Testimonial – Dr Hillary Currie-Gray – Christchurch

Thanks so much for the help at Rosewood. You did a fantastic job.

 

I have four facilities using HCSL. I have been impressed with HCSL. I frequently access it from home and on my phone. Because remote access is via the internet it enables me to interchange between HCSL and the medication chart easily unlike other systems that require remote access in via Citrix which “takes over” the computer. Log in is secure but quick.

 

Residents are easily searched for and once a file is open it immediately directs me to produce a new progress note. Care planning functions are easy to review and there is a simple tool for medical classifications with common conditions in a drop down list with room for free text below. On the whole this is an easy tool to access and one of the less cluttered programmes I have used.

Dr Hillary Currie-Gray

Christchurch

HCSL Aged Care Software user feedback

We asked a random group of clients for their responses in relation to using HCSL Aged Care Cloud based software.

What do you like best about the HCSL software and your current use of it? Below is their responses:

  • I like the layout of the LTCP and being able to load and access documents in the one programme.
  • At the end of the month the stats are all there done without me having to calculate; the system does that itself, love it, I print off the bar graphs for the staff to see each months results with the related information written up to show the story behind the data
  • The advantage of having HCSL software in our facility means enabling quick access to residents records for more coordinated, efficient care and securely share information with residents and other clinicians. Holly Lea is in the process of having most of the documentations online. Moving to electronic significantly improved our archiving processes and the need for physical storage space for paper records is also significantly reduced. Being able to search for a file or document from the computer rather than manually dig through a filing cabinet saves time for all of us.
  • Know it is kiwi made and covers aged care in NZ requirements
  • Analysis of data and logs for complaints and incidents
  • Ease of access and user friendly
  • Log in pages are bright and cheerful.
  • Everything is in one spot and easy to access.
  • Audit system, ease of use, easy access to forms.
  • Its clear and easy to use.
  • The Long Term Care Plan (LTCP) is much more concise, great feedback from the care staff, easy to read and understand.
  • Able to compare to the average when reviewing falls or infection rates.
  • Ability to analyse present the information e.g falls.
  • I like the ease of use – the easy to generate reports – everything being in a logical order that ties in very well with the paper files
  • Used correctly the system does pass audit, meets all the requirements of the MOH Standards.
  • Receiving the continual updates we know we always have the most updated material available to meet our MOH requirements
  • This is a central point for data gathering. We have the potential to have most information on line.
  • The system is new to our team, it is still getting established here. We are finding it quite easy to use.
  • Its web based which means I can look at it anytime and am fully up-to date always with whats happening
  • The audits are detailed, and clear
  • The bench-marking is great and easy – saving time – great reporting
  • All of it, Everything on the website is easy to find and I like the bench-marking.
  • I don’t think we utilize enough of the paperwork some things I am discovering now after 5 years of using it!
  • I like the simplicity of the software.
  • I like that it is integrated with quality documentation.
  • I like that it is cloud based.
  • I like the flat fee for use, rather than a fee the number of devices (tablets).
  • The ease of uploading resident photo and easy layout
  • Ability to easily track trends in adverse events.
  • The straight forward user friendly interface, the data analysis, the way corrective actions populate straight to the corrective actions log,

HCSL Aged Care Software – Version 2  instruction videos

HCSL Aged Care Software incorporates quality and risk, bench-marking, internal audit management systems as well as clinical functions) and how to use them.  These systems have all been audited numerous times for ARC provider Certification with maximum four year outcomes being achieved where the system is fully implemented. Tried and testing; pre-approved audit compliant.

Please click on the following links (the blue words below) to watch videos which describe the functions of the HCSL Aged Care cloud-based aged care software.

Gives you a general over-view of the key Dashboard and Resident clinical management functions available as at December 2019.

Guides you in how to upload or change a resident photo within their online profile

Guides you in how to add, view or search resident progress notes.

The HCSL system functions are able to be used in their entirety or some care providers use only the policies and procedures with the dashboard for quality and risk management; while others use the full system including the care planning and progress notes.

