If you are operating an aged care facility, you understand that the challenges of keeping up with changing legislation and guidelines in the highly regulated aged care industry is a difficult task. An effective way of informing staff about these changes can be impossible without an effective communication system. At MedeHealth, we see first-hand the difficulty that these changes can cause for facilities that are busily rolling out and administering training programmes to cover off these changes. To put the number of changes in perspective, there were 1046 clinical guidelines published between 2005 and 2015. Working out which of these apply to aged care and having appropriate systems in place so that staff are knowledgeable and have been assessed is an enormous challenge.
We’ve compiled a list of the top six compliance challenges that some of our aged care customers face:
Area 1 – Drugs as Hazardous Substances
What is it? Legislation exists in each state about the occupational health and safety issues relating to drugs as hazardous substances, including cytotoxic drugs. This legislation spells out the training and management obligations required by aged care providers who administer these substances.
What are your obligations? Your obligations regarding this area are subject to state guidelines, for example, The Safe Handling of Cytotoxic Drugs and Related Wastes: Guidelines for South Australian Health Services. These guidelines detail your legal obligations and have been developed based on reviews of safe handling practices that incorporate evidence-based and best-practice standards.
These guidelines include maintenance of a hazardous substance register together with Safety Data Sheets (SDS) and training sheets. Information, training and instruction must be provided in such a way that it is easily understood. The amount of detail and extent of training will depend on the nature of the hazards and the complexity of the work procedures and control measures required to minimise the risks. As an aged care provider, records of training provided to workers should be kept, documenting who was trained, when and on what.
Area 2 – Minor Burns in Aged Care
What is it? Guidelines issued by the Australian and New Zealand Burns Association (ANZBA) recommend that all burns in the elderly are referred to a burns unit.
What are your obligations as an aged care provider? Referral to the nearest burns unit is required when a care recipient meets the burns criteria. In the case of burns in the elderly, the criteria are very broad stating that referral is required in “burns in the extremes of age – infants and elderly.” To follow these guidelines, correct early treatment, contacting your local burns unit and the care recipient’s medical practitioner, and thorough documentation are key points. ANZBA referral criteria can be found here.
Area 3 – Nurse Initiated Medicines (NIM)
What is it? Although these medicines look harmless, many facilities we speak with don’t have sufficient detail in their Nurse Initiated Medicines (NIM) list for an accurate assessment about whether a Nurse Initiated Medicine should be administered.
What are your obligations as an aged care provider? Guiding Principle 5 – Nurse Initiated Non-Prescription Medicines from the guideline Guiding Principles for Medication Management in Residential Aged Care Facilities 2012 exist to support decision making for NIM’s and medication administration. It is essential that you have documented protocols for assessing and administering NIMs. A well-executed education and training programme for medication administration with ongoing competency assessment should also be implemented to ensure you are meeting your compliance obligations.
Area 4 – LGBTI Training
What is it? LGBTI refers collectively to people who are lesbian, gay, bisexual, trans, and/or intersex. It is now that LGBTI elders are starting to access aged care that the issue of appropriate support is arising. Older LGBTI people thinking of accessing aged care services have often had many experiences of discrimination which influences how they engage with service providers. The key concern is that people won’t seek support or assistance when they need it because of fears of discrimination. These fears could be unfounded because a lot of aged care providers are becoming a lot more LGBTI-sensitive.
What are your obligations as an aged care provider? Your LGBTI obligations are subject to the Sex Discrimination Amendment (Sexual Orientation, Gender Identity and Intersex Act) Act 2013; All aged care providers are required to comply with this legislation. Religious organisations that provide Commonwealth-funded aged care services are not exempt.
Area 5 – Administering Oral Medications Safely
What is it? Approximately 40-50% of residents in aged care facilities have difficulty with swallowing which increases the risk of choking.
These care recipients must be administered their medication with an appropriate amount of water in the right body position. The crushing of tablets may be required, which if not done safely and correctly can lead to safety issues.
What are your obligations as an aged care provider? Guiding Principle 16 – Alteration of Solid Dose Forms from the guideline Guiding Principles for Medication Management in Residential Aged Care Facilities 2012 exist to support decision making for crushing tablets during medication administration. These guidelines exist because inappropriate crushing can be hazardous to the care recipient and the staff member.
Guidelines exist that state that aged care facilities should use ongoing quality improvement activities such as staff education and training, and ongoing competency assessments to administer medications safely.
Area 6 – Reportable Assaults
What is it? According to data from the Department of Health and Ageing, alleged reportable assaults in Commonwealth funded residential aged care facilities increased by almost 30% between 2008 and 2012.
A reportable assault as defined in the Act (section 63-1AA) means:
- unlawful sexual contact with a care recipient of an aged care home, or
- unreasonable use of force on a care recipient of an aged care home.
This definition captures assaults ranging from deliberate and violent physical attacks to the use of physical force on a care recipient.
What are your obligations as an aged care provider? Compulsory reporting of assaults is the responsibility of an approved provider under the Aged Care Act 1997 (the Act). Effective staff education is the key to minimising assaults in an aged care setting, as there remains confusion among some staff about what is considered to be a reportable assault. Strategies for the management and reporting of elder abuse are an essential part of an aged care facility’s plan to protect the rights, safety and dignity of its residents. It is important that all members of staff have a good understanding of the information surrounding elder abuse and have clear guidelines on the reporting process. It is also essential that staff who work at aged care facilities understand what is considered to be a reportable assault and the process of how to report it.
Recap
These six compliance areas can be addressed relatively easily. Understanding your obligations in an ever-changing regulatory environment can be difficult. However, the aged care community has published some great resources to assist you in staying abreast of these changes. Here are a few examples:
- Guiding Principles for Medication Management in Residential Aged Care Facilities 2012, Department of Health and Ageing
- Australian and New Zealand Burn Association Guidelines
- Guide for reporting reportable assaults, Department of Social Services
- LGBTI aged care training e-learning module
These topics will be examined in further detail in future blog posts.