What is Governance?

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what is governanceWhat is Governance?

Governance is a term used regularly in the echelons of high-ranking businesses. The business has largely grasped the concept of Governance to improve outcomes for all stakeholders. However, the same cannot be said for Aged Care.

Governance and Clinical Care. Are they related? I just had somebody come to tell me that Governance is totally separate from care, and that management of an aged care home is not involved in care governance. I did not wish to argue but felt the need to point out that Governance is All About Care.

The new Aged Care Standards (2019 – introduced 3 years ago now) are focused on Governance. Governance is oversight of the resources required to provide appropriate care. Resources incorporate all the standard things like staffing, equipment, cleanliness, clinical stores, and so on. However, with an increased focus on consumer rights, and safety, there is a requirement for increased clinical assessment. Assessment when communicated clearly and documented well on the care plan meets the care and governance standards. When this is done poorly both areas are similarly affected.

Registered Nurses

Are Registered nurses essential for good care? The answer is simple, yet complex. If you see a medical specialist and are booked in for surgery, you expect the people preparing you and operating on you to have the knowledge and skills to perform safely and effectively. It is exactly the same in aged care.

When someone enters an aged care home, they do not automatically give up their right to good care. Does a registered nurse have the appropriate knowledge and skills to undertake comprehensive clinical assessments and to document these? The answer is Yes! If you answered no, it could be best to review the skill levels of your staff. We talked about just this matter, in our previous post (https://clinical-governance.com.au/upskilling-staff-savvier-than-enlisting-new/) – the dilemma of finding or training to ensure you have competent staff.

So what!

So where is the connection between a bowel management chart and Governance, you ask! Allow me to explain. If a consumer suffers with constipation, and this goes on for many days unnoticed, with no records documented, the consumer is at risk of bowel obstruction. When admitted to hospital for surgical management of said bowel obstruction, and simultaneously become sick with septicaemia; the Governance rises to the fore. Governance is about the systems of documentation to ensure everyone has such details recorded accurately. Governance is about having appropriately skilled staff, through education, competency or a combination of both, to ensure the staff managing care have the relevant skills. Governance links directly to consumer safety and choice. All consumers wish to remain safe, and none would make a choice to have surgery unless necessary. The very nature of this small issue, as it started has turned into one affecting care and governance standards.

Good care is good governance. Good governance results in good care. The two are permanently interlinked; they are not separate.

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Upskilling staff savvier than enlisting new

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nursing education aged careUpskilling staff is definitively smarter than enlisting new ones.

Current market labor forces would have you believe there is a shortage of nurses. Alas, if we look in the right places, and attract the right staff; there are mountains of people looking to work with you. To support this, I bring to your attention the hundreds of virtually retired registered nurses, who were brought back to life again by AHPRA during the Covid Crisis.

The situation is so ridiculously serious that Aged Care Journals have in recent months published articles from University Professors. However, there are some interesting points raised by this research. Firstly, that onboarding is a complex and costly process. Then there is the push for full-time workers. Staff need options, not weeks of onboarding paperwork, and inflexibility with working shifts. Pulling the hard line on shifts relies heavily on attracting that market workforce where there is a shortage – new staff that knows no better. If you want experienced staff, then you may have to change some of the onboarding processes and offer more flexibility.

Staffing Ratios

Staffing ratios have always been a thing. Since the beginning of time nurses have been battling to maintain some sort of staffing ratio. In aged care, prior to the introduction of the Aged Care Standards in 1997, there was a funding tool that by its own virtue required a certain number of staff to meet clients’ care needs. This has all been superseded by Quality Outcome goals.

What we know is when a registered nurse commences work in Aged Care, there is an expectation that the registered nurse is able to perform a huge number of tasks competently: clinical assessment, medical communications, appointment bookings, crisis family management, human resource management, rostering, and legally appropriate documentation on all of these events. Oh, and don’t forget that all this must be done whilst filling in the incident form, completing the computerized care plans, and meeting the Quality Standards. Then we hear complaints about the new registered nurse not performing well. In what other industry do you expect someone to complete their degree and function at the level of a Major General, on day One.

