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Elise, Brianna. "Person-centred care in Australian aged care." International Practice Development Journal 13, no. 1 (May 24, 2023): 1–4. http://dx.doi.org/10.19043/ipdj.131.011.
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This paper is derived from research I undertook as a part of my honours degree in nursing. My research produced a thesis that examined person-centred care in Australian residential aged-care settings. The idea for this came from my 15 years’ experience as an aged-care nurse and questions arising from my lived experience of person-centred care not being a reality for residents, families and staff despite being widely espoused in the aged-care sector. The sector in Australia is undergoing a system redesign, with proposals for a new Aged Care Act put forward this year by the Royal Commission into Aged Care Quality and Safety (RCACQS, 2021) after a review of the aged-care system between 2018 and 2021. The review looked into the prevalence of elder abuse and estimated that almost 40% of residents may have experienced emotional, physical or neglectful abuse (RCACQS, 2020a). Person-centred care could be an important concept to establish in Australian residential aged care in order to tackle the experience of abuse and embed high-quality, safe services.
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Ibrahim, Joseph E. "Royal Commission into Aged Care Quality and Safety: the key clinical issues." Medical Journal of Australia 210, no. 10 (May 19, 2019): 439. http://dx.doi.org/10.5694/mja2.50168.
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Parkinson, Lynne. "AJA and the Australian Royal Commission into Aged Care Quality and Safety." Australasian Journal on Ageing 38, no. 2 (June 2019): 77. http://dx.doi.org/10.1111/ajag.12689.
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Cheluvappa, Rajkumar, and Selwyn Selvendran. "Antipodean Perspectives—Aged Care Nursing and the Multifaceted Role of the Aged Care Nurse." Nursing Reports 12, no. 3 (August 30, 2022): 629–36. http://dx.doi.org/10.3390/nursrep12030062.
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Healthy ageing refers to the development and maintenance of the functional ability of ageing individuals. Aged care nurses provide nursing care to elderly individuals and usually work in aged care residential facilities, nursing homes, home care services, and/or hospital departments. The registered nurse working in the aged care sector has several important roles. Key roles cover both therapeutic and preventative paradigms, as discussed in this paper. The aged care nurse is also “tasked with” holistic patient-centred care and the promotion of healthy ageing via advocacy and sociocultural roles. This paper examined, described, and analysed the multifaceted role of an aged care nurse from an Australian perspective. We conducted meticulous searches using PubMed, Google Scholar, government guidelines, authoritative body regulations, quality control guidelines, and government portals pertaining to aged care nursing in Australia. This paper relied upon the information garnered from publications, reports, and guidelines resulting from these searches and analyses. Multiple aspects of healthy ageing and holistic aged care nursing are discussed. The key roles of the aged care nurse are enumerated next, in accordance with the code of conduct from the Nursing and Midwifery Board of Australia (NMBA). The NMBA promotes evidence-based, culturally sensitive, consultative, holistic aged care clinical practice that includes input from care recipients, their decision makers, and/or their health care providers. The difficult issue of loneliness is discussed with strategies to ameliorate aspects of this. Good social networks, community interactions, meaningful friendships, and participation in personalised spiritual/religious practices improve the quality of aged care. The key topic of elder abuse and its forms are discussed apropos of aged care nursing. Healthy ageing is promoted by identifying and reporting elder abuse at the earliest. Current Australian law and recent federal legislation changes pertaining to aged care nursing are discussed next. As a result of these legislation changes, several new quality control imperatives (for aged care organisations/facilities) under the Aged Care Quality and Safety Commission (ACQSC) have been implemented. Residential and flexible aged care providers should now have robust ongoing documentation and a well-developed behaviour support plan (BSP) for each care recipient who currently requires or may require restrictive practices, which must be reported under the new serious incident reporting scheme (SIRS). Various strategies to promote healthy ageing and approaches to communicate effectively with aged care recipients are also discussed. Healthy ageing is promoted when age care recipients are empowered with making their own autonomous choices in “major and minor” aspects of life. Finally, approaches to optimise quality aged care nursing care are discussed. The Roper–Logan–Tierney model is one of the models used to assess and optimise nursing care. This is premised on the capability of an ageing individual to accomplish 12 basic activities of daily living.
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Inacio, Maria C., Gillian Elizabeth Caughey, and Steve Wesselingh. "Registry of Senior Australians (ROSA): integrating cross-sectoral information to evaluate quality and safety of care provided to older people." BMJ Open 12, no. 11 (November 2022): e066390. http://dx.doi.org/10.1136/bmjopen-2022-066390.
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PurposeThe Registry of Senior Australians (ROSA) was established to evaluate aged care experiences in Australia. In this manuscript, we describe the ROSA framework, the two ROSA cohorts, highlights from research findings, and future plans.ParticipantsThe South AustralianROSA Prospective Cohort(August 2018–June 2020) enrolled 26 605 participants, of which 59.2% (N=15 745) are women, with a median age of 83 (interquartile range (IQR) 77–88). The NationalROSA Historical Cohort(January 2002–June 2020) includes 1 694 206 participants with an aged care eligibility assessment, of which 59.1% (N=1 001 705) are women and the median age is 78 (IQR 72–83).Findings to dateMost research using the ROSA has focused on dementia, service accessibility, quality and safety of care, falls and injuries and quality use of medicines. The ROSA has also examined the experience of individuals with highly prevalent and understudied conditions in aged care settings (eg, eye and mental health) and aspects of services (eg, built environment) and innovation (eg, mobile radiological services) that can affect older people’s health. Important learnings from the ROSA’s development include the significant resources and multidisciplinary expertise required for establishing this platform. Between 2018 and 2022, 43 academic publications, eight reports of the Australian Government Royal Commission into Aged Care Quality and Safety, and several reports to state health authorities and professional societies have used the ROSA.Future plansOur plans include to: (1) continue delivering high-quality evidence to support the improvement of ageing and aged care services; (2) influence and improve the quality of research in and for the aged care sector; (3) expand scope to facilitate examining aims in more depth; (4) include future aged care sector data collections within the ROSA; (5) inform best practices and innovate how consumer engagement occurs in research; (6) monitor and evaluate the impact of the 2021 Australian Aged Care Reforms.
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Davis, Jenny, Amee Morgans, and Stephen Burgess. "Information management in the Australian aged care setting." Health Information Management Journal 46, no. 1 (July 26, 2016): 3–14. http://dx.doi.org/10.1177/1833358316639434.
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Background: Information management systems and processes have an impact on quality and safety of care in any setting and particularly in the complex care setting of aged care. Few studies have comprehensively examined information management in the Australian aged care setting. Objective: To (i) critically analyse and synthesize evidence related to information management in aged care, (ii) identify aged care data collection frameworks and (iii) identify factors impacting information management. Methods: An integrative review of Australian literature published between March 2008 and August 2014 and data collection frameworks concerning information management in aged care were carried out. Results: There is limited research investigating the information-rich setting of aged care in Australia. Electronic systems featured strongly in the review. Existing research focuses on residential settings with community aged care largely absent. Information systems and processes in the setting of aged care in Australia are underdeveloped and poorly integrated. Conclusions: Data quality and access are more problematic within community aged care than residential care settings. The results of this review represent an argument for a national approach to information management in aged care to address multiple stakeholder information needs and more effectively support client care.
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Caughey, Gillian Elizabeth, Catherine E. Lang, Sarah Catherine Elizabeth Bray, Janet K. Sluggett, Craig Whitehead, Renuka Visvanathan, Keith Evans, et al. "Quality and safety indicators for home care recipients in Australia: development and cross-sectional analyses." BMJ Open 12, no. 8 (August 2022): e063152. http://dx.doi.org/10.1136/bmjopen-2022-063152.
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ObjectivesTo develop and examine the prevalence of quality and safety indicators to monitor care of older Australians receiving home care packages (HCPs), a government-funded aged care programme to support individuals to live at home independently.DesignCross-sectional.SettingHome care recipients, Australia.Participants90 650 older individuals (aged ≥65 years old and ≥50 years old for people of Aboriginal or Torres Strait Islander descent) who received a HCP between 1 January 2016 and 31 December 2016 nationally were included.Primary and secondary outcome measuresThe Registry of Senior Australians developed 15 quality and safety indicators: antipsychotic use, high sedative load, chronic opioid use, antimicrobial use, premature mortality, home medicines reviews, chronic disease management plan, wait-time for HCP, falls, fractures, medication-related adverse events, weight loss/malnutrition, delirium/dementia-related hospitalisations, emergency department (ED) presentations and pressure injuries. Risk adjusted prevalence (%, 95% CI) and geographical area (statistical level 3) variation during 2016 were examined.ResultsIn 2016, a total of 102 590 HCP episodes were included for 90 650 individuals, with 66.9% (n=68 598) level 1–2 HCP episodes (ie, for basic care needs) and 33.1% (n=33 992) level 3–4 HCP (ie, higher care needs). The most prevalent indicators included: antibiotic use (52.4%, 95% CI 52.0 to 52.7), chronic disease management plans (38.1%, 95% CI 37.8 to 38.4), high sedative load (29.1%, 95% CI 28.8 to 29.4) and ED presentations (26.4%, 95% CI 25.9 to 26.9). HCP median wait time was 134 days (IQR 41–406). Geographical variation was highest in chronic disease management plans and ED presentations (20.7% of areas outside expected range).ConclusionA comprehensive outcome monitoring system to monitor the quality and safety of care and variation for HCP recipients was developed. It provides a pragmatic, efficient and low burden tool to support evidence-based quality and safety improvement initiatives for the aged care sector.
