aged care

 by Gillian Robinson

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

in News
 by Gillian Robinson

RN – Manager, Kaiapoi Lodge Resthome and Hospital – February 2017

We are a medium sized rest home and hospital. The complexities of the various standards means that without a product such as HCSL we would find it difficult to function. Health Care Compliance Solutions Ltd has ensured we stay up to date and compliant in all areas of our industry.

The recent introduction of the online tool has been a massive invaluable boost, all staff now have access to the latest documents online.

Never before have we been able to compare ourselves against industry. Instant access to current documents, analysis of events and graphical representation are just a click away. Adverse events and infections are recorded and compared against industry.  The ability to log complaints, restraints and complete internal audit has aided in our ability to close the quality circle.

With HCSL we no longer need to worry about the policies and procedures we just need to focus on the implementation.

 

 

Jonathan Prangnell

Registered Nurse/Manager 

Kaiapoi Lodge Residential Care Ltd  – February 2017

in Testimonials
 by Gillian Robinson

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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 by hcsl

Policies & Procedures

More Time HCSL

Residential Care Services policies and procedures – customised to reflect to levels of care provided

HCSL is still the only New Zealand provider that, along with our software offer fully customised (Site by Site) up to date. New Zealand compliant policies & procedures, so you don’t have to update, edit or create them yourselves.

The services offered includes access to customised ‘ready to use’ policy and procedures under license with online access.

New Zealand compliant policies & procedures
Customised for you.

Documents HCSL

The HCSL solution gives you access to Policies and Procedure documents for the following catagories.

  • Consumer Rights

    (CR) 32 Documents

  • Service Delivery

    (SD) 23 Documents

  • Learning & Development

    (HR) 72 Documents

  • Food Service

    (FS) 38 Documents

  • Clinical Service

    (CS) 166 Documents

  • Safe & Appropriate Environment

    (SAE) 59 Documents

  • Entry To Service

    (Entry) 25 Documents

  • Infection Prevention & Anti-microbial Stewardship

    (IPAS) 38 Documents

  • Village

    (V) 33 Documents

  • Organisational Management

    (OM) 37 Documents

  • General Documents

    (GD) 26 Documents

  • Clinical Resources

    (Clinical) 1 Documents

  • Community

    (HCSS) 27 Documents

  • Meals On Wheels

    (MOW) 9 Documents

Current to October 2021

Want To Know More?

Contact Us
in Policies & Procedures
 by Gillian Robinson

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

in News
 by Gillian Robinson

Falls – When is a fall not a fall?

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.

in News
 by Gillian Robinson

Pressure Injuries – ACC may be able to help

‘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

in News
 by Gillian Robinson

Person-centered Care depends on your recruitment processes

On a recent trip to Cambodia and Singapore I visited the older members of the community where they were being cared for and spend their final days.  In Cambodia, where there are no formal aged care services; I found the older members of their communities being care for by each other in either family or Buddhist temple settings.  The choice is often made by the oldest members of families in Cambodian society to leave home and move into a temple and take on the lifestyle of a Buddhist Monk or Nun.

I was honoured to have had the opportunity to visit these folk and talk with them about their lives and experiences. I asked them if they missed anything about their previous life.  The answer when I’ve asked that same question of elder folk in New Zealand has resulted in a long list. These gentle folk smiled broadly at me and told me no, there was not a single thing they missed. Their families still came to visit them. It seemed that was all they needed from life as it was!

In caring for each other these ladies practiced the principles of person-centered care. They were not familiar with the term, were not trained nurses and were not carers who had received formal training. Never the less, they provided care as needed by those receiving it. This was about social housing and accommodation rather than a focus on infirmity, disability or ill health.

On my visit to a nursing home in Singapore, it was inspiring to see the elder ladies sewing staff uniforms and other elder men and women preparing vegetables. These would become meals of the children crèche down the road. These folk talked as they worked together. They were connecting and contributing. Making a difference. They were needed and had value.  They held a high status within their community.

In the Singapore Nursing home residents lived in the nursing home in 8 bed units, men segregated from the woman. The sense of connection between residents however was obvious from the numbers of people I saw sitting beside other residents’ beds talking with them, interacting together and chatting as they worked.

There were trained nurses and the Welfare Officer who was a fountain of knowledge talked about person-centered care. The residents’ activities programme was full and could have easily been transferable to any NZ residential care facility.

The terms used were the same as ours but as I looked around I could see the implementation of person-centered care was very different from our interpretation of that type of service. Residents were certainly engaged, appeared happy and well care for.

What struck me however was how different our understanding of the term ‘person centered care’ is and how a society’s culture or organisational policies can mean our practice is very different.

