What does a Physiotherapy programme look like in Aged Care?

Prior to contracting a Physiotherapist, or as part of your Physiotherapy service review process, you should consider what your goal is in having physiotherapy input.  These should include key values such as Meaningful Outcomes for residents.

We asked Jessie Snowden of On The Go Physio what should felt was important for a Physiotherapy programme to which she offered the following:

For us this means we carry out thorough assessments, find out what is important or meaningful to the resident, their whānau and how this impacts their functioning in the aged care environment. Our input with people can range from rehabilitation to a previous level of function.  This may be intensive physio input for a few weeks, to ensuring someone is safe and comfortable with appropriate seating and pressure care at the end of life (which could be one visit only).

This level of assessment means that you need to ‘budget’ for 40-60 minutes (sometimes longer for complicated admissions) of physiotherapy time for a new assessment and possibly longer if they are needing to make referrals, liaise with other services and family. Follow up visits will be shorter. It is recommended that if you have a set number of hours per week that your staff and the physiotherapist are clear on expectations and priorities. If you only contract 2 hours per week it is not fair to have 10 new assessments on your ‘urgent’ list!

Some facilities have a set standard of 6 monthly reviews of all their residents. Although we do undertake these if asked, it is often more meaningful to use physiotherapy skills for those residents who may improve with input, or who your staff need assistance with due to functional decline. We suggest  if a 6 monthly review is wanted, then the RN is able to carry this out by considering if there have been changes in mobility, falls rates or other physical changes affecting function. If not then your physiotherapy dollar could be better spent on residents with clear rehabilitation needs or declining function.  The key goal here being to optimise mobility and maintain as much independence as possible.

Once the Physiotherapy service is up and running you can expect your physiotherapist to provide a clearly written assessment and a clear treatment plan, including either a discharge comment or a review date. Ideally you will maintain data related to Physiotherapy input and be able to see clearly if your allocated time is meeting the needs of your staff and residents.

Finally consider which residents will be eligible for physiotherapy assessments. If you are funding a Physiotherapy service you may choose to extend this to your hospital level and rest home level of care residents but not to independent studio units/apartments as these residents will usually be eligible for DHB funded services. Some DHBs will happily provide physiotherapy to rest home level of care residents and some put guidelines around who they will see. Depending on your DHB and care philosophy you may choose only to fund Physiotherapy services to hospital level of care residents or to extend this to rest home. In our company we work with aged care facilities who operate under both of these models and the key is to have it clear to both your Physiotherapist and staff who are completing referrals.

Spend your dollar wisely!

A final note here. Physiotherapists are highly skilled healthcare professionals who will be an asset to your team. The days of Physiotherapists spending all their time on walking programmes are long gone and you should set your expectations high for a physiotherapist who will add quality of life to your residents and cost benefit to your organisation. To use your physiotherapist wisely I strongly recommend you have the expectation that your care staff will have time to walk with people who are safe to do so.  We also encourage you to employ or allocate a Physiotherapy assistant hours into your roster to implement Physiotherapy plans. For information on using Physiotherapy assistants please look at an earlier article here .

This article was kindly contributed by Jessie Snowdon – Director of On the Go Physio. On the Go Physio provide physiotherapy services to over 20 facilities in Christchurch and Moving and Handling training to many more facilities and the CDHB.

Maintaining independence – maximising mobility

When it comes to maintaining functional ability for residents whether in a retirement village setting or in an aged residential care facility, the input for a skilled Physiotherapist is a huge advantage in setting up strengths and balance or falls prevention programmes.

Getting in the support of that type of expertise is certainly going to help residents maximise their potential.  Not all professionals are created equal and physiotherapists are no different to other professionals!  How do you go about choosing a Physiotherapist though and what should you check for when selecting the right person to support physical therapy for your residents.

I asked local well know registered Physiotherapist Jessie Snowdon what she thought on this topic.  Here’s what she recommends:

How to choose a physiotherapist for your aged care facility.

Physiotherapists are a key member of the healthcare team in aged care facilities. Having physiotherapy input can improve quality of life for your residents, improve safety and lessen workloads of your care staff. Many physiotherapists are also able to offer moving and handling training onsite as part of their service.  Physiotherapists who are passionate about aged care are usually very special people – so how can you pick them?

