Download PDF: RAC Communiqué November 2017
In this edition
Editorial
Case: Not one to complain
Commentary: Through the eyes of a GP
Commentary: Through the eyes of a RN
Update on Inquiries
Save the day
Recommendations for prevention of injury-related deaths in residential aged care services
List of Resources
Editorial
Welcome to the final issue of the RACC for 2017. It has been an amazingly busy year with residential aged care often being in the news. This is a mixed blessing as it highlights the dedication of staff and the need for change, but it also creates an atmosphere of fear and dread for those older residents and their families.
Issues of staffing levels, recognition of the complexity, need for specialist gerontic nursing and geriatric medicine training, as well as better support for all are now being debated. The results from the different inquiries will generate debate making this the best time since the year 2000 for everyone to become involved and have their say for future directions.
The case we present in this issue is multi-layered and requires time to contemplate and incorporate into improving practice. The family learn at the last minute their loved one is unwell and it is they, not the staff, that make the telephone call. The resident, a stoic man who was not one to complain, trusted and relied on staff to act to keep him well but showed all the signs of a person who was clearly unwell.
It is expected that experienced medical and nursing staff will document clear instructions about clinical monitoring and parameters for when to act. The need for good communication begins with knowing who is who, and what they do, and what they cannot do. It is more challenging for new staff who have to orientate themselves to the residents, local procedures and the staff. This adds further complexity as escalation of clinical matters requires an understanding of clinical practice as well as how, when, where, and who to escalate concerns!
Should we do what the teams in the operating room do before surgery where they go through a checklist and everyone introduces themselves? — when you read the case — ask yourself if that would have made a difference. For the management, the issue of staffing levels, experience, their expected level of assertiveness and ability to reach that level all come into play. Finally, the staff rosters deserve consideration — is continuity having the same person, or the same discipline provide care?
It is too easy to describe this case as a failure to recognise a deteriorating resident and failure to escalate care — and so it looks only like a clinical skill issue. Over the past ten years we have known that our readers are more sophisticated than that, and will see the cultural issues within the RACS and between the medical and nursing staff as contributing factors; as well as the structural process used to deliver care.
We are fortunate to have two expert commentaries, one from a senior nurse, Associate Professor Deirdre Fetherstonhaugh, and another from a senior General Practitioner, Professor Dimity Pond, who will explore the issues in greater depth.