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Guidelines for the Serious Incident Response Scheme (SIRS) Updated 27 May 2021: What this Means for Residential Aged Care Providers

On 27 May 2021, the Aged Care Quality and Safety Commission (the Commission) updated its Serious Incident Response Scheme – Guidelines for residential aged care providers.

The Commission provided a summary of the updates on page 3 of the new guidelines. However, this summary is brief and does not mention all of the updates. So we’ve made a detailed comparison of the old version and the new version of the guidelines to provide you a more comprehensive list of what’s changed.

 

What is the Serious Incident Response Scheme (SIRS)?

The SIRS is a national framework for incident management and reporting of serious incidents in residential aged care. It imposes obligations on aged care providers to manage and report on incidents, and expands the powers of the Commission.

 

What has Changed in the 27 May 2021 Updates?

Overview of key changes

  • “Priority 2 reportable incident” is now defined as “An incident that does not meet the criteria for a Priority 1 incident”.
  • “Duty of care” now has a narrower, more precise definition.
  • Unexpected death: new guidelines state that not all unexpected deaths have to be reported; examples in the new guidelines suggest that only events that result in death need to be reported (rather than events that “contribute to” death).
  • Stealing and financial coercion: requirements for reporting systems are now less prescriptive; missing valuables now only have to be reported to the Commission if the consumer “believes that a staff member is responsible and appears concerned or distressed about the loss”.
  • Neglect: the new guidelines acknowledge that there may be minor incidents of neglect that do not need to be reported.
  • Commission’s function of “supporting” providers has changed to “providing guidance” to providers.
  • Powers of the Commission: new guidelines state that Commission may “take any reasonable action” in response to an incident; Commission may use SIRS data for other purposes.
  • Attachment A: SIRS notification form questions: “impact” now includes “not only actual harm, but also harm that could reasonably have been expected to have been caused”.

 

Clarification of Priority 2 obligations and commencement dates

The new guidelines state that: “From 1 April 2021 providers are required to have in place an effective incident management system and report to the Commission all reportable incidents assessed as Priority 1 reportable incidents. From 1 October 2021 providers are required to report all reportable incidents whether they are assessed as Priority 1 or Priority 2.”

 

New definition of “Priority 2 reportable incident”

 

Old version (1.3)

Current version (1.4)

An incident that results in a low level of harm to a consumer.

 

An incident that does not meet the criteria for a Priority 1 incident

 

Duty of care – narrower, more precise definition

 

Old version (1.3)

Current version (1.4)

A duty of care exists when someone’s actions could reasonably be expected to affect other people.

A duty of care exists when someone’s actions could reasonably be expected to harm other people.

 

 

Unreasonable use of force – “allegations of force” deleted from list of examples of unreasonable use of force

 

Old version (1.3)

Current version (1.4)

What is unreasonable use of force?

 

 

Where a consumer (or anyone else) alleges there was an unreasonable use of force (regardless of whether physical injury occurred and regardless of whether

the consumer alleged to have used the force or the consumer against whom force was used has a cognitive impairment).

 

[Deleted]

 

Note: page 3 of the new guidelines says that the Commission has provided an “Additional example of ‘rough handling’ in the section detailing unreasonable use of force.” However, no such update appears to have been made to that section.

 

Sexual contact or inappropriate sexual conduct – example amended to broaden possible inappropriate contact

One of the examples has been amended to make it clear that in some cases, “rubbing a consumer’s back or patting a consumer on the knee” will constitute unlawful contact.

 

Old version (1.3)

Current version (1.4)

What is not unlawful sexual contact or inappropriate sexual conduct:

 

 

Gestures of comfort, for example a carer rubbing a consumer’s back or patting a consumer on the knee.

Gestures of comfort, for example a carer rubbing a consumer’s back or patting a consumer on the knee where this aligns with the consumer’s personal preferences.

