Client Centred Practice and Management of Risk

Falls Prevention Forum for People with Dementia in Gippsland

Monday 15th September 2014

Nicole TierneyOccupational Therapy Manager, LRH

NSQHSStandard 2: Partnering With

Consumers

Key Messages:

•Partnering with consumers is essential to patients care

•Patients and carers should be encouraged to participate in treatment decisions

•Ensure patients and carers have avenues to provide feedback

NSQHSStandard 10: Preventing Falls and

Harm from Falls

Ensure:•Falls risk is assessed and documented•Prevention strategies are identified & used•Falls are reported and investigated•Patient/carer are informed of risk & strategies•Patient/carer are engaged in development of appropriate falls prevention plan

Australian Charter of Healthcare Rights

What can patients expect:

My rights What This Means

Respect: I have a right to be shown respect, dignity and consideration.

The care provided shows respect to me and my culture, beliefs, values and personal characteristics.

Communication: I have a right to be informed about services, treatment options and costs in a clear and open way.

I receive open, timely and appropriate communication about my healthcare in a way I can understand.

Participation: I have a right to be included in decisions and choices about my care.

I may join in making decisions and choices about my care and health care planning.

Client Centred Practice

Client Centred Practice: what?Healthcare that is respectful of, and responsive to, the

preferences, needs and values of patients and consumers (NSQHS)

•Philosophical approach to service development and delivery•A partnership with clients and carers•Underpins organisational policies, models of care and staff actions•Needs consistency and persistence

Treating people the way they want to be treated

Client Centred Practice – why?Associated clinical benefits include:•Decreased mortality 1

•Decreased readmission rates 2

•Reduced length of stay 3

•Improved adherence to treatment regimes 4

•Improved functional status 3

•Improved healthcare workers’ sense of professional worth 5

1. Meterko, Wright et al (2010)

2. Boulding, Glickman et al (2011)

3. DiGioia, Greenhouse et al (2007)

4. Arbuthnott, Sharpe (2009)

5. Dow, Haralambous et al (2006)

Client Centred Practice: how?

• Get to know the patient as a person: build relationships with patients and carers

• Share power and responsibility: partnership in setting goals, planning care and making decisions

• Accessibility and flexibility: sensitive to individual needs, provide information in a way that facilitated informed decision making

• Coordination and integration: work as a team

• Environments: supportive physical, organisational and cultural environments

Best Care for Older People Everywhere: The Toolkit (2012)

Dow, Haralambous et al (2006)

Client Centred Practice: barriers

• Time• Dissolution of professional power: staff perceiving

loss• Staff lacking autonomy• Lack of clarity and awareness• Clients with communication difficulties• Constraining nature of organisations

Dow, Haralambous et al (2006)

Client Centred Practice: enablers

• Skilled, knowledgeable and enthusiastic staff• Opportunities for involving client and carer • Opportunity for staff to reflect & express concerns• Staff training and education• Feedback from consumers• Organisational support• Being in the client’s home

Dow, Haralambous et al (2006)

Client Centred Practice: OT

• Canadian Association of Occupational Therapists: national guidelines 1983

• 5 key concepts:- the individual as an important and active participant- view clients holistically- therapeutic use of activity/occupation- consider client’s life stage and role demands

Dow, Haralambous et al (2006)

Client Centred Practice: OT

• Canadian Model of Occupational Performance• Key concepts include:- Client autonomy and choice- Partnership and responsibility: active roles- Contextual congruence: client’s roles, values,

interests and environment are central- Respect for diversity

Law, Baptiste and Mills (1995)

Risk Management

Risk Management: what?

• Risk: The chance of something happening that will have a negative impact. Measured by consequences and likelihood.

• Risk management: the design and implementation of a program to identify and avoid or minimise risks to patients, employees, volunteers, visitors and the institution.

NSQHS Standards 2011

Risk Management

5 Basic Principles:

•Avoid risk: eliminate or manage

•Identify risk: screen and assess

•Analyse risk: examine how and why, potential consequences

•Evaluate risk: determine how to reduce or eliminate

•Treat risk: implement prevention strategies

Management Programs: Best Practice

• Cognitive impairment should be identified, assessed and investigated (eg: presence of delirium)

• Assess risk factors for falls • Address risk factors as part of a multifactorial falls

prevention program• Injury minimisation strategies should be consideredPreventing Falls and Harm from Falls in Older People

Best Practice Guidelines for Australian Hospitals

2009

Between knowledge and action

Between evidence and practice

Between organisational policy and supported practice/infrastructure

Thanks

Nicole Tierney

5173 8383

ntierney@lrh.com.au