Is the company email the employers property?

In simple terms, a work or company email is an employer’s property in the same way a direct dial phone number, phone (mobile and/or land line) and any other piece of equipment or resource is.  Therefore, as a matter of principle, the employer is entitled to have access to that email address as necessary in order to conduct its business activities.  Correspondingly, employees are obliged to co-operate with any request for access.

Where issues can arise is when an employee is allowed to use their work email for personal emails.  This can either be set out in policy or implicit.  In this case, care needs to be taken to ensure that personal emails are not read.  The access should be limited to ensuring the employer can access business related emails.

If an employee is objecting to providing access to their work email, you can address this by confirming that as a matter or principle the work email address is the employer’s property and you require access to all work emails.  Reinforce with the employee, you will not be reviewing personal emails and they can either forward those emails to their personal email address, delete them etc (as noted below).  However, you will require their password and access as needed.

If an employee continues to resist, inform them you will be making arrangements with your IT service provider to gain access to the work email and given their lack of co-operation, suspending their personal use until further notice.  If this step is required, it’s advisable to contact your employment law adviser first in order to ensure clear and succinct written communications are provided in respect of this step.

To avoid issues in the future, if there is no policy in place, or if there is a policy in place which does not address it, in the first instance all employees should be told that:

(a)       Any work assigned email address is for work purposes;

(b)       That where necessary you will require employees to provide access in order for you to ensure that email communications are dealt with as needed and to provide for business continuity;

(c)       Personal emails received at the work email address can be forwarded to a personal email address, deleted, flagged or moved into a separate folder so they remain private; and

(d)       A policy will be introduced to clarify email and internet access shortly, or recirculate the current policy (updated if/as needed).

Noting point (d), if there is no policy in place, it would also be timely to introduce an email and internet policy specifying how the internet and email facilities can and will be used.  Alternatively, if there is a policy, but it does not cover this situation, the policy should be updated.

Above article kindly contributed by: Dean Kilpatrick (Special Counsel – Employment), Anthony Harper Law,  For more information contact –  Email

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Using physiotherapy assistants in residential care

Employing a physiotherapy assistant (PTA) is a fantastic and cost effective way to implement physiotherapy programmes. Many residential care facilities contract in physiotherapy services at an hourly rate, often for only a few hours per week. Supporting this service by having an employee who can accompany the physio on their visit, and then put the exercise programmes in place supports real outcomes for residents.  When I quote for services to residential care facilities I always put a persuasive argument in place for them to appoint a PTA at the same time.

Of concern is that we sometimes visit facilities who have a physiotherapy assistant employed but no contracted physiotherapy hours. Why is this a problem and what are the consequences? The problem lies with the fact that “Physiotherapist” is a legally protected title and to practice in New Zealand you must be registered and hold a practising certificate. If there is any perception that the person is a physiotherapist or is carrying out ‘physiotherapy’ then this is illegal and the fine can be up to $10 000. The key word here is perception. Below are some examples that I have come across where I believe the work was illegal.

– A GP requested a physio assessment of a resident with a sore shoulder. This assessment was carried out by an overseas qualified   physio working as a PTA in a facility;

– A PTA doing exercises with a resident and the family said “she is having her physiotherapy session so we will wait”;

– Staff referring to their physiotherapy assistant as the “physiotherapist” in conversations.

Physiotherapy New Zealand has written guidelines for using a physiotherapy assistant (this covers the term rehab assistant also). The guidelines state that a client must have:

– An assessment by a NZ registered Physiotherapist and a treatment plan;

– Ongoing monitoring of the physiotherapy status and needs of the client.

The physiotherapy assistant must have strict boundaries which include being deemed competent by a supervising physiotherapist, not advancing or changing the treatment plan without written and verbal instruction from the physiotherapist, not offering any advice or opinion (other than reiterating the physiotherapist’s advice). They must have a clear written job description and adequate support. The work they carry out is the responsibility of the supervising physiotherapist which means only the physiotherapist can prescribe treatments which they have observed the physiotherapy assistant. Competency must be confirmed in respect of each individual treatment plan. This even includes simple exercises such as a walking programme.

We also recommend to our facilities that they consider getting a uniform that clearly designates the person as a ‘physiotherapy assistant’ and a name badge with this written. This helps greatly with the problem of other peoples ‘perception’ as already mentioned. We also recommend and provide separate documentation forms for PTAs.

