All mobile device compatible so you can be with your residents rather than stuck in the office!
HCSL bringing cost effective, specifically designed tools for the New Zealand residential care sector. The Corporates have their tools, why shouldn’t you have the same advantage?!
To find out more and get a no obligation free quote for use contact us here.
Upon reading one policy everything fell neatly into place. I found her documentation to be outstanding. It is very reassuring to know that every policy and procedure is the most up to date and designed to meet audit requirements. All her forms are easily accessible and very user friendly. We can instantly benchmark against others. At the click of a button we can analyse falls, infections and adverse events. Creating graphs and other information for Board reports takes minutes rather than hours.
Having come from a background of many years in QA, HSE and Electronic Document Management in the Oil and Gas Industry, when I entered the aged care sector, it was a huge “eye opener”. After sitting through several handovers and meetings and listening to discussions on medications etc I felt as if I was listening to a foreign language. Oh my goodness I thought and then Gillian’s documentation arrived together with a visit from her shortly after.
Gillian’s enthusiasm and commitment for both the aged care sector and her documentation is contagious. I feel I can now discuss, with the knowledge I have acquired in a few short months, aspects of aged care I never knew existed. Gillian is only a phone call or email away and all queries are always answered promptly, no matter how minor.
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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….
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Topics included: Quality & Risk Management, Clinical Leadership, Clinical Documentation, EPoA, ARRC, Communication and Difficult Conversations
I am writing this endorsement on behalf of my colleague and myself, in relation to our attendance at the study day you hosted 5 July 2017.
The topics you presented were most relevant to our Registered Nurse role within the aged care sector, and between us both provided new learning opportunities, as well as refreshing the current knowledge we already held.
You addressed each session in a professional and engaging manner that held our attention, complemented by comprehensive written material as well as PowerPoint presentations, along with plenty of opportunity for questions and comments from the floor.
Gillian you are one of very few speakers that is able to hold my attention for more than one session let alone a whole study day, a perfect balance between speech and conversational styles!
We were also most impressed by the quality of the complementary gift bag that was given to each attendee containing not only goodies to help us through the day, but with something to take back to the workplace, I acknowledge both Cubro and Ebos for their support with this.
The venue was great with easy access and good parking, and it was clean and refreshing providing plenty of comfort and personal space for those attending. I will be recommending my associates to make a note in their diary for next time. Thank you Gillian
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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;
‘Smooth puree’ becomes pureed (which is also extremely thick fluids)
‘Minced and moist’ remains unchanged
‘Soft diet’ becomes ‘soft & bite sized’
Moderately thick and mildly thick remain unchanged for thickened fluids
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.
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:
Stop using any terms that are not on the framework. The term ‘mouli’ is not recognised and should not be used to describe a texture modified diet.
Download the app or look at the IDDSI website to familiarise yourself with the framework.
Try testing one of the textures you currently prepare. Does the ‘puree diet’ your site produce pass the spoon tilt test? Does the size of the minced food for ‘minced & moist diets’ fit between the prongs of a fork? Is the size of meat offered for residents on the ‘soft & bite size diet’ the size of your thumb nail?
Ask your dietitian or SLT for further training on the correct testing and preparation of dysphagia diets.
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.
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Success leaves clues but often these aren’t being picked up so you miss the learning and miss the opportunity to recognise growth or gain continuous improvement in your audits.
In residential care, HealthCert (MoH) Certification processes appear solely to promote a goal of verifying compliance with requirements. Looking deeper however, the goal of meeting requirements ensures the protection and support of those in your care. This can then be evidenced in a way that’s reflective of service received as meaningful, safe and appropriate by individual residents.
It’s no longer an expectation that you’ll have a number of partial attainments as a result of an external audit. The expectation is full compliance and showing evidence of continuous improvement, going over and above the base ‘pass-mark’ brings you into line with your high performing peers. I’ve heard managers say “but it’s the Auditors job to find things wrong so we expect to get partial attainments.” That is out-dated thinking and doesn’t fit the current audit and compliance environment or continuous improvement philosophy.
Systems can’t be implemented to show compliance, if staff are not looking at policies and procedures, or using them to guide services and care of residents. If individual staff or managers do what they think best, based on previous experience, without verifying whether that practice is still appropriate or best practice, they do themselves and residents a disservice.
Success leaves clues. It’s apparent when quality systems are implemented, outcomes are checked in a measurable way, recorded, examined, analysed and greater gains identified for future implementation. This is a cycle and if you have the right tools to record your continuous improvement projects on, you too will be in the elite who are out-performing those who continue to have multiple partial attainments (deficits) in audit. Don’t be a provider that looks at others saying it’s ok for them; they have this or that or the other reason for their success but we don’t have those things so we can’t achieve. Don’t make others extraordinary to let yourself off the hook. You can have, and deserve to have, all the recognition for the amazing work you perform just like others who are achieving four years.
