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LASA Q Tracey Rees State Manager Agenda • • • • Round six Industry performance Managing risk Promoting quality The ‘accreditation round’ Industry performance - % homes 44/44 as at last audit* – Round one (2000) – 64 per cent • 243 homes had 10 or more not met expected outcomes, 68 had five or more – Round five (2012) – 95 per cent • 26 homes had 10 or more not mets, 13 had five or more – Round six??? • Next ‘round’ will be as at 31 December 2015* Ownership is not a performance factor *Based on the last decision before 31 December every three years e.g. 2000, 2003, 2006, 2009, 2012. Industry performance – as at 31 January 2015 • 2,688 homes – 24 homes on timetable for improvement – Two with 4+ not mets – One with 10+ not mets Industry performance • Three-year data to 31 December 2014 • 17,135 visits, of which: – 9,139 unannounced assessment contacts • >one per year for each home – 4,965 announced assessment contacts • mainly TFI monitoring visits – 2,898 re-accreditation audits – 133 review audits The not mets • In 17,135 visits over three years: – 170 not mets in information systems – 115 not mets in clinical care – 115 not mets in medication management – 106 not mets in human resource management – 97 not mets in behavioural management The not mets • Most expected outcomes are linked – Failure in one area of a home’s performance usually impacts other areas of care, service delivery • Failure in Standard One often a causal factor linked to failures in Standard two and Standard three • Combined with a poor systemic approach to CI Information systems • Ineffective approaches to collecting and recording information • Ineffective approaches to updating care planning and assessment • Poor approaches to sharing information – Eg allergies/dietary needs noted in care plan, not relayed to kitchen • Poor shift handover practices Often impacts other outcomes Pareto Chart Frequency of system failures Expected outcome 1.8 Information Systems 40 100% 90% 35 80% 70% 25 60% 20 50% 40% 15 30% 10 20% 5 10% 0 0% Process/system failure Cumulative percentage Frequency per process 30 Clinical care • Care needs not regularly assessed and documented • Outcomes of care not evaluated to identify changes in needs • Ineffective process monitoring systems • Limited oversight of staff practice Medication management • Limited oversight of staff practice in medication administration • Failure to identify and manage medication errors and omissions and taking prompt action • Medications not stored correctly (eg temperature range) or securely (eg potential for unauthorised access) • Ineffective communication process for managing medication orders Human resource management • Poor recruitment practices • Poor management and induction of casual or temporary staff • Ineffective management of staff skills mix to meet current resident needs (eg, increase in acuity of residents) • Ineffective rostering practices Behavioural management • Ineffective behavioural management care plans • Poor assessment and review • Staff skills inadequate for managing challenging behaviours • Poor approach to managing incidents and responding with appropriate management strategies • Ineffective process for identifying changes in care needs • Information to guide staff not up-to-date Managing risk • Risk cannot be avoided • Risk must be identified and managed • Systems and people create or reduce risk • Failure usually occurs as a result of a combination of factors: • Some known, some unforeseen, sometimes related, sometimes not Reason theory James Reason’s 7 myths about error • • • • • • Errors are intrinsically bad Bad people make bad errors Errors are random and highly variable Practice makes perfect Errors of highly trained people are rare Errors of highly trained people are usually sufficient to cause bad outcomes • It is easier to change people than situations Managing risks in aged care • Changes in key personnel • Change of management systems (incl. IT) • Changes in processes and procedures not supported by appropriate staff training • Change in resident numbers/mix • Building programs / relocation • Changes in business strategy / restructuring • Change of ownership Managing risk • There are risks to be managed in all activities • The problem is not the risk! • Problems occur when the risk is not properly managed • Risk management is everyone’s responsibility • Risk management is part of ‘business as usual’, not ‘an add-on’ • Develop risk mitigation plans • Regularly review risks and update plans Promoting quality – Better Practice Brisbane Brisbane 12/13 November – make it a date Promoting quality – for all providers • Better Practice Program includes residential and home care components • Needs analysis covers all - under review • Quest • Qhome • Understanding accreditation • Understanding quality review Better Practice Awards • • • • • Scheme currently under review Recognise better practice/high performance Residential providers Home support program providers Supports Better Practice conference program and participation Baptcare Victoria use of psychotropic medication • Drug use evaluation tool to assist in identifying risk and opportunities for improvement • Organisation-wide approach – 67% reduction in the use of psychotropic medications – 40% improvement in compliance with therapeutic guidelines and prescribing patterns – Successful implementation of alternate therapies “Benefits for all concerned are clearly demonstrated and the programme is worthy of wider implementation across all RACFs.” – Judges’ comment Uniting Care NSW Starrett Lodge - bucket list program • The BLiP on the horizon - showing people with dementia at the centre of their own life story, communicating with their communities what is important and why their life is worth living • Improves residents‘ aspirations and autonomy by empowering identification of Bucket List goals • self esteem by engendering purpose, self worth and achievement in helping each other reach goals • social networks and social inclusion “The key thing it does well is it treats people with dementia as real people! And gives them choice and agency!” – Judges’ comment Aldinga Beach Court Lifecare, SA – from bedtime to breakfast • 240 calls overnight in a 24-bed secure unit • Review of practices and environment to identify sleep disturbance triggers • Identify usual sleep patterns • Modify daytime social and recreational activities • Overnight calls reduced to <100 “Sleep is not all about night time – it is about what happens 24 hours a day” - submission Thankyou!