This article is written with contracted physiotherapy services in mind but many aspects will apply to employing a physiotherapist directly.

Ask about their experience

In order to meet the varied needs of residents in aged care, physiotherapists need to have a broad clinical background. I would suggest that your physiotherapist should have experience in most of the following clinical areas.  Because this is a long list you should be seeking a physiotherapist with a minimum of 5 years’ experience – or actively supervised by a more senior colleague.

  • Orthopaedics
  • Neurology
  • Dementia (even if not working in a specific dementia facility)
  • Cardiac respiratory
  • Moving and handling
  • Basic seating and wheelchair assessment
  • Falls prevention
  • Arthritis
  • Chronic Pain
  • Pressure injury prevention

Ask about their professional development

To maintain registration in New Zealand, a physiotherapist must adhere to The Physiotherapy Board Code of Standards which is available to the general public here. They must also have a minimum of 100 hours CPD per 3 years, show evidence of reflective practice and have one professional peer review per 3 years. At On the Go Physio we require a peer review each year and active ongoing engagement with colleagues and professional development.

It is not uncommon for aged care facilities to directly contract a physiotherapist working as a sole trader. This can be an isolating role for a physiotherapist and it is important they regularly engage in professional development and in supervision and peer review.  If you are employing, rather than contracting, a physiotherapist you will need to budget for this as it is reasonable that you meet these costs.

Eight quick questions when choosing a physiotherapist contractor

As well as the right experience and compliance with physiotherapy regulations, contractor physiotherapists are also businesses in their own right (whether a sole trader or employee of a company) and need to operate as such. These are some legal requirements and compliance issues you should consider.

  1. Ask to see and maintain a copy of their Annual Practicing Certificate (APC – a new one will be issued annually and you should have a copy of this prior to 1st April of each year).
  2. Ask for a copy of their professional indemnity and public liability insurance certificates.
  3. Ask to view their (or their employers) health and safety policy.
  4. Ask if they undertake regular supervision or mentoring to help assure their own professional safety.
  5. Ask them to arrange for a colleague to undertake a clinical notes audit within 3 months of starting in the role and annually following this. Ask for a copy. (You may need to negotiate this and if there will be a cost it would not be unreasonable for you to consider paying this).
  6. How will they cover your facility during periods of leave.
  7. Are they a member of Physiotherapy New Zealand – this is not compulsory but demonstrates a dedication to their profession and provides development opportunities.
  8. What moving and handling training experience do they have? Will they be happy to provide training or will you need to contract those services separately.

 This article was kindly contributed to by Jessie Snowdon – Director of On the Go Physio. On the Go Physio provide physiotherapy services to over 20 facilities in Christchurch and Moving and Handling training to many more facilities and the CDHB.

A further article will follow on how to set up a Physiotherapy service in your facility.

Disaster Management should include security measures

This is a good time to be reminded that disaster management or your security policy may need to be extended to include management of threats, both internal and external to your organisation.  During the past years I’ve been personally involved with facilities where a resident entered the facility with a fire-arm, an intruder break-in during the night with a fire-arm, and another where intruders who entered the facility went into an occupied residents room. This last case related to intruders who had allegedly held-up the local bottle store earlier that same day.

Things happen which we don’t expect and we must be prepared as best we can.  It’s impossible to cover every possible eventuality but when events such as the shootings in Christchurch occur, it’s a reminder to ask are we doing enough?  For example, staff security rounds should be strictly enforced and documented to verify these were carried out. If you have surveillance cameras, where are your blind spots? If it’s the staff car park for staff going off duty late at night, improvements are desirable for staff safety. What about your processes for visitor verification? 

Security isn’t just about the people and environment but also about assets and information.  These should all be detailed in your policy documents.

HCSL are currently updating the security policies we provide ARC services to include reduction of risk from internal and external threats. This includes a procedure for lock-down. Let’s hope we never need to use it! 

