Creating a caring and safe home environment

23 May 2012
On a quiet street in leafy Remuera, an age-related residential care facility is methodically going about the task of implementing patient safety best practice.

While from the street, Care Alliance Waimarie may look like any other grand old home in one of Auckland’s most prestigious suburbs, on the inside its residents are benefiting from a new approach to harm risk reduction as a feature of their care.

“These residents are my family,” says Manager Josephine Comrie.

“I’ve been here for three-and-a-half years and we’ve been through a lot of change together. It’s been challenging but very rewarding.”

That change has seen a healthy reporting culture fostered among staff with emphasis on moving beyond blame for patient harm incidents to identification and implementation of solutions.

It has also included a package of initiatives aimed at improving patient safety while supporting residents to enjoy their independence.

When Josephine arrived, the 50-bed facility was operating with a 33 per cent restraint level. She quickly set about reducing the use of restraint to the point where it is no longer practiced at all.

“Families have seen a difference in culture. They say it doesn’t look and feel like a hospital now; it’s more of a home environment. We’ve tried hard to get away from that clinical, hospital environment,” says Josephine.

The homely feel has seen the addition of Ally the Cocker Spaniel, who spends her days wandering among the residents.

Around 30 new beds have been bought for residents that can be electronically raised and lowered to minimise the risk of harm from falls while trying to get out of bed.

Sensor mats on the floor alert staff to residents who are getting in and out of bed so they can keep a close watch on them.

Josephine has observed that red-coloured pads are – for reasons yet to be confirmed by study – highly effective with dementia patients.

“They don’t try to step over the red mats but there is a tendency to try to step over black ones. I had one resident tell me they thought the black mat was a hole in the floor,” she said.

Medication errors were identified as an area where action was needed and a simple change has led to a reduction in mix-ups with the potential to harm.

“There was a tendency for residents and their families to walk up to nurses and start having conversations while they were in the middle of providing medication.

“These disturbances created obvious risks for errors in the medicines patients were receiving, so we did a project where nurses were allowed to focus on their medication rounds.

“We started using bright yellow vests with ‘Do not disturb’ written in bold on the back and this has been very successful.”

Carers working in tandem with nurses on medication rounds have become the key point of contact for residents and their families as they work their way around the facility.

This has allowed nurses to take a more ‘hands-on’ role and has created a team environment where staff feel supported to do their jobs properly.

“There’s no more ‘them and us’ – we’re one team. Nurses are now more involved in providing care before things become a problem and the team gels better.

“Our staff turnover is very minimal and that is good for the residents and good for our organisation.”

Care Alliance Waimarie has informal networks with other age-related residential care facilities which work together to share information about patient safety initiatives.

Josephine is a keen advocate for the age-related residential care sector to embrace the regional approach to learning and development that is the cornerstone of the First, Do No Harm campaign.

“I think, as a group, we all have to be open about adverse events. We have to work together as a team and discuss ideas because patient safety is a learning process.”

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