Being a physiotherapy assistant is usually a very rewarding job but can be isolating for staff as they are usually the only one in their facility and often also have hours as a carer. It is good practice to support them with ongoing training and regular supervision with a physiotherapist that is not just focussed on their clinical role.

On the Go Physio offer regular training for physiotherapy assistants including a full day conference later in 2017. To find out more about the pending conference go here and request details.

This article kindly contributed by Jessie Snowdon – Physiotherapist,  founder and director of On the Go Physio. She graduated from Otago University in 1998 and has worked in Christchurch, Edinburgh and London in a variety of roles

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Influenza season

Prepared for winter coughs and colds?

Winter is fast approaching and now is the time to be preparing your facility for the season’s usual crop of influenza, coughs and colds.

Last year the elderly were hit hard with, not just influenza, but also other respiratory viral infections. Many were admitted to hospital with complications such as pneumonia.

The predominant circulating influenza strain in 2016 was Influenza A, H3N2, different from the previous year’s Influenza A, H1N1. Although covered by the vaccine, last year’s predominant strain changed slightly from what was covered in the vaccine and there were numerous reports of laboratory confirmed cases of young vaccinated adults who still acquired influenza. Despite this, vaccination still affords some protection and symptoms are less severe than without it. This is the same for the elderly whose uptake of the influenza vaccine is not so good – experts agree that there are still benefits from the elderly having an annual influenza vaccine.

Some of the other respiratory viruses last year that caused severe disease in our elderly included coronavirus, rhinovirus and parainfluenza.

Check list for winter virus planning

  • Encourage and offer seasonal influenza vaccination to both staff and residents
  • Ensure hand sanitiser is available for visitors at the entrance of the home
  • Consider displaying a poster discouraging visitors with symptoms – a poster is available from CDHB communications
  • Remind staff and residents about good cough etiquette / respiratory hygiene
  • Have a good stock of tissues and hand sanitiser for residents
  • Remind staff to stay off work if sick – no-one wants their germs!
  • Educate staff about S&S of influenza – not all residents will display fever or cough
  • Keep residents in their rooms if symptomatic and introduce droplet precautions, i.e. droplet masks for staff providing cares
  • If you suspect an outbreak then confirm the outbreak[1] and introduce control measures[2]

Ensure all infections are logged into you infection register (for HCSL QA online uses – this is part of your infection log process) – remember your outbreak notification requirements as per your policies and procedures.  If you would like more assistance with this please contact us.

This article kindly contributed by: Ruth Barratt RN, BSc, MAdvPrac (Hons) – Independent Infection Prevention & Control Advisor (Canterbury)

Infectprevent@gmail.com

[1]  Infection Prevention & Control Guidelines for the management of a respiratory outbreak in ARC / LTCF

[2] A Practical Guide to assist in the Prevention and Management of Influenza Outbreaks in Residential Care Facilities in Australia

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Infection Prevention and Control – 2017 review

Antimicrobial stewardship for aged residential care  

The below article was contributed by Ruth Barrett – RN, BSc, MAdvPrac (Hons); Independent Infection Prevention & Control Advisor

What is your New Year resolution for 2017 in the world of infection prevention and control (IPC)? If you haven’t thought of it I would suggest looking at antimicrobial stewardship in your facility.

I was fortunate to attend a recent international IPC conference in Melbourne (ACIPC Conference 2016) and was pleased that aged residential care was a popular theme for both oral presentations and posters. One of the topical subjects was feedback from the first survey of antimicrobial use in residential care facilities in Australia. The results of this research are freely available and make interesting reading[1][2]. A good deal of the findings could equally apply to ARC in New Zealand.

Antimicrobial resistance and antimicrobial stewardship are two topics that go hand in hand.

As rates of antibiotic resistant bacteria continue to rise in New Zealand, then the responsibility for and management of the use of antibiotics becomes more important. Aged residential care (ARC) facilities are an important reservoir for MDRO transmission within the community. In the ARC setting, there are frequent transfers between the acute hospital setting and back to the rest home. This along with an over-use of antibiotics in the community can lead to a higher prevalence of multi-drug resistant organisms (MDRO) in ARC.

Even if a resident does not usually receive antibiotics, the resident is still at risk of picking up an MDRO if a lot of antibiotics are used. Managers, nurses and carers who work in a residential care facility all have apart to play in reducing the amount of antibiotics used and minimising the increase and spread of MDRO.