 

 

Unexpected death: not all unexpected deaths have to be reported

The new guidelines provide “clarification that the term unexpected death refers to circumstances where the death could reasonably be considered to be related to a mistake, failure or incident. Previous guidance noted that all unexpected deaths need to be notified to the Commission, this has been updated to refer to unexpected deaths that meet the criteria in Subsection 15NA(8) of the Quality of Care Principles. Removal of examples that were not consistent with these criteria.”

 

Old version (1.3)

Current version (1.4)

 

New addition, p 32:

 

“You are not required to report all deaths where the cause of death is yet to be confirmed, only those that could reasonably be considered to be related to a mistake, failure or incident. If the cause of death does not include circumstances mentioned under section 15NA(8) of the Quality of Care Principles, you are not required to notify the Commission of the unexpected death.”

 

 

Unexpected deaths: broad examples have been narrowed

The language used in the examples of unexpected death has been changed so that unexpected death now has a narrower, more precise definition. In the old version, if certain events “contributed to or resulted in the consumer’s death” this would qualify as “unexpected death”. In the new version, the term “contributed to” has been removed. Also, some examples have been deleted from the new version.

 

Old version (1.3)

Current version (1.4)

What is unexpected death:

 

 

Where a consumer falls while being moved or shifted, with the injuries sustained contributing to or resulting in the consumer’s death.

 

Where a consumer falls while being moved or shifted, with the injuries sustained resulting in the consumer’s death.

Where the actions of another contribute to or result in the death of a consumer. For example, the death follows an assault by another consumer, a staff member or a family member.

 

[Deleted]

Where poor quality clinical care is provided to a consumer contributing to or resulting in their death.

Where poor quality clinical care is provided to a consumer resulting in their death.

 

Where medical assessment or treatment is delayed, contributing to or resulting in a consumer’s death.

Where medical assessment or treatment is delayed, resulting in a consumer’s death.

 

Where a consumer dies suddenly or unexpectedly, and the police have been contacted, or where there are delays in the preparation of a death certificate due to concerns regarding the cause of death, or if the provider otherwise considers that the circumstances of the death may give rise to the need to involve the coroner.

 

[Deleted]

 

Stealing and Financial coercion – requirements of your reporting system are now less prescriptive

 

Old version (1.3)

Current version (1.4)

Your incident management system must be able to record incidents in a way that allows for repeated minor instances of stealing or financial coercion to be readily identified so that any pattern or series of incidents can be recognised and notified as a single reportable incident.

 

Your incident management system must be able to record incidents in a way that allows for any pattern or series of incidents to be recognised and appropriately managed.

 

Stealing and Financial coercion – narrower definition of reportable incidents involving missing valuables

The new guidelines suggest that missing valuables only have to be reported to the Commission if the consumer “believes that a staff member is responsible and appears concerned or distressed about the loss.”

 

Old version (1.3)

Current version (1.4)

Where a consumer’s money or valuables go missing without explanation, you should try to help the consumer to locate the item(s). If they cannot be found and the consumer is concerned or distressed about the loss, this should be notified to the Commission.

Where a consumer’s money or valuables go missing without explanation, you should try to help the consumer to locate the item(s). If they cannot be found and the consumer believes that a staff member is responsible and appears concerned or distressed about the loss, this should be notified to the Commission.

 

What is stealing or financial coercion?

 

Where an item goes inexplicably missing and cannot be found and the consumer (or their family) are concerned.

 

What is stealing or financial coercion?

 

Where an item goes missing and the consumer (or their family) have alleged or suspect that a staff member is involved.

 

 

Neglect – example amended to include “failure to administer correct medications”

 

Old version (1.3)

Current version (1.4)

What is neglect?

 

Regular late or missed administration of medications, or failure to administer time critical medications.

 

Regular late or missed administration of medications, or failure to administer correct or time critical medications.

