Safety and Quality Issues in Aged care
The top five areas to explore for safety care investigation are; restraint use, information sharing systems, behavioural management, staffing issues and reducing unnecessary hospital transfers in aged care. The topic chosen to explore for safety and quality improvement is, finding ways in which hospitalisation among the elderly people living in the community or the nursing home can be reduced.
Between 2016-2017, there was 1.6 million emergency department presentation among people over the age of 65 (Older Australia at a Glance, 2018). The three most common presentation to the emergency department was dependant on the age group. Pain in the throat or chest was the most common presentation, the other was related to musculoskeletal issues resulting from either a fall or general deterioration. Several reasons could account for this high rate in hospitalisation. For example, (Halter et al., 2017) found that the high turnover of nurses in aged care affects the clinical leadership and the general clinical framework for managing chronic illnesses. (King et al., 2018) also found that a high number of transfers to the hospital where initiated by nurses, and in most of these cases clinical guidance from the doctor was sub-optimal. The present study also found that most of the end of life to hospital transfers could have been prevented if the facilities had a specialist doctor on-site or the GP seeing the resident before transfer (King et al., 2018).
Reducing unnecessary hospitalisation among the elderly would be beneficial for both the resident and the health care system (Möllers et al., 2020). Hospital transfers from nursing homes are frequent, burdensome for resident and are often avoidable (Toh et al., 2017). Studies show that most resident if given a choice would rather remain in their home should their condition deteriorate (Health, 2019). Once they return to the care home, they are often more disoriented, agitated and confused, this is especially the case for people with dementia that need a proper routine to reduce challenging behaviours (Shenvi et al., 2020). Frequent hospitalisation and prolonged hospital stay, can lead to increased risk of falls, sleep deprivation and a higher risk of developing hospital acquired infections, like MRSA (Australian Commission on Safety and Quality in Health Care, 2020).
At an institutional level, reducing the number of hospital admissions from aged care would reduce the physical and financial burden on the health care system (challenges of an Ageing Population, 2019). For example, in the elderly, falls, are a major cause of functional decline, disability, increased lengthy hospitalisation and death (Florence et al., 2018). Studies show that exercise, particularly ones that target strength, gait and balance, reduce the risk of falls (Dellinger, 2017). Other studies show that withdraw of psychotropics or limiting the use of medication that cause dizziness, sedation, confusion and blurred vision also reduce the risk of falls (Johnell et al., 2017). A neck of femur fracture for example, would mean, extended rehabilitation, which often means more staff to cater for the needs of one patient. In the absence of falls prevention programs, it is projected that the total cost of hospitalisation related falls will cost the Western Australian Government $174 million by 2021 (Consequences of Falls, 2020).
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Dellinger, A. (2017). Older Adult Falls: Effective Approaches to Prevention. Current Trauma Reports, 3(2), 118–123. https://doi.org/10.1007/s40719-017-0087-x
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Halter, M., Pelone, F., Boiko, O., Beighton, C., Harris, R., Gale, J., Gourlay, S., & Drennan, V. (2017). Interventions to Reduce Adult Nursing Turnover: A Systematic Review of Systematic Reviews. The Open Nursing Journal, 11, 108–123. https://doi.org/10.2174/1874434601711010108
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Johnell, K., Jonasdottir Bergman, G., Fastbom, J., Danielsson, B., Borg, N., & Salmi, P. (2017). Psychotropic drugs and the risk of fall injuries, hospitalisations and mortality among older adults. International Journal of Geriatric Psychiatry, 32(4), 414–420. https://doi.org/10.1002/gps.4483
King, B., Pecanac, K., Krupp, A., Liebzeit, D., & Mahoney, J. (2018). Impact of Fall Prevention on Nurses and Care of Fall Risk Patients. The Gerontologist, 58(2), 331–340. https://doi.org/10.1093/geront/gnw156
Möllers, T., Perna, L., Stocker, H., Ihle, P., Schubert, I., Schöttker, B., Frölich, L., Bauer, J., & Brenner, H. (2020). Alzheimer’s disease medication and outcomes of hospitalisation among patients with dementia. Epidemiology and Psychiatric Sciences, 29. https://doi.org/10.1017/S2045796019000702
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Shenvi, C., Kennedy, M., Austin, C. A., Wilson, M. P., Gerardi, M., & Schneider, S. (2020). Managing Delirium and Agitation in the Older Emergency Department Patient: The ADEPT Tool. Annals of Emergency Medicine, 75(2), 136–145. https://doi.org/10.1016/j.annemergmed.2019.07.023
Toh, H. J., Lim, Z. Y., Yap, P., & Tang, T. (2017). Factors associated with prolonged length of stay in older patients. Singapore Medical Journal, 58(3), 134–138. https://doi.org/10.11622/smedj.2016158