Some of the ways you can do this include-

  • Ensuring hand hygiene compliance is high for all staff and providing hand sanitiser close at hand for carers.
  • Using other specific contact precautions to control the spread of MDRO in your facility according to local policy.
  • Not using topical antimicrobial creams unless prescribed e.g. don’t routinely use Mupiricin (Bactroban) on wounds.
  • Only sending wound swabs, urines etc if there are obvious signs and symptoms of infection.
  • Recognising influenza or other respiratory outbreaks earlier to avoid secondary chest infections in the elderly, which would require antibiotics. Remember that in the winter season, many respiratory infections are caused by viruses and do not need antibiotic treatment.
  • Ensuring the residents finish their course of antibiotics.
  • Monitoring infections using a surveillance programme.
  • Monitoring the incidence of MDRO in the facility.
  • Accessing specialist IPC advice if infection or MDRO rates are of a concern.

So why don’t you make antimicorbial stwardship your IPC focus for 2017?

Contributed by:

Ruth Barratt RN, BSc, MAdvPrac (Hons)

Independent Infection Prevention & Control Advisor

Infectprevent@gmail.com

[1] Antibiotic use in residential aged care facilities, Australian Family Physician, Volume 44, No.4, April 2015

[2] Antimicrobial Stewardship in Residential Aged Care Facilities. Result of survey.

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Moving and Handling in residential age care

Moving and Handling and the Health and Safety Act

Thanks to Jessie Snowdon, Physiotherapist for contributing the below article – 

All managers will be acutely aware of the Health and Safety at Work Act 2015 (HSWA) and the responsibilities of, and potential penalties, for PCBUs (persons conducting a business or undertaking).

The HSWA requires businesses to ensure, as far as reasonably practicable, the health and safety of its workers. This includes safe systems of work, equipment, training and monitoring the health of workers. These processes are all included in the policies and procedures designed specifically for residential aged care facilities by HCSL.

Within the residential care industry staff are exposed to significant hazards daily in terms of patient handling and manual handling for kitchen/laundry staff.  Moving and handling is a hazardous task – it is repetitive, can involve high force (heavy residents) and frequently involves awkward postures. The likelihood of injury for both care staff and residents is high and the consequences can be serious, meaning that moving and handling is a high risk activity.

When we consider moving and handling in this light, managers need to be confident that they have safe systems. Consider how each resident’s transfer abilities are assessed. How is this documented and communicated? How do you know you have the correct equipment on site and how do you ensure that you have enough equipment in order for staff to be able to access it when they need it?

Our experience shows that often if the equipment is not available many staff will do an unsafe transfer in order to save time.  How do you ensure new staff are competent prior to undertaking moving and handling tasks? How do you ensure that existing staff are up-skilled? How do you implement the New Zealand guidelines? And how do you monitor your systems, equipment and training? These are questions all managers should be able to answer.

‘On the Go Physio’ carries out Moving and Handling training in over 15 facilities in Canterbury and offer training to representatives from many others. We offer tailored packages which can include up-skilling your whole team, or training your own moving and handling trainers and assessors. We can review your training and orientation systems and assist in equipment trials. If you are interested in discussing your facilities requirements to help you ensure your staff, and resident’s, health and safety contact us here.

For residential care specific policies and procedures related to safe moving and handling, along with related forms for use, contact HCSL here.

Contributed by: Jessie Snowdon (Senior Physiotherapist and Director)

‘On the Go Physio Ltd’

PO Box 32 004, Christchurch 8147

Ph: 0800 000 856 or Mobile: 021 030 9061

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Food Safety in residential aged care

Cooling and Reheating Meals

Thanks to Liz Beaglehole – Registered Dietitian for contributing the below article –

With the introduction of the Food Act 2014 and the requirement for most aged care facilities to have registered their food control plan (FCP) by March 2018, I thought I would write this article on a common kitchen practice that will require review. This relates to one important key component of food safety.

FCP’s are included in the policy and procedure documentation provided by HCSL specifically designed for residential care facilities.

In many facilities the main meal is served in the middle of the day and the tea meal served at night.  The main cook of the day will prepare the tea meal earlier in the afternoon, and then finish his or her shift.  The tea meal will be reheated by the afternoon staff and served to the residents.

The process of cooking, cooling and reheating requires careful control of the food safety risk.  Many tea options are protein or carbohydrate based; macaroni cheese, egg dishes, savoury mince, chicken options – all of which are high risk foods for bacteria growth.

Foods need to be cooled quickly to avoid time and temperature abuse, which may allow bacteria growth.  The guidelines state that when cooling hot cooked foods, the food must cool to at least 21° within the first two hours, and then cool to below 5° in four more hours.  Overall, the food must be out of the danger zone (between 5°C and 60°C) within six hours.