In the coming weeks, we are going to look at how to best work with these registered nurses, for the benefit of all stakeholders. Stay tuned, and drop us a line to say hello.

IPC in residential care

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Clinical Governance & Covid

 

 

How is your Infection Prevention and Control (IPC)

 

 

Over recent months we have seen many residential aged care facilities suffer at the hands of Covid-19. Concurrently we have also seen increased vaccination rates for residents and compulsory vaccinations for staff. In addition IPC leads are a regulatory requirement, and their role will evolve post pandemic.

Current Covid Case Numbers

As of 2 October 2021, the Commonwealth Department of Health shows 728 people have died from Covid-19 in residential care, across Australia. The largest numbers in New South Wales and Victoria. Every week the current Covid cases in residential care are listed. At the time of writing, there are 39 Active Covid-19 Active Outbreaks in Residential Care across Australia.

 

The updated advice to residential aged care facilities in New South Wales, can change daily. If your home has an IPC Lead it could be advisable for them to check this information daily. If your home does not yet have an IPC Lead, consider having someone else allocated to this important information update task.

Covid Lockdown

There are number of things that will happen when a Covid positive case, in either residents or staff, is identified. The positive Covid identification engages supports from Commonwealth and State Health Departments.

However, each home also has to implement an Outbreak Management plan. The best guide available is from the Aged Care Quality and Safety Commission. The Aged Care Royal Commission makes mention of the input from external experts on developing appropriate outbreak management plans.

The Outbreak Management Plan is in addition to the home’s Infection Control Policy, Donning and Doffing competencies and Hand Hygiene competencies. Each document forms part of the suite of information to meet Infection Control and Covid Pandemic requirements.

Another source of vital information is the Clinical Excellence Commission.  They have valuable information and resources for infection control, and residential care specific resources.

PPE and other services

PPE becomes the primary thing in lockdown. PPE inventory, PPE usage, PPE donning and doffing, PPE donning and doffing stations, PPE orders, and PPE waste removal.

Mask fitting becomes a crucial component of keeping safe. Incorrectly fitted masks increase the risk of spreading Covid. There is information available on how to correctly fit a face mask. Correctly applied, the face mask reduces the risk of spreading Covid-19.

Depending on the number of residents and staff, size and shape of the building; an appropriate zone allocation for cohorting staff plan needs to be put in place. This will ensure that staff work in one area of the home only, whereby reducing the risk of spread.

PCR and RAT testing

The number of Polymerase Chain Reaction (PCR) and Rapid Antigen Testing (RAT) have increased to phenomenal levels during 2021. But which one works best. The research shows RAT are fast and largely accurate. However, the PCR test holds the Gold Standard for accuracy.

Some providers have moved to regular usage of RAT testing. Consider, this in itself can also be time consuming to perform on site. In addition, any false positive will need to be followed up by PCR testing to confirm or deny Covid-19.

Covid Vaccination

Around 97% of aged care staff has now received at least their first dose. This is expected to reach 100% soon, with the availability of vaccination venues becoming more readily available.

Clinical Governance

In July 2019 the new Aged Care Standards were introduced. As part of the process Governance was introduced into residential aged care. Governance is now a critical part of the process for residential aged care providers to meet the Standards. So what exactly is Governance.

The Australian Standards, outside of residential care demonstrate that Governance provides principles to guide governing bodies to meet their responsibilities. This is the most positive and innovative change to the Aged Care Standards since 1997. Correct implementation of Governance will enhance care outcomes for consumers, whilst promoting the business simultaneously.

Where to next

Implementation of appropriate Governance alongside adequate IPC processes, will reduce your risk of exposure to Covid-19. How do I know? Because I have expertise in Covid testing, on Covid hospital wards, and in Covid lockdown residential care facilities. With a background in ED Nursing, and Aged Care Auditing, I have immense knowledge and expertise around how to reduce your risk, and get out of lockdown quickly and safely.

As we come towards a reduction in Covid numbers in New South Wales, nobody has a crystal ball for what the future holds. Get in touch so that we can help you reduce your risk.