For those of you wondering about how to debrief with your staff as a means to support them, there are some great resources available here.  For more resources on supporting others in relation to disaster type events, go here

Culture Change in Long Term Care

Culture is a word we hear a lot and goes hand in hand with the concept of culture change.  In this article I’d like to touch on how to facilitate culture change and why it is beneficial to your long term care setting.  Let’s face it, aged residential care in New Zealand is changing rapidly and this impacts the experience of residents, staff and visitors to long term care settings. It impacts their desire to be in your care facility or to move somewhere else. This applies to be both residents and staff.  Families often choose the care provider for their elderly relatives.  What do they perceive when they visit you?

There are also barriers and challenges to creating and sustaining a definable and deliberate culture. The experience of the residents and staff is a result of the culture (behaviours) which should be aligned to your organisation values, mission and goals.  There are well publicised workforce shortages and high turnover of staff. Long term care is also in the middle of change from paper-based systems to electronic storage and management of information. The environment in which care is being provided is also changing through new construction of buildings from a institution to non-institutional. The atmosphere being created by those within the long term aged care residential setting is changing to a more relaxed feel.

Care  and direct support is now also being provided within retirement village studios, apartments, villas, homes.  This means a change of not only the context of care.  Ensuring person centred care where each individual feels seen, heard and respected takes consistent focus and strong leadership.  Not always easy in a industry that is changing in so many ways. I wrote in a previous article on workplace culture that behaviours could be a better point of focus rather than simply focusing conversation on culture as a concept.

The behaviours which support a culture you can be proud of and one that sets you as an industry leader, require a long term focus and not just a one time exercise.  The strong leadership needed along with education and ongoing communication is key to setting a desirable culture.  Have you aligned your staff, management and Governance behaviours with your organisation vision and mission statements?  Behaviours reflect actions and they can be optimal actions, good actions, poor actions or non-action.  All will have an outcome which impacts the residents experience and determine how they feel about residing in your long term aged residential care setting.

For change to occur there needs to be a focus on improvement, a reason to change which residents and their families see as beneficial.  We tend to stick to doing what we’ve always done unless we can see a personal gain or something which provides a sense of satisfaction on a personal level.  What’s in it for me?  Culture change is not something that’s going to be achieved from a top-down directive. It’s going to take engagement from all levels of the organisation and create wins for those involved. Without perceived gains or wins, people stay stuck in old habits which don’t fit the new expectations of those seeking care and support.

If you’re the manager or CEO and delegate a ‘change management’ process to someone else and expect to check in later to find wonderful results without your direct involvement and engagement, you may be disappointed.  Culture change is a team effort. To achieve change, everyone needs to participate.  They need to believe in the outcomes you’re trying to achieve with whatever strategies or initiatives you put in place.

Who is going to lead change?  There is an old saying that everything flows from the top down and this is also true of culture.  If the Board are dysfunctional then there should be no surprise when staff working at all levels of the organisation are dysfunctional. How is communication about strategies of change being done to gain buy-in? How are you going to measure your change initiatives to find out if you’ve been successful?  How are you going to ensure the desired culture is maintained?  There are a number of tools (mostly overseas based) which can be used to start this process. Here is a free online culture change assessment tool you could use.

What is the experience of your resident and your staff on a daily basis?  Would they recommend you to others in a way to reflects loyalty to your care facility as a preferred place to live or work? If not, what are you going to do about it?

When Norovirus hit, the staff hit back!

ONE EXPERIENCE OF NOROVIRUS MANAGEMENT  

Some may think the actions a little extreme but the objective was to minimise risk to others and in doing so, minimise the numbers of people (residents and staff) infected with Norovirus. The below is how one facility dealt with a norovirus outbreak recently.

Here’s how we dealt with what happened in our facility:

With the Clinical Nurse Manager on annual leave at 8.00 am on Friday 11 January the Senior RN advised the QA we had two suspected cases of vomiting and diarrhoea.  At 10.00 am the Senior RN advised the QA we could have four more cases of diarrhoea.

