Dear Gillian
As noted previously, I have sold my business. Thanks so much for your fabulous support and encouragement and especially the ‘find me’ conversations we had; so without much ado, I will say ‘cherrio’ and depart quietly.
I wish you the very best going forward with all your ventures and I am sure you have something new on the go as you never seem to sit still….
Warmest regards
Nadene Elrick
Owner – Shoal Bay Villa (Northcote, Auckland)
Mobile app now available for conducting your residential care ARRC specific internal audits.
There are a full range of internal audits pre-loaded ready for use. Collectively, these audits reflect the criteria Certification auditors will be checking.
This process gives you the opportunity to be sure you’re on track with achieving compliance. The findings auto-populate into corrective action tables which prompt timely addressing of these corrective actions. This system syncs with your main computer system and makes reporting to management and Governance boards very easy.
The Certification auditors (after given specific access authority with your permission) are also able to access the results of the internal audits you’ve completed.
To view a brief video on the use of this system, click here.
Dysphagia diets and a lack of understanding of how to implement them consistently, is increasing risk to residents in aged residential care services.
Texture modified diets are commonly used in aged care facilities to manage the risk of aspiration pneumonia and choking with eating and drinking. Residents with dysphagia may be placed on a texture modified diet following assessment with a speech and language therapist. However there are often a range of terms used for texture modified diets, and differing opinions on exactly how the diets should be prepared.
Confusion with terms, and the types of foods and fluids offered leads to increased risk of harm for the resident. This is particularly obvious when transferring from one facility to another. Information on texture modified diets is passed to the new facility who may use different terms. For example a site may report ‘this resident requires a soft diet’ and the interpretation of this diet at the new facility is to puree all food.
The International Dysphagia Diet Standardisation Initiative (IDDSI) is a framework to standardise terminology and offer simple testing methods to check that the preparation of the diets are correct. Dietitians New Zealand and Speech Language Therapists of New Zealand have endorsed in principle the IDDSI framework.
The goal is to reduce the risk of harm for our patients and residents due to miscommunication and poorly prepared texture modified diets. It is important to note that the framework relates to dysphagia diets only. Residents may be on a modified diet due to other factors not related to dysphagia. For example a resident with no teeth may need softer foods but can actually manage sandwiches.
The good news is that for many sites, there is very little change needed as they are already using the correct terms. The diagram above shows the new terminology and the minimal change in wording;
The IDDSI framework assigns standard colours and numbers to assist with easily identifying texture modified foods and fluids. Some manufactures of texture modified foods and fluids are looking at ways to incorporate the terms, colours and numbers onto their food packaging.
Food and Fluid Preparation and Testing
The IDDSI framework offers simple tests to check that the thickness of the fluids or the size of the particles for modified foods are correct. The tests use forks, spoons, fingers or syringes – equipment that is readily available at sites.
With training and education on how to do these tests, kitchen staff and managers will be able to easily check their texture modified diets and thickened fluids are prepared correctly.
IDDSI App and Website
The IDDSI framework have developed many resources and videos to assist with the standardisation process.
Download the app https://play.google.com/store/apps/details?id=com.appdataroom.iddsi&hl=en
or go to www.IDDSI.org
or ask your dietitian and speech language therapist for more information.
Where to From Here?
Here are some small steps to help implement the IDDSI framework at your site:
This article was contributed by Liz Beaglehole NZRD (Canterbury Dietitians) and Anna Miles PhD, Speech-language Therapist, Senior Lecturer, Speech Science, School of Psychology. The University of Auckland.
Winter is fast approaching and now is the time to be preparing your facility for the season’s usual crop of influenza, coughs and colds.
Last year the elderly were hit hard with, not just influenza, but also other respiratory viral infections. Many were admitted to hospital with complications such as pneumonia.
The predominant circulating influenza strain in 2016 was Influenza A, H3N2, different from the previous year’s Influenza A, H1N1. Although covered by the vaccine, last year’s predominant strain changed slightly from what was covered in the vaccine and there were numerous reports of laboratory confirmed cases of young vaccinated adults who still acquired influenza. Despite this, vaccination still affords some protection and symptoms are less severe than without it. This is the same for the elderly whose uptake of the influenza vaccine is not so good – experts agree that there are still benefits from the elderly having an annual influenza vaccine.