We have several care provider sites currently who have become paperless using the HCSL system in conjunction with Time-target, Medimap or 1chart and InterRai. The mix of paper based and IT based depends on your site, the IT skills of your staff and their access to computers.  There are a range of service options available depending on what suits your current circumstances.  To find out more about the service level options available click here

We continue to add features to evolve the system in response to changes in clients and industry needs. This evolution is intended to be an ongoing process and we look forward to your feedback and ideas.  Each change is considered on the basis of how it can be used by clients to ease their workload, streamline and save time while giving useful information.

HCSL Aged Care software systems are created by Healthcare Compliance Solutions Ltd through Version 1 or for version 2Access codes are provided to clients with a current service agreement in place.

If you would like more information on the services which are available click here.

If you would like to receive our HCSL Aged Care newsletter which is published every 6-8 weeks, email us on gill@agedcarecompliance.com with your contact details.  This is also the email address if you have any further questions on HCSL software and services.

 

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.

Spiritual care and Pastoral Care

As we age, the need for spiritual care and pastoral care often come to the fore.  This is particularly so as people near the end of their life.  The need for comfort and peace of mind on a holistic basis.  Let’s firstly lets define the difference between these two concepts.

Pastoral care is an ancient model of emotional and spiritual support that can be found in all cultures and traditions. It has been described in our modern context as individual and corporate patience in which trained pastoral carers support people in their pain, loss and anxiety, and their triumphs, joys and victories. Spiritual care attends to a person’s spiritual or religious needs as he or she copes with illness, loss, grief or pain and can help him or her heal emotionally as well as physically, rebuild relationships and regain a sense of spiritual wellbeing.

For most of human history, in all major religions, an ultimate goal of spiritual practice was accomplishing a good death. When this goal was held in common by the whole society, spiritual care could focus on the interaction between a dying person and his or her caregivers.

A number of clergy have commented to me that spiritual care is not recognised by many aged care facility staff as important. They have frequently commented on services being interrupted by staff activity, or being asked to hold services or provide pastoral care in areas of the facility that are very close to the main entrance or actually in main thoroughfare areas. This is not respectful of the needs of the residents who choose to attend, or the need to peace and calm to receive spiritual care. In learning more about the importance of these concepts, it may support good holistic care for residents if you were to discuss with the clergy and pastoral care workers whether the circumstances being provided for them to support residents are appropriate.

To read more on this topic go here.

 

Critical thinking – the foundation of good nursing practice

There are lots of ‘trendy’ words in each work environment but one of the most important concepts which appears to be increasingly missing particularly in aged care nursing is that of critical thinking and reflective practice. Critical thinking is the core foundation of good nursing practice.

It is essential to evaluate what is occurring clinically for those in care and regularly reviewing what is being done for each individual resident along with what else needs to be done in order to provide the best care. The skills of critical thinking may not be instinctive for example for those nurses coming from a schooling system which promotes ‘rote’ learning and deters from challenging senior staff.  To question another may be seen in some settings as disrespectful however in the field of clinical care, to challenge and question is essential.  The attributes of those who critically think and reflect on nursing practice and care outcomes use evidence-based practice (EBP) guidelines including current EBP policies and procedures to form decisions.

Some of the skills of critical thinking are more important than others and certainly the ability to reflect while communicating with other members of the team is essential to safe and person centred care.  The nurse who has developed critical thinking skills is able to interpret, understand and explain the meaning of information. This can be event based or data based eg; reading lab result forms. Investigating possible interventions based on the information at hand and analysing which will achieve a desired outcome is also part of reflecting and critically evaluating a clinical scenario.  Assessing the value of information to determine it’s relevance, reliability and credibility in relation to a particular clinical presentation is also necessary.

There are potential barriers to optimising clinical outcomes by clinical staff when a pre-determined bias or fixed mind-set are applied to a set of data or resident clinical presentation. It’s only in the bringing together of information through evaluation, analysis, communicating, referencing EBP guidelines and a growth mind-set that care can be optimised.

Click here to read more on critical thinking.