 

 

Why do we need a COVID vaccine in Australia

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COVID vaccination

Why do we need to get a Covid Vaccine in Australia

Have you had your vaccine? Are you concerned? The focus seems to have moved from keeping the population safe, to what harm will it cause me!

 

 

The History of Vaccinations

Smallpox, Tetanus, Diptheria, Pertussis and Polio have all been successfully eradicated or significantly contained through mass vaccination. But today, we see too many people who were either not born in the 1800’s when this commenced or have not experienced its trauma. I know you are not over 200 years old, but my point is your health has been protected by a Vaccine given more than 200 years ago. What we achieve today, tomorrow they will forget. But if we do not Vaccinate today, there may not be a tomorrow to remember.

So, how does this relate to Nursing, and more specifically aged care! Please just turn on the television, or Facebook and see the daily changes in active COVID for Aged Care across Australia. There are past and current cases. Even cases of Nurses in more recent times testing positive for COVID.

What has Education go to do with COVID

If you are an Aged Care Provider, you need to be reading this. Your business success depends on the competency and understanding of Clinical Governance, and Aged Care Standards, alongside how your staff implement them.

Why more education you ask! All education is not the same. It is very likely that most if not all of your registered nurses have a University Degree. However, what sort of Clinical Governance education have they received since they finished their nursing degree? Yes, experience is the greatest teacher, but you as the business owner do not have another 20 years to wait for the nurses to gain that experience. The right education and training, can increase staff competence, and improve the business bottom line.

Specialist Training

There are a plethora of online education providers in aged care, healthcare and nursing. COVID has increased this. Whilst this is good, what I want you to ask is how good! How good is it for your staff to have online education, often in their own time, not directly related to what they are doing, not directly related to your workplace, or not directly related to the population they are providing care for. The answer is, as you already know, face to face education.

Training should not be “old hat” in that staff just have to put up with the negative work environment. Nor should the training be all “online” as there is no interaction with the trainer, the workplace or the teachings. The time has come for a face to face trainer, experienced in Clinical Governance, and Aged Care Standards, to present this specialised training.

How much you ask?

Everything depends on your client population, your location, and your needs. A small 40 bed regional stand-alone home has very different education needs to a large city multi-level-site facility, and some sites are co-located with hospitals. A needs assessment can be undertaken and a plan developed to meet your specific needs.

Handwashing

Why handwashing!  In the midst of this world-wide pandemic the fastest and most effective way to prevent infection is to wash your hands. There is a course anyone can do National Hand Hygiene Initiative (NHHI) help desk to show they understand the importance of handwashing and how to do it safety and correctly. This does not detract from social-distancing or vaccination; but it does help.

 

 

How to go further with my Nursing Career

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principles of clinical governanceHow to go further with my Nursing Career

Are you a Registered Nurse in Australia; looking for a promotion, or just more respect? You are not alone! Our own Prime Minister has today, called increased Respect in the healthcare workplace a “Game Changer”.

Aged Care Accreditation

For some, who have worked in Aged Care, since the early days of Aged Care Accreditation, they are celebrating. For others, they are asking why this is even a question. There it is! Within one small niche in the complexity of healthcare, we see two different divides over something as basic as Respect.

So, how does this relate to your career in Nursing. In case you have missed the news, Aged Care has been through the wringer lately. Aged Care is in desperate need of Registered Nurses who are skilled in Respect, and Clinical Governance. As a Registered Nurse you are probably reading this knowing you have the pick of the jobs, because you hold the composite skill set.

Training for Nurses in Aged Care

If you are an employer reading this; then I know you are wondering where on earth you are going to find someone or somebody who can provide appropriate education and training to facilitate this end. The end being a Registered Nurse who understands Clinical Governance, Aged Care Standards, and implements them with Respect.

The Government has promised to deliver training programs across a range of sectors on prevention strategies, as outlined in the recent article on Respect. But, wait; how exactly does Respect translate to clinical care? Is it person focused or culturally focused? Is it one on one or is it via a particular event or time? Can it be managed by care staff or lifestyle staff? The questions go on, and I feel certain there are many more questions you have.