Some of the other respiratory viruses last year that caused severe disease in our elderly included coronavirus, rhinovirus and parainfluenza.
Check list for winter virus planning
Ensure all infections are logged into you infection register (for HCSL QA online uses – this is part of your infection log process) – remember your outbreak notification requirements as per your policies and procedures. If you would like more assistance with this please contact us.
This article kindly contributed by: Ruth Barratt RN, BSc, MAdvPrac (Hons) – Independent Infection Prevention & Control Advisor (Canterbury)
[1] Infection Prevention & Control Guidelines for the management of a respiratory outbreak in ARC / LTCF
[2] A Practical Guide to assist in the Prevention and Management of Influenza Outbreaks in Residential Care Facilities in Australia
Moving and Handling and the Health and Safety Act
Thanks to Jessie Snowdon, Physiotherapist for contributing the below article –
All managers will be acutely aware of the Health and Safety at Work Act 2015 (HSWA) and the responsibilities of, and potential penalties, for PCBUs (persons conducting a business or undertaking).
The HSWA requires businesses to ensure, as far as reasonably practicable, the health and safety of its workers. This includes safe systems of work, equipment, training and monitoring the health of workers. These processes are all included in the policies and procedures designed specifically for residential aged care facilities by HCSL.
Within the residential care industry staff are exposed to significant hazards daily in terms of patient handling and manual handling for kitchen/laundry staff. Moving and handling is a hazardous task – it is repetitive, can involve high force (heavy residents) and frequently involves awkward postures. The likelihood of injury for both care staff and residents is high and the consequences can be serious, meaning that moving and handling is a high risk activity.
When we consider moving and handling in this light, managers need to be confident that they have safe systems. Consider how each resident’s transfer abilities are assessed. How is this documented and communicated? How do you know you have the correct equipment on site and how do you ensure that you have enough equipment in order for staff to be able to access it when they need it?
Our experience shows that often if the equipment is not available many staff will do an unsafe transfer in order to save time. How do you ensure new staff are competent prior to undertaking moving and handling tasks? How do you ensure that existing staff are up-skilled? How do you implement the New Zealand guidelines? And how do you monitor your systems, equipment and training? These are questions all managers should be able to answer.
‘On the Go Physio’ carries out Moving and Handling training in over 15 facilities in Canterbury and offer training to representatives from many others. We offer tailored packages which can include up-skilling your whole team, or training your own moving and handling trainers and assessors. We can review your training and orientation systems and assist in equipment trials. If you are interested in discussing your facilities requirements to help you ensure your staff, and resident’s, health and safety contact us here.
For residential care specific policies and procedures related to safe moving and handling, along with related forms for use, contact HCSL here.
Contributed by: Jessie Snowdon (Senior Physiotherapist and Director)
PO Box 32 004, Christchurch 8147
Ph: 0800 000 856 or Mobile: 021 030 9061
Cardigans – a potential vector of infection?
Each winter cardigans or long sleeved tops under uniform tunics appear as part of clothing worn by carers, nurses and other staff providing resident care. Does this practice increase the risk of cross infection?
There are certainly studies that demonstrate that uniforms become contaminated with potential pathogenic organisms including Staphylococcus aureus, Clostridium difficile and Norovirus[1]. It is more difficult to find evidence that links contaminated uniforms with the transmission of pathogens to patients and residents.
Most contamination occurs in areas of greatest hand contact such as pockets and cuffs[2], which may the cause the wearer to re-contaminate their cleaned hands. Long sleeves may also become contaminated with bodily fluids, which then directly contaminate another resident through direct hands on care. This would be a great way to spread around those multi-drug resistant organisms that live in the bowel, such as ESBL, VRE and CRE!
The biggest risk of wearing long sleeves when delivering care involving patient contact is that hand hygiene cannot be carried out effectively. Anyone who has been taught hand washing using the Glitterbug gel and UV light will remember how the wrists were often left glowing, demonstrating that your wrists also get contaminated and need cleaning. In many healthcare facilities across the world, a ‘Bare Below the Elbows’ policy is used to ensure that effective hand hygiene is undertaken. This applies to the use of an alcohol based hand rub or gel, as well as washing with soap and water.