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Inacio, Maria C., Catherine Lang, Gillian E. Caughey, Sarah C. E. Bray, Stephanie L. Harrison, Craig Whitehead, Renuka Visvanathan, et al. "The Registry of Senior Australians outcome monitoring system: quality and safety indicators for residential aged care." International Journal for Quality in Health Care 32, no. 8 (July 21, 2020): 502–10. http://dx.doi.org/10.1093/intqhc/mzaa078.
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Abstract Objectives To introduce the Registry of Senior Australians (ROSA) Outcome Monitoring System, which can monitor the quality and safety of care provided to individuals accessing residential aged care. Development and examination of 12 quality and safety indicators of care and their 2016 prevalence estimates are presented. Design Retrospective. Setting 2690 national and 254 South Australian (SA) aged care facilities. Participants 208 355 unique residents nationally and 18 956 in SA. Main Outcome Measures Risk-adjusted prevalence of high sedative load, antipsychotic use, chronic opioid use, antibiotic use, premature mortality, falls, fractures, medication-related adverse events, weight loss/malnutrition, delirium and/or dementia hospitalisations, emergency department presentations, and pressure injuries. Results Five indicators were estimated nationally; antibiotic use (67.5%, 95% confidence interval (CI): 67.3–67.7%) had the highest prevalence, followed by high sedative load (48.1%, 95% CI: 47.9–48.3%), chronic opioid use (26.8%, 95% CI: 26.6–26.9%), antipsychotic use (23.5%, 95% CI: 23.4–23.7%) and premature mortality (0.6%, 95% CI: 0.6–0.7%). Seven indicators were estimated in SA; emergency department presentations (19.1%, 95% CI: 18.3–20.0%) had the highest prevalence, followed by falls (10.1%, 95% CI: 9.7–10.4%), fractures (4.8%, 95% CI: 4.6–5.1%), pressure injuries (2.9%, 95% CI: 2.7–3.1%), delirium and/or dementia related hospitalisations (2.3%, 95% CI: 2.1–2.6%), weight loss/malnutrition (0.7%, 95% CI: 0.6–0.8%) and medication-related events (0.6%, 95% CI: 0.5–0.7%). Conclusions Twelve quality and safety indicators were developed to monitor aged care provided to older Australians based on the synthesis of existing literature and expert advisory input. These indicators rely on existing data within the aged care and healthcare sectors, therefore creating a pragmatic tool to examine quality and unwarranted care variation.
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Clarke, Marilyn Alexandra, and Sally Rao Hill. "Promoting employee wellbeing and quality service outcomes: The role of HRM practices." Journal of Management & Organization 18, no. 5 (September 2012): 702–13. http://dx.doi.org/10.1017/s1833367200000626.
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AbstractAs a transformative service, aged care has the capacity to create uplifting changes and improvements to the quality of life for individuals and communities. Recent studies have, however, highlighted the pressures faced by aged care workers and the impact that these pressures have on employee wellbeing and quality of care. This paper explores the relationship between employee wellbeing and service quality. We present a model for the aged care sector which suggests that by identifying and implementing appropriate HRM strategies both employee wellbeing and service quality will be enhanced thus ensuring that this transformative service meets the needs of its many stakeholders. Essentially, we argue that employee wellbeing is directly linked to service delivery outcomes and overall business performance and that HR practices that address issues such as learning and development, employee voice and involvement and workplace health and safety play a significant role in enhancing and maintaining employee wellbeing.
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Clarke, Marilyn Alexandra, and Sally Rao Hill. "Promoting employee wellbeing and quality service outcomes: The role of HRM practices." Journal of Management & Organization 18, no. 5 (September 2012): 702–13. http://dx.doi.org/10.5172/jmo.2012.18.5.702.
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AbstractAs a transformative service, aged care has the capacity to create uplifting changes and improvements to the quality of life for individuals and communities. Recent studies have, however, highlighted the pressures faced by aged care workers and the impact that these pressures have on employee wellbeing and quality of care. This paper explores the relationship between employee wellbeing and service quality. We present a model for the aged care sector which suggests that by identifying and implementing appropriate HRM strategies both employee wellbeing and service quality will be enhanced thus ensuring that this transformative service meets the needs of its many stakeholders. Essentially, we argue that employee wellbeing is directly linked to service delivery outcomes and overall business performance and that HR practices that address issues such as learning and development, employee voice and involvement and workplace health and safety play a significant role in enhancing and maintaining employee wellbeing.
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Johnston, Carolyn. "Ethical Design and Use of Robotic Care of the Elderly." Journal of Bioethical Inquiry 19, no. 1 (March 2022): 11–14. http://dx.doi.org/10.1007/s11673-022-10181-z.
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AbstractThe Australian Royal Commission into Aged Care Quality and Safety acknowledged understaffing and substandard care in residential aged care and home care services, and recommendations were made that that the Australian Government should promote assistive technology within aged care. Robotic care assistants can provide care and companionship for the elderly—both in their own homes and within health and aged care institutions. Although more research is required into their use, studies indicate benefits, including enabling the elderly to live independently at home, assistance with medication and monitoring of safety. Nevertheless, there are inherent ethical challenges in the use of robots as carers, including loss of privacy, unwarranted restrictions on autonomy, lack of dignity, deception, and the exacerbation of loneliness. Ethics by design can counter these issues in development of robotics and clinical ethics committees have been put forward as a way of dealing with the ethical use of robotic care in healthcare institutions. In this paper I outline the ethical challenges of robotic care assistants and how these may be mediated in their design and use.
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Cain, Patricia, Janine Alan, and Davina Porock. "Emergency department transfers from residential aged care: what can we learn from secondary qualitative analysis of Australian Royal Commission data?" BMJ Open 12, no. 9 (September 2022): e063790. http://dx.doi.org/10.1136/bmjopen-2022-063790.
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ObjectivesTo use publicly available submissions and evidence from the Australian Royal Commission into Aged Care Quality and Safety as data for secondary qualitative analysis. By investigating the topic of emergency department transfer from the perspective of residents, family members and healthcare professionals, we aimed to identify modifiable factors to reduce transfer rates and improve quality of care.DesignThe Australian Royal Commission into Aged Care Quality and Safety has made over 7000 documents publicly available. We used the documents as a large data corpus from which we extracted a data set specific to our topic using keywords. The analysis focused on submissions and hearing transcripts (including exhibits). Qualitative thematic analysis was used to interrogate the text to determine what could be learnt about transfer events from a scholarly perspective.ResultsThree overarching themes were identified: shortfalls and failings, reluctance and misunderstanding, and discovery and exposure.ConclusionsThe results speak to workforce inadequacies that have been central to problems in the Australian aged care sector to date. We identified issues around clinical and pain assessment, lack of consideration to advance care directives and poor communication among all parties. We also highlighted the role that emergency departments play in identifying unmet clinical needs, substandard care and neglect. Given the inadequate clinical care available in some residential aged care facilities, transferring residents to a hospital emergency department may be making the best of a bad situation. If the objective of reducing unnecessary transfers to emergency departments is to be achieved, then access to appropriate clinical care is the first step.
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Solly, Kane Norman, and Yvonne Wells. "What predicts consumer experience in residential aged care? An analysis of consumer experience report data." Australian Health Review 45, no. 4 (2021): 485. http://dx.doi.org/10.1071/ah20270.
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ObjectivesThis study explored whether consumer experience report (CER) data from residential aged care services (RACSs) could be combined into a general factor and determined whether poor experience in RACSs could be predicted by known resident or home characteristics or sampling procedures. MethodsCER data collected by structured interviews in 2018 and early 2019 were analysed using structural equation modelling and linear regression analysis. ResultsData were available from 17194 interviews undertaken at 1159 RACSs. The 10 CER items loaded onto two independent factors. Bifactorial modelling indicated that items could be combined into a general factor. Controlling for state or territory, consumer experience was best predicted by home size: those in large facilities reported poorer experience than those in smaller facilities. Other significant negative predictors with small effect sizes included not being independently mobile, being male and not being randomly selected. Dementia did not predict total CER score. ConclusionsThe results of this study support the inclusion of people with dementia and exclusion of volunteer participants from published CERs. Further research is needed to explore why a relatively poor consumer experience is reported by people in larger homes, men and those with mobility issues. What is known about the topic?Poor experience in aged care is a persistent concern for government, individuals and aged care services. The recent Royal Commission into Aged Care Quality and Safety has identified systemic failure. Although many organisational features and processes have previously been identified as important in determining the quality of care, few studies have explored the characteristics that predict the consumer experience of residents in aged care. What does this paper add?This paper provides empirical evidence that several variables influence consumer experience in aged care, including facility size and resident sex and mobility. There is evidence that smaller facilities provide care that is perceived better by residents, and that men and people with mobility issues have worse experiences in aged care. There is a lack of clarity as to what other influences, such as facility ethos, facility location and staffing levels, may contribute to resident experience. Such clarity is important, because Australian aged care is currently facing comprehensive scrutiny, and governments are looking to ensure the safety and quality of aged care services. What are the implications for practitioners?Identifying and addressing inequities in aged care services and mitigating risks must be a priority in Australia to ensure aged care services provide safe and high-quality care. The results of this study challenge current funding structures that encourage the development of larger aged care homes, and instead suggest that better funding for smaller-sized facilities may be able to improve the experience of residents in aged care. The results also suggest that facilities and governments should attend to the experiences of specific groups, such as men and people with mobility issues.
