Standard 3 - Requirement (3) (b)
Effective management of high-impact or high-prevalence risks associated with the care of each consumer.
Intent of this requirement
To meet this requirement, organisations need to do all they can to manage risks related to the personal and clinical care of each consumer. This means following best practice guidance and applying measures to make sure the risk is as low as possible whilst supporting a consumer’s independence and self-determination to make their own choices, including to take some risks in life.
Effective management of risks is underpinned by clinical governance systems for safety and quality. This includes reviewing how personal and clinical care is delivered to apply new practices and responding appropriately and promptly to a consumer’s changing needs.
For high-impact or high-prevalent risks related to the personal and clinical care of each consumer, organisations are expected to use risk assessments to find ways to reduce these risks. They should do these assessments in consultation with the consumer. This can involve the organisation’s service environment, equipment, workforce training, systems, processes or practices that affect any aspect of how they deliver personal and clinical care to consumers.
Organisations are expected to manage risks related to the care of each consumer in line with the consumer’s care and services plan. This is so that the organisation supports them to safely maintain their best possible level of independence and function. For example, if there is a risk that a consumer may fall, the care and services plan would include what assistance or mobility aid the organisation will provide to help the consumer to move about safely.
The organisation is expected to educate and support its workforce to minimise risks to consumers. Members of the workforce providing personal and clinical care to consumers also need to have the right qualifications, knowledge and experience to deliver care safely. To develop strategies to minimise the affect and number of risks for consumers, organisations can use advice from allied health practitioners and others.
Organisations need to deliver personal or clinical care and manage risk in a way that balances the consumer’s rights and preferences with their safety and the safety of others. This includes managing challenging behaviours in ways that involve the consumers, and respects their rights, dignity and independence. This means organisations can manage risk and provide personal and clinical care in the least restrictive way and least restrictive service environment, while keeping consumers, the workforce and others safe.
Dementia affects many consumers receiving care and services.There are some gaps between what generally happens now and what is best practice care for consumers living with dementia. Although antipsychotic medicines may be appropriate for adults with severe mental health issues or long-term mental illness, there is concern that these medicines are being prescribed inappropriately in people aged 65 years and over for their sedative effects – that is, as a form of chemical restraint for people with psychological and behavioural symptoms of dementia or delirium.
Understanding and applying best practice in care and services for consumers living with dementia is vital to delivering safe and effective care and services that meet the consumer’s needs, goals and preferences. Consumers living with dementia are also at higher risk of harm from the points listed below.
While organisations need to manage all risks related to the personal and clinical care for each consumer, some risks are more common and have a higher impact on the health and well-being of consumers. Preventable harm from these risks continues to happen in aged care. This includes:
- managing hydration and nutrition – This is important for a consumer’s quality of life. It helps to minimise the risk of infections, pressure injuries, anaemia, hypotension, confusion and impaired cognition, decreased wound healing and fractures.
- managing risks of choking – Swallowing difficulties are common among consumers. If a service doesn’t manage swallowing problems, it can lead to death from choking.
- managing medications safely – Consumers can have multiple medical conditions and use several drugs together. This means that they are at high risk of medication mistakes. These mistakes can result in hospital visits that could have been avoided, illness and death. This risk can be minimised through effective policies and procedures that support safe use of medicines.
- managing pain – If pain isn’t managed, it can make consumers confused, they can have interrupted sleep, not get the nutrition they need, be less mobile, feel depressed and isolated and take longer to get better.
- preventing and managing pressure injuries – When consumers can’t move around on their own, they can get pressure injuries. Factors such as poor nutrition, poor skin health and lack of oxygen to tissues can also cause pressure injuries.
- minimising restrictive practices– These interventions have high potential for harm and are practices that organisations can avoid with positive changes to how they assess, plan and deliver personal and clinical care for consumers. If an organisation uses restrictive practices, they should be a last resort, for as short a time as possible and in line with best practice.
- managing delirium – This is a common and serious problem for consumers that isn’t well understood. Not recognising the signs of delirium can prevent organisations from providing quality personal and clinical care, and impact the consumer’s well-being.
- managing hearing loss – Hearing loss is a common condition in consumers. There is a clear link between hearing assistance and improving a consumer’s quality of life. This includes less social isolation, stress and frustration, as well as reducing the risk of consumers developing medical conditions, such as depression.
These examples are not all the risks that an organisation may need to manage for consumers. However, there are some of the common risks that organisations need to identify and manage. If organisations appropriately manage risks, a consumer’s care and services should be safe and effective and improve their health and well-being.
- How does the organisation tell the workforce about relevant legislation and best practice standards for managing high-impact or high-prevalence risks when caring for consumers? What processes are in place to make sure that evidence-based documents and tools for managing high-impact or high-prevalence risks are up-to-date and in line with best practice?
- How does the organisation make sure that the workforce is following best practice guidelines and tools to prevent and manage high-impact or high-prevalence risks?
- What assessment tools or processes does the organisation use to monitor and respond to high-impact or high-prevalence risks to consumers? How are consumer care and services plans and risks communicated to members of the workforce who deliver personal and clinical care?
- What systems are in place to gain access to relevant health professionals’ assessments that can help prevent and manage high-impact or high-prevalence risks for consumers?
- What information and support does the organisation provide to consumers about preventing and managing high-impact and high-prevalence risks related to their personal and clinical care?
- How does the organisation evaluate and review how they manage of high-impact or high-prevalence risks in the personal and clinical care the deliver for consumers?
Examples of actions and evidence
- Consumers say their care is safe and right for them.
- Consumers say members of the workforce explain risks to their well-being and they get to have input into the steps to reduce the risks.
Workforce and others
- Members of the workforce can describe how they identify, assess and manage high-impact or high-prevalence risks to the safety, health and well-being of each consumer when delivering personal or clinical care.
- The workforce can describe how they get information or advice on best practice to manage high-impact or high-prevalence risks.
- The workforce can describe how the organisation supports them to identify and manage the high-impact or high-prevalence risks to the safety, health and well-being for each consumer.
- Workforce orientation, training or other records that show how the organisation supported the workforce to understand their roles and responsibilities to prevent and reduce harm from high-impact or high-prevalence risksand meet this requirement.
- Policies and procedures describe how the organisation manages high-impact or high-prevalence risks to the safety, health or well-being of consumers.
- The organisation uses best practice guidelines, decision-making tools and protocols to manage high-impact or high-prevalent risks to consumers.
- Documented risk assessments and care and services plans for each consumer and evidence that the organisation delivers personal and clinical care in line with these assessments and care and services plans.
- Records of relevant allied health input to preventing and managing high-impact or high-prevalence risks for consumers.
- Records of ‘near-misses’ and incidents and actions taken to address risks are documented.
- Communications that show that the organisation updates the workforce on new or changed practices to assess and manage high-impact or high-prevalence risks to consumers’ safety, health and well-being.
- Evidence of continuous improvement, including how the organisation reviews its policies, procedures and practices based on evidence. As well as how it learns from what’s not working.
- Evidence of monitoring and reporting of performance against this requirement.