 

 

Neglect – “failing to appropriately dress consumer for weather conditions” deleted from examples

 

Old version (1.3)

Current version (1.4)

What is neglect?

 

Failing to supervise a consumer in an environment that leaves them susceptible to injury. For example:

 

 

Failing to appropriately dress a consumer for the weather conditions.

 

[Deleted]

 

Neglect – acknowledgement that there may be minor incidents of neglect that do not need to be reported

 

Old version (1.3)

Current version (1.4)

These examples are illustrative only and each case will need to be assessed individually.

 

These examples are illustrative only and each case will need to be assessed individually. There may be incidents of neglect that are minor and do not necessarily need to be reported to the Commission. In these instances, the incident may be best addressed through the service’s continuous improvement process and should be clearly documented in the service’s records.

 

 

Restraint – “physical restraint used in non-emergency situations” removed from list of examples of restraint that must be reported

 

Old version (1.3)

Current version (1.4)

Any use of restraint that is inconsistent with the requirements in the Quality of Care Principles must be notified to the Commission. For example, where physical or chemical restraint is used without prior consent or without notifying the consumer’s representative as soon as practicable; where physical restraint is used in a non-emergency situation; or when a provider gives a drug to a consumer to influence their behaviour as a form of chemical restraint.

 

Any use of restraint that is inconsistent with the requirements in the Quality of Care Principles must be notified to the Commission. For example, where physical or chemical restraint is used without prior consent or without notifying the consumer’s representative as soon as practicable; or when a provider gives a drug to a consumer to influence their behaviour as a form of chemical restraint.

 

Restraint – if chemical restraint is used you must document the reason it was necessary

 

Old version (1.3)

Current version (1.4)

If you do use chemical restraint in relation to a consumer, you must … document in the consumer’s care and services plan … the reasons the restraint is necessary (if known).

 

If you do use chemical restraint in relation to a consumer, you must … document in the consumer’s care and services plan … the reasons the restraint is necessary.

 

 

Reporting to police – meaning of “reasonable grounds” clarified

You must report an incident to police when you have “reasonable grounds” to do so. The new guidelines have not changed this requirement, but they have added this statement to clarify when you must report to police:

“In practice:

  • if you become aware of a reportable incident
  • that reportable incident is criminal in nature

 the grounds for reporting to police are reasonable in the circumstances reporting must occur. Reporting to the police in relation to criminal conduct should occur regardless of whether the incident is alleged or suspected to have occur.”

 

Notification – time limit is counted in “calendar days” not “work days”

The new guidelines clarify that reporting deadlines are in calendar days not working days: five calendar days to notify the Commission of additional information (if required); 30 calendar days to notify a Priority 2 incident (from 1 October 2021).

 

Notification – new example of “significant new information”

If you become aware of significant new information in relation to an incident after you have reported it, you must notify the Commission as soon as possible. This requirement has not changed. However, the new guidelines clarify the meaning of “significant new information” with this example:

An example is where a consumer has had a fall due to a failure by care staff to follow standard procedures. The provider has submitted a SIRS notice as the incident is a reportable incident which details that the consumer has been hospitalised and is palliative. If the consumer dies, this is considered significant new information and must be notified to the Commission.

 

Role, Powers and Processes of the Commission – Commission’s response procedure clarified

 

Old version (1.3)

Current version (1.4)

Once a notification has been submitted, a receipt number will automatically be issued, and the Commission will be in contact to provide a case number and to request any further information that may be required.

 

 

Once a notification has been submitted, you will receive an email confirming receipt of your submission. This email is automatically issued and will include a SIRS notice number (e.g. NF21/012345). If the Commission is in contact to request any further information that may be required, the Commission will refer to the notice number to which the request for further information relates. In submitting missing, further or significant new information, you are required to submit this information to the Commission using the Commission-approved forms. There is work underway to build capability into the My Aged Care service provider portal to service submission of missing, further or significant new information.

