Residential Aged Care Communiqué
Download PDF: RAC Communiqué February 2019
In this edition
- Case Précis: Too Much
- Commentary #1: The coroner’s
requirement of organisations to
- Summary of organisational
responses to the coroner’s findings
- Management of BPSD:
- In the news recently
- The ‘Dignity of Risk’
Welcome to the first issue of 2019. This will be a busy year for all our readers with the Royal Commission and the introduction of the new standards for accreditation. This edition focuses on one case with so many issues it is almost too difficult to comprehend. Each gap in care probably would not have led to the resident’s death, but together, the combination was fatal. The case exemplifies the complexity of issues confronting the Royal Commission and highlights that improving aged care requires an approach that involves the whole community as evident by the recommendations made by the coroner to multiple organisations.
Consider for a moment the following occurring over a period of two months, a resident with dementia who is unable to advocate, transition from home to respite to permanent care, the prescription of sedative medication, escalation of dosing, involvement of two RACS, two visits to an acute hospital, the care divided among several general practitioners, and delays in accessing specialist medical support. Each point in the provision of care represents a potential source of risk to the resident.
The case also highlights issues we have addressed in the past including the challenges of managing residents entering respite care, management of behaviours and psychological symptoms of dementia (BPSD), monitoring of high risk medication, gaps in communicating relevant information between residential aged care and other health services. Despite the complexity of this case, this is not an uncommon reality for RACS staff and is noteworthy because of the absence of safety nets to identify the overall risk and clear stewardship for managing the resident.
In particular, I want to emphasise a fundamental aspect of clinical care which is the importance of following-up the initiation of any treatment. This is easily overlooked with the common use of high risk medications as we become complacent about these agents. In every medical, nursing and allied health school, students and practitioners are taught and reminded to ensure the indications for initiating treatment are identified and valid. Further, that initiation or change in treatment requires timely evaluation of the patient’s response to treatment and to assess for the presence of any adverse effects.
Our expert commentaries are written by Dr Margaret Bird and Dr Chelsea Baird, both geriatricians with a profound interest in good patient care. Their contribution is a reminder of the next generation of health professionals that will lead us towards better care of older persons. This is timely with the confronting and depressing evidence currently emerging at the Royal Commission for Aged Care Quality and Safety.
Medication safety is a huge topic, one need only refer to the comprehensive report by the Institute of Medicine. Preventing medication errors. Washington, DC: National Academy Press; 2007. While the focus is often on the administration, it is essential to justify the indication for prescribing and to review whether the medication has the desired and not any untoward effects. On a more personal and historic note, this is our 49th issue of the RAC Communique and we are intending for our 50th to be reflective and practical. Keep an eye out for our 2019 seminar and a book of all 50 issues of the RACC in one volume!