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Alexander, Gregory L., Andrew Georgiou, Joyce Siette, Richard Madsen, Anne Livingstone, Johanna Westbrook, and Chelsea Deroche. "Exploring information technology (IT) sophistication in New South Wales residential aged care facilities." Australian Health Review 44, no. 2 (2020): 288. http://dx.doi.org/10.1071/ah18260.
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Objective The aim of this study was to determine baseline information technology (IT) sophistication in New South Wales (NSW), Australia, residential aged care facilities. Method IT sophistication measures IT capabilities, extent of IT use and IT integration in two domains, resident care and clinical support. A survey was administered to all NSW residential aged care facilities (n = 876) between February and May 2017. A 15% response rate was achieved (130/876). Facilities were organised by organisational type, total residential places and remoteness. Using post-stratification weights, estimates of IT sophistication scores for NSW were determined. Regression was used to examine whether there was a linear relationship between IT sophistication and the ratio of residents receiving high care. Results Participating facilities were similar to other NSW facilities in residential places and remoteness, but different in organisational type. IT sophistication was highest in IT capabilities and integration in resident care. IT sophistication was lowest in clinical support. Respondents had a mean of 1.2 years of IT experience. IT sophistication varied among aged care facilities. There was a linear relationship (P < 0.05) with the proportion of high-care residents and total IT sophistication Conclusion Routine reports of IT sophistication in aged care are not available. If data were available, determining the influence of IT sophistication on the quality care for residential aged care would be possible. What is known about the topic? Aged care settings that deliver care to the older population need to be contemporary in their approach to delivering high-quality and safe care. Health IT holds great potential for improving the quality and safety of care of older residents in aged care facilities. What does this paper add? This report provides a baseline assessment of IT capabilities, extent of IT use and IT integration, called IT sophistication, among aged care facilities with variable characteristics. What are implications for practitioners? Increasing IT sophistication has the potential to improve the quality of care delivered by aged care staff.
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Moore, Kirsten J., Keith D. Hill, Andrew L. Robinson, Terry P. Haines, Betty Haralambous, and Jennifer C. Nitz. "The state of physical environments in Australian residential aged care facilities." Australian Health Review 35, no. 4 (2011): 412. http://dx.doi.org/10.1071/ah10932.
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Objective. This paper examines the quality and safety of the physical environment in Australian residential aged care facilities (RACFs). Design. Cross-sectional study. One assessor completed environmental audits to identify areas of the physical environment that needed to be addressed to improve the wellbeing and safety of residents. Setting. Nine RACFs participating in a broader falls prevention project were audited. RACFs were located in Queensland, Tasmania or Victoria and were chosen by convenience to represent high level, low level, dementia and psychogeriatric care, regional and metropolitan facilities, small and large facilities and a culturally specific facility. Main outcome measure. An environmental audit tool was adapted from a tool designed to foster older person friendly hospital environments. The tool consisted of 147 items. Results. Across all sites 450 items (34%) required action. This ranged from 21 to 44% across sites. The audit domains most commonly requiring action included signage, visual perception and lighting, and outdoor areas. Conclusions. Although not representative of all residential facilities in Australia, this audit process has identified common environmental problems across a diverse mix of residential care facilities. Results highlight the need for further investigation into the quality of physical environments, and interventions to improve physical environments in Australian RACFs. What is known about the topic? Despite the importance of the physical environment on the health, wellbeing and safety of older people in residential aged care facilities, few studies have comprehensively evaluated the physical environment in facilities in Australia. What does this paper add? This paper provides findings from comprehensive audits of nine residential aged care facilities representing a broad range of facility settings in terms of location, level and type of care and target population. Findings indicate that each facility had at least 21% of items requiring action with an average of 34% of items requiring action across all facilities. What are the implications for practitioners? There is a need to undertake intermittent, thorough assessments of the physical environments in which residents live and, if applicable, implement strategies or modifications to improve the environment. Areas requiring particular consideration may be lighting, colour contrasts, signage and outdoor areas.
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Roberts, Lisa, Kelvin CY Leung, and Carmelle Peisah. "The role of palliative care nurse practitioner in promoting end-of-life care in residential care facilities." Journal of Nursing Education and Practice 12, no. 10 (May 31, 2022): 7. http://dx.doi.org/10.5430/jnep.v12n10p7.
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Background and objective: The neglect of older people at the end of life in residential care documented in the Australian Royal Commission into Aged Care and Quality and Safety mandates urgent solutions to improve care. This integrative literature review aimed to explore the potential role of the palliative care nurse practitioner (PC-NP) in promoting quality end of life in residential care.Methods: Databases Medline, Emcare, PsychINFO and CINAHL were searched from January 2010 to April 2022. Full text of primary articles meeting inclusion criteria encompassing residents living in residential care settings, the role of the PC-NP in supporting quality dying were obtained and independently screened to determine final studies for review. Findings were thematically analysed. Two reviewers independently extracted data and assessed level of evidence and quality ratings for both quantitative and qualitative studies.Results: Of 12 articles meeting eligibility criteria, four specifically focused on the PC-NP or the palliative care nurse in residential care, seven examined the generic nurse practitioner role, and one the aged care nurse role in supporting palliative care. Themes common to all roles including positive patient outcomes, advance care planning, hospital avoidance, staff education and enhanced communication with families. Themes specific to the PC-NP included meeting end-of-life needs, end-of-life prescribing, and enhancing the role of the General Practitioner.Conclusions: Although reflected in only a handful of studies, this integrative review has provided preliminary insights into potential contributions of the PC-NP to quality end-of-life care for residential care residents.
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Jessop, Tiffany, and Carmelle Peisah. "Human Rights and Empowerment in Aged Care: Restraint, Consent and Dying with Dignity." International Journal of Environmental Research and Public Health 18, no. 15 (July 26, 2021): 7899. http://dx.doi.org/10.3390/ijerph18157899.
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The aged care system in Australia is in crisis and people living with dementia are especially vulnerable to breaches of human rights to autonomy, dignity, respect, and equitable access to the highest quality of health care including meeting needs on account of disability. To be powerful advocates for themselves and others, people with dementia and the wider community with vested interests in quality aged care must be informed about their rights and what should be expected from the system. Prior to the Australian Royal Commission into Aged Care Quality and Safety, the Empowered Project was established to empower and raise awareness amongst people with dementia and their families about changed behaviours, chemical restraint, consent, end of life care, and security of tenure. A primary care-embedded health media campaign and national seminar tour were undertaken to meet the project aims of awareness-raising and empowerment, based on 10 Essential Facts about changed behaviours and rights for people with dementia, established as part of the project. Knowledge translation was assessed to examine the need and potential benefit of such seminars. We demonstrated that this brief educational engagement improved community knowledge of these issues and provided attendees with the information and confidence to question the nature and quality of care provision. With the completion of the Royal Commission and corresponding recommendations with government, we believe the community is ready to be an active player in reframing Australia’s aged care system with a human rights approach.
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Brimelow, Rachel E., Annie Gibney, Suzanne Meakin, and Judy A. Wollin. "Accessing care summaries at point-of-care: Implementation of mobile devices for personal carers in aged care." Health Informatics Journal 25, no. 1 (April 24, 2017): 126–38. http://dx.doi.org/10.1177/1460458217704251.
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Continued development of mobile technology now allows access to information at the point-of-care. This study was conducted to evaluate the use of one such tool on a mobile device, from the carer perspective. Caregivers across 12 aged-care facilities were supplied mobile devices to access a Picture Care Plan (PCP), a specific tool designed around the role of the personal carer. An anonymous questionnaire was subsequently completed by 85 carers with questions relating to participants’ experience. Perceived helpfulness of the PCP at the point-of-care was high (87%). A significant number of participants believed the use of the PCP increased resident safety and quality of care (76%). Practical components related to the carrying of the device, network speed and the requirement to maintain communication with senior members of staff to ascertain updates were also expressed by participants. Findings suggest that staff are receptive to adoption of mobile devices to access care directives at the point-of-care and that the technology is useful.
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Oakman, Jodi, Natasha Kinsman, and Natassia Goode. "A STAMP analysis of the staff safety management system in residential Aged Care." Safety Science 146 (February 2022): 105563. http://dx.doi.org/10.1016/j.ssci.2021.105563.
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Thwaites, Claire, Jonathan P. McKercher, Deirdre Fetherstonhaugh, Irene Blackberry, Julia F.-M. Gilmartin-Thomas, Nicholas F. Taylor, Sharon L. Bourke, Sally Fowler-Davis, Susan Hammond, and Meg E. Morris. "Factors Impacting Retention of Aged Care Workers: A Systematic Review." Healthcare 11, no. 23 (November 21, 2023): 3008. http://dx.doi.org/10.3390/healthcare11233008.