Specialist Training

The article on Respect also highlights problems with sexual harassment! What! How does sexual harassment from people in care, towards staff, rate on the same page as Respect? It is because to this day, there is no post-graduate, site specific, aged care focused, training and mentoring. Yes, there is post graduate training on Aged Care / Gerontology and other specialities. However, there is no specialists currently providing Clinical Governance Frameworks training specific to Aged Care, encompassing respect. Such education would include how best to manage the previous situation of sexual harassment.

Training should not be “old hat” in that staff just have to put up with the negative work environment. Nor should the training be all “online” as there is no interaction with the trainer, the workplace or the teachings. The time has come for a face to face trainer, experienced in Clinical Governance, and Aged Care Standards, to present this specialised training.

The role of the Regulator

Everything that Nurses do, leading up to and following their Registration in Australia is beholden to the Regulator. This ensures that nurses maintain their skills, knowledge, and continue learning in an ever-changing healthcare environment. The addition of specialist education and training, for Aged Care nurses would be welcomed by the regulator. Compulsory Professional Development for Aged Care nurses has often been hard. This would change everything. It is time, Now!

We will be sourcing various companies and individuals who can provide such training in the near future. Please keep a watch for the next update or email us through the contact page so we can keep you updated with changes.

Covid-19 and what we know

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Covid-19

It’s a weird feeling, that your job could take your life.

As an experienced nurse of more than 30 years, working across aged care, community care, and critical care; it is my observation the current health crises will affect everyone in some way.

 

 With the world in lockdown, are we able to stop the spread of coronavirus?

How long can we stay in lockdown? And will our economy recover? These are the central questions across the world right now. Each nation has enacted some level of lockdown, and yet we are hearing little about any plans to come out of such lockdowns.

 

So, what are we, each individually, able to do to stay safe and stay well in the midst of this pandemic? There are two age old truths, that are as meaningful now as they have ever been. Your overall physical health plays a part; and handwashing is the gold standard for protection.

 

The first studies, from data in January 2020 within China, show medical decline associated with Covid-19 largely involves co-morbidities. What this means for all of us is that the old adage “stay fit” actually has a purpose now. There is enough evidence to demonstrate those who are fitter, with less health issues, suffer less during pandemics. Covid-19 is no different.

 

Masks, I hear you say. Give me a mask!

The situation is varied, depending on where you live; however, the advice from the World Health Organisation remains the same – you only need a mask if you are looking after someone with covid-19. Let’s look at this hypothesis. The basis of mask wearing falls apart when we look at symptoms of covid-19. All research agrees that many people present with little or no symptoms and yet can transmit covid-19 to others. Therefore, we have a situation where the incorrect use of masks actually puts the wearer at higher risk of infection. And health care workers are facing a very real shortage of masks, working directly with covid-19 patients. Are home made masks any value. The jury is still out on that one, and the choice has to be a personal one; remembering that incorrectly applied and used masks cause more harm than good.

 

With all this noise about masks, we have forgotten the most reliable indicator of reducing transmission of infection – handwashing.

Sounds terribly boring, but it is absolutely true. Since Dr Semmelweis made the discovery in 1847 that handwashing saves lives, we have paid little attention to this great fact. Remember being told as a child “wash your hands”. Such reminders are based on historic evidence that handwashing reduces the spread of infection. This analogy is no different with adults and is even more important during times of pandemic. Yes Covid-19 is transmitted through coughing, however social distancing promoted by the World Health Organisation is key to reducing the spread of Covid-19. So why handwashing again? Without handwashing, all the social distancing and masks available will be of no use. Handwashing remains at the heart of reducing the spread of Covid-19. The World Health Organisation has PDF templates, videos and written instructions on how to handwash safely, with soap and water, using a 20-30 second technique that can be easily learned.

 

As you read this article, remember to stay safe and stay well. What that actually means is as explained above. Stay as fit and healthy as you possibly can; and practice good handwashing.

handwashing

Corporate Governance

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governance structure

Corporate Governance

We keep hearing about clinical governance all over the web. So, what has shifted?

Since the changing of the guard in Australia, and the move to the New Aged Care Standards;

Clinical Governance has become the topic of the day.

