People in any healthcare business have to deal with the complexities of legislation, standards and guidelines. But what is the difference between these three words, and how can you convey this information to staff while being able to show the link between training and continuous improvement.
If legislation, standards and guidelines in residential aged care are broken down, we can see how they relate to one another. It can be as simple as 1, 2, 3.
1. Legislation
Legislation is a directive from the government, passed by parliament, which must be complied with to meet the legal boundaries of that industry. The Quality of Care Principles 2014 (https://www.comlaw.gov.au/Details/F2014L00830 ) sets out the responsibilities of approved providers in providing care and services for residential and home care.
The principles specify the care and services that an approved provider of residential care is to provide and sets out the Accreditation Standards that must be met to achieve accreditation.
What does this mean in simple terms?
In simple terms, legislation is a collection of laws and rules made by the government. There are legal ramifications for not complying with legislation.
2. Standards
There are four Standards which apply to the quality of care and quality of life for the provision of residential care. There are 44 expected outcomes across these four Standards. Residential Aged Care facilities must comply with all 44 expected outcomes at all times.
The Accreditation Standards are intended to provide a structured approach to the management of quality and represent clear statements of expected performance. They do not provide an instruction or recipe for satisfying expectations but, rather, opportunities to pursue quality in ways that best suit the characteristics of each individual residential care service and the needs of its care recipients.
What does this mean in simple terms?
In simple terms, Aged Care Standards are contained within legislation and have specifications which must be met.
3. Guidelines
Guidelines are the key to establishing effective, high quality and safe health care practices and policies. Guidelines enable you to meet Standards which in turn allow you to meet the legislative requirements of residential aged care facilities.
As an example:
- Following Guidelines for a Palliative Approach in Residential Aged Care helps a facility meet:
- Standard 2.9 relating to Palliative care, which ensures the comfort and dignity of terminally ill care recipients are maintained, which allows a facility to meet:
- Legislation in the form of Quality of Care Principles 2014
- Standard 2.9 relating to Palliative care, which ensures the comfort and dignity of terminally ill care recipients are maintained, which allows a facility to meet:
There are a number of reasons why guidelines should be followed in residential aged care facilities and should form an integral part of staff development across your organisation. With increased media coverage concerning any adverse event in aged care, it becomes, even more, important to ensure that your facility has access to resources to enable compliance with best practice guidelines. Guidelines should enable those who are ultimately responsible for applying judgement and making health care decisions to do so with a degree of confidence.
What does this mean in simple terms?
Guidelines are provided by reputable experts and exist to advise and assist us to make informed decisions.
Challenges for Clinical Managers & Senior Management in Aged Care
There are some challenges facing the use of clinical guidelines in Australia. There are three departments currently looking at health guidelines in Australia:
- The National Health and Medical Research Council (NHMRC)
- The Australian Commission of Safety and Quality on Health Care
- The Department of Health
They released a publication in November 2015 titled “Better informed healthcare through better clinical guidelines”. The findings in this publication list the five key challenges facing clinical guidelines, of which three can be covered using technology and a good e-health platform such as MedeHealth. These three areas which can be easily covered are:
- Lack of investment in information technology – most people have access to a computer or tablet
- Inaccessibility – how to reach your workforce with guidelines that they may not know even exist
- Obsolescence – updating old guidelines with new guidelines
The two areas which require further consultation but are outside the scope of aged care providers are:
- Inefficiency: a strategic, priority-driven approach is needed
- Poor quality: problems with conflicts of interest not being declared
Reasons for using clinical guidelines in your residential aged care facility
Here are three reasons why the use of current clinical guidelines in aged care is critical:
1. Better Resident Care: High-quality clinical practice guidelines provide an opportunity to close the gaps between current clinical practice and best available evidence. One key rationale for the development of clinical practice guidelines is the rapid growth of research in various medical conditions, which means that recommendations for best practice may change as the results of important studies or new treatments become available.
There has been significant growth in the number of Australian clinical practice guidelines in the past 15 years. A recent study identified nine times more guidelines than identified in 1993. There were 1046 clinical guidelines published between 2005 and 2013, of which government agencies produced or funded just over half the clinical practice guidelines identified.
2. Risk Reduction: There are a number of medical conditions suffered by elderly residents subject to guidelines in residential aged care facilities. It is critical that current guidelines are followed both from a quality of care perspective and a residential care facilities reputation.
3. Litigation: If a resident suffers an adverse event and the matter results in court action, one of the first questions asked is: “Were the guidelines followed?”
In Australia, it should be noted that courts are not bound by the following of clinical guidelines as a defence against an incident. However, if the guidelines have been issued by a reputable body and are accepted in the medical community as a statement of accepted medical practice, expert evidence on the guideline may well be influential or decisive.
How can I meet these challenges?
MedeHealth provides access to MedeGuides (our online modules), which are linked to legislation and guidelines resulting in maximum resident care while minimising the chance of resident harm. Each MedeGuide states which standards are affected by the content of the module. The training and assessment of guidelines with a record of completion for each staff member can present problems. Accessibility, ease of use, clarity and currency are all possible with the use of technology and a good e-learning platform.
A good e-learning platform can push topics linked with legislation, standards and guidelines across a facility or become part of an organisation’s strategy for staff development. A couple of great resources for clinical guidelines are:
- Guiding Principles for Medication Management in Residential Aged Care Facilities; Department of Health and Ageing, October 2012
- Better informed health care through better clinical guidelines; A NHMRC Draft Discussion Paper, November 2015
MedeHealth links its topic against legislation and guidelines allowing aged care providers to meet the standards expected by care recipients, the general public and the media.