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Retention of care support workers in residential aged care facilities and home-based, domiciliary aged care is a global challenge, with rapid turnover, low job satisfaction, and poorly defined career pathways. A mixed-methods systematic review of the workforce literature was conducted to understand the factors that attract and retain care staff across the aged care workforce. The search yielded 49 studies. Three studies tested education and training interventions with the aim of boosting workforce retention and the remaining 46 studies explored opinions and experiences of care workers in 20 quantitative, four mixed-methods and 22 qualitative studies. A range of factors impacted retention of aged care staff. Two broad themes emerged from the analysis: individual and organisational factors facilitating retention. Individual factors related to personal satisfaction with the role, positive relationships with other staff, families, and residents, and a cooperative workplace culture. Organisational factors included opportunities for on-the-job training and career development, appropriate wages, policies to prevent workplace injuries, and job stability. Understaffing was often cited as a factor associated with turnover, together with heavy workloads, stress, and low job satisfaction. With global concerns about the safety and quality of aged care services, this study presents the data associated with best practice for retaining aged care workers.
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Jaye, Chrystal, June Tordoff, Mary Butler, Beatrice Hale, Roz McKechnie, Linda Robertson, and Jean Simpson. "Quality in residential care: exploring residents’, family members’, managers’ and staff perspectives." Quality in Ageing and Older Adults 17, no. 4 (December 12, 2016): 253–62. http://dx.doi.org/10.1108/qaoa-03-2016-0015.
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Purpose The purpose of this paper is to explore the indicators of quality in care for people working and living in aged residential care (ARC) settings. Design/methodology/approach This research was conducted using an ethnographic design in two distinct ARC facilities in a New Zealand city, a large facility with residential, dementia and hospital level care, and a small family owned facility providing residential care only. In total, 50 hours of observational data were collected, and semi-structured interviews were conducted with 21 people, including managers, careworkers, nurses, family members and residents. These data were thematically analysed using the constant comparative method. Findings The main indicators of quality for staff, family and residents included: a home-like, friendly and safe environment; good medical and personal care; respect for the residents; and good staff. Participants also acknowledged the need for adjustments by residents to living in aged care; and the challenges of caring for increasingly frail residents. Originality/value Findings support the growing recognition of a need for resident-centred approaches to ARC that are reflected in government policy and regulatory apparatus. Managers in ARC facilities must balance adherence with health and safety standards, and providing an environment where their residents can enjoy a meaningful life that has purpose and value.
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Watson, Wendy L., Yang Li, and Rebecca J. Mitchell. "Projections of hospitalised fall-related injury in NSW, Australia: Impacts on the hospital and aged care sectors." Journal of Safety Research 42, no. 6 (December 2011): 487–92. http://dx.doi.org/10.1016/j.jsr.2011.07.009.
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Fetherstonhaugh, Deirdre M., Yvonne Wells, and Angela Herd. "MEASURING CLIENT EXPERIENCE IN RESIDENTIAL AGED CARE TO INFORM AND SUPPORT CONSUMER CHOICE." Innovation in Aging 3, Supplement_1 (November 2019): S507. http://dx.doi.org/10.1093/geroni/igz038.1875.
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Abstract The Australian Government Aged Care Quality and Safety Commission (prior to January 2019 known as the Australian Aged Care Quality Agency) is responsible for accreditation of Australian aged care services which are audited against the Australian Accreditation Standards. Accreditation reports are publicly available. Prior to 2017, some clients were interviewed about their experiences, but the resulting information could not represent the client experience within a service due to low numbers, biased sampling, and an unsystematic approach to asking questions. La Trobe University was engaged to develop and pilot an interview tool to measure client experience for use in accreditation. Potential questions were identified through a literature review, mapped against the Accreditation Standards, and workshopped with an expert reference group. Twenty-four questions and a visual analogue were then piloted. Consumer groups and groups of Indigenous and culturally diverse clients in residential aged care homes were consulted. The perspective of Quality Agency surveyors was sought on the questions’ usability. Statistical analyses sought to identify questions that minimised missing data, were responded to similarly by residents and their representatives, and elicited stable responses on retest. Twelve questions were identified as optimal. The 10 quantitative questions proved to reflect a single underlying dimension (consumer experience) and, when summed and explored through regression analyses, differentiated services significantly. The consumer experience interview tool is now used in all accreditation audits in Australia. Results are then used to generate consumer experience reports, which are published online and can support consumer choice of a residential aged care home.
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Coman, Robyn L., Carlo Caponecchia, and Andrew S. McIntosh. "Manual Handling in Aged Care: Impact of Environment-related Interventions on Mobility." Safety and Health at Work 9, no. 4 (December 2018): 372–80. http://dx.doi.org/10.1016/j.shaw.2018.02.003.
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Beal, Anne C., John Patrick T. Co, Denise Dougherty, Tanisha Jorsling, Jeanelle Kam, James Perrin, and R. Heather Palmer. "Quality Measures for Children’s Health Care." Pediatrics 113, Supplement_1 (January 1, 2004): 199–209. http://dx.doi.org/10.1542/peds.113.s1.199.
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Background. The ability to measure and improve the quality of children’s health care is of national importance. Despite the existence of numerous health care quality measures, the collective ability of measures to assess children’s health care quality is unclear. A review of existing health care quality measures for children is timely for both assessing the current state of quality measures for children and identifying areas requiring additional research and development. Objectives. To identify and collect current health care quality measures for child health and then to systematically categorize and classify measures and identify gaps in child health care quality measures requiring additional development. Design/Methods. We first identified child health care quality instruments with assistance from staff at the Agency for Healthcare Research and Quality, experts in the field, the Computerized Needs-oriented Quality Measurement Evaluation System, the Child and Adolescent Health Measurement Initiative, and a medical literature review. From these instruments, we then selected clinical performance measures applicable to children (aged 0–18 years). We categorized the individual measures into the Institute of Medicine’s framework for the National Health Care Quality Report. The framework includes health care quality domains (patient safety, effectiveness, patient-centeredness, and timeliness) and patient-perspective domains (staying healthy, getting better, living with illness, and end-of-life care). We then determined the balance of the measures (how well they assess care for all children versus children with special health care needs) and their comprehensiveness (how well the measures apply to the developmental range of children). Finally, we analyzed the ability of the measures to assess equity in care. Results. We identified 19 measure sets, and 396 individual measures were used to assess children’s health care quality. The distribution of measures in the health care quality domains was: safety, 14.4%; effectiveness, 59.1%; patient-centeredness, 32.1%; and timeliness, 33.3%. The distribution of measures in the patient-perspective domains was: staying healthy, 24%; getting better, 40.2%; living with illness, 17.4%; end of life, 0%; and multidimensional, 23.5% (measures were multidimensional if they applied to >1 domain). Most of the measures were meant for use in the general pediatric population (81.1%), with a significant proportion designed for children with special health care needs (18.9%). The majority (≥79%) of the measures could be applied to children across all age groups. However, there were relatively few measures designed specifically for each developmental stage. Regarding the use of measures to study equity in health care, 6 of the measure sets have been used in previous studies of equity. All the survey measure sets contain items that identify patients at risk for poor outcomes, and 4 are available in languages other than English. However, only 1 survey (Consumer Assessment of Health Plans) has undergone studies of cross-cultural validation. Among the measure sets based on administrative data, 3 included infant mortality, a well-known measure of health disparity. Conclusions. There are several instruments designed to measure health care quality for children. Despite this, we found relatively few measures for assessing patient safety and living with illness and none for end-of-life care. Few measures are designed for specific age categories among children. Although equity is an overarching concern in health care quality, the application of current measures to assess disparities has been limited. These areas need additional research and development for a more complete assessment of health care quality for children.
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Bogusława Urbaniak. "Social security and safety of older adults in Poland." Magyar Gerontológia 12 (November 26, 2020): 9–11. http://dx.doi.org/10.47225/mg/12/kulonszam/8450.
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Poland’ population will be ageing at a fast rate in the coming decades. It is projected that in 2070 the Polish ratio between people aged 65 and over and those aged 15-64 years will be 62.6, the highest among EU-27 countries. Population ageing appeared in the public debate in Poland as a separate subject in the 1990s, following a negative natural population increase and the looming impact of the massive withdrawal of baby boomers from the labour market on the pension system. One of the reasons for older persons’ growing interest in retirement was pension system reforms planned by successive governments.
The announcement of the year 2012 as the European Year for Active Ageing and Solidarity Between Generations (decision no. 940/2011/EU of the European Parliament and of the Council of 14 September 2011) contributed in Poland to the emergence of a senior policy from a social policy and initiated major legislative, institutional, and organisational changes at the national, regional and local levels of government. It also inspired the redefinition of measures used hitherto in line with the evolution in the perception of older people from social care recipients to active members of their communities entitled to education and economic, social, civic and political activity. In 2013, the Senior Policy Council was established as a consultative and advisory body to the Ministry of Labour and Social Policy, and then similar councils supporting regional and local authorities were organised.
In order to encourage greater activity among seniors, a special governmental programme was created in December 2013, which grants funds on a competitive basis to projects concerning social activities, education, and intergenerational cooperation submitted by informal and formal groups of seniors.
The national government’s key documents on senior policy, one for the period from 2014 to 2020 and the other spanning the years until 2030, are Resolution 238 of 24 Dec. 2013 by the Board of Ministers on the Adoption of Long-term Senior Policy in Poland for the Years 2015-2020 and Resolution 161 of 28 Oct. 2018 by the Board of Ministers on the adoption of Social Policy Towards the Older Persons 2030. Security-Participation-Solidarity. In 2015, the Polish Parliament passed the elderly people act, which requires institutions in charge of the well-being of older persons to monitor and report on their situation. The reports submitted by the institutions are used by the Ministry of Labour to compile and present an annual evaluation of the status of the older population in Poland.
