Home' Australian Ageing Agenda : AAA Nov-Dec 2016 Contents Transfers of aged care residents to
hospital emergency departments
are costly, stressful and often
unnecessary or avoidable.
But research has shown that
addressing the confidence and clinical skills of
facility nursing staff, and improved access to
resources, can potentially reduce unnecessary
transfers to the ED, according to Sandra
Thomson, PresCare's chief clinical officer.
During 2014, PresCare implemented a
government-funded pilot to develop a simple
traffic light system to detect, assess, report and
respond early to deteriorating residents.
"Prior to implementation of the sub-acute
model of care, staff identified trends in care
recipients being transported to hospital when
their condition changed," says Thomson, who is
also facility manager at Alexandra Gardens.
Transfer were due to eight common and
often avoidable clinical conditions: UTIs, chest
pain, dyspnoea, dehydration, falls, constipation,
delirium and end-of-life care, she says.
WHAT WAS INVOLVED?
Thomson says the project team wanted a
simple way to identify changes in a resident's
condition early and respond quickly. They also
wanted a skilled nursing service, a suite of tools
to guide the decision-making process when a
resident deteriorated, and clear reporting lines
"This involved up-skilling staff to provide
more advanced clinical care and improved clinical
communication, equipment to assist clinical
assessment, and robust partnerships across the
Rockhampton health sector," says Thomson.
A committee was established to oversee
and drive implementation, consisting of the
hospital, Medicare Local, Central Queensland
University (CQU), a geriatrician and another
local residential aged care provider.
"The team coordinated information sessions
internally with staff and then consulted with
residents and families, GPs, Queensland Health
officers and nursing staff, specialists and the
Medicare Local to gain support," she says.
A sub-acute toolkit was developed consisting
of a suite of resources to guide the early
identification and management of clinical
deterioration in residents.
This included a simple traffic light system of
green (continue as current) to amber (sub-acute)
to red (acute), promoting early identification and
management of symptoms for the eight common
clinical conditions identified earlier.
The project also included a residential acute
deterioration detection chart, end-of-life care
pathway, clinical management guidelines for
the eight conditions, new diagnostic equipment,
new policies and an educational DVD.
"Workforce development and a clear clinical
governance structure were crucial in enabling
staff to identify early and deliver the clinical care
encompassed by the model," says Thomson.
WHAT HAVE THE
Through an agreement with CQU, an analysis of
PresCare's model was carried out.
It found that during the first 12 months the
number of residents transferred to hospital
decreased by 50 per cent, while the number of days
they were in hospital decreased by 57 per cent.
Since 2014 there have been no UTI admissions
to hospital, falls for residents with dementia
decreased by 14 per cent and falls with injury
decreased by 40 per cent, Thomson reports.
"Nursing staff are now confidently working
to their full scope of practice. The program has
also made a positive impact on staff satisfaction,
with post-project survey results finding
increased staff satisfaction and motivation to 92
per cent," she says.
Given the success, the model is now
being expanded, with the Early Detection of
Deterioration in Elderly (EDDIE) initiative
being implemented in a second facility.
Thomson says the project has identified
the importance of clinical leadership, clear
reporting lines for escalation with simple tools
to guide decision making, and close working
relationships with hospital and residential in-
The commitment and continual involvement
of all stakeholders is also essential, she says.
Earlier this year, PresCare Alexandra
Gardens won a Better Practice award in
recognition of its sub-acute program. n
Traffic light system catches
seen a 50 per
care at its
PresCare's sub-acute care
system is seeing reduced
for aged care residents.
www.australianageingagenda.com.au | 41
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