As you will be aware, assisted dying will be legally available in New Zealand from November 7 when the End-of-Life Choice Act 2019 comes into effect.
The introduction of assisted dying means that a person with a terminal illness who meets the eligibility criteria can request medication to relieve their suffering and end their life.
The Act sets out the legal framework and a high-level process for accessing assisted dying, including strict eligibility criteria and safeguards.
Assisted dying is not a replacement for palliative care or health care services more generally. It provides another option for people with a terminal illness in certain circumstances.
Assisted dying remains illegal until 7 November 2021. The Ministry of Health will be responsible for the Act and has an implementation programme underway to implement the assisted dying service.
This may impact hospitals, care facilities and retirement villages across the country in an entirely new way, so we at Healthcare Compliance Solutions Ltd have been following the Ministry of Health’s guidance along the way, to ensure our policies and procedures help our new and existing clients through the process, as best as possible.
If you would like to learn more about how Healthcare Compliance Solutions can help you and your orgnisation.
“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
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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
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I operate a medical practice that specializes in aged-care facilities in Auckland. In the last two years most have adopted a system for keeping medical file notes electronically. There are a number of systems on the market and I have experience of four. None appear to have consulted end users when developing their functions. All of them have problems, which hopefully will be ironed out over time.
HCSL is one them. The vital medical problem list is buried within the system and clunky when you find it. Some of its navigation is not intuitive. However, compared to the others it has a clean and uncluttered feel.
The tab buttons and the boxes for inserting text are large and easy to use. The ability to find previous medical file notes within all the nursing and caregiver entries (a vital consideration) is ahead of the pack. It is also smooth as silk to access from an offsite computer.
The team behind it are much easier to access, and more responsive to feedback, than anyone else. From what I know, HCSL is the system I would use if I was running an aged-care facility.
Dr Roderick Mulgan. FRNZCGP.
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I was first introduced to Gillian Robinson of Healthcare Compliance Solutions Ltd (HCSL) in 2016 when I took up the Facility Manager position at Terrace View Retirement Village.
The facility had HCSL in place but were not fully utilising Healthcare Compliance Solutions policies. The first thing to do was to get Terrace View fully operational under Healthcare Compliance Solutions. Gillian was very supportive during this change providing education to myself, Clinical care manager and our team.
HCSL aged care software is easy to find your way around. Our Nurses have reported that care planning in HCSL is saving them time. Everything is in a logical order.
Features that make my role easier are the ability to track trends in adverse events and infection control. To be able to bench-mark our data within the industry to see how we are trending against our peers.
Terrace View is very excited to be moving to HCSL aged care software version 2 so we can become fully electronic. To be able to search a file or document from the computer saves all the team time.
Gillian’s knowledge of the aged care industry and how the sector works is reflected in the software she has developed and is designed to increase nursing team efficiency in a very time restricted environment.
Donna Coxshall
Facility Manager
18th February 2020
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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.
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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.
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