TE HOPAI TRUST
January 2018
At the start of the year, the Quality Team is always very busy reflecting on the previous year and setting up our quality objectives for the coming one. We conduct a comprehensive auditing and benchmarking system, which has clearly laid out objectives, on an annual basis, but alongside this, we also focus on extra areas of interest, which are designed to improve our service further.
Firstly we would like more responses to our surveys. We only ever receive a very small number of surveys and this does not give us an accurate representation as to the views of our clients. We have tried posting surveys, leaving them at the nurses’ stations, sending them by email, but no method seems to improve the response rate. We love to hear back from you, so in future we will post a link on the website to any survey we are conducting, unless it is resident only, and hopefully that will engender a greater response rate.
This year we have decided to focus on five projects which we identified as areas of need after analysing our surveys, audits and the complaints process from 2017. These include resident support and we have the services of a facilitator who will run sessions on relaxation and well-being. One of our Diversional Therapists also has recently gained a qualification in Clinical Pastoral Education. TheNew Zealand Association for Clinical Pastoral Education, with whom she completed her course,is a professional association committed to advancing experienced-based theological education for people of diverse cultures, ethnic groups and faith traditions. Its ultimate goal is to equip people to provide quality pastoral care within community.
NZACPE courses:
- integrate pastoral work and theology, with relevant medical, psychological and behavioural sciences
- engage participants in reflection about what happens before their eyes
- develop better pastoral relationships by bringing together participants' personal experience, spirituality and theology
- offer professional education for ministry, designed to establish and improve ministry practice
We hope that residents will avail of her services if they need spiritual or psychological support, as we recognise it can be very difficult to transition into residential care and often people end up feeling down or lonely.
Our second project will focus on improving the literacy and numeracy of our staff. We know that low literacy and numeracy skill levels are a problem not only in New Zealand, but also in a number of other Organisation for Economic Cooperation and Development (OECD) countries. The Programme for the International Assessment of Adult Competencies (PIAAC) highlighted the fact that a considerable number of adults in OECD countries possess only limited literacy and numeracy skills (Windisch, 2016).
In New Zealand 43% of adults are classed as having low level literacy skills (PIAAC, 2016) and it has been identified that those with low skills in this area are likely to be left behind (Windisch, 2016). There is a recognised relationship between skills and prosperity at an individual and collective level, with countries that have a lower level skilled population losing competitiveness as the world economy becomes more dependent on having a population who possess these skills (Windisch, 2016). Both productivity and the ability to earn good money depend on how well people have developed their literacy and numeracy skills.
In addition to this, it is important our staff can communicate effectively with each other and with the people they care for. Residents want to be able to foster relationships with the staff and to feel they can trust them with their care. Being able to talk to each other is an important part of this relationship.
The Quality Manager is undertaking a qualification to enable her to improve the literacy and numeracy of those who have English as a second language. Thus we will have internal support for our staff who struggle with their literacy and we can help them improve their English skills for the good of all.
After benchmarking bedrail use against the other facilities we compare ourselves to, we have realised that we use bedrails far more frequently than is necessary. We have produced a leaflet entitled “A guide to bedrail safety” which anyone is welcome to request.
Antibiotic over use is a problem we all should be concerned about. An Australian study found that up to 67% of antibiotic prescriptions in aged care facilities were inappropriate i.e. the drugs were given to people who did not need them. We are using a programme called “Symptom Free Pee – let it be” andwe aim to reduce our use of antibiotics to treat asymptomatic bacteriuria (which is when the bladder is colonised with bacteria, but they are not causing any symptoms of urinary tract infection). We have already held one training session to educate our staff in what to look for when a person has a UTI, strategies to reduce the use of antibiotics and also what things do not need treating e.g. malodourous urine.
Our final project is to continue to improve our norovirus outbreak management. We realise there is a fine line between eliminating infection from the facility and protecting visitors rights to come into the facility. We know from experience that shutting down the whole facility eliminates the infection faster, reduces resident and staff sickness and reduces costs. However, we also appreciate that people may have travelled long distances to come and see someone and it is distressing for relatives and friends to not be able to visit. Thus, we have decided if we have an outbreak again, we will improve our communication processes and are setting up a Facebook site, one function of which will be to broadcast messages, and we also have our new-look website where we can also post information about what is happening.
In conjunction with this, we have decided to pilot supervised visiting, with senior staff on hand to give instructions about how to put on and take off Personal Protective Equipment and how to perform hand hygiene effectively. If this does not increase infection rates, then we will adopt it as practice.
We are also very excited to have the University of Otago conducting research in the facility and their paper will be an investigation of how health professionals work together when a person is admitted to die in an aged residential care setting. This research is needed as aged care facilities take on increasing numbers of complex palliative cases and we need to work closely with other organisations so we can provide excellent palliative care.
Our progress on all of these projects will be reported on at the mid-year point.
Sam Ogilvie (Quality and Training Manager)