The regional governments’ senior policy is reflected in their social policy strategies. The strategies’ operational goals started to address needs specific to older people since 2002, focusing in particular on improving their quality of life, developing round-the-clock care services, at-home care services, and rehabilitation services, and on reducing social exclusion and marginalization of seniors.
Social security and the safety of older adults are progressively improving in Poland, but the greatest progress has been made in the area of active ageing. Social care services for the elderly still require improvement, because the predominant family care model is inefficient in many ways due to:
limited financing of care services by public institutions,
the growing proportion of single elderly persons,
the increasing number of people aged 85+ (the so-called double population ageing),
social insurance disregarding long-term care to an elderly family member as an insurable risk,
a lack of legislation allowing employed people to seek a long-term leave to give care to an older family member,
the informal expectation that women who retire at the age of 60 years will take care of the oldest family members.
While neither the scale nor the quality of home care services given to older persons is regularly surveyed in Poland, it can be presumed that the scale of care services is insufficient and that they excessively burden families with a member in need of care. Between 2010 and 2018, the number of persons aged 65+ increased in Poland by over 1.5 million, the number of the users of attendance services and specialised attendance services by 29,000 (from 99,000 to 128,000), and the number of residences in homes and facilities providing assistance to aged persons by 7,000 (from 20,000 to 27,100.)
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Maruyama, Tsugito, and Muneshige Yamazaki. "Autonomous Mobile Robot Carrying Food Trays to the Aged and Disabled – Robot Technology and Results of the Field Evaluation Test –." Journal of Robotics and Mechatronics 11, no. 6 (December 20, 1999): 531–33. http://dx.doi.org/10.20965/jrm.1999.p0531.
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A food-carrying robot developed for the aged and disabled consisted of 6 basic components, i.e., a compact light-weight manipulator, a moving mechanism, an environmental perception unit, an information display, a navigator, and a remote supervisory controller. Practical evaluation tests at medical and welfare facilities showed that targets for safety, autonomy, and human friendliness were achieved. Such a robot will help to resolve shortages in health-care workers and improve overall care quality.
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Haarbauer-Krupa, Juliet K., Johna K. Register-Mihalik, Aliza K. Nedimyer, Avinash Chandran, Melissa C. Kay, Paula Gildner, and Zachary Y. Kerr. "Factors associated with concussion symptom knowledge and attitudes towards concussion care-seeking among parents of children aged 5–10 years." Journal of Safety Research 78 (September 2021): 203–9. http://dx.doi.org/10.1016/j.jsr.2021.05.003.
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Khatib, Atef Hasan, Ayman M. Hamdan-Mansour, and Manar Ali Bani Hani. "Theoretical Perspectives of Hospitalized Older Patients and Their Health-Related Problems and Quality of Care: Systematic Literature Review." Open Public Health Journal 10, no. 1 (November 14, 2017): 215–25. http://dx.doi.org/10.2174/1874944501710010215.
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Introduction:The proportion of aged people is growing worldwide. Older persons are affected by a number of physical, psychological and social factors that influence their health and quality of life. These factors are usually multiple and are often masked by sensory and cognitive impairments.Purpose:The purpose of this study was to examine the available literature emphasizing older persons’ care, care-related problems, and older persons’ quality of healthcare. Also, the paper aimed at exploring the future direction of research needs.Results:Good quality older patients’ care involves safety, professional interventions, recognition and management of physical and emotional wellbeing. Care of older patients requires addressing the aging process itself, the expected decrease in functionality, and diminished cognitive ability. Little statistical data were found to address the quality of hospitalized elderly patients in particular as well as study on healthcare facilities and nursing homes. Literature does not provide much guidance to the effectiveness of care strategies.Conclusion:The results assert that elderly health care is a priority. However, health care systems are not specific about elderly patients’ needs, leading to low quality of elderly care. There is a need to use an integrated model of care to improve the quality of life and quality of care provided to hospitalized older patients.
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Foley, Meraiah, Sue Williamson, and Sarah Mosseri. "Women, work and industrial relations in Australia in 2019." Journal of Industrial Relations 62, no. 3 (March 18, 2020): 365–79. http://dx.doi.org/10.1177/0022185620909402.
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Interest in women’s labour force participation, economic security and pay equity received substantial media and public policy attention throughout 2019, largely attributable to the federal election and the Australian Labor Party platform, which included a comprehensive suite of policies aimed at advancing workplace gender equality. Following the Australian Labor Party’s unexpected loss at the polls, however, workplace gender equality largely faded from the political agenda. In this annual review, we cover key gender equality indicators in Australia, examine key election promises made by both major parties, discuss the implications of the Royal Commission into Aged Care Quality and Safety for the female-dominated aged care workforce, and provide a gendered analysis on recent debates and developments surrounding the ‘future of work’ in Australia.
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Wan, Lei, Lei Huang, Ke Wang, and Jingjing An. "Effect of Preventive Care on Postoperative Rehabilitation and Nutritional Status in Patients with Cerebral Hemorrhage." Current Topics in Nutraceutical Research 22, no. 2 (February 6, 2024): 503–8. http://dx.doi.org/10.37290/ctnr2641-452x.22:503-508.
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Cerebral hemorrhage is a common cerebrovascular disease affecting middle-aged and older adults, with an increasing annual incidence. Surgical removal of intracranial hematomas can save the lives of patients with cerebral hemorrhage. However, surgery-induced stress injuries can severely affect the perioperative nutritional status of patients, leading to an adverse prognosis. This study aimed to examine the effect of preventive care on patients with cerebral hemorrhage to improve patient safety during treatment. We found that patients in the experimental group who received preventive care had substantially improved postoperative rehabilitation quality, a decreased incidence of postoperative adverse reactions, and a shortened hospital stay than those in the control group who received routine care. Furthermore, preventive care reduced the risk of malnutrition and considerably improved the nutritional status of patients with CH. Preventive care can effectively improve the postoperative safety of patients with CH, shorten their rehabilitation cycle, promote their body function recovery, and enhance their nutritional status, which is essential in clinical practice.
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Brooker, Christa, Rebekah Compton, Terri Babineau, Cornelius Afetorli Normeshie, Li Li, and Sarah Rachel Blackstone. "Identifying and reducing inappropriate aspirin use in primary care." BMJ Open Quality 12, no. 4 (November 2023): e002457. http://dx.doi.org/10.1136/bmjoq-2023-002457.
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ObjectiveRecent studies have called into question the safety of aspirin use for the primary prevention of atherosclerotic cardiovascular disease, particularly in older adults. Therefore, the objectives of this study were to (1) develop a systematic approach to identifying patients aged 70 and older taking aspirin for primary prevention, (2) provide patient and provider education about updated literature and recommendations regarding aspirin safety and (3) evaluate the impact of this intervention on aspirin de-prescribing.DesignThis was a quality improvement intervention with prospective, longitudinal follow-up.SettingThis study was conducted in two family medicine practices within an academic medical centre.ParticipantsPatients aged 70 years and older with aspirin listed on the current medication list.MethodsThis is an electronic medical record-based chart review and educational intervention based on shared decision-making to reduce inappropriate aspirin use in primary practice. A chart review process was developed to identify the clinical indication for aspirin use. Patients taking aspirin for primary prevention were flagged for the primary care providers to review. Multilevel logistic regression models assessed factors affecting aspirin de-prescribing and longitudinal trend.ResultsOf 361 patients aged 70 years or older, 145 (40%) were taking aspirin for primary prevention of atherosclerotic cardiovascular disease. After 9 months, aspirin was deprescribed in 42 (29%) of these patients. Patients seen by their providers during the study period had lower odds of having aspirin on their medication list (OR=0.87, 95% CI: 0.81, 0.94) as compared with patients taking aspirin who were not seen by their healthcare provider.ConclusionThis is the first study to develop and implement a method of identifying potentially inappropriate aspirin use based on recent clinical evidence highlighting the risk of aspirin use for primary prevention in older adults. Future initiatives can leverage existing electronic medical record platforms to efficiently identify patients and expand these efforts to larger patient populations.
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Assiri, Ghadah Asaad, Bashayr Mohammed Alanazi, and Yazed AlRuthia. "The Prevalence of High-Risk Prescribing of Oral Non-Steroidal Anti-Inflammatory Drugs in Primary Healthcare: A Single-Centre Retrospective Chart Review Study." Healthcare 10, no. 5 (May 7, 2022): 867. http://dx.doi.org/10.3390/healthcare10050867.
