Compliance Insights – Consumer Facing Risk
The Aged care standards have brought forward a focus on consumer facing risk. Much the way that changes in work health safety have done for employee facing risk, Boards and Clinical Governance sub committees are grappling to understand if they have a sufficient handle on the risks that have the greatest impact and harm to those receiving care.
Governing bodies are required to consider how risk mitigation and minimisation strategies are being discussed or deployed, satisfying themselves that those strategies are sufficient to reduce real harm to consumers whilst also balancing the dignity of risk equation. They must satisfy themselves that there is clarity around decision making and consent, that consumers have the opportunity to take risks, and that consumers are engaged in risk decisions that apply to them.
On the other side we also recognise that our services will improve when consumers have improved their health literacy and insights into the risks that apply to them.
The only way a genuine ‘partner in care’ approach will work is when both the providers team and the consumer/representative have a way to engage and dialogue. A dignity of risk discussion only flows when all the issues are squarely laid out in order that the care review discussion enables thoughtful reflection and discussion. When completed the care planning and frameworks for goals, needs and preferences can really then be understood with informed consent.
Whilst not an absolute definitive list, the evolving compliance landscape and the application for the aged care standards is yielding feedback that Homes are still maturing in assessing and enabling a consumer engaged review of risks that apply them. Here’s the framework unpacked stimulating food for thoughts over your own policies and approaches:
Decision making and consent
Standard 1 in particular really draws attention to the issue of consent and consumer decision making. Whilst not new concepts by any means, it is very apparent that there is ongoing confusion about what health professionals do versus what consumers do in terms of making decisions about the issues and risks that apply to themselves. Fact- Doctors and Nurses provide professional guidance. They do not make decisions on behalf of a consumer- Consumers do. Now when I make that statement it all seems so obvious yet frequently hear aged care staff use language like ‘we allow him to have two beers at dinner’- really its 2020!
The notion of capacity is also key in supporting consumers with their decision making. It is important that capacity and decision making is applied to individual scenarios and there is not the assumption that a consumer does not have capacity to make any decisions. They may be able to make decisions about certain activities in their day, for example when they could like their meal served, however may not have capacity to make a decision about a medication or treatment that is required. Capacity is assessed by health care professionals and it is decision specific meaning the decision is framed against understanding the ‘nature, risks and consequences’. We are assessing the decision making capacity not the decision itself.
Each person’s medical history, current diagnosis and medication all have risk implications. The comprehensive clinical consideration of these cannot be understated. Understanding each individual’s medical history will help to anticipate what care and support and intervention may need to be considered in the future.
Standard 2 in particular highlights the need for initial and ongoing assessment and planning of care and services. The assessment process begins in the pre-admission phase where clear conversations with the consumer and/or their representatives outline how their medical history and diagnosis may lead to increased risk for example, a consumer with a diagnosis of Parkinson’s Disease, as their disease progresses, will almost certainly have an increased risk of falls.
Clinical High Impact risk
High Impact Clinical Risk points to clinical diagnoses that are more likely to cause harm to a consumer if not effectively managed and consistently monitored. Comprehensive and regular assessment of risk is required to ensure that all risks are identified and appropriate minimisation strategies are implemented.
The risk assessment and subsequent care and service planning must always be connected to the consumer’s goals, needs and preferences. For example, if a consumer who is identified as being at high risk of falls should have a care and service plan that has assessed their need but also supports and promotes independence and has considered dignity of risk.
Physical, movement and Environment risk
It is important for all consumers to feel comfortable and safe within the built environment. This environment should be welcoming, allow freedom of movement (both inside and outdoors), be comfortable and clean and well maintained.
Environmental assessments should be carried out on a regular basis to minimise risk of harm to consumers. For a consumer who is visually impaired, enable access to the outdoor areas through tactiles and colour coding.
Restraint (Physical and Chemical) need compliance attention- remember the legislation is very clear of obligations (see Quality of Care Principles).
Spiritual, Cultural and Ethical risk
Spiritual care for older people must be cognisant of background, family situation and social networks and how this may impact their experience of care and service delivery. Spiritual care is provided within a culture of acceptance and inclusivity. All beliefs, values and social connections are respected. This includes the right of the consumer to make their own decisions about how spiritual support is provided.
For example, culturally sensitive staff allocation is expected. It is essential that organisations are able to demonstrate that services are culturally safe and reflective of individualised care.
Social and Meaningful engagement risk
Social connectedness is a central component of cultural safety. Providing meaningful activity for the individual consumer is central to all activity and lifestyle programs. Consumer preference based on choice facilitates holistic care.
Individual and group activities that promote growth should be cognisant of the capacity, both physical and emotional, of the consumer. Risk assessments should consider these characteristics.
Emotional and Psychological risk
It is critical to provide support for consumers who are anxious, depressed, exhibit challenging behaviours or present with Post Traumatic Stress Disorder. The risks associated with providing care and services for consumers should reflect staffing skill mix and capability. For example targeted recruitment processes that align with existing skill mix.
Your dignity of risk framework coupled with your Clinical governance framework is where it is important to articulate the detail of your policy, procedures, forms and education plans. At Anchor Excellence we provide a full service consulting solution to ensure your policies are designed to your own organisations requirements. Please reach out if you are looking for this level of support, we are delighted to assist.