A functioning chiller should allow cooked foods to cool within this timeframe.  Using domestic fridges that are overcrowded, may mean the cooling guidelines are not met.  Using shallow dishes rather than large deep dishes will also allow foods to cool faster.

The food control plan will specify the process the site kitchen must follow with regards to cooling of cooked food.  Temperatures during cooling will need to be checked and recorded to ensure the time / temperature targets are met.

Prior to serving, the food must be reheated to above 75°C.

Some sites choose to hold the prepared food hot until service.  Food must be held hot at a temperature of at least 60°C, usually in a bain-marie or oven at 70°C.  Any food held below 60°C for more than 2 hours, must be thrown out.  Note that holding foods hot for this period of time may affect the food quality.

Main Points:

  • Food safety risk with cooling and reheating foods must be managed with FCP
  • Cool cooked food to below 21°C in 2 hours and below 5°C in 4 hours
  • Reheat foods to above 75°C before service
  • Hold hot prepared foods at 60°C or more
  • Document food temperatures and any corrective action
  • Review corrective action implementation to ensure they have been effective

Article contributed by:

Liz Beaglehole

NZ Registered Dietitian

Canterbury Dietitians

Email: liz@canterburydietitians.co.nz

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Unintentional weight loss

A very common adverse clinical outcome for residents is unintentional weight loss. It can contribute to a decline in general health, energy, about to heal in relation to skin / wound care and increase the risk of accidents.

Ensuring adequate nutritional intake relevant to the health status for each resident is ultimately the responsibility of Registered Nurses. There has been the perception in some instances that it’s normal to lose weight as people age. While there is an increased tendency to lose weight, it should not be considered normal.

If unintentional weight loss is detected, ensure thorough multi-disciplinary clinical assessment and development of specific short term care plan to define strategies to meet the specified care plan goal. Offering more frequent high energy (high calorie) and high protein snacks and drinks between main meals and instigating the recording of all food and fluid intake should be part of this plan (unless contraindicated). The dietitian can best help guide you through the best nutritional support for each individual resident and their circumstances at the time.

Unintentional weight loss or the undesirable decline in total body weight over a specified period of time is common however should not be ignored as ‘part of ageing’.  Sarcopenia (muscle loss in the elderly) is also common however not inevitable and should be addressed through a targeted exercise and balance programme. Light body weight in the elderly have been shown to have a detrimental effect on the resident ability to function and on their general quality of life.

Unintentional weight loss of 3 -5 percent (or greater) in 30 days (or 10 percent in 180 days) must be monitored more closely and a short term care plan must be developed to promote weight loss cessation and implementation of weight management practices. RN’s must ensure they review regular weight monitoring records to identify progressive changes and respond to adverse patterns.

Residents that have been determined to be in later stages of palliative care or receiving terminal cares should be excluded from the need for close monitoring and related care planning related to trying to reverse unintentional weight loss.  This is at the discretion of the Registered Nurse in consultation with the Doctor and next-of-kin / advocate / whanau.  Discussions will also be had with the resident and the Medical Practitioner regarding the extent or type of tests, investigations and interventions that are desirable.  These must be clearly documented in the Care plan evaluation and interventions recorded in the long term care plan and Doctors consultation notes.

Ensure the specific instructions (interventions) are recorded in the care plan for staff to implement on a consistent basis.  Ensure these are reviewed at each weight monitoring event (time-frame specified in care plan) and adjust interventions according to weight monitoring outcomes.

If after two weeks of weekly monitoring the weight has not stabilized or started to increase, consult a Dietitian to review the resident and provide recommendations.  Ensure any recommendations are followed as directed.

Treat any underlying cause and continue monitoring of weight until it has reached optimum levels in accordance with care plan goals.  Return to monthly monitoring of weight at this stage.  Those on special diets must be monitored more closely than those residents that are independent with eating and drinking or those that have no identified difficulties which may lead to increased potential for unintentional weight loss.

