Results from our recent survey indicate that many of our readers are keen for more information about how to manage Aged Care Quality and Safety Commission (ACQSC) assessments in relation to coronavirus / COVID-19.
It turns out this concern is timely and justified. The ACQSC is now using a “Sample Self-Assessment Survey” to guide its assessments of aged care providers’ outbreak-readiness.
The ACQSC is using this survey in different ways. One aged care provider reported to ACE that they were asked to complete the survey and submit it; another told us the survey was incorporated into a phone review; a third told us that the survey was going to be considered as part of an upcoming unannounced visit.
The ACQSC self-assessment survey provides valuable insight into what the ACQSC expects aged care providers to include in their outbreak management plans. It has 10 sections, each containing several questions. In this article we summarise the questions in each section and provide pinpoint references to useful resources that can help you answer them. Our key resources are:
Note, in some cases, these resources provide identical advice and templates.
1. Planning Actions
Do you have a recently updated infection control/respiratory outbreak plan? Did you include relevant health care providers/organisations in your community in the planning process? Has the plan been communicated to staff? Have you identified consumers at greater risk? Are your health records up to date? Have you promoted, provided and recorded influenza vaccinations?
Resources
Also see the Victorian Plan, pp 11-14 for general information and links to further resources. The checklist at Appendix 2 might also be useful.
See the CDNA Guidelines, pp 9-11 (section 3.1) for general information on preparing and planning for an outbreak. See also the Outbreak Preparedness Checklist at Appendix 2.
2. Staff, Resident and Family Education
Have you trained staff and volunteers on all aspects of outbreak identification and management, particularly infection control? Have you provided residents and their potential visitors with information regarding prevention of transmission?
Resources
There is also specific COVID-19 infection control training available. Once staff have completed this training, they will be provided with a certificate that can be used as evidence of completion.
For volunteers, residents and potential visitors, consider using the Department of Health’s Coronavirus (COVID-19) campaign resources. These are available as short videos and printed posters.
See the Victorian Plan, p 13 for general information. See Appendix 1 for a template letter to families and Appendices 9-11 for posters on hygiene.
See the CDNA Guidelines, p 11 (3.1.4) for general information. See Appendix 3 for a template letter to families and Appendix 10 for posters on hygiene.
3. Staffing Actions
Do you have a staffing contingency plan in case up to 20% to 30% of staff are unable to present for work? Do you have a plan for allocating staff to the care of residents affected by the virus?
Resources
See the Victorian Plan, p 13 for information on Workforce Management. On p 28 you’ll also find useful information on protocols for staff returning from overseas or from sick leave. Note that in contrast to the ACQSC survey, the Victorian Plan advises aged care providers to prepare for a situation in which up to 40% of staff are unable to work.
See the CDNA Guidelines, p 11 (section 3.1.3) for information on Workforce Management. See also pp 17 (5.2) and 23 (5.4.7) for useful information on managing the risk or occurrence of infected staff.
4. Stock Levels
Do you have a current stock of PPE, hand hygiene products, nose and throat swabs and cleaning supplies in anticipation of increased need?
Resources
See the Victorian Plan, p 14 for information on consumable stocks, including this:
“The Commonwealth Department of Health has advised they will ensure the availability of PPE for aged care services. RACF should contact the Commonwealth regarding PPE supplies. Information and access to Commonwealth PPE for RACF is currently through: stockpile.ops@health.gov.au.”
See the CDNA Guidelines p 11 (3.1.5) for further information on managing consumable stocks.
5. Identifying an outbreak
Do you routinely assess residents for respiratory illness? Do you have a plan for reducing transmission through isolation or cohorting during an outbreak? Do you encourage staff to report COVID-19 symptoms? Do you have a process to notify the facility manager and the state/territory Department of Health as soon as practicable (and within 24 hours) of when a COVID-19 case is suspected?
Resources
See the Victorian Plan, pp 17-19 for general information and links to further resources such as signage and factsheets along with useful phone numbers and information on testing. To help prepare staff for an outbreak, use the “Response Checklists” on pp 25-28 and the checklist at Appendix 2 to review potential scenarios and plan the required actions.
See the CDNA Guidelines, pp 14-16 (section 4) for useful general information and Appendix 7 for an Outbreak Management Checklist.
6. Communication Actions
Do you have a contact list for the state/territory health department and other relevant stakeholders (e.g. GPs and infection control consultants)? Does your infection control/respiratory outbreak management plan cover communications, including timely communication of significant changes in visiting arrangements?
Resources
See the Victorian Plan, pp 18-19 for key information on case notification and outbreak notification (but note that some of the links are specific to Victoria). See Appendix 1 for a template letter to families, and Appendix 4 for a template letter to GPs.
See the CDNA Guidelines, p 13 (3.2.2) and pp 15-16 (4.4 and 4.5) for useful information. See also Appendix 3 for a template letter to families and Appendix 5 for a template letter to GPs.
7. Cleaning
Does your infection control/respiratory outbreak management plan identify who is responsible for overseeing increased frequency of cleaning, liaison with contractors or hiring extra cleaners as necessary?
Resources
See the Victorian Plan, Appendix 2 for a checklist that covers this issue.
See the CDNA Guidelines, Appendix 2 for a similar checklist.
8. Infection control/respiratory outbreak management plan
Does your infection control/respiratory outbreak management plan cover all the areas identified above?
Resources
See the Victorian Plan, Appendices 1, 2, 3 and 6 for some checklists that will help you assess the comprehensiveness of your outbreak management plan.
See the CDNA Guidelines, Appendices 2 and 7 for some checklists that will help you assess the comprehensiveness of your outbreak management plan.
This question is a timely reminder that it is important not only to have a COVID-19 outbreak management plan, but also to have structured outbreak plans for other infections. Coming into winter, surveillance and preparedness for other respiratory outbreaks is essential.
9. Restriction of visitors
Have you implemented appropriate arrangements to restrict visitors consistent with requirements found in the statement from the Australian Health Protection Principal Committee (AHPPC)?
Resources
AHPPC Statement
Coronavirus Visitor Control in Aged Care: Check Your Readiness
See the Victorian Plan, p 15 and pp 21-24. Appendix 7 also provides a useful checklist for assessing visitors.
See the CDNA Guidelines, p 13 (3.2.2) for information on “Prevention of Introduction to the Facility.”
Note that it’s important to prepare families to ensure that they understand and can support any visiting guidelines and restrictions. This can be achieved by sending information directly to consumers’ representatives and by posting information on your website.
Also, remember that in the Australian Federal system, most of the key health laws and regulations are issued by state/territory departments of health. You will have to meet these local requirements in addition to requirements issued by the Commonwealth Department of Health and bodies such as the AHPPC and ACQSC. We will be giving some tips on how to manage this minefield of complexity in an upcoming article.
10. Readiness
Overall, how would you rate your readiness in the event of a COVID-19 outbreak at your home?
When dealing with this final question bear in mind that you are being asked to perform the impossible task of predicting the future. You can’t be 100% prepared for something that hasn’t happened yet so don’t stress yourself into the ground trying to achieve perfection. Do what is manageable and sustainable for you each day, bearing in mind that it could be months before life gets