Audit Tips – Common findings in audits

Audits in the aged residential care sector in New Zealand are assessed against their ability to comply with a raft of legislation, standards and contractual requirements.

Below are common findings which continue to be reported on during audits:

 

Criteria

Gaps in meeting full compliance

Consumer Rights

– 1.1

·         Complaints management processes not completed as per                   requirements. Eg; not being logged on the complaints                         register, time-frames not being met, lack of evidence of                     resolution.

Organisational Management

– 1.2

·         Not completing internal audits

·         Not evidencing completion of regular meetings

·         Corrective action plans not being developed or completed

·         Lack evidence of investigation

·         Lack evidence of family notifications of adverse events

·         Lack evidence of reference checks at time of employing new             staff

·         Lack of 1st Aid certified staff member on each duty in each                 work area – this must consider the size, and layout of your                   building.

·         No signed employment agreement or job description

·         Lack evidence of timely completion of orientation

·         Annual appraisals not completed for all staff

Service Delivery

– 1.3

·         Lack of timely clinical assessment

·         Lack of assessment and care-planning related to behaviours               of concern (challenging behaviours)

·         Lack of evidence in progress notes of Registered Nurse input

·         Lack of evidence in progress notes of interventions from long             term care plan

·         Lack of evidence of family / residents input

·         Lack of evidence of outcomes from clinical assessments                     (including InterRai) being used to inform the care plan

·         Transcribing of medications in care plans

·         Doctor’s instructions in medical notes not followed /                             implemented

·         Wound assessment chart not updated as per wound care plan

·         Neurological observations not completed following falls                      where there was a possibility of the resident having sustained             a head injury

·         GP reviews not recorded at time-frames determined in ARRC

·         Lack of evidence of RN acting on caregivers reporting of                     adverse health symptoms in progress notes.

Safe and Appropriate Environment

– 1.4

·         Lack of evidence of medical calibration of equipment

·         Hoists not checked and verified as fit for use.

·         Surfaces unable to be cleaned adequately

·         Non labelled or decanted chemicals

·         Lack of evidence of hot water temperatures not exceeding 45            degrees

 

Restraint minimisation and safe practice – 2.0

·         No evidence of enabler monitoring

·         Lack of evidence of incomplete restraint register.

Infection prevention and control

– 3.0

·         Infection control nurse in care facilities who have not                           completed training in infection prevention and control and                  therefore cannot demonstrate relevant knowledge on which              to base practice and monitor staff performance.

·         Not all infections are noted on the infection register. Your                    policy and procedure should include the internationally                      recognised definitions for infections on which to base your                  monitoring.  For those of you using the HCSL policies and                   procedures, these definitions are noted within the Anti-                     microbial  Policy – document code IC1.

 

 

Ensure your internal audits review the above common errors to verify you are providing safe and appropriate services in all aspects of your service.

For more assistance with this contact us.

Bench-marking – Aged Residential Care

This New Zealand designed web based (on-line / in-the-cloud) Bench-marking and quality management system from Healthcare Compliance Solutions Ltd allows you to:

  • Bench-mark in real-time – specific to resident type, event type, date and time of day.
  • Have automated default reports to save you time analysing your data trends and patterns
  • Drill down into your data easily to identify opportunities for continuous improvement
  • Complete your internal audits online and have the corrective actions auto-populate into a corrective action log
  • Log and manage adverse events
  • Bench-marking of adverse events against other aged care providers
  • Support evidencing an active Health & Safety programme is in place
  • Log and manage infections
  • Bench-marking of infections against other aged care providers
  • Log and manage your complaints with time-frame, investigation and response prompts
  • Dashboard view options for level of care and any chosen 3 monthly time-frame review
  • Dashboard view option of adverse events or infections
  • Logs (event registers) appear with individual events in one colour when open and change to another colour when the event is closed. This allows you to see quickly the status of events. 
  • Use in conjunction with your current policies / procedures or update to the HCSL site specific created policies and procedures. 

Your organisation policies and procedures and related documents (if created by HCSL) are also accessible to the lower left of the screen for remote anytime, anywhere access.  The search option on the policies and procedures in addition to precise indexing and coding of documents makes it very quick and easy to locate information for staff to reference.

This is what Rhonda Sherriff, NZACA Clinical Advisor says about using the HCSL QA system:

“I am very happy to endorse your system as the information is invaluable for CNMs to analyse the data/information and make informed decisions on best practice and innovation to decrease hazards, improve outcomes, and mitigating factors for resident welfare. I’m pleased you are delving into the data to the level you are, as it’s time saving for sites in many respects, and so easy to dice and slice the information to get the trends. CNM’s used to spend hours just writing up the collective information before the analysis, so hugely time saving”

To view a brief video explanation of the system click here.