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The quality and safety of prescribed drugs can be assessed using prescribing safety indicators (PSIs). This study aimed to estimate the prevalence of PSIs of oral non-steroidal anti-inflammatory drugs (NSAIDs) at primary care clinics of a tertiary care hospital in Saudi Arabia and to identify the risk factors associated with positive PSIs for patients. In this retrospective chart review study, data from the medical records of 450 patients aged ≥18 years, who were prescribed oral NSAIDs, were reviewed and collected manually. Seven PSIs were chosen and defined as follows: prescription of an oral NSAID to any patient with a peptic ulcer; aged ≥75 years; aged ≥65 years with a glomerular filtration rate <60; heart failure; co-prescribed warfarin; co-prescribed aspirin or clopidogrel; or co-prescribed angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker and a diuretic. Patients with positive indicators are at risk of harm from high-risk prescribing. The overall period prevalence of PSIs is 153/450 (34%; 95% CI 29.60–38.39). The overall proportion of PSIs is 202/431 (46.9%; 95% CI 42.12–51.61). The most common safety indicators were for NSAIDs prescribed to patients with heart failure and patients aged ≥65 years with a glomerular filtration rate <60. The elderly and patients using polypharmacy are at increased risk of having at least one positive PSI (OR 5.22; 95% CI 3.32–8.21, p-value < 0.001 and OR 2.97; 95% CI 1.17–7.55, p-value 0.022, respectively). Patients at risk of harm from high-risk NSAID prescriptions are common in primary care. The elderly and patients on polypharmacy are at increased risk of having at least one positive PSI. Therefore, when NSAIDs are prescribed, it is recommended to weigh the benefits versus the risks for high-risk patients, such as the elderly and those with multiple-drug therapy.
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Wells, Yvonne, Elizabeth Brooke, and Kane N. Solly. "Quality and Safety in Aged Care Virtual Issue: What Australian research published in the Australasian Journal on Ageing tells us." Australasian Journal on Ageing 38, no. 1 (March 2019): E1—E6. http://dx.doi.org/10.1111/ajag.12638.
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Fetherstonhaugh, Deirdre M., Jo-anne Rayner, Elizabeth Beattie, Ann Harrington, Yun-Hee Jeon, Wendy Moyle, Deborah Parker, and Chris Toye. "BUILDING CAPACITY TO CARE FOR OLDER PEOPLE! HOW IS CARE OF THE OLDER PERSON TAUGHT IN AUSTRALIAN SCHOOLS OF NURSING?" Innovation in Aging 3, Supplement_1 (November 2019): S3. http://dx.doi.org/10.1093/geroni/igz038.007.
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Abstract As the Australian population ages the demand for nursing care which focuses on responding to the needs of the older person will increase. Few newly graduated Registered Nurses (RNs) currently enter the aged care workforce and few select a career in caring for older people; yet older people are the largest patient group in most health care environments. This research, conducted by the Australian Hartford Consortium of Gerontological Nursing Excellence (Aus-HCGNE), explored how care of the older person is currently taught in Australian schools of nursing (SoN). The interview guide included questions about: whether care of the older person is taught in separate subjects or integrated across the curriculum; academics’ qualifications; subject content; and aged care clinical placements. The head of each of the 33 Australian schools of nursing was contacted, invited to participate and asked to nominate the appropriate academics (undergraduate/curriculum co-ordinators) who would be the most appropriate person to participate in the interview. These academics were then contacted, written informed consent was obtained, interviews were scheduled and completed. This research is timely given the current Royal Commission into Aged Care Quality and Safety in Australia, one focus of which is nurses in residential aged care in respect to numbers, education and competence. This research will be completed by mid-2019. The results will be fed back to SoN to inform the development of their curricula and the preparation of future RNs who will undoubtably need to be expert in the care of older people across the health sector.
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Dougherty, Denise, and Lisa A. Simpson. "Measuring the Quality of Children’s Health Care: A Prerequisite to Action." Pediatrics 113, Supplement_1 (January 1, 2004): 185–98. http://dx.doi.org/10.1542/peds.113.s1.185.
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Objective. To assess the availability and use of quality measures for children’s health care, highlight promising developments, and develop recommendations for future action steps by the child health quality measurement and improvement fields, pediatrics, and the national quality of care enterprise generally. Study Design. Two-day invitational expert meeting, informed by 3 commissioned articles. Results. Quality of care for children is far less than optimal. A number of measures are available for measuring children’s health care quality on a regular basis, although measures are scarce at least in many areas (eg, pediatric patient safety, end-of-life-care, mental health care, oral health care, neonatal care, care for school-aged children, and coordination of care). Many of the available measures are not being applied regularly to measure the quality of children’s health care; barriers to implementation include lack of an information infrastructure that is child- and quality-friendly and lack of public support for improving children’s health care quality. To improve the availability and use of quality measures for accountability and improvement, meeting participants recommended that at least 4 activities be national priorities: 1) build public support for quality measurement and improvement in children’s health care; 2) create the information technology infrastructure that can facilitate collection and use of data; 3) improve the reliability, validity, and feasibility of existing measures; and 4) create the evidence base for measures development and quality improvement. Conclusions. Although substantial progress has been made in the development of quality measures and the implementation of quality-improvement strategies for children’s health care, interest in quality of care for children lags behind that for adult conditions and disorders. Making significant progress will require not only sustained attention by those concerned about improving children’s health and health care but also activities to build a broad base of support among the public and key health care decision-makers.
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Shen, Jay, Ji Yoo, and Pearl Kim. "EVALUATE THE IMPACT OF INTERDISCIPLINARY EDUCATION AND TELEHEALTH PRIMARY CARE: QUALITY AND EFFICIENCY." Innovation in Aging 7, Supplement_1 (December 1, 2023): 435. http://dx.doi.org/10.1093/geroni/igad104.1435.
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Abstract In a provider shortage area, an Interprofessional Education and Telehealth Primary Care (IPETC) for geriatrics workforce was developed in 2020. To analyze the impact of IPETC on quality and efficiency of care, we measured quality outcomes defined by the CMS defined quality measures - dementia caregiver education/referral and advance care plan, and efficiency outcomes by estimating healthcare cost savings from reducing hospitalization. Fifty eight community-dwelling adults aged 67 to 94 with mild to moderate dementia were selected in an urban safety-net primary care clinic. Propensity - demographics and level of physical impairment was matched. Main outcomes were (A) hospitalization-related healthcare cost estimates from the State Inpatient Dataset using the ICD-10 codes of principal diagnosis and hospital length of stay between January-December 2021. Twenty nine patients were cared by primary care providers who received the IPETC;29 patients were by those who did not have the IPETC; (2) CMS quality measures were compared between 2019 (baseline) and 2021. An average cost-saving of $22,135 per patient was observed among those treated by the healthcare providers who received the IPE/telehealth curriculum training than those treated by the providers without the training. CMS quality measures improved from 15.6% to 51.0% in dementia caregiver education/referral; 10.8% to 42.8% in documented advance care plans. Innovative interdisciplinary education and telehealth primary care has shown improvement of quality and efficiency of dementia care in a provider shortage area.
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Ong, Natalie, Abbie Lucien, Janet C. Long, Janelle Weise, Merrilyn Walton, and Annette Burgess. "What do healthcare staff think about the quality and safety of care provided to children and young people with an intellectual disability? A qualitative study using the framework method of analysis." BMJ Open 13, no. 7 (July 2023): e071494. http://dx.doi.org/10.1136/bmjopen-2022-071494.
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ObjectiveTo elicit patient safety issues pertaining to children and young people with intellectual disability in hospital from healthcare staff perspectives. This follows a previous paper of parent interviews of patient safety experiences of their child in hospital.DesignQualitative study.SettingWe conducted semi-structured interviews and focus groups of staff of tertiary children’s hospitals based on the domains of the Patient Safety Education Framework and using the framework methodology for data analysis.ParticipantsThere were 29 female and 7 male staff aged between 27 and 70 years from a range of departments and specialties including ancillary staff.InterventionQuestions based on the patient safety framework were developed from consultation with parents, researchers and clinicians exploring staff views and experiences of safety and quality care of these children in hospital. During April 2021 to May 2022, 22 interviews and 3 focus groups were conducted of staff who have had experience caring for children and young people with intellectual disability in the last 12 months in the hospital.ResultsKey themes elicited includeDefinition of Safety, Need to consider additional vulnerabilities of children and young people with intellectual disability in hospital, Communication is key to safe care, Parent and family perspectives on safe care, Management challenges compromising safety and Service system gaps in preventing, identifying and managing risk.ConclusionsStaff need to consider additional vulnerabilities, mitigate negative attitudes and biases towards better engagement and relationships with parents, children and young people of this population. Improvement of current systems that prevent the identification, prevention and management of risk and safety issues for this population need to be undertaken. Future developments include combining data from parent interviews, academic and grey literature in developing safety competencies in this population for training and education of staff across the health system.
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Moussa, Fatchima L., Mahaman Moussa, Hussain Ahmed Sofyani, Bander Hammad Alblowi, Yahia Ahmad Oqdi, Saleh Khallaf, Hamad S. Alharbi, and Ahmed Albarqi. "Attitudes of Critical Care Nurses towards Teamwork and Patient Safety in Saudi Arabia: A Descriptive Cross-Sectional Assessment." Healthcare 10, no. 10 (September 25, 2022): 1866. http://dx.doi.org/10.3390/healthcare10101866.