 

 

Audit Tips for Clinical Documentation

Clinical documentation and clinical management relate to section 1.3.1 to 1.3.8 of the Health and Disability Services Standards and are referred to in section D5.4 of the ARRC.  There are key reference documents which provide reference at residential care facility level which should be used in conjunction and addition to your organisation policies and procedures.  These reference documents include:

 

  • Age Related Residential Care (ARRC) contract
  • NZS 8134:2008 Health and Disability Services Standards
  • Clinical best practice (EBP) guidelines – eg; Lippincott
  • The Code of Health & Disability Consumers Services Rights 1996

 

Clinical documentation errors of any type noted during audits will result in partial attainments at best.  This is an indication there could be risk associated with gaps in service. In a previous article about medication management we noted that even a single signature missing off an administration signing sheet was enough for the auditor to assign a partial attainment finding.

 

Below are some of the common compliance gaps which relate to clinical documentation:

   
General compliance

gaps

Missed signatures off notations.

Not dated.

Not signed by the author with a full signature.

No designation written with signature.

Not legible.

Inconsistent structure of resident files.

Unclear or unsecured archiving of documents.

Privacy breaches due to clinical documents placed in a situation that allowed unauthorized viewing.

Initial assessments

including InterRai

Not completed within time-frames defined in ARRC.

Baseline recordings at time of admission not recorded.

Assessment outcomes not used as a basis of care planning to link assessment to goals and interventions.

Additional detailed assessments not reviewed in a timely manner eg; six monthly to coincide with InterRai reassessments.

Failure to re-assess for each period of admission eg; respite care.

Clinical risk

Assessment not describing risk.

Risk not reflected in care plan interventions.

Lack of risk reviews.

Level of risk noted in interRai assessments not included in care planning

Progress notes

Not recorded in on a shift by shift basis.

Lack evidence of regular registered nurse input.

Writing beyond the bottom line of the page.

Failure to put resident identifiers on each side of each page (this applies to other clinical documents as well).

Lack evidence of interventions being implemented.

Lack evidence of RN response to clinical symptoms reported by care staff.

Lack of evidence of rationale for PRN medication administration or the resulting effect.

Short Term

Care Plans

Not developed for changes in clinical status eg; increased pain; infection; wounds, change in medication (to allow evaluation of effectiveness).

24 hours plans not developed for residents displaying behaviours of concern (challenging behaviours).

Not evaluated regularly (I suggested at least once every 7 days) by a Registered Nurse.

Not recorded as resolved or transferred to Long Term Care Plan.

Not developed to implement instructions included in General Pracitioner consultation plans recorded in notes.

Long Term

Care Plan (LTCP)

Not reflective of all presenting potential and actual medical / clinical problems.

Not documented within 3 weeks of the date of admission (ARRC requirement).

Not changed at the time of health status / functional change.

Interventions not reflective of each medical diagnosis.

Interventions not changed within LTCP to reflect changes recorded in care plan evaluations.

Frequency of clinical assessment for each actual clinical presentation eg; pain.

Do not clearly indicate the level of function, assistance required for each component of care / support.

Do not clearly evidence input and instruction from Medical or Nurse practitioner / Physiotherapist, Diversional Therapist, Dietitian,Psychiatric services             for the elderly etc.

Care Plan

Evaluations

Review of care plans not reflecting changes in residents health status as they occur.

Not reflective of how well the care plan goals/ objectives have been met since the previous evaluation.

Not completed within ARRC defined time-frames (at least six monthly).

Multi-Disciplinary

Input

Lack evidence of MDT input into care plan reviews and/or evaluations.

Lack evidence of resident, Next of Kin (NOK) / Family / Whanau / EPOA input into assessment and care planning.

Lack of evidence of timely referral in response to clinical presentation eg; unintentional weight loss not referred to Dietitian.

Failure to evidence implementing instructions ofMedical or Nurse Practitioner eg; B/P to be recorded daily for the next 7/7 may be noted in the medical           consultation notes however not evidenced as having been done.

Lack evidence of notification to NOK / EPOA relating to resident adverse events, change in health status, medical consults etc.

Policy and

procedures

Not consistent with service delivery as noted in clinical documentation.

 

Internal audits are available through the online HCSL quality system utilised by our clients which allows tracking of compliance status and corrective actions as part of on-site quality and risk management. This means when the auditors arrive, there will be no surprises and you’ll know you’ve achieved excellence in care in conjunction with providing a compliant service.

If you have any comments to make about this article, please contact us here.

 

Moving  and Handling People – Good Practice Guidelines – December 2017

The Draft Moving and Handling guidelines are currently being finalised with the view to be implemented from December 2017.  Developed by Worksafe, they cover Health and Safety at Work Act 2015 (HSWA) duties and risk management for PCBUs in the health care industry and supersede the 2012 guidelines.  There are a range of factors noted in these which need to be taken into consideration for those building new facilities or doing refurbishment of existing facilities. There is also a raft of information on Bariatric Care which is an increasing part of the services being provided in residential care.

The draft guidelines include the following:

Please note that there is not a complete consensus on the criteria for classifying a person as bariatric based on weight or Body Mass Index (BMI). However some examples include those people:

– with a body weight greater than 140 kilograms.

– with a BMI greater than 40 (severely obese), or a BMI greater than 35 (obese) with co‑morbidities.

– with restricted mobility, or is immobile, owing to their size in terms of height and girth.

– whose weight exceeds, or appears to exceed, the identified safe working loads (SWLs).

Health risks for bariatric clients

People who have been bariatric for a considerable time face chronic and serious health conditions, many of which should be considered before moving or handling them. Health conditions to take into account include:

– skin excoriation

– rashes or ulcers in the deep tissue folds of the perineum, breast, legs and abdominal areas

– fungal infection

– bodily congestion, including causing the leaking of fluid from pores throughout the body, a state called diaphoresis, which makes the skin even more vulnerable to infections and tearing

– diabetes

– respiratory problems

– added stress to the joints, which may result in osteoarthritis.

Planning for bariatric clients:

The planning process for bariatric clients in order to reduce moving and handling risks should include:

– admission planning

– client assessment

– communication

– room preparation

– mobilisation plan

– equipment needs

– space and facility design considerations

– planning for discharge.

Facility and equipment needs for bariatric clients

Health care and other facilities providing care for bariatric clients need to provide adequate spaces for these clients. Some considerations could include:

– ramps and handrails at entrances

– bariatric wheelchairs

– that the facility’s main entrance has sufficient clearance

– adequate door clearance and weight capacity in lifts

It must be remembered that the above comes from a draft but as drafts often end up being very close to the finished document, I felt it timely to share this information. To read more on Health and Safety in the Workplace go here

Clinical online tools for Aged Residential Care

HCSL are pleased to announce that from January 2018, you will be able to access clinical online tools for:

  • Initial assessment and initial care plan.
  • Short term care plans (and evaluations)
  • Long term care planning (and evaluations)
  • Progress notes
  • Restraint/ Enabler restraint management (and evaluations)

All mobile device compatible so you can be with your residents rather than stuck in the office!

HCSL bringing cost effective, specifically designed tools for the New Zealand residential care sector.  The Corporates have their tools, why shouldn’t you have the same advantage?!

 

To find out more and get a no obligation free quote for use contact us here.

 

Testimonial from Tainui Village – New Plymouth

Upon reading one policy everything fell neatly into place. I found her documentation to be outstanding.  It is very reassuring to know that every policy and procedure is the most up to date and designed to meet audit requirements.  All her forms are easily accessible and very user friendly.   We can instantly benchmark against others.  At the click of a button we can analyse falls, infections and adverse events.   Creating graphs and other information for Board reports takes minutes rather than hours.

Having come from a background of many years in QA, HSE and Electronic Document Management in the Oil and Gas Industry, when I entered the aged care sector, it was a huge “eye opener”.  After sitting through several handovers and meetings and listening to discussions on medications etc I felt as if I was listening to a foreign language.  Oh my goodness I thought and then Gillian’s documentation arrived together with a visit from her shortly after.

Gillian’s enthusiasm and commitment for both the aged care sector and her documentation is contagious.  I feel I can now discuss, with the knowledge I have acquired in a few short months, aspects of aged care I never knew existed.  Gillian is only a phone call or email away and all queries are always answered promptly, no matter how minor.

 

Thank you very much Gillian.

Lois Lash – Quality Assurance

Tainui Village –  October 2017