|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:
Empathy and perspective are two concepts well known Leadership author Simon Sinek speaks about in relation to leaders. He talks about the real job of a leader as not being in-charge but taking care of those in our charge. How many leaders play the blame and shame game when things don’t go as planned? Instead how would it be if leaders in aged care services worked in accordance with a Leader’s Oath. My version is noted below as an example.
You may want to create your own for your organisation, or adopt this.
The Leader’s Oath
I focus on the betterment of this organisation above my own career needs
I focus on accountability above the need to be popular
I focus on caring for those in my charge over being in charge
I focus on clarity above certainty
I share clear expectations
I hold myself accountable for all employees poor performance including my own
I welcome respectful challenges
I will table the tough issues
I treat all interactions as though my career depends on a successful outcome
I am committed to personal and professional development
I am focused on excellence.
While the above Leadership Oath forms a focus for clinical leadership, it’s necessary to make sure your nurses are familiar with the ARRC funding agreement responsibilities for Registered Nurses. These are also clearly defined in the HCSL policies and procedures to ensure they’re integrated into practice. The ARRC includes time-frames for nursing documentation responsibilities, while the nursing council guidelines for delegation define staff delegation of staff working under the supervision of Registered Nurses are appropriate led and supported. When we refer to tabling the touch issues, one key aspect of leadership is holding staff accountable. Nurses are often not keen to hold others responsible for their conduct and performance and therefore avoid performance managing staff when performance is below the expected standard. This in turn means the service provided will be below the expected standard. If you want to provide the best care and support to those in your care, these are skills you must learn and put into daily practice. To learn more about these skills and others needed for leading a team of care and support staff, go here.
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:
Missed signatures off notations.
Not signed by the author with a full signature.
No designation written with signature.
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.
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.
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
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.
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.
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.
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).
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.
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.
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
– 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
– 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.
Mobile app now available for conducting your residential care ARRC specific internal audits.
There are a full range of internal audits pre-loaded ready for use. Collectively, these audits reflect the criteria Certification auditors will be checking.
This process gives you the opportunity to be sure you’re on track with achieving compliance. The findings auto-populate into corrective action tables which prompt timely addressing of these corrective actions. This system syncs with your main computer system and makes reporting to management and Governance boards very easy.
The Certification auditors (after given specific access authority with your permission) are also able to access the results of the internal audits you’ve completed.
To view a brief video on the use of this system, click here.
In residential care, HealthCert (MoH) Certification processes appear solely to promote a goal of verifying compliance with requirements. Looking deeper however, the goal of meeting requirements ensures the protection and support of those in your care. This can then be evidenced in a way that’s reflective of service received as meaningful, safe and appropriate by individual residents.
It’s no longer an expectation that you’ll have a number of partial attainments as a result of an external audit. The expectation is full compliance and showing evidence of continuous improvement, going over and above the base ‘pass-mark’ brings you into line with your high performing peers. I’ve heard managers say “but it’s the Auditors job to find things wrong so we expect to get partial attainments.” That is out-dated thinking and doesn’t fit the current audit and compliance environment or continuous improvement philosophy.
Systems can’t be implemented to show compliance, if staff are not looking at policies and procedures, or using them to guide services and care of residents. If individual staff or managers do what they think best, based on previous experience, without verifying whether that practice is still appropriate or best practice, they do themselves and residents a disservice.
Success leaves clues. It’s apparent when quality systems are implemented, outcomes are checked in a measurable way, recorded, examined, analysed and greater gains identified for future implementation. This is a cycle and if you have the right tools to record your continuous improvement projects on, you too will be in the elite who are out-performing those who continue to have multiple partial attainments (deficits) in audit. Don’t be a provider that looks at others saying it’s ok for them; they have this or that or the other reason for their success but we don’t have those things so we can’t achieve. Don’t make others extraordinary to let yourself off the hook. You can have, and deserve to have, all the recognition for the amazing work you perform just like others who are achieving four years.
The lack of a robust up to date quality system, along with deficits in implementation, will lead you down an expensive compliance track. Expensive in loss of reputation as audits are published and accessed online by the public, expensive in loss of time trying to figure things out yourself, increased risk to residents, loss of financial resources as you end up being audited more often than would have otherwise been necessary. The better you achieve at audit, the longer your period of certification, the less often you are audited and therefore less often you’re paying auditors fees!
A common failing in the care facilities under Temporary Management has been from the lack of a proven quality system and application of that system into service provision. I’ve been contracted into a number of sites as a Temporary Manager over the years and this has consistently been the case.
If you would like a free Continuous Improvement Project template to help you identify and record your success, contact us and we’ll email it to you.
Go here to read testimonials from a few of our clients.
Our eyes see what is familiar and what they expect to see. Are we good at picking up subtle changes through your assessment processes and acting on them appropriately? The ability to see the less than obvious is essential when responsible for clinical assessment as you won’t act on those things you haven’t noticed.
On the 5th July I presented a full day seminar on a range of topics to Nurses working in aged care. During the day I made what should have been an obvious change but I have no doubt it wasn’t noticed by all. In the morning I wore a dress with a white jacket. In the afternoon I’d changed the dress for one of a different colour and pattern but retained the white jacket. I made the change during the lunch break.
When I entered the room after the lunch break three people commented straight away. I saw a small number of puzzled looks but those nurses didn’t say anything. Others didn’t seem to notice and didn’t make comment. We had three distinct groups. Those that notice and comment, those that notice but don’t comment and those that don’t notice and therefore don’t comment! Which are the nurses you’d feel safest with if it came to performing a clinical assessment on you on an ongoing basis day after day? Which differences would they notice and which wouldn’t get a second glance. Which changes would be commented on?
We need a mix of ‘detail’ thinkers and ‘big picture’ thinkers to see everything that occurs. Equally these two groups of people can complement each other. Working separately they will each only see part of what needs managing. Some over think and others don’t seem to think or reflect. Awareness of how the members of your nursing team work and think could be important in supporting you to minimise risk resulting from subtle changes occurring which may not have been addressed.
It may be beneficial to review personality types to see how your team are working separately or collectively to ensure the best outcome for residents in their care. This increased recognition of each others natural thinking styles may also enhance the ability of the team to understand each other and consciously support others differences. There are a raft of profiling tests however Myers Briggs has been around as a validated tool for a long time and may be a useful one for you and your team.
What subtle changes are occurring with your residents that you haven’t noticed? Did you see the white dress in the morning change to a black one in the afternoon? If not, what else are you not seeing that could expose someone to risk? Are any of your team seeing things but not saying anything because they don’t recognise it’s their responsibility or think someone else has commented?
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.
The below question and answer were published in the New Zealand Aged Care Association industry ‘In-Touch’ newsletter (19th February 2016).
Question: A member asks “if we purchase a comprehensive quality management system from a provider how assured are we that the system will meet full compliance, come certification and surveillance audit time, as requirements and compliance expectations change frequently?
NZACA Clinical Advisor Answer: “You should be purchasing a complete quality management system that will comply with the Health and Disability Standards specifications, health and safety requirements and meet DHB/ARRC contractual requirements.
The provider of the system would normally initially tailor the full quality management package to reflect accurately the site specifications, H.R. component, and best practice guidelines, after consultation with the owner and management on site. These documents need to be site specific. The provider will normally contract to the site, which sets out obligations between the provider and the site management.
The contract will include the full review and updates of policies and procedures on a bi-annual basis, unless specified more frequently, to keep documents accurate and reflective of best practice. There may be an educational element provided within the contract as well, to benefit staff knowledge and skills. There is normally a good document control system in place and cross referencing of information where required.
Quality management systems are reliant on the skills and knowledge of the site personnel working with them, the way the system is managed and the outcomes/reviews, content and information extricated from the use of the system to improve quality care provision/outputs. The documentation system is reflective of the people using them, and the depth to which documentation and information is created, analysed and utilised for improvements.
Auditors on site rely on the provision of robust up-to-date policies and site adherence to them. Partial attainments can sometimes result from staff deviating from, or not following, their sites actual policies or processes as outlined in their quality management system.”
Where can you get such a system?
Here at Healthcare Compliance Solutions Ltd we provide the services described above and noted as being optimal for achieving excellence in care and audit outcomes.
Request a no obligation consultation here.