An immediate meeting was called with management and the situation discussed.  The following steps were instigated –

  • We immediately referred to our HCSL Safe and Appropriate Infection Control policy manual.
  • We decided to take the “worst case” scenario approach eg Norovirus.
  • We then set out an “action plan” and held a meeting at 11.00 am with all the staff present to advise the situation and actions to be taken –

Action Plan 

  • Infection Control at DHB were advised and samples were sent for analysis
  • The Rest Home was put into “lock down”. The families and next of kin of all the residents were advised.
  • The Village residents were advised and instructions given to them on procedures to follow.
  • The doors between the three sections of the Rest Home were closed and staff confined to these areas only – no exceptions.
  • The infection log from HCSL system was immediately put into use – an RN had to sight all vomit and diarrhoea together with noting the times and dates – this information was supplied on a daily basis to  DHB – this information was imperative to identify if virus was spreading, how quickly, or if it had been confined to certain areas etc.
  • The RNs appointed “dirty” nurses on each shift. A “clean” person was also appointed for delivering supplies around the whole rest home. Trollies were meticulously sanitised when “travelling” between these areas.
  • Kitchen staff were confined to the kitchen only
  • All residents were confined to their rooms with meals being delivered using “clean” and “dirty” trollies. This may seem extreme but the residents were agreeable to this.
  • Diagrams out of our policy manual were put in the Nurses Stations on how to put on PPE. Full PPE was mandatory in all “dirty” residents rooms and when serving food or drinks.   Face masks were mandatory for all staff at all times – no exceptions.  Full face shields were used in the laundry and any very soiled linen was disposed of as per instructions.
  • Hand washing and sanitising techniques were vigorously adhered to.
  • The cleaners were issued with “heavy duty” cleaning products and all vacuuming was banned.
  • Being an older Rest Home with only certain areas being air conditioned it was easy to turn off all conditioning and keep off.
  • Residents were encouraged to open their windows for fresh air and let in the sunlight.
  • Cleaning equipment was kept in the “dirty” rooms for their use.
  • All residents were advised to put toilet seats down prior to flushing and flush twice.
  • All residents and staff were reminded of hand hygiene practices and we ensured the appropriate supplies of hand washing and hand hygiene gels were available.
  • Communal areas in the Rest Home were closed, cleaned, sanitised and not used.
  • Management held a daily meeting at 9:00am to report on the up to date situation and a report was issued to the staff at 1:00pm and a daily report issued to the DHB.
  • The rest home was advised by DHB ON 16 January 2019 to let residents out of their rooms but stay confined to the areas of the Rest Home they lived in
  • On 21 January 2019 the rest home underwent a complete steam clean of carpets, drapes etc,
  • On 22 January 2019 we re-opened the Rest Home to visitors again.

LESSONS LEARNT

We had a total of  only 4 confirmed cases of Norovirus – one in the hospital and three in the rest home.  At the time the Rest Home was fully occupied (60 residents).

Follow your Policies and Procedures “to the letter”.  Without the excellent information contained in our policy manual we would not have achieved the result we did as everyone had varying views on what to do.  We had only one “view”.

We received congratulations from our DHB on handling this situation and receiving the outcome we did.

And of course we knew we always had the back-up of Gillian at HCSL either via email or telephone if required.

 

Models of care and addressing Isolation

Since the emergence of residential care facilities in New Zealand, the models of care have continued to change, but are they changing fast enough? The clinical needs of residents have escalated and so the way services are provided must also reflect a change in practice to meet changing resident needs. A common theme being reported among older member of our communities is that of isolation and depression. Isolation, according to the Collins dictionary relates to separation, withdrawal, loneliness and segregation.

I was fortunate to visit Greece recently which is reputed to have a larger proportion of older adults than most other EU countries.  Gerontology is derived from the Greek words geron, “old man” and -logia, “study of” so it made sense to discuss models of care with families and health care professionals including pharmacists.  I discovered there are few residential care services in Greece and those that do exist are found mostly in Athens rather than the islands. Families provide the majority of care with ‘family’ being noted as the key foundation to Greek society. Grandparents are frequently living within the extended family with the younger generations and taking responsibility for caring for their grandchildren.  The economy is poor and social networks are heavily relied on to provide support.