The lack of a robust up to date quality system, along with deficits in implementation, will lead you down an expensive compliance track. Expensive in loss of reputation as audits are published and accessed online by the public, expensive in loss of time trying to figure things out yourself, increased risk to residents, loss of financial resources as you end up being audited more often than would have otherwise been necessary. The better you achieve at audit, the longer your period of certification, the less often you are audited and therefore less often you’re paying auditors fees!
A common failing in the care facilities under Temporary Management has been from the lack of a proven quality system and application of that system into service provision. I’ve been contracted into a number of sites as a Temporary Manager over the years and this has consistently been the case.
If you would like a free Continuous Improvement Project template to help you identify and record your success, contact us and we’ll email it to you.
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
Encourage and offer seasonal influenza vaccination to both staff and residents
Ensure hand sanitiser is available for visitors at the entrance of the home
Consider displaying a poster discouraging visitors with symptoms – a poster is available from CDHB communications
Remind staff and residents about good cough etiquette / respiratory hygiene
Have a good stock of tissues and hand sanitiser for residents
Remind staff to stay off work if sick – no-one wants their germs!
Educate staff about S&S of influenza – not all residents will display fever or cough
Keep residents in their rooms if symptomatic and introduce droplet precautions, i.e. droplet masks for staff providing cares
If you suspect an outbreak then confirm the outbreak[1] and introduce control measures[2]
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)
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 HCSLhere.
Contributed by: Jessie Snowdon (Senior Physiotherapist and Director)
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Thanks to Liz Beaglehole – Registered Dietitian for contributing the below article –
With the introduction of the Food Act 2014and the requirement for most aged care facilities to have registered their food control plan (FCP) by March 2018, I thought I would write this article on a common kitchen practice that will require review. This relates to one important key component of food safety.
FCP’s are included in the policy and procedure documentation provided by HCSL specifically designed for residential care facilities.
In many facilities the main meal is served in the middle of the day and the tea meal served at night. The main cook of the day will prepare the tea meal earlier in the afternoon, and then finish his or her shift. The tea meal will be reheated by the afternoon staff and served to the residents.
The process of cooking, cooling and reheating requires careful control of the food safety risk. Many tea options are protein or carbohydrate based; macaroni cheese, egg dishes, savoury mince, chicken options – all of which are high risk foods for bacteria growth.
Foods need to be cooled quickly to avoid time and temperature abuse, which may allow bacteria growth. The guidelines state that when cooling hot cooked foods, the food must cool to at least 21° within the first two hours, and then cool to below 5° in four more hours. Overall, the food must be out of the danger zone (between 5°C and 60°C) within six hours.
A functioning chiller should allow cooked foods to cool within this timeframe. Using domestic fridges that are overcrowded, may mean the cooling guidelines are not met. Using shallow dishes rather than large deep dishes will also allow foods to cool faster.
The food control plan will specify the process the site kitchen must follow with regards to cooling of cooked food. Temperatures during cooling will need to be checked and recorded to ensure the time / temperature targets are met.
Prior to serving, the food must be reheated to above 75°C.
Some sites choose to hold the prepared food hot until service. Food must be held hot at a temperature of at least 60°C, usually in a bain-marie or oven at 70°C. Any food held below 60°C for more than 2 hours, must be thrown out. Note that holding foods hot for this period of time may affect the food quality.
Main Points:
Food safety risk with cooling and reheating foods must be managed with FCP
Cool cooked food to below 21°C in 2 hours and below 5°C in 4 hours
Reheat foods to above 75°C before service
Hold hot prepared foods at 60°C or more
Document food temperatures and any corrective action
Review corrective action implementation to ensure they have been effective
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I have found that having Gillian’s (the HCSL) system available has been a huge help to our village. Documents are easily accessible at my fingertips and it hasn’t taken long to memorise some of the codes for the more frequently used ones.
If we are having trouble finding a document or we want to make any adjustments, Gillian is always very accommodating and helpful. She is easily contacted by telephone or email and if she is busy, always gets back to me as soon as she is able to. I particularly like that if I want to type into a document, Gillian makes this available.
When the documents are due for updating, Gillian takes care of this, printing all of the documents and putting them into new folders for us. She even delivers them personally, which is always a pleasure. I find Gillian very approachable and extremely knowledgeable and happy to share her knowledge.
Gillian assists us with our training requirements by coming to Chatswood and going through the annual compulsory subjects with myself and my staff. She is great at presenting and the passion about her work shows in the way she shares her own experiences with us.
I look forward to our continued working relationship.
