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End of Life Choice Act implementation – 7th Nov 2021

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End Of Life Choice Act HCSL

As you will be aware, assisted dying will be legally available in New Zealand from November 7 when the End-of-Life Choice Act 2019 comes into effect.

The introduction of assisted dying means that a person with a terminal illness who meets the eligibility criteria can request medication to relieve their suffering and end their life.

The Act sets out the legal framework and a high-level process for accessing assisted dying, including strict eligibility criteria and safeguards.

Assisted dying is not a replacement for palliative care or health care services more generally. It provides another option for people with a terminal illness in certain circumstances.

Assisted dying remains illegal until 7 November 2021.  The Ministry of Health will be responsible for the Act and has an implementation programme underway to implement the assisted dying service.

This may impact hospitals, care facilities and retirement villages across the country in an entirely new way, so we at Healthcare Compliance Solutions Ltd have been following the Ministry of Health’s guidance along the way, to ensure our policies and procedures help our new and existing clients through the process, as best as possible.

If you would like to learn more about how Healthcare Compliance Solutions can help you and your orgnisation.



Contact Us

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Alexander House

Alexander Rest Home

“HCSL has been incredibly easy to navigate since we went live on the system on the 1st of October. Our team have people with varying levels of technology literacy and the ease of this system has meant that staff are more confident to use technology and see how it can help to improve time management by not having to double or triple up on written documentation.”

Manager

Alexander House Rest Home

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Bench-marking – Aged Residential Care

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his New Zealand designed web based (on-line / in-the-cloud) Bench-marking and quality management system from Healthcare Compliance Solutionhttp://www.hcslqms.co.nz/s Ltd allows you to:

  • Bench-mark in real-time – specific to resident type, event type, date and time of day.
  • Have automated default reports to save you time analysing your data trends and patterns
  • Drill down into your data easily to identify opportunities for continuous improvement
  • Complete your internal audits online and have the corrective actions auto-populate into a corrective action log
  • Log and manage adverse events
  • Bench-marking of adverse events against other aged care providers
  • Support evidencing an active Health & Safety programme is in place
  • Log and manage infections – automatic outbreak registers
  • Bench-marking of infections against other aged care providers
  • Log and manage your complaints with time-frame, investigation and response prompts
  • Dashboard view options for level of care and any chosen 3 monthly time-frame review
  • Dashboard view option of adverse events or infections
  • Logs (event registers) appear with individual events in one colour when open and change to another colour when the event is closed. This allows you to see quickly the status of events. 
  • Use in conjunction with your current policies / procedures or update to the HCSL site specific created policies and procedures. 

Your organisation policies and procedures and related documents (if created by HCSL) are also accessible through the Facility Documents tab on the left of the screen for remote anytime, anywhere access.  The keyword search option on the policies and procedures in addition to precise indexing and coding of documents makes it very quick and easy to locate information for staff to reference.

You can also upload your own documents for confidential safe storage.

This is what Rhonda Sherriff, NZACA Clinical Advisor says about using the HCSL QA system:

“I am very happy to endorse your system as the information is invaluable for CNMs to analyse the data/information and make informed decisions on best practice and innovation to decrease hazards, improve outcomes, and mitigating factors for resident welfare. I’m pleased you are delving into the data to the level you are, as it’s time saving for sites in many respects, and so easy to dice and slice the information to get the trends. CNM’s used to spend hours just writing up the collective information before the analysis, so hugely time saving”

To view a brief video explanation of the system click here. This programme has been operating in NZ Aged Care since mid 2016 so now has many thousands of pieces of data to compare yourself against.  

To find out more contact us here.

 

Making monitoring your service remotely in LIVE time easy!

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Quality Management Systems

The below question and answer were published in the New Zealand Aged Care Association industry ‘In-Touch’ newsletter (19th February 2016).

Question: A member asks “if we purchase a comprehensive quality management system from a provider how assured are we that the system will meet full compliance, come certification and surveillance audit time, as requirements and compliance expectations change frequently?

NZACA Clinical Advisor Answer: “You should be purchasing a complete quality management system that will comply with the Health and Disability Standards specifications, health and safety requirements and meet DHB/ARRC contractual requirements.

The provider of the system would normally initially tailor the full quality management package to reflect accurately the site specifications, H.R. component, and best practice guidelines, after consultation with the owner and management on site. These documents need to be site specific. The provider will normally contract to the site, which sets out obligations between the provider and the site management.

The contract will include the full review and updates of policies and procedures on a bi-annual basis, unless specified more frequently, to keep documents accurate and reflective of best practice. There may be an educational element provided within the contract as well, to benefit staff knowledge and skills. There is normally a good document control system in place and cross referencing of information where required.