From my observations, conversations with others, and literature, the older adults of Greece are kept actively engaged in the community. They are frequently involved in running family businesses if they are not relied on for supporting the needs of their children or grandchildren. Family networks remain strong and when interviewing people about how older adults will be cared for, the automatic assumption is that family will provide that service. Dr Elizabeth Mestheneos told me that approximately 1% of their older population may well be in residential homes. There are Open Care Community centres in virtually every Local Authority which are called KAPI. There are also Help at Home services and Day care centres in some Local authorities.

The models of care and workforce capacity currently in place in New Zealand are unlikely to meet increasing demands so change is needed.  The aged care sector could lead change as new models are developed, trialed and advanced.  Multiple studies confirm these new models need to include holistic, consumer directed services.  Not only meeting physical needs but also social connections and the opportunity to be involved in meaningful activities that contribute to others. This also includes some use of technology to support connections with others. While they are of assistance to some, there is no substitute for human connection, person to person, face to face. The experience of ageing, social network supports, funding models and the context in which care and support are provided certainly differ from country to country.

In New Zealand residential care settings we have activities / recreational programmes which support inclusion and engagement.   Being involved in meaningful activities are also key factors in contributing to a sense of well-being. I observed older adults in Greece undertaking meaningful activities in the community like feeding the communal cats of Kos or looking after grandchildren, continuing to run a second hand open-air shop to add to the family income or playing games with friends games. Groups of older men often congregated outside cafes for conversation, coffee and playing cards or board games.  A Menzshed story reflects on how one New Zealand community are attempting to address the gap ageing can create in the life of some men. While funding is different in NZ to Greece and the family network is more often scattered geographically in New Zealand, there remains more opportunity to include community. The care setting could also be enhanced more by reflecting the smaller numbers of people we are used to living with in the family home, rather than the larger numbers in some care facilities. A model that more closely reflects the life patterns our community members have been used to, with them directing how these continue into the latter years of life with the goal of ageing in a healthy way, optimising body, brain and social networks.

 

 

 

Mattresses – are your mattresses causing harm?

Mattresses aren’t just something to lie on but if not maintained and cared for appropriately, also have the potential for causing harm.

As I travel a lot for work, I have the opportunity to test many different mattresses, all with varying degrees of comfort.  This reminds me how difficult it must be for those who may be suffering painful joints to get a good night’s sleep.  Appropriate mattresses are not only required to reduce pain from positioning discomfort but also reducing risk to residents. This include ensuring the mattresses are of a suitable standard and fit for purpose.

I’ve seen a number of mattresses which had hardened and torn linings and were well past being able to provide much comfort or an appropriate degree of pressure support. Some had masking tape used in an attempt to cover splits in the mattress cover.  Others had holes in and were badly stained from exposure to body substances.  As the residents in care are becoming frailer, with increasing acuity, the need for ensuring appropriate pressure support is crucial to preventing pressure injuries, maintaining comfort and maximizing the opportunity for good sleep.

There is the potential for old and in poor condition mattresses to be a potential source for infection transmission.  For those of you operating newer facilities, this may not yet be an issue. For older facilities, part of stock and resource control should include mattress stock checks to verify they are in fact still fit for use.  When conducting checks, determine the mix of mattress types you have and speak with your supplier about a replacement programme should this be necessary.  As mattresses differ, so do beds and it’s important to make sure the mattress you use is appropriate for the particular bed type and size.

When reviewing your mattress stocks and purchasing new mattresses you might like to think about the following factors:

  • Only purchase from reputable suppliers. Review the manufacturer’s instructions for use to ensure they include verification of cleaning instructions and ask about preventative maintenance. This may include staffing training e.g. via the use of online training videos or instruction booklets.
  • Make sure you record the date of purchase and do your best to track each mattress and pillow to maximize warranties and make plans for replacement. Add the item to the facility cleaning schedules for regular cleaning and drying of exterior surfaces which should be durable, water-repellent and quick drying. They should also be seamless, if possible. When there are seams or edges, much sure these are situated away from resident skin contact to prevent absorption of liquid into interior and increased friction.
  • All seams must be tightly closed and sealed. Masking or packaging tape is not appropriate for sealing. When mattresses become worn and tear, you might like to have a supplier representative review to see what options are available for repair or replacement.
  • When reviewing the condition of mattresses, inspect all mattress surfaces, covers, seams and zippers for proper function and damage including wear, tears, splits, cracks, punctures, permanent odours and stains. If visible contamination from body substances are present, determine appropriate steps (eg. replacement or repair).
  • To support longevity of mattresses, remind staff not to place any furniture or sharp objects on mattresses. Protect the mattress with mattress protectors only if advised by the supplier this is appropriate. A number of pressure support functions in mattresses may be adversely impacted by the use of additional mattress coverings to do check.
  • Cleaning and disinfection must be considered in relation to mattresses, covers, wedges, cushions and pillows which are all classified as non-critical medical devices. Clean and low-level disinfect according to the manufacturer’s instructions between different resident use and when visibly soiled. Some mattress covers are removable for laundering so remember to verify which ones can be cleaned separately.
  • Remove damaged or stained items from service and report these in your maintenance book or to the Manager. Follow manufacturer’s instructions for use and disposal of damaged mattresses, covers, and pillows, and in accordance with infection prevention and control guidelines.
  • Ensure when using alternating therapy type mattresses that there is a process in place for a shift by shift verification that the pressure is maintained at the current level for the individual resident utilizing that mattress. If you plan to use an air alternating topper pad on a mattress, ensure it’s suitable for the mattress as depending on heights and size, it may not be appropriate.

Harm prevention can also be supported with advances in technology such as Pressure Monitoring sensing devices to ensure appropriate pressure distribution.  I’m not aware of anyone who can rent or lease out Pressure Mappers in NZ. However Cubro have one that they can bring onsite to facilities for training and education. Make contact with your supplier to see if they can assist if this could be useful for you.

Also remember that other devices used in beds should be checked  as well to ensure they are still safe and appropriate for use eg; wedges, rolls, pillows, seat cushions, mattress covers (where these are appropriate for use), bed sensor monitoring pads.  For reading on how to choose the best mattress option for your needs go here.

For more related information view here.

Article compiled by Gillian Robinson (RN, BN, Lead Auditor) for Healthcare Compliance Solutions Ltd.