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The study aimed to assess the teamwork and safety attitudes among the critical care unit (CCU) nurses in Saudi Arabia. A descriptive cross-sectional study was carried out in public tertiary hospitals in Al-Madinah, Saudi Arabia. All participants answered a three-part questionnaire that included demographic data, a teamwork attitude questionnaire (T-TAQ), and the Safety Attitudes Questionnaire (SAQ). The analysis revealed that the majority of the nurses were female, n = 52 (76.5%), and almost half of the nurses were aged from 29 to 39 years, n = 29 (42.6%). Teamwork attitude values are found to be relatively stable in all subscales, ranging from 1.63 (SD = 1.23) to higher at 2.92 (SD = 1.32). Of the six dimensions of SAQ, job satisfaction (M = 70, SD 21.46) had the highest positive rate and was approached with a positive attitude, followed by teamwork (M = 66.09, SD 15.12) and safety climate (M = 67.11, SD 17.70). The analysis also shows work experience was the influencing factor of teamwork attitude and safety attitude of nurses, recording beta values of 0.24, p < 0.05 and 0.10, p < 0.001, respectively. The results also identified an association between teamwork and safety attitudes. The study reflected the positive attitudes towards teamwork and less positive attitudes toward patient safety among critical care nurses in Saudi Arabia. Collaborative team performance among nurses improves the medical care quality and patients’ safety, decreasing the occurrence rate of adverse events.
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Kesgin, Buse, and Muhammet Ayar. "The effects of the COVID-19 pandemic on the oral health of patients." Balkan Journal of Dental Medicine 27, no. 2 (2023): 85–91. http://dx.doi.org/10.5937/bjdm2302085k.
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Background/Aim: The coronavirus pandemic, which has affected the world, has also affected living habits, oral care and dental treatments. In this study, demographic characteristics, nutrition and lifestyle habits, systemic diseases, oral care and dental problems and solutions of adult individuals during the COVID-19 pandemic were investigated. Material and Methods: A questionnaire about demographic information and pandemic was distributed to 303 people aged between 18-75. Oral care was recorded using the 'Simplified Oral Hygiene Index'. In the examination of the categorical variables of the findings, Pearson Chi-Square test was used when the assumption of sample size (n>5) was met, and Fisher's Exact test was used when it was not. IBM SPSS Statistics 25 program was used in the statistical analysis. Results: It has been observed that the importance given to oral care and health is higher in young, single, educated and female participants, and oral care increased with anxiety level. It was observed that the participants most frequently preferred to go to the dentist if all other methods were unsuccessful (p<0.05). Conclusions: The pandemic period has affected oral health and care habits. It is thought that knowledge has an important role in increasing oral health in infectious diseases.
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Yoo, Ji, and Jay Shen. "EVALUATE THE IMPACT OF INTERDISCIPLINARY EDUCATION AND TELEHEALTH PRIMARY CARE: QUALITY AND EFFICIENCY." Innovation in Aging 7, Supplement_1 (December 1, 2023): 633. http://dx.doi.org/10.1093/geroni/igad104.2063.
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Abstract In a provider shortage area, an Interprofessional Education and Telehealth Primary Care (IPETC) for geriatrics workforce was developed in 2020. To analyze the impact of IPETC on quality and efficiency of care, we measured quality outcomes defined by the CMS defined quality measures - dementia caregiver education/referral and advance care plan, and efficiency outcomes by estimating healthcare cost savings from reducing hospitalization. Two-hundred forty-four community-dwelling adults aged 60 to 97 with mild to moderate dementia were selected in an urban safety-net primary care clinic. Propensity - demographics and comorbidity was matched. Main outcomes were (A) number of hospitalization and 90-day rehospitalization rate, hospitalization-related healthcare cost estimates from the State Inpatient Dataset using the ICD-10 codes of principal diagnosis and hospital length of stay between January-December 2021. One-hundred twenty-two patients were cared by primary care providers who received the IPETC;122 patients were by those who did not have the IPETC; (2) CMS quality measures were compared between 2019 (baseline) and 2021 of patients cared by providers with IPETC. Number of hospitalization with IPETC was fewer than those without IPETC (0.72 vs. 1.38, p < .01). Number of 90-day rehospitalization with IPETC was fewer than those without IPETC (0.14 vs. 0.30, p < .01). An average cost-saving of $20,289 per patient was observed among those with IPETC than those without IPETC (p < .001). CMS quality measures improved from 15.6% to 51.0% in dementia caregiver education/referral; 10.2% to 24.7% in documented advance care plans.
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Brattwall, Metha, Magareta Warrén Stomberg, Pether Jildenstål, Irene Sellbrandt, and Jan G. Jakobsson. "What can a mobile App add to improve quality of care, with focus on ambulatory surgery?" European Journal for Person Centered Healthcare 6, no. 1 (April 30, 2018): 20. http://dx.doi.org/10.5750/ejpch.v6i1.1370.
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Rationale, aims and objectives: Many surgical procedures are nowadays performed as ambulatory or short stay procedures, reducing hospital length of stay. Patient safety and quality of care remain imperative especially when adopting enhanced recovery pathways. Patients should be adequately informed and prepared prior to admission. Recovery is to a major extent dependent after discharge on self-care and thus techniques to follow the post-operative course after leaving hospital are warranted. Telemedicine has grown tremendously over recent years and the incorporation of mobile telephone app technology for the pre- and post-operative coaching of the ambulatory surgical patient may represent an effective means of assisting patients. The present paper presents a feasibility study of a mobile telephone app providing pre-operative information and following the post-operative recovery following day surgery.Method: Patients scheduled for elective day surgery were asked to participate, testing the app and to assess its usefulness on visual analogue scales.Results: Sixty-nine patients aged 18 to 73 years tested the app. Patients aged 30 to 50 where the most frequent users and patients < 30 less frequent. The app was in general assessed as useful and most users expressed an interest in the option of having an app as a source of information before undergoing a scheduled procedure. General pre-operative information was assessed as the most important. A willingness to submit follow-up information decreased rapidly, only 26 and 16 responded at day 10 and 30, respectively.Conclusion: A mobile telephone app is a feasible and appreciated tool for pre-operative information and coaching as part of person-centered healthcare, but its use for follow-up after discharge is challenging and requires further investigation.
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HITCHEN, TATIANA, JOSEPH E. IBRAHIM, MARTA WOOLFORD, LYNDAL BUGEJA, and DAVID RANSON. "Premature and preventable deaths in frail, older people: a new perspective." Ageing and Society 37, no. 8 (May 19, 2016): 1531–42. http://dx.doi.org/10.1017/s0144686x16000428.
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ABSTRACTThe concept and potential implications of a premature death of an older person are under-recognised and misunderstood by society. Clinical, forensic and public health practitioners need to redress this gap to prepare society better for a future where an increasing proportion of the population are vulnerable older people. Reliable and valid information is paramount for understanding how many older people have premature, preventable deaths, with implications for aged care services, health-care expenditure, quality and safety, and human rights. Our aim is to: (a) provide discourse on the limitations and challenges to the use of the concepts ‘premature’ and ‘preventable’ deaths, examining the situation for nursing home residents; and (b) propose the use of a novel classification system of ‘treated’, ‘un-treated’ and ‘untreatable’ causes of death that is more sophisticated and reflects the demographic reality of our ageing population. Accepting that preventable, premature deaths may happen to older people and adopting a new classification is a novel approach that has considerable benefits for health and life care of older persons. Improved assessment of the quality of care provided, including identification of health or life care practices that are unsafe or deleterious, can be identified and addressed.
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Trenaman, Logan, Mark Harrison, and Jeffrey S. Hoch. "Medicare Beneficiaries’ Perspectives on the Quality of Hospital Care and Their Implications for Value-Based Payment." JAMA Network Open 6, no. 6 (June 21, 2023): e2319047. http://dx.doi.org/10.1001/jamanetworkopen.2023.19047.
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ImportanceMedicare’s Hospital Value-Based Purchasing (HVBP) program adjusts hospital payments according to performance on 4 equally weighted quality domains: clinical outcomes, safety, patient experience, and efficiency. The assumption that performance on each domain is equally important may not reflect the preferences of Medicare beneficiaries.ObjectiveTo estimate the relative importance (ie, weight) of the 4 quality domains in the HVBP program from the perspective of Medicare beneficiaries and the impact of using beneficiary value weights on incentive payments for hospitals enrolled in fiscal year 2019.Design, Setting, and ParticipantsAn online survey was conducted in March 2022. A nationally representative sample of Medicare beneficiaries was recruited through Ipsos KnowledgePanel. Value weights were estimated using a discrete choice experiment that asked respondents to choose between 2 hospitals and indicate which they preferred. Hospitals were described using 6 attributes, including (1) clinical outcomes, (2) patient experience, (3) safety, (4) Medicare spending per patient, (5) distance, and (6) out-of-pocket cost. Data analysis was performed from April to November 2022.Main Outcomes and MeasuresAn effects-coded mixed logit regression model was used to estimate the relative importance of quality domains. HVBP program performance was linked to Medicare payment data in the Medicare Inpatient Hospitals by Provider and Service data set and hospital characteristics from the American Hospital Association Annual Survey data set, and the estimated impact of using beneficiary value weights on hospital payments was estimated.ResultsA total of 1025 Medicare beneficiaries (518 women [51%]; 879 individuals [86%] aged ≥65 years; 717 White individuals [70%]) responded to the survey. A hospital’s performance on clinical outcomes was most highly valued by beneficiaries (49%), followed by safety (22%), patient experience (21%), and efficiency (8%). Nearly twice as many hospitals would see a payment reduction when using beneficiary value weights than would see an increase (1830 vs 922 hospitals); however, the average net decrease was smaller (mean [SD], −$46 978 [$71 211]; median [IQR], −$24 628 [−$53 507 to −$9562]) than the comparable increase (mean [SD], $93 243 [$190 654]; median [IQR], $35 358 [$9906 to $97 348]). Hospitals seeing a net reduction with beneficiary value weights were more likely to be smaller, lower volume, nonteaching, and non–safety-net hospitals located in more deprived areas that served less complex patients.Conclusions and RelevanceThis survey study of Medicare beneficiaries found that current HVBP program value weights do not reflect beneficiary preferences, suggesting that the use of beneficiary value weights may exacerbate disparities by rewarding larger, high-volume hospitals.