To find out more contact us here.

Health and Safety at Work 2015 implications for Aged care and Retirement Villages

I’ve been working through the new Health and Safety at Work 2015 legislation and have concerns about how this applies to not only care facilities and new reporting requirements, but also to Villages.  This legislation could cause all sorts of issues for you and in my view needs further clarification as to how it is to be applied to ARRC residential care setting and Villages that come under the RVA.

The Retirement Villages Association define a ‘Licence to Occupy’ as –

Licence to occupy – This is the most common form of occupation right in New Zealand. A licence to occupy gives you the right to live in your residential unit and to use to village facilities according to the terms of the licence to occupy. The ownership of the land and building remain with the village operator.”

The new Health and Safety at Work Act 2015 which applies from the 4th of April 2016 requires a PCBU (Person Conducting a Business or Undertaking) to report notifiable injuries or illnesses and all notifiable incidents. Looking closer at the terminology used in the legislation is states in relation to responsibility to notify

Health and Safety at Work Act 2015.
Sub Section part 2 – clause 37 Duty of PCBU who manages or controls workplace  (
this appears to apply to Village operators as well as ARRC providers)

(4) In this section, a PCBU who manages or controls a workplace—

(a) means a PCBU to the extent that the business or undertaking involves the management or control (in whole or in part) of the workplace; but
(b) does not include—
(i) the occupier of a residence, unless the residence is occupied for the purposes of, or as part of, the conduct of a business or undertaking.

The red text seems to be the rationale for notifications being required from care facilities but it would seem it also applies to village units, studios and apartments.  How are you going to know if your village residents have had an injury or illness which is classified as notifiable?

Part 1 Section 23 –  Meaning of notifiable injury or illness

(1) In this Act, unless the context otherwise requires, a notifiable injury or illness, in relation to a person, means—
(a) any of the following injuries or illnesses that require the person to have immediate treatment (other than first aid):

(i) the amputation of any part of his or her body:
(ii) a serious head injury: (
This could apply in the case of a fall where a resident has a knock to their head?)
(iii) a serious eye injury:
(iv) a serious burn:
(v) the separation of his or her skin from an underlying tissue (such as
degloving or scalping): (
Does this apply to skin tears of a particular size?)
(vi) a spinal injury:
(vii) the loss of a bodily function:  (
Fall resulting in fracture?)
(viii) serious lacerations:

(b) an injury or illness that requires, or would usually require, the person to be admitted to a hospital for immediate treatment:
(c) an injury or illness that requires, or would usually require, the person to have medical treatment within 48 hours of exposure to a substance:

Implementing this into this sector may be difficult due to the rights to privacy of those living in ‘independent’ ORA situations. The key definer in this section is clause a) any of the following injuries or illnesses that require the person to have immediate treatment (other than first aid).  If an ambulance is called to attend to a village resident this could be deemed ‘immediate treatment’.

Part 1 Section 24 – Meaning of notifiable incident –

(1) In this Act, unless the context otherwise requires, a notifiable incident means an unplanned or uncontrolled incident in relation to a workplace that exposes a
worker or any other person
to a serious risk to that person’s health or safety arising from an immediate or imminent exposure to—

(a) an escape, a spillage, or a leakage of a substance; or
(b) an implosion, explosion, or fire; or
(c) an escape of gas or steam; or
(d) an escape of a pressurised substance; or
(e) an electric shock; or
(f) the fall or release from a height of any plant, substance, or thing; or
(g) the collapse, overturning, failure, or malfunction of, or damage to, any
plant that is required to be authorised for use in accordance with regulations;
or
(h) the collapse or partial collapse of a structure; or
(i) the collapse or failure of an excavation or any shoring supporting an excavation;
or
(j) the inrush of water, mud, or gas in workings in an underground excavation or tunnel; or
(k) the interruption of the main system of ventilation in an underground excavation or tunnel; or
(l) a collision between 2 vessels, a vessel capsize, or the inrush of water into a vessel; or
(m) any other incident declared by regulations to be a notifiable incident for the purposes of this section.

Clearly the majority of these apply to manufacturing and industrial sites however some could potentially be applied to the care and village setting.

What do you see as your liabilities?  What is the responsibility for the operator in managing potential risk?  Which assessment tools and accompanying definitions are we best to apply if any?  If alcohol consumption by a resident or failing cognitive state is likely to contribute to their safety, where are the boundaries for responsibility between the resident and the operator? 

Share your comments ….