Quality management systems are reliant on the skills and knowledge of the site personnel working with them, the way the system is managed and the outcomes/reviews, content and information extricated from the use of the system to improve quality care provision/outputs. The documentation system is reflective of the people using them, and the depth to which documentation and information is created, analysed and utilised for improvements.

Auditors on site rely on the provision of robust up-to-date policies and site adherence to them. Partial attainments can sometimes result from staff deviating from, or not following, their sites actual policies or processes as outlined in their quality management system.”

Where can you get such a system? 

Here at Healthcare Compliance Solutions Ltd we provide the services described above and noted as being optimal for achieving excellence in care and audit outcomes.   To see a brief video about the Aged Care software update and now in use by over 3,800 users in NZ, click here. 

Request a no obligation consultation here.  

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HCSL Aged Care Software – Version 2  instruction videos

HCSL Aged Care Software incorporates quality and risk, bench-marking, internal audit management systems as well as clinical functions) and how to use them.  These systems have all been audited numerous times for ARC provider Certification with maximum four year outcomes being achieved where the system is fully implemented. Tried and testing; pre-approved audit compliant.

Please click on the following links (the blue words below) to watch videos which describe the functions of the HCSL Aged Care cloud-based aged care software.

Gives you a general over-view of the key Dashboard and Resident clinical management functions available as at December 2019.

Guides you in how to upload or change a resident photo within their online profile

Guides you in how to add, view or search resident progress notes.

The HCSL system functions are able to be used in their entirety or some care providers use only the policies and procedures with the dashboard for quality and risk management; while others use the full system including the care planning and progress notes.

We have several care provider sites currently who have become paperless using the HCSL system in conjunction with Time-target, Medimap or 1chart and InterRai. The mix of paper based and IT based depends on your site, the IT skills of your staff and their access to computers.  There are a range of service options available depending on what suits your current circumstances.  To find out more about the service level options available click here

We continue to add features to evolve the system in response to changes in clients and industry needs. This evolution is intended to be an ongoing process and we look forward to your feedback and ideas.  Each change is considered on the basis of how it can be used by clients to ease their workload, streamline and save time while giving useful information.

HCSL Aged Care software systems are created by Healthcare Compliance Solutions Ltd through Version 1 or for version 2. Access codes are provided to clients with a current service agreement in place.

If you would like more information on the services which are available click here.

If you would like to receive our HCSL Aged Care newsletter which is published every 6-8 weeks, email us on gill@agedcarecompliance.com with your contact details.  This is also the email address if you have any further questions on HCSL software and services.

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Terrace View Retirement Village – Ashburton

I was first introduced to Gillian Robinson of Healthcare Compliance Solutions Ltd (HCSL) in 2016 when I took up the Facility Manager position at Terrace View Retirement Village.

The facility had HCSL in place but were not fully utilising Healthcare Compliance Solutions policies. The first thing to do was to get Terrace View fully operational under Healthcare Compliance Solutions. Gillian was very supportive during this change providing education to myself, Clinical care manager and our team.

HCSL aged care software is easy to find your way around. Our Nurses have reported that care planning in HCSL is saving them time. Everything is in a logical order.

Features that make my role easier are the ability to track trends in adverse events and infection control. To be able to bench-mark our data within the industry to see how we are trending against our peers.

Terrace View is very excited to be moving to HCSL aged care software version 2 so we can become fully electronic. To be able to search a file or document from the computer saves all the team time.

Gillian’s knowledge of the aged care industry and how the sector works is reflected in the software she has developed and is designed to increase nursing team efficiency in a very time restricted environment.

Donna Coxshall

Facility Manager

18th February 2020

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Staffing levels – is skill-mix the formula for success?

This month we look at the discussion around whether mandated staffing levels in aged care, as a ratio of care hours to residents, would improve care services?

Rather than numbers of personnel alone, to provide safe and appropriate nursing services, staffing skill-mix (taking into consideration the workforce diversity) is essential to ensuring appropriate effective staffing. These factors are not taken into account or provided for within the industry funding levels which puts additional pressure on those working in aged care services.

While performing statutory (temporary) management roles over past years, adequate numbers of staffing alone hasn’t guaranteed safe and appropriate care. Nursing outcomes for residents have been reliant on a mix of highly skilled staff working in conjunction with newer or less experienced staff to guide and mentor.  There could be 10 staff on duty but if none of them have had previous experience working in aged care services, these staff are set-up to fail in performance of their duties, and the resident care outcomes are likely at risk.

SNZ HB 8163:2005 – ‘Indicators for safe aged-care and dementia-care for consumers‘ is a national document which includes formulas for staffing levels based on acuity of residents. This document set industry guidelines and although not mandated, defines staffing from a best practice perspective. Numbers alone as already mentioned are not sufficient.