 

Review of reportable incident notice complete

 

You will be notified in writing when the Commission has completed a review of the information you have submitted about a reportable incident; this may have involved an assessment or investigation.

 

 

Role, Powers and Processes of the Commission – Commission’s function of “supporting” providers changed to “providing guidance”

 

Old version (1.3)

Current version (1.4)

The Commission’s functions in relation to the SIRS include:

 

 

Supporting providers to develop and implement an effective incident management system and to build provider capability to prevent and manage incidents.

 

 

Providing guidance and resources for use by providers to develop and implement an effective incident management system and to build provider capability to prevent and manage incidents.

 

 

Role, Powers and Processes of the Commission – Commission’s procedure for “assessment of a reportable incident” clarified

Under “Assessment of a reportable incident” (p. 69), the new guidelines include this new explanation of what the Commission does when it receives a notification:

When the Commission receives a notification of a reportable incident, it will review the notice to assess the risk to consumers, the adequacy of the actions being taken by the provider to manage and mitigate any such risk and any other factors that may influence the Commission’s confidence in the provider’s ability to manage the risk and reduce the likelihood of recurrence.

 

Role, Powers and Processes of the Commission – new statement of broad powers to respond, investigate and use information

 

Commission can take any reasonable action

The new guidelines add this power to the list of what the Commission can do when responding to an incident: “take any other action to deal with the reportable incident that the Commissioner considers reasonable.”

 

Commission can use SIRS data for other purposes such as performance assessments

Under “Review of reportable incident notice complete” (p. 59), the new guidelines say:

The Commission may also use the information provided in the SIRS notice and any further information obtained by the Commission as part of its ongoing regulatory functions under the Aged Care Quality and Safety Commission Act 2018. Information notified through the SIRS also informs the Commission’s risk profiling of providers and the prioritisation and scope of monitoring and performance assessment activities.

And:

Where an investigation is required, this may include a visit to the site by authorised officers of the Commission. Authorised officers may exercise monitoring powers to determine whether a provider is complying with its incident management responsibilities.

The Commission’s monitoring powers can be utilised regardless of whether or not there has been non-compliance, and may support, precede or follow other actions.

 

Miscellaneous Changes in terminology

 

Old version (1.3)

Current version (1.4)

Serious incident report

 

(e.g. “the Commission will receive serious incident reports from providers”)

 

Serious incident notice

 

Alleged offender

 

(i.e. staff member or other person accused of being involved in a reportable incident such as stealing from a resident)

 

Subject of the allegation

 

(Note: the old term of “alleged offender” is still used in Attachment A: SIRS notification form questions. This appears to be an error or an amendment that is pending.)

 

Absconding

 

Leaving or wanting to leave a residential aged care service without explanation or reason.

 

 

Attachment A: SIRS notification form questions – “impact” now includes “not only actual harm, but also harm that could reasonably have been expected to have been caused”

The new guidelines add the following words (shown in bold) to the instructions regarding “victim details” and “alleged offender details”:

  • “Select the appropriate level of psychological impact (provide further details if some level of impact is selected including not only actual harm, but also harm that could reasonably have been expected to have been caused).”
  • “Select the appropriate level of physical impact (provide further details if some level of impact is selected including not only actual harm, but also harm that could reasonably have been expected to have been caused).”

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Mark Bryan
ABOUT THE AUTHOR | Mark Bryan
Mark is a Legal Research Consultant at CompliSpace and the editor for ACE. Mark has worked as a Legal Policy Officer for the Commonwealth Attorney-General’s Department and the NSW Department of Justice. He also spent three years as lead editor for the private sessions narratives team at the Royal Commission into Institutional Responses to Child Sexual Abuse. Mark holds a bachelor’s degree in Arts/Law from the Australian National University with First Class Honours in Law, a Graduate Diploma in Writing from UTS and a Graduate Certificate in Film Directing from the Australian Film Television and Radio School.

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