This is an important factor to remember when recruiting staff that have been trained and work in other countries. When you describe something to an applicant you’re recruiting and they say they understand the concept, does it necessarily mean you have the same understanding. The picture in your mind of what the outcome will look like may be very different to their mind-view?  Sometimes it pays to ask more questions!

in News
 by Gillian Robinson

Medication Management Audit Tips

 

 Medication management relates to section 1.3.12 of the Health and Disability Services Standards and referred to in section D5.4 of the ARRC.  There are key reference documents which provide reference at facility level which should be used in conjunction and addition to your organisation policies and procedures.  These reference documents are (first two are key for residential care):

 

Medication errors of any type, when reporting through the audit process to MoH HealthCert as part of your audit, will receive a higher ‘weighting’ than other partial or non-attainments.  Even a single signature missing off an administration signing sheet may come into this category and mean your audit outcome is diminished.  Below are common errors which continue to be made:

Aspect of medication management 

Common Errors 
Medication charts

Not dated

Not signed by the prescriber

Not signed by the General Practitioner or Nurse Practitioner at each review (3 monthly)

Not legible

Allergies not documented (or inconsistent with other resident documents)

Transcribing on medication charts or PRN signing sheets

PRN medication charting does not include ‘indication for use’

Medication order does not include time, dose, frequency, route, type etc
Signing sheets

Missed signatures on the signing sheets

Only one signature (instead of two) on controlled drug administration records and register

PRN medication not signed for accurately
Self-medicating residents

Competency to verify self-medication not signed by prescriber

Competency for self-medication not signed as having been reviewed by prescriber (3 monthly)

Staff verification of self-medicating occurred not recorded on a shift by shift basis (as relevant to the individual residents medication order)

Not retaining a current list of all medication ordered for self-medicating residents
Storage

Medication not securely stored (also see ARRC D15.3(c)

Controlled drugs not entered accurately into Controlled Drug Register (at time of supply or return to pharmacy)

Controlled drugs not stored in locked cabinet in locked room

Drug trolley left in common areas unlocked

Expired medication continue to be stored on site (should be returned to pharmacy)

Medication for resident who has been discharge or deceased remain on site

Medication fridge temperature not monitored / recorded

Labels on medication containers not clear / legible
Identification of resident

Photograph not representative of current presentation of resident (photograph should be colour)

Photograph of residents not validated regularly
Medication errors

Not reported

Not managed (through an adverse event management process to ensure identification of contributing factor and preventive measures).
Competency

All staff (including Registered Nurses and Enrolled Nurses) involved in medication administration must have first successfully completed a medication competency

Annual review of medication competencies

If you’re uncertain about the competency of a particular staff member, do not be tempted to sign them off and monitor.  The risk is too high for the residents and your organisation.  Medication errors can be classified as ‘sub-standard care’ and due to the possible consequences, are at least a moderate risk.

Remember when changing staff around, the key priority is do you have a medication competent staff member on each duty and if controlled drugs are being administered, you need a minimum of two medication competent staff rostered on each duty.  Registered Nurses cannot be leaving the ‘hospital’ area of the facility to administer medication in other areas as this leaves the hospital residents vulnerable so this also needs to be factored into your rostering.  Refer to the Aged Related Residential Care Contract (ARRC) for further information.

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

in News
 by Gillian Robinson

Taking things for granted….

I ate the best crispest, crunchiest, juiciest, rosiest, sweetest most marvellous apple while I was driving home last night after attending a seminar. I had put it in my bag earlier for just such an occasion and it really was the very best apple.

You might be wondering why I’m writing about eating an apple. Well the point is I can eat an apple. I can eat an apple while driving a car. No-one should drink and drive and we are not allowed to text and drive but eating an apple while driving is still allowed.

The reason it was good to eat this most marvellous apple was that in order to eat it I first had to achieve a whole range of things. I had to have the money to pay for this crunchy crisp apple which confirms I have the financial reserves to not only pay for the petrol and maintenance for my car but also to pay for this beautiful rosy apple. I had to also remember that I liked apples along with remembering where the supermarket was to buy that most marvellous apple. I then had to recall where I’d parked my car and have the mental competence to get myself and my car and my apple out of the car-park and heading for home.

This all takes having an intact mind so I find it rather encouraging and reassuring that my mind seems to be working just fine.
To be able to eat this delicious thirst quenching juicy apple I had to have physical strength to drive my car and walk into the shop, buy the apple and walk with ease back to my car without getting short of breath in order to drive home. I had to have the muscular strength in my legs to walk, use the foot controls in my car with ease and have the physical reactions to stop in a hurry if I had to. All this being achieved while enjoying a gift of natures food, my wonderful apple. The hand dexterity needed to hold and manoeuvre that apple so I could bite the piece I wanted while steering the car was also something I take for granted. I realise I take for granted having healthy teeth to munch and crunch that beautiful apple. This all confirms my body and mind seem to still be functioning with strength and ease which I am very grateful for.

As I savoured every mouth full of this delectable apple while driving home tonight I wondered if when I’m 80 or 90 years old I will still be able to do this most enjoyable feat. I thought of all the things that must function for me to buy apples year after year. Will I have the ability to drive my car and walk into the supermarket and pick the nicest looking apple, pay for it and eat it with my natural teeth? Oh I do hope so.

To increase my odds of repeating this enjoyable drive home devouring delicious mouth full by delicious mouth full of apple, I decide I will need to take good care of myself. I will need to make sure I keep up my physical strength through regular exercise and eat a good diet to maintain a healthy weight. I will need to look after my eyesight with regular eye checks. I will remember to take regular visits to the dental hygienist and look after my teeth. I will manage my finances and enjoy reading books, socialising and learning new things to keep my mind active. And yes, I will continue to hope that with all the right self-cares and a bit of luck, when I am 80 or 90 years old I will be able to go to the supermarket to pick out the very best apple.

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