So the next time that you put your cardigan on or come to work with a long-sleeved top, remember that, prior to any patient contact remove the cardigan or roll up your sleeves and perform hand hygiene.
[1] Mitchell et al. Role of healthcare apparel and other healthcare textiles in the transmission of pathogens: a review of the literature. Journal of Hospital Infection, 2015 Aug;90(4):285-92
[2]Loh et al. Bacterial flora on the white coats of medical students. Journal of Hospital Infection, 2000 May;45(1):65-8.
Contributed by:
Ruth Barratt
Infection Prevention & Control Advisor
infectprevent@gmail.com
On a recent trip to Cambodia and Singapore I visited the older members of the community where they were being cared for and spend their final days. In Cambodia, where there are no formal aged care services; I found the older members of their communities being care for by each other in either family or Buddhist temple settings. The choice is often made by the oldest members of families in Cambodian society to leave home and move into a temple and take on the lifestyle of a Buddhist Monk or Nun.
I was honoured to have had the opportunity to visit these folk and talk with them about their lives and experiences. I asked them if they missed anything about their previous life. The answer when I’ve asked that same question of elder folk in New Zealand has resulted in a long list. These gentle folk smiled broadly at me and told me no, there was not a single thing they missed. Their families still came to visit them. It seemed that was all they needed from life as it was!
In caring for each other these ladies practiced the principles of person-centered care. They were not familiar with the term, were not trained nurses and were not carers who had received formal training. Never the less, they provided care as needed by those receiving it. This was about social housing and accommodation rather than a focus on infirmity, disability or ill health.
On my visit to a nursing home in Singapore, it was inspiring to see the elder ladies sewing staff uniforms and other elder men and women preparing vegetables. These would become meals of the children crèche down the road. These folk talked as they worked together. They were connecting and contributing. Making a difference. They were needed and had value. They held a high status within their community.
In the Singapore Nursing home residents lived in the nursing home in 8 bed units, men segregated from the woman. The sense of connection between residents however was obvious from the numbers of people I saw sitting beside other residents’ beds talking with them, interacting together and chatting as they worked.
There were trained nurses and the Welfare Officer who was a fountain of knowledge talked about person-centered care. The residents’ activities programme was full and could have easily been transferable to any NZ residential care facility.
The terms used were the same as ours but as I looked around I could see the implementation of person-centered care was very different from our interpretation of that type of service. Residents were certainly engaged, appeared happy and well care for.
What struck me however was how different our understanding of the term ‘person centered care’ is and how a society’s culture or organisational policies can mean our practice is very different.
This is an important factor to remember when recruiting staff that have been trained and work in other countries. When you describe something to an applicant you’re recruiting and they say they understand the concept, does it necessarily mean you have the same understanding. The picture in your mind of what the outcome will look like may be very different to their mind-view? Sometimes it pays to ask more questions!
“I was referred to Gillian Robinson (HSCL) through a colleague as I knew I needed expertise help when starting out in the aged care industry. Little did I know I would get the best!
Working alongside someone as passionate as Gillian is a privilege which reflects the level of commitment she makes to you as a client. From the phone calls and emails, to the training sessions, to the continuous improvement guidance and depth of knowledge that is implemented in our system. I can’t thank Gillian enough for her support and have no hesitation in recommending her services to anybody in the healthcare sector.
She knows this industry inside and out and has played a pivotal role in our success as an organisation”.
Tracey Dimmock-Rump – Owner / Manager
I remember years and years ago hearing about the coming of the paperless society! Do you recall that? Have we achieved it? If anything, we’re surrounded by more and more paperwork. I receive enquiries on a regular basis from disgruntled nurses that are bogged down in paperwork and wanting to know if there is a simpler way to do things that will allow them time to get back to hands-on nursing; spending time with their residents.
I’m more than happy to help you with freeing up your time and still achieve all the necessities of documenting service provision. One way to do this is using smart computer software. I realise that up until recently our industry has not been ready for this however with the surge in uses of Facebook and other social networking sites, computers are not as intimidating as they once were!
I’m committed to getting your nurses back on the floor while working on the basis of continuous improvement and providing excellence in care based on evidence based practice. In order to help me develop the tools you need I’d appreciate you taking a few minutes to complete this quick and simple survey.
Thank you for your time and look forward to getting a solution that will allow you to get out of the office and back to your residents!
