“HCSL has been incredibly easy to navigate since we went live on the system on the 1st of October. Our team have people with varying levels of technology literacy and the ease of this system has meant that staff are more confident to use technology and see how it can help to improve time management by not having to double or triple up on written documentation.”
Manager
Alexander House Rest Home
his New Zealand designed web based (on-line / in-the-cloud) Bench-marking and quality management system from Healthcare Compliance Solutionhttp://www.hcslqms.co.nz/s Ltd allows you to:
Your organisation policies and procedures and related documents (if created by HCSL) are also accessible through the Facility Documents tab on the left of the screen for remote anytime, anywhere access. The keyword 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.
You can also upload your own documents for confidential safe storage.
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. This programme has been operating in NZ Aged Care since mid 2016 so now has many thousands of pieces of data to compare yourself against.
To find out more contact us here.
Making monitoring your service remotely in LIVE time easy!
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.
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.
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.
Is a slip off a chair or off the side of the bed onto the floor a fall? Is a ‘controlled lowering’ by a staff member of a resident to the floor a fall?
When recording adverse events such as falls, it’s important for the purposes of consistent reporting and bench-marking that the same definition is used to define a ‘fall’. We suggest using the definition provided by the World Health Organisation (WHO) which states “A fall is defined as an event which results in a person coming to rest inadvertently on the ground or floor or other lower level.” The WHO falls prevention guidelines also report that “Globally, falls are a major public health problem. An estimated 424 000 fatal falls occur each year, making it the second leading cause of unintentional injury death, after road traffic injuries.”
Working in aged care related services means you are interacting on a daily basis with those in the high risk category for falls. WHO also report for example, in the United States of America, 20–30% of older people who fall suffer moderate to severe injuries such as bruises, hip fractures, or head traumas. The Health Quality and Safety Commission New Zealand report “for every fall in hospital, there are five in aged residential care and another 40 at home and in the community. Between 2010 and 2012, a total of 200 people fell while in hospital care and broke their hips.”
The HCSL QA online bench-marking includes tracking of falls and falls related injuries so educating your staff to become familiar with the definition is important in ensuring data collected is accurate. Accurate data measurements also allow you to be aware of your start point for quality improvement projects which can then be measured at the end of a project to measure the degree of improvement.
In answer to the questions posed at the start of this article, if we apply the WHO definition, then both should be classified as falls. For those of you using the HCSL policy and procedure system, refer to the Falls Prevention Programme (document CS19) for more information on falls prevention.
‘Pressure injury’ according to ACC can be classified in some instances as a ‘treatment related injury’ and therefore you may have the option of gaining support / assistance from ACC in relation to treatment of the pressure injury. In their 2011 fact-sheet, ACC noted “Pressure areas are a significant source of treatment injury claims and impact on both patient morbidity and mortality (1). Between July 2005 and March 2011, ACC accepted 506 claims for pressure areas, and notified 45 as adverse events to the Ministry of Health”.
As pressure injuries are a key focus for Ministry of Health (MoH) this year, auditors will be looking closely at the documentation around identification, management, treatment / care planning and evaluation of these events. Ensure you have comprehensive evidence of your clinical management processes.
Also remember when you log a pressure injury into the adverse event reporting system, you include the stage of the pressure injury. In the HCSL QA online system click ‘pressure injury’ in the ‘type of event’ box and then in the box directly under that, you can record the additional detail of the stage of the pressure injury.
The required MoH notification forms can be found here. You will need the resident GP to complete a ACC45 form. Then contact ACC and rather than asking for what you want, ask what they can do to help. If you ask first, you may be missing out on something they could have provided access to.
For more information on seeking support contact Assistant ACC directly or the ACC Contracts Manager – CDHB Email: Leanne.davie@cdhb.health.nz