the Aged Care Legislation Amendment (Serious Incident Response
Scheme and Other Measures) Act 2021
(Cth) has commenced. This legislation amends section 54 of the Aged Care Act 1997 (Cth), to add protections for disclosures of information related to reportable incidents.

Providers are advised to implement an internal whistleblowing policy in compliance with the Aged Care Legislation Amendment (Serious Incident Response Scheme and Other Measures) Act , which protects consumers, staff and families from reprisal when voicing concerns.

Such a policy should:

  • articulate protections for whistleblowers from criminal prosecution, administrative action or civil litigation, such as breach of employment contract or duty of confidentiality; and
  • formalise that staff or representatives of the provider will not be permitted to cause or threaten detriment to someone who has made or wishes to make a whistleblower disclosure.

Separately, providers should ensure their complaints management policies and processes are consumer-centred, and clearly state the protections in place for consumers, staff and family who seek to report concerns. There should be clear expectations that managerial staff will act ethically and will not target consumers, staff or family who make a complaint.

In addition, whistleblowing policies and procedures should comply with the Corporations Act 2001 (Cth), which contains certain protections for ‘eligible whistleblowers’. It is important that providers familiarise themselves with the Act, and are aware of their obligations under the Act. More information is available on the ASIC website.

Resources

We have a number of whistleblowing resources on SPP that can assist you to achieve best practice in this space.

  • Info: Whistleblower protection – This info sheet provides an introduction to the concept of whistleblowing and an overview of key rules under the legislation.
  • Policy: Whistleblower protection (public companies) – This is a policy most suitable for larger organisations who are obliged to comply with corporate whistleblowing laws, or for organisations who voluntarily follow the corporate regime.
  • Policy: Whistleblower protection (small organisations) – This is a simpler policy, which still covers key steps in the whistleblowing process. It is a more approachable resource for providers who are not currently required to implement a policy, but still wish to do so.

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You can access these resources and many more in the SPP platform. 

Clinical governance

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

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

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

Managing high impact and high prevalence risks

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.