Policies and Procedures folders

Policies & Procedures

Policy No. Titles for residential care service policies and procedures
CSM Care Services Manual introduction page
CS1 Admission to hospital for medical emergency
CS2 Adverse Health Policy
CS3 Anti-coagulation monitor
CS4 Warfarin blood monitoring results
CS5
CS6 Bereavement / Termination Care policy
CS6 A Bereavement notification form (and resource material)
CS7 Blood Glucose monitor form
CS7 A Blood sugar levels record sheet
CS7 B Diabetes Testing and Treatment sheet
CS7 C Blood glucose monitor form
CS8 Blood sugar equipment check
CS9 Blood sugar testing
CS10 Case Conference for care plan review forms
CS11 Care Plan Review Schedule
CS11 A Doctors Visits Schedule
CS12 Catheter management policy
CS12 A Catheter change schedule
CS13 Continence management policy
CS13 A Continence assessment form
CS13 B Continence Voiding Chart and Bowel chart
CS14 Clinical Management Policy (includes resource directly and key responsibilities)
CS14 A Robinson’s Resident Acuity & Clinical Risk Assessment
CS15 Challenging behavior assessment form
CS15 A Behavior monitoring chart
CS15 B Challenging behavior assessment form
CS16 Diversional Therapy – Quality of life policy
CS16 A Diversional Therapy – Residential profile
CS16 B Diversional Therapy – Care plan
CS16 C Diversional Therapy – Activities attendance register
CS16 D Diversional Therapy – Care plan evaluation form
CS16 E Sample Activities Calendar
CS17
CS18
CS19 Falls Prevention Programme
CS19 A Falls Risk Assessment – Coombe’s Assessment Form
CS19 B Repeated Falls Analysis – Accident Summary
CS19 C Resident Mobility Assessment Chart
CS19 D Resident Mobility Guide Form
CS19 E Post Falls Investigation Form
CS20 Fluid Balance Chart
CS20 A Daily Fluid Balance Chart (more reflective of hospital level care)
CS21 Handover sheet
CS22 Health status and clinical risk assessment policy
CS22 A Health status and clinical risk assessment form
CS23 ‘Health Promotion’ Initiative Planner
CS24 Lab form – Pathology report storage sheet
CS25
CS26 Long Term Care Plan (Including InterRai prompts and Evaluations)
CS26 A Short term care plan for acute issues
CS26 B Treatment Sheet
CS26 C Daily Care Summary (for inside wardrobe reference in resident room)
CS27 Care Plan multi-disciplinary review policy (and associated form)
CS28 Administration of medication policy – different version supplies for those using Medimap / 1 Chart
CS28 A Administration of medication procedure – different version supplies for those using Medimap / 1 Chart
CS28 B Glucagon Administration
CS28 C Blister pack contents verification
CS28 D Medication competency assessment forms
CS28 E Insulin competency assessment form
CS28 F Medication changes / order notification
CS28 G Medication order sheet – supplied for non-electronic system users
CS28 H Medication Signing sheet – supplied for non-electronic system users
CS28 I PRN medication signing sheet – supplied for non-electronic system users
CS28 J Medication error analysis form
CS28 K  Medication error analysis form
CS28 L  Respite / short term resident medication signing
CS28 M  Self Medication resident initial competency reviews
CS28 N  Self medicating – shift by shift verification
CS28 O Medication Returned to Pharmacy form
CS28 P Medication Key Holder Register
CS28 Q Injection Register form
CS30 Nebulizer usage and maintenance policy
CS31 Neurological Recordings policy
CS31 A Neurological Observation sheet
CS32 Podiatrist Service agreement
CS33 Pain Management policy
CS33 A Pain – Detailed Assessment form
CS33 B Pain – Review Assessment form
CS33 C Pain – ABBEY pain scale (for non-verbal resident)
CS33 D Pain – ABBEY pain scale reviews form
CS34 Personal hygiene and grooming policy
CS35 Pharmacy Service Agreement
CS36 Temp, Pulse and Respirations monitor form
CS36 A General Recordings record (optional use)
CS36 B Weight and Blood Pressure Monitor form
CS36 C Blood Pressure Monitor form
CS37 Pressure Injury Risk policy
CS37 A Pressure Injury Clinical Procedures
CS37 B Pressure Injury risk assessment form
CS38 Nursing (care) progress notes form
CS38 A Pressure Note Writing Guidelines
CS39 Medical Notes progress forms
CS40 Restraint / Enabler use policy and procedure
CS40 A Restraint / Enabler Authorisation form
CS40 B Restraint / Enabler Monitoring record
CS40 C Restraint / Enabler Register
CS40 D Restraint / Enabler Assessment prior to use
CS40 E Restraint / Enabler monitoring guidelines
CS40 F Restraint Approval Group Review meeting
CS40 G Restraint / Enabler Review form
CS41 RN – Medical practitioner communication
CS42 Sleep and Comfort policy
CS42 A Sleep Monitor form
CS43 Turn Chart for bed-ridden resident
CS44 Weight Management policy
CS44 A Weight Monitoring chart
CS45 Wound Management policy
CS45 A Wound care plan / dressing schedule
CS45 B Wound care competency assessment
Policy No. Title for residential care food services policies and procedures
FSM Food Services Manual introduction page
FS1 Admission Food & Nutrition Information
FS1 A Breakfast Order forms
FS2 Food brought into the facility
FS3 Food Safety policy
FS4 Food Services for the Elderly
FS4 A Food & Nutrition guidelines for the older person
FS4 B General tips for helping older persons eat etc.
FS4 C Ageing Process and Care Provisions Issues
FS4 D Eating Difficulties – Dry or Sore Mouth
FS4 E Fluids – Preventing Constipation
FS4 F Food and Medication Interactions
FS4 G Vitamin and Mineral Supplements
FS5 Food Services Questionnaire for Residents
FS6 Safety Checklist for Kitchen Services Areas
FS7
FS7 A Sample Menu – Winter 1
FS7 B Sample Menu – Winter 2
FS7 C Sample Menu – Winter 3
FS8 Microbiological Data Sheets – food Safety
FS9 Food services ordering and monitoring
FS10 Food services preferred suppliers
FS11 Food/fluid Intake Chart
FS12 Resident Food / Fluids Preferences at a glance form
FS13 Food Services Staff Responsibilities
FS14 Food Storage Policy
FS15 Food Thawing Policy
FS16 Meal Service Policy
FS16 A Resident Meal Receipt Verification Form
Policy No. Policy Title for Residential Care Service Delivery policies and procedures
SD1 Acquisitions Order Form
SD2 Common Abbreviations
SD3 Communication Policy
SD3 A   –  Sensory Communication Policy
SD4 Clinical documentation and report writing policy
SD5 Day Care Policy
SD5A Day Care – Client Care Plan
SD6 Family / Whanau / Resident Representative Contact sheet
SD7 Reassessment Referral Policy
SD8 Resident Inquiry for Admission Form
SD8 A Resident Inquiry for Admission Form (alternative form)
SD9 Resident Medical File Checklist
SD10 Transfer / Discharge of Residents Policy
SD10 A Transfer / Discharge Form
SD11 Medical Services Contract
SD12 Authorised Signatures register
SD13 Change of Resident Status Notification
SD14 Internal Telephone Numbers Listing

