LASA Q

Tracey Rees

State Manager

• Round six

• Industry performance

• Managing risk

• Promoting quality

Agenda

The ‘accreditation round’

– 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 - % homes 44/44 as at last audit*

• 2,688 homes

– 24 homes on timetable for improvement

– Two with 4+ not mets

– One with 10+ not mets

Industry performance – as at 31 January 2015

• 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

Industry performance

• 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

The not mets

• 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

Information systems

• 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

Clinical care

• 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

Medication 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

Human resource 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

Behavioural management

• 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

Managing risk

Reason theory

• 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

James Reason’s 7 myths about error

• 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 risks in aged care

• 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

Managing risk

Promoting quality – Better Practice Brisbane

Brisbane 12/13 November – make it a date

• Better Practice Program includes residential and home care components

• Needs analysis covers all - under review • Quest• Qhome• Understanding accreditation• Understanding quality review

Promoting quality – for all providers

• Scheme currently under review• Recognise better practice/high performance• Residential providers• Home support program providers• Supports Better Practice conference program

and participation

Better Practice Awards

• 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

Baptcare Victoria use of psychotropic medication

• 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

Uniting Care NSW Starrett Lodge - bucket list program

• 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

Aldinga Beach Court Lifecare, SA – from bedtime to breakfast

Thankyou!