Outdated for the acuity of residents needs in 2019 and onward, the 2005 guidelines didn’t take into account a range of factors. For example the size and physical layout of the facility, location of resources, the leadership structure and how work teams are configured, economy of scale and appropriate cover.  The minimum staffing requirements in the ARRC   is well below that sufficient to meet resident needs.  Having been implemented in 2005 (SNZ HB 8163:2005) when resident needs were less complex than they are now, it’s well past time to review how staffing skill-mix is determined and more importantly how the industry will be funded for increased staffing to meet the increased needs of residents.

HCSL developed a 5 step acuity assessment tool in response to providers requests after being frustrated by using the two tier InterRai assessment which give outcomes of resthome or hospital level of care. InterRai doesn’t reflect the range of acuity represented in SNZ HB 8163:2005 from a care level perspective.  As reported by numerous registered nurses working in aged care, the complex clinical presentation of residents being admitted into care is not accurately reflected in InterRai which is why they still need to supplement InterRai at times with more detailed clinical assessments.

Achieving desired outcomes for residents and the timeliness of appropriate care support based on individual assessed needs should be the aim for the allocation funding to ensure adequate staffing levels.

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Bethsaida Resthome, Hospital and Retirement Village Testimonial

We are very pleased to have recently been granted 4 year MOH Certification! No corrective actions and three Continuous Improvements.

This follows on from a fully attained Partial Provisional Audit that was required prior to opening our two new wings earlier this year with no corrective actions.

Make no mistake!  HCSL policies, software and support have played a major part in these accomplishments.  The HCSL software we use means we have easy access to information in real time.

I started working with Gillian of HCSL shortly after I took on the role of Facility Nurse Manager at Bethsaida Retirement Village six years ago. The facility was not using Healthcare Compliance Solutions policies at the time and perhaps this was reflected in the previous audit results.

Gillian is always responsive to emails and phone calls which is critical when timely advice is required.

The HCSL regular newsletters are interesting with relevant and up to date information on issues affecting aged care.

Gillian is a lovely person to deal with. She is thoughtful, professional, pragmatic and I have always found her to be keen to help, with practical advice on any issues that might arise in the management of a retirement facility.

I thoroughly recommend HCSL to all aged care facilities.

Tracy Holdaway RN BN

Facility Nurse Manager

Bethsaida Retirement Village

August 2019

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Mandated minimum nursing hours – will it work to ensure safety and productivity?

The question of whether mandated minimum nursing hours would work has been asked previously. The workload of care and nursing staff is frequently discussed with staff reporting they are pressured for time to complete all the necessary duties assigned.  The Nursing staff have different but over-lapping functions to care staff.  When reviewing your staffing, it’s important to include a number of factors into any review when looking at the productivity and efficiency of your team.

We suggest you look at not only leadership and skill-mix, which are vital for safe services but also consider other factors. These can include the location of high acuity needs residents within your service.  With an increase in the use of dual beds, the mix between rest home and higher acuity hospital level of care are now intermingled and not specifically allocated to one area of the building.  This means the Registered Nurses providing clinical monitoring and oversight may have to spread their attention to a much more fragmented and broader geographical area in your service than was previously the case.

The location of resources and time spent looking for items of use and equipment could be minimised if more thought was put into the design of new facilities and the locating and management of replenishing stores for ready access by staff as and where they need them.  Who does the running and fetching could also be considered in work roles so staff with high end clinical skills are spending the bulk of their time on performing functions specific to their role and skill.  Not doing tasks that could be better delegated to others.

After the recent sudden closure of a care facility in Australia without apparent planning or communication with families, there has been outrage that such a thing could happen.  The “Queensland Premier Annastacia Palaszczuk announced her Government would order fixed nurse-to-resident ratios in state-owned aged-care facilities.”  The ABC news report (19th July 2019) goes on to say “at least 50 per cent of staff having contact with residents in 16 publicly run aged-care centres to be nurses.”  I don’t know if by nurses they mean Registered Nurses only and not Enrolled nurses but I can’t help wonder if this alone will ensure safety.

One year on from Simon Wallace (NZACA CEO) reporting on staffing shortages, we haven’t seen any improvement it would seem!  In New Zealand an increasing proportion of our Registered Nurses have come to New Zealand to practice with no prior working knowledge of aged care services. They frequently have limited aged care related experience to conduct the complex assessment and clinical management of high acuity residents in a residential care setting.  This is not to diminish their value as we can’t provide the services needed otherwise.