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de la Perrelle, Lenore, Monica Cations, Gaery Barbery, Gorjana Radisic, Billingsley Kaambwa, Maria Crotty, Janna Anneke Fitzgerald, et al. "How, why and under what circumstances does a quality improvement collaborative build knowledge and skills in clinicians working with people with dementia? A realist informed process evaluation." BMJ Open Quality 10, no. 2 (May 2021): e001147. http://dx.doi.org/10.1136/bmjoq-2020-001147.
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In increasingly constrained health and aged care services, strategies are needed to improve quality and translate evidence into practice. In dementia care, recent failures in quality and safety have led the WHO to prioritise the translation of known evidence into practice. While quality improvement collaboratives have been widely used in healthcare, there are few examples in dementia care.We describe a recent quality improvement collaborative to improve dementia care across Australia and assess the implementation outcomes of acceptability and feasibility of this strategy to translate known evidence into practice. A realist-informed process evaluation was used to analyse how, why and under what circumstances a quality improvement collaborative built knowledge and skills in clinicians working in dementia care.This realist-informed process evaluation developed, tested and refined the programme theory of a quality improvement collaborative. Data were collected pre-intervention and post-intervention using surveys and interviews with participants (n=28). A combined inductive and deductive data analysis process integrated three frameworks to examine the context and mechanisms of knowledge and skill building in participant clinicians.A refined program theory showed how and why clinicians built knowledge and skills in quality improvement in dementia care. Six mechanisms were identified: motivation, accountability, identity, collective learning, credibility and reflective practice. These mechanisms, in combination, operated to overcome constraints, role boundaries and pessimism about improved practice in dementia care.A quality improvement collaborative designed for clinicians in different contexts and roles was acceptable and feasible in building knowledge, skills and confidence of clinicians to improve dementia care. Supportive reflective practice and a credible, flexible and collaborative process optimised quality improvement knowledge and skills in clinicians working with people with dementia.Trial registration numberACTRN12618000268246.
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Boulton, Chris, Claudia Baldwin, Tony Matthews, and Silvia Tavares. "Environmental Design for Urban Cooling, Access, and Safety: A Novel Approach to Auditing Outdoor Areas in Residential Aged Care Facilities." Land 12, no. 2 (February 20, 2023): 514. http://dx.doi.org/10.3390/land12020514.
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Strategies and guidelines for best practice environmental design typically have a singular focus and intended outcome, for example, green infrastructure management for urban cooling in a hotter climate. However, when applied to specific situations such as aged care, matters such as accessibility, wayfinding, and safety are also critical. Combining various audit tools offer multiple benefits to meet a variety of needs for thermal comfort, health, and well-being, as well as cost-effectiveness. In the absence of such a tool, using a place-based analysis, we developed a novel audit tool for external settings of residential aged care facilities (ACFs) incorporating urban cooling, Crime Prevention Through Environmental Design (CPTED), and universal design criteria. To determine how ACFs perform in the face of increased levels of urban heat required evaluation of additional urban cooling measures. The Audit Tool was developed and tested in collaboration with ACFs across sub-tropical and tropical areas of Australia, varying in climate, scale, and urban density. Quality of life for residents, visitors, and staff of ACFs can be supported by the provision of green infrastructure to improve the thermal comfort of outdoor settings and, if located appropriately, reduce the need for an increase in internal air-conditioning. The aim of this article is to propose a user-friendly Hybrid Environmental Design Audit Tool (HEDAT) to support facility managers, planners, and design consultants to inform the prioritization and targeting of interventions and monitoring of implementation and outcomes.
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Franklin, Matthew, and Rachael Maree Hunter. "A modelling-based economic evaluation of primary-care-based fall-risk screening followed by fall-prevention intervention: a cohort-based Markov model stratified by older age groups." Age and Ageing 49, no. 1 (November 11, 2019): 57–66. http://dx.doi.org/10.1093/ageing/afz125.
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Abstract Background fall-risk assessment with fall-prevention intervention referral for at-risk groups to avoid falls could be cost-effective from a care-payer perspective. Aims to model the cost-effectiveness of a fall-risk assessment (QTUG compared to TUG) with referral to one of four fall-prevention interventions (Otago, FaME, Tai Chi, home safety assessment and modification) compared to no care pathway, when the decision to screen is based on older age in a primary care setting for community-dwelling people. Methods a cohort-based, decision analytic Markov model was stratified by five age groupings (65–70, 70–75, 65–89, 70–89 and 75–89) to estimate cost per quality-adjusted life years (QALYs). Costs included fall-risk assessment, fall-prevention intervention and downstream resource use (e.g. inpatient and care home admission). Uncertainty was explored using univariate, bivariate and probabilistic sensitivity analyses. Results screening with QTUG dominates (>QALYs; <costs) screening with TUG irrespective of subsequent fall-prevention intervention. The QTUG-based care pathways relative to no care pathway have a high probability of cost-effectiveness in those aged 75–89 (>85%), relative to those aged 70–74 (~10 < 30%) or 65–69 (<10%). In the older age group, only a 10% referral uptake is required for the QTUG with FaME or Otago modelled care pathways to remain cost-effective. Conclusion the highest probability of cost-effectiveness observed was a care pathway incorporating QTUG with FaME in those aged 75–89. Although the model does not fully represent current NICE Falls guidance, decision makers should still give careful consideration to implementing the aforementioned care pathway due to the modelled high probability of cost-effectiveness.
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Wharton, Tracy, Daniel Paulson, Kimberly Burcher, and Heather Lesch. "Delirium and Antipsychotic Medications at Hospital Intake: Screening to Decrease Likelihood of Aggression in Inpatient Settings Among Unknown Patients With Dementia." American Journal of Alzheimer's Disease & Other Dementiasr 34, no. 2 (November 1, 2018): 118–23. http://dx.doi.org/10.1177/1533317518809345.
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For individuals with dementia, disorientation and both external and internal stimuli may trigger behaviors that are difficult to manage or dangerous to health-care providers. Identification of correlational risk factors to aggressive behavior in patients who are unknown to the hospital can allow providers to adapt patient care quickly. Records for patients aged 60+ who spent at least 24 hours at the hospital other than in the psychiatric unit were used (N = 14 080). The first 4000 records and every 10th person who met criteria (N = 5008) were searched for documentation of dementia (n = 505). Logistic regressions and χ2 tests were used to examine relationships between variables. Recognition of delirium ( P = .014, Exp(B) = 2.53), coupled with an existing prescription for antipsychotic medication at intake ( P < .001, Exp(B) < 4.37), may be a reliable means of screening for risk and intervening at the earliest possible contact, improving quality of care and safety in acute care for individuals with dementia.
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Cochrane, Susan F., Alice L. Holmes, and Joseph E. Ibrahim. "Progressing Towards a Freer Market in Australian Residential Aged Care." Social Policy and Society, December 3, 2021, 1–25. http://dx.doi.org/10.1017/s1474746421000786.
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The Royal Commission into Aged Care Quality and Safety has again focussed attention on the failings of the Australian aged care system. Residential aged care in Australia has become increasingly market-driven since the major reforms of 1997. The aims of increased marketisation include providing residents with greater choice, higher quality services, and increasing providers’ efficiency and innovation. However, marketisation is not meeting these aims, predominantly due to asymmetries of knowledge and power between residents and aged care providers. These asymmetries arise from inadequate provision of information, geographic disparities, urgency for care as needs arise acutely, and issues surrounding safety, including cultural safety. We propose a human rights framework, supported by responsive regulation, to overcome the failings of the current system and deliver an improved aged care system which is fit for purpose.
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Hutchinson, Claire, Julie Ratcliffe, Matthew Crocker, Sheela Kumaran, Rachel Milte, and Jyoti Khadka. "‘Knowledge is everything?’ How well do the general public understand aged care and how does this affect their attitudes towards quality of care and future funding?" Ageing and Society, October 20, 2021, 1–23. http://dx.doi.org/10.1017/s0144686x21001549.
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Abstract The recent Royal Commission into Aged Care Quality and Safety in Australia has documented systemic failures and shocking incidences of abuse and neglect, a not uncommon story internationally. As aged care in many countries is predominantly publicly funded, it is important to understand the general public's attitudes towards aged care quality, what aspects of care quality they think are most important and their willingness to contribute to increased funding to the sector. This paper asks specifically whether self-reported aged care literacy impacts expectations and willingness to pay. More than 10,000 members of the general population were surveyed stratified by age, gender and state. Regardless of the level of aged care literacy, there was consensus about what constitutes quality care, and care priorities for the sector. However, aged care literacy affected willingness to pay to fund a better-quality aged care system. The current crisis facing Australia's aged care system and that of many other countries internationally demonstrates the central importance of general public support to drive quality improvements, recognising that increasing public expenditure on aged care is a necessary part of the solution. This study provides important baseline data from which to commence national and international conversations to consider all options for ensuring the quality, safety and sustainability of aged care now and into the future.