There are seminars you can complete, left, right and centre.

Each one will have information on Clinical and Corporate Governance.

They will all provide valuable information, and if your organisation is able to act on that information things could change for the better.

But there it is

….. things could change……

How do things actually, really change, with positive business outcomes?

All this and more questions about how to put in place Governance structures.

What are Governance Structures?

They are the frameworks most likely already in place such as strategic directives, financial reasons, and organisational processes.

Yes, that is correct. Governance frameworks are the structures and processes that have always been in place in your company. Whether or not these structures provide a benefit to the consumer/client is a question only you can answer.

aged care standards

There is the link to Clinical Governance.

Clinical Governance requires Corporate Governance to succeed. Put very simply; if a centre of care, does not provide enough staff or enough equipment, then the recipient of care is not receiving adequate care.

So, who decides what is adequate? The answer to that depends on the Corporate Governance structures you have in place to monitor compliance.

If this is sounding like what you are already accustomed to, you are correct.

The new standards are based on care outcomes.

Care outcomes are evidenced through Corporate and Clinical Governance structures, and they evidence they collect, collate and present.

The key is the link. Previously the Aged Care Standards focused solely on assessment and provision of care, and the surrounding environment.

The new Aged Care Standards focus on the role of the Corporate body in contributing to, oversighting, and working with care outcomes.

Why a Registered Nurse

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registered nurse

 

Why a Registered Nurse

 

Since time immemorial registered nurses have been at the forefront of care.

 

Whether in the hospital setting or aged care. Registered nurses provide care for the patients as well as assisting physicians in providing treatment to patients in various hospital and community settings.

The tasks often associated with nursing includes monitoring, recording and reporting symptoms or changes in patient’s conditions.

 

 

The primary issue of the day is why do we need a registered nurse in aged care, when someone with a certificate III or IV can administer medications and perform wound dressings?

The answer is the same as it has always been.

A bowel chart defining seven days with no bowel motion, is just that – a chart.

Any person will know there is a problem; however a registered nurse will understand how serious the problem is, will take immediate action to have it rectified, will undertake a detailed assessment and analyse the data to prevent this from happening again; will contact relevant people to notify of any potential changes; and will clearly document all events.

What happens if there is no registered nurse in this situation..

is not for discussion in this article. The resultant perpetuating medical problems are potentially insurmountable.

 

Why again?

Registered nurses provide not only physical care in terms of administering medication and other treatments, but they also undertake the provision of emotional support during care transition; counsel and educate families in the transition process; collaborate with other medical professionals about changes in care needs; and registered nurses clearly document the issue, the actions taken and the resultant outcome.

 

But!

If your staff are not performing at this level, you have a problem.

Call me right now, so that you can get the professional care you require from your registered nurses.

 

NHQHS Standards

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clinical governance standardsNSQHS Standards

The National Safety and Quality Health Service Standards (NSQHS) provide a Nationwide Consistent approach to about the level of care consumers can expect from health care service providers. Leaders of a organisation providing health care services have a responsibility to the community for continuous improvement of the safety and quality of their services, and ensuring that they are patient centred, safe and effective.

The NSQHS Standards

The NSQHS Standards were developed by the Australian Commission on Safety and Quality in Health Care (the Commission) in collaboration with the Australian Government, states and territories, the private sector, clinical experts, patients and carers. The primary aims of the NSQHS Standards are:

  • to protect the public from harm
  • to improve the quality of health service provision.

They provide a quality assurance mechanism that tests whether relevant systems are in place to ensure that expected standards of safety and quality are met.

https://www.safetyandquality.gov.au/standards/nsqhs-standards/implementation-nsqhs-standards

The NSQHS Standards – Second edition

The second edition of the NSQHS Standards was endorsed by Health Ministers in June 2017 and released in November 2017. Assessment to the second edition commenced in January 2019.

Safe and high-quality care requires the vigilance and cooperation of the whole healthcare workforce.

It is based on a risk management approach that focuses on implementing the NSQHS Standards as routine practice and identifies healthcare staff responsible for specific actions. The second edition addresses gaps identified in the first edition, including:

  • Mental health
  • Cognitive impairment
  • Health literacy
  • End-of-life care
  • Aboriginal and Torres Strait Islander health.