Case Study:

An 84 year old female resident (Mrs A) with a diagnosis of chronic heart failure and early dementia was noted to be experiencing progressive weight loss. Staff indicated she was able to physically feed herself but often refused to eat, pushing the meal tray away from her.  She was able to express her needs to the extent of saying she didn’t want her meal. Staff recorded this in the progress notes however no investigation was done to identify the cause of her refusal to eat. Her weight had reduced at that point to 38kg having had an admission weight of 48kg only six months previously. Staff noted Mrs A was often sleepy during the day and expressed their belief her dementia was advancing. A new Clinical Nurse Lead (CNL) sat down and talked with Mrs A to discover that her mouth wasn’t sore and her dentures were well fitting. There appeared to be no difficulty with her ability to eat or swallow.  The CNL consulted with the dietitian to support the assessment process. It was decided that a staff member would sit with Mrs A and gently talk with her as the staff member offered small spoonfuls of food.  Mrs A obliged with eating with no resistance or protest and seemed to enjoy her meal. Progressively day after day her intake increased and she seemed to be sleeping less. She had more energy and within a period of one week had shown an 800 gram weight gain.  Staff continued with supporting Mrs A with assisting her with her meal and within 6 weeks her weight had increased from 38kg to 41kg.  At that time she was no longer sleeping most of the day and had resumed feeding herself. Short term care plans were instigated at the start of this process and more detailed long term care planning and regular assessment was also documented. Family input had been sought to gain a greater understanding of Mrs A’s previous eating patterns and she was able to talk about the foods she enjoyed having with her family.  Asking questions about a context such as family meals assisted the staff in gaining more information than if they’d simply asked Mrs A what her favourite foods were.  Giving a direct answer to a specific question wasn’t easy for Mrs A however she was able to talk about family meal times which proved a valuable source of information for nursing staff in supporting her. At the end of an 8 week period Mrs A had more energy, was interacting more with others, was sleeping less during the day,appeared happier and was enjoying her meals. She was no longer refusing to eat.  It stands to reason that when a person is lacking nutrients, they may actually lose the energy needed to feed themselves.  Getting the basics right is a good place to start.

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Residential care education workshops

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We provide a number of aged residential care education workshops throughout the year. Topics include:

  • Code of Rights (includes Advocacy, Informed consent, Privacy, Advance Directives, Open Disclosure, Complaint management)
  • Conflict Resolution
  • Cultural and Spiritual Safety
  • Restraint (including Enablers) safe practice and minimization
  • Challenging behavior management (including de-escalation strategies)
  • Clinical documentation and managing clinical risk
  • Quality and Risk management
  • Infection prevention and control surveillance
  • Death and dying – loss and grief
  • Leadership skills for managers and nurses
  • Intimacy and sexuality in the elderly
  • Skills for orientation ‘buddies’
  • Stress management and
  • Advanced communication skills

The workshops will initially be held in Christchurch however could be presented in other areas if the interest is high enough. Please feel free to contact us with your requests.

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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:

 
CriteriaGaps 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.

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Are your staff increasing risk of cross infection?

Cardigans – a potential vector of infection?

Each winter cardigans or long sleeved tops under uniform tunics appear as part of clothing worn by carers, nurses and other staff providing resident care.  Does this practice increase the risk of cross infection?

There are certainly studies that demonstrate that uniforms become contaminated with potential pathogenic organisms including Staphylococcus aureus, Clostridium difficile and Norovirus[1]. It is more difficult to find evidence that links contaminated uniforms with the transmission of pathogens to patients and residents.

Most contamination occurs in areas of greatest hand contact such as pockets and cuffs[2], which may the cause the wearer to re-contaminate their cleaned hands. Long sleeves may also become contaminated with bodily fluids, which then directly contaminate another resident through direct hands on care. This would be a great way to spread around those multi-drug resistant organisms that live in the bowel, such as ESBL, VRE and CRE!

The biggest risk of wearing long sleeves when delivering care involving patient contact is that hand hygiene cannot be carried out effectively. Anyone who has been taught hand washing using the Glitterbug gel and UV light will remember how the wrists were often left glowing, demonstrating that your wrists also get contaminated and need cleaning. In many healthcare facilities across the world, a ‘Bare Below the Elbows’ policy is used to ensure that effective hand hygiene is undertaken. This applies to the use of an alcohol based hand rub or gel, as well as washing with soap and water.

So the next time that you put your cardigan on or come to work with a long-sleeved top, remember that, prior to any patient contact remove the cardigan or roll up your sleeves and perform hand hygiene.

[1] Mitchell et al. Role of healthcare apparel and other healthcare textiles in the transmission of pathogens: a review of the literature. Journal of Hospital Infection, 2015 Aug;90(4):285-92

[2]Loh et al. Bacterial flora on the white coats of medical students. Journal of Hospital Infection,  2000 May;45(1):65-8.

Contributed by:

Ruth Barratt

Infection Prevention & Control Advisor

infectprevent@gmail.com

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