What I’m trying to highlight in the current circumstances is, we’re frequently seeing nurses set up to fail or provide less than safe care as they simply don’t have the experience in this specialised field of nursing.  I recall conversations in the early 1990’s predicting a massive nursing shortage.  It appears that in the time-span between then and now, we haven’t addressed this issue.

We welcome comments and suggestions of how this could be addressed here in New Zealand before we end up in the depths of a staffing crisis which halts care.

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Audit Tips for Clinical Documentation

Clinical documentation and clinical management relate to section 1.3.1 to 1.3.8 of the Health and Disability Services Standards and are referred to in section D5.4 of the ARRC.  There are key reference documents which provide reference at residential care facility level which should be used in conjunction and addition to your organisation policies and procedures.  These reference documents include:

  • Age Related Residential Care (ARRC) contract
  • NZS 8134:2008 Health and Disability Services Standards
  • Clinical best practice (EBP) guidelines – eg; Lippincott
  • The Code of Health & Disability Consumers Services Rights 1996

Clinical documentation errors of any type noted during audits will result in partial attainments at best.  This is an indication there could be risk associated with gaps in service. In a previous article about medication management we noted that even a single signature missing off an administration signing sheet was enough for the auditor to assign a partial attainment finding.

Below are some of the common compliance gaps which relate to clinical documentation:

General compliancegapsMissed signatures off notations.Not dated.Not signed by the author with a full signature.No designation written with signature.Not legible.Inconsistent structure of resident files.Unclear or unsecured archiving of documents.Privacy breaches due to clinical documents placed in a situation that allowed unauthorized viewing.
Initial assessmentsincluding InterRaiNot completed within time-frames defined in ARRC.Baseline recordings at time of admission not recorded.Assessment outcomes not used as a basis of care planning to link assessment to goals and interventions.Additional detailed assessments not reviewed in a timely manner eg; six monthly to coincide with InterRai reassessments.Failure to re-assess for each period of admission eg; respite care.
Clinical riskAssessment not describing risk.Risk not reflected in care plan interventions.Lack of risk reviews.Level of risk noted in interRai assessments not included in care planning
Progress notesNot recorded in on a shift by shift basis.Lack evidence of regular registered nurse input.Writing beyond the bottom line of the page.Failure to put resident identifiers on each side of each page (this applies to other clinical documents as well).Lack evidence of interventions being implemented.Lack evidence of RN response to clinical symptoms reported by care staff.Lack of evidence of rationale for PRN medication administration or the resulting effect.
Short TermCare PlansNot developed for changes in clinical status eg; increased pain; infection; wounds, change in medication (to allow evaluation of effectiveness).24 hours plans not developed for residents displaying behaviours of concern (challenging behaviours).Not evaluated regularly (I suggested at least once every 7 days) by a Registered Nurse.Not recorded as resolved or transferred to Long Term Care Plan.Not developed to implement instructions included in General Pracitioner consultation plans recorded in notes.
Long TermCare Plan (LTCP)Not reflective of all presenting potential and actual medical / clinical problems.Not documented within 3 weeks of the date of admission (ARRC requirement).Not changed at the time of health status / functional change.Interventions not reflective of each medical diagnosis.Interventions not changed within LTCP to reflect changes recorded in care plan evaluations.Frequency of clinical assessment for each actual clinical presentation eg; pain.Do not clearly indicate the level of function, assistance required for each component of care / support.Do not clearly evidence input and instruction from Medical or Nurse practitioner / Physiotherapist, Diversional Therapist, Dietitian,Psychiatric services             for the elderly etc.
Care PlanEvaluationsReview of care plans not reflecting changes in residents health status as they occur.Not reflective of how well the care plan goals/ objectives have been met since the previous evaluation.Not completed within ARRC defined time-frames (at least six monthly).
Multi-DisciplinaryInputLack evidence of MDT input into care plan reviews and/or evaluations.Lack evidence of resident, Next of Kin (NOK) / Family / Whanau / EPOA input into assessment and care planning.Lack of evidence of timely referral in response to clinical presentation eg; unintentional weight loss not referred to Dietitian.Failure to evidence implementing instructions ofMedical or Nurse Practitioner eg; B/P to be recorded daily for the next 7/7 may be noted in the medical           consultation notes however not evidenced as having been done.Lack evidence of notification to NOK / EPOA relating to resident adverse events, change in health status, medical consults etc.
Policy andproceduresNot consistent with service delivery as noted in clinical documentation.

Internal audits are available through the online HCSL quality system utilised by our clients which allows tracking of compliance status and corrective actions as part of on-site quality and risk management. This means when the auditors arrive, there will be no surprises and you’ll know you’ve achieved excellence in care in conjunction with providing a compliant service.

If you have any comments to make about this article, please contact us here.

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