Quality Systems Development / Support

Bogged down in paperwork? Wasting your time re-inventing the wheel, creating documents to meet audit requirements? 

  • Are you spending unnecessary time on researching, developing and reviewing policies and procedures?
  • You don’t need to do this any longer!
  • You can now get back to doing what you enjoy!

Healthcare Compliance Solutions Limited (HCSL) supports you in achieving Certification and contractual audit outcomes through provision of a completely integrated tried and tested quality system. This system consists of a set of policy and procedure manuals accompanied by the relevant clinical practice forms. Everything you need in customised ready to use hard-copy manuals AND accessible in-the-cloud   To view a brief video demo of the system click here.

This documented Quality System has been developed and continuously refined by us over the past 15 years taking into consideration all legislation and contractual requirements for Aged Residential Care setting.

Our Quality System package which continues to pass numerous audits in multiple facilities nationally for both Certification and District Health Board contract (ARRC) audit purposes consists of:

  • Policy and procedure manuals to guide meeting compliance requirements
  • Fully indexed and cross referenced
  • Incorporates the requirements of the Health & Safety at Work; and Food Safety Act legislation
  • System accompanied by coaching and mentoring services
  • Flexibility to enable modification to meet the specific requirements of your facility.
  • User friendly format
  • Written in practical common sense terminology

Service contracts ensure ongoing updates are provided as regulatory requirements change.  A number of our clients have achieved Four Years Certification.

Policy and Procedure manuals are grouped as:

  • Human Resources
  • Organisation Management (includes quality  and risk)
  • Entry (admission) and Consumer Rights
  • Safe and Appropriate Environment (Health and Safety; and Infection Prevention and Control)
  • Services delivery (care services)
  • Food Services
  • Village (RVA related policies and procedures for those with Village facilities)

During service provision HCSL work alongside you to ensure that your system is adapted to your specific needs and provides guidance for consistent service which in turn retains happy clients for your facility. Where clinical practices are identified as not complying with current accepted best practice, you will receive mentoring and support in the change management process to achieve improvements.

Don’t waste any more of your precious time – make contact today to gain access to a System that will support you in achieving Certification, and can be maintained on your behalf!

For more information on our national NZ designed bench-marking and online quality and risk programmes, read more here or contact us

Contact us now for more information.

Consumer Surveys

Research indicates that 80% of clients transferring their business (and money) to another service provider leave without ever saying a word. Independent consumer surveys gain feedback in a pro-active way that empowers clients and increases client retention.

We conduct surveys on your behalf to gain stakeholder feedback on their perception of your service. Their responses are analysed and a documented report is completed which identifies areas of perceived excellence in service provision and identifies opportunities for improvement where these have been identified.

Gaining stakeholder (i.e.; family/whanau) feedback is a health sector audit requirement and you need to be seen to be utilising the information gained which is what we support you to achieve. Use our time rather than your own!

To find out more click here.