It also updates the evidence for actions, consolidates and streamlines standards and actions to make them clearer and easier to implement.

The second edition of the NSQHS Standards comprises eight standards. Clinical Governance and Partnering with Consumers Standards combine to form the clinical governance framework for all health service organisations. They support and integrate with all the clinical standards, which cover specific areas of patient care. The eight standards are:

  • Clinical Governance Standard
  • Partnering with Consumers Standard
  • Preventing and Controlling Healthcare-associated Infection Standard
  • Medication Safety Standard
  • Comprehensive Care Standard
  • Communicating for Safety Standard
  • Blood Management Standard
  • Recognising and Responding to Acute Deterioration Standard.

 

https://www.safetyandquality.gov.au/standards/nsqhs-standards/implementation-nsqhs-standards

 

Aged Care Standards form part of the Clinical Governance Frameworks in place.

https://clinical-governance.com.au/clinical-governance-2/

 

 

 

principles of clinical governance

Aged Care Funding

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aged care funding

aged care fundingHISTORY

The 1970’s and 1980’s saw a growth in the number of nursing homes built and operated by what we know as the Charitable sector, or Not for Profit (NFP). Resulting in an explosion in the proposals for building new nursing homes and hostels. In the late 1970’s a deficit financing system was established, where Government would meet the deficits incurred in running of homes in the NFP sector. This resulted in more homes taking up the scheme, increasing by 54% by 1983.

As a result a new funding model was introduced in 1987. This was the Standard Aggregated Module (SAM), the Care Aggregated Module (CAM), Other Cost Reimbursed Expenditure Module (OCRE) and the Resident Classification Instrument (RCI).

 

At the same time was the introduction of the geriatric assessment teams which were the forerunners for the Aged Care Assessment Teams (ACAT) that are currently in place. Outcome standards were introduced in 1987 and respite care subsidies introduced in 1988.

In 1992 the Personal Care Assessment Instrument (PCAI) which was modelled on the RCI was introduced into hostels. Funding moved from the RCI to the Resident Classification Scale (RCS), which operated across both hostels and nursing homes. In 1990 a national plan for dementia care was funded.

In 1997 the Aged Care Act was introduced.

CAM (Care Aggregated Module)

These funds were provided to pay for the nursing and personal care of residents. CAM funding is provided at different levels for different residents based on the level of care each resident requires. Residents are classified according to their care needs using the Resident Classification Instrument (RCI). This places residents into one of five categories, with Category One residents requiring the most care, and Category Five residents requiring the least. More funding is provided for those residents with higher care needs. This removes the disincentive to admit residents with greater (and thus costlier) needs.

The audit process used by the Department of Health and Family Services to verify the expenditure of CAM is called validation.
Validation identifies any CAM funding not spent on care, and this was recovered by the Department. Hence at that time we see providers penalised for not utilising the RCI funding on direct care costs.

SAM (Standard Aggregated Module)

SAM funding is for non-nursing care costs, such as food, administration, and building maintenance. SAM funding was a uniform grant, with all nursing homes receiving SAM at the same rate. Unlike CAM, any unspent SAM funds are kept by the operator as profit or surplus. This provides an incentive for operators to reduce SAM costs, so that they can increase their surplus.

OCRE (Other Cost Reimbursed Expenditure)

These funds are provided to reimburse staff related costs such as superannuation, workers’ compensation and payroll tax. Nursing homes in each State receive OCRE at a rate based on the average costs of these staff-related expenses in their State. OCRE funds are also validated by the Commonwealth Department of Health and Family Services.

 

RESIDENT CONTRIBUTION

In addition, residents also contribute to their care costs. The standard contribution was 87.5% of the full single pension plus rent assistance. A small number of nursing homes have been allowed to charge above this rate in return for a higher level of services. These homes were called “exempt” homes, and they had to gain approval through a formal application process.

 

Aged Care Standards form part of the Corporate Governance Frameworks in place.

https://clinical-governance.com.au/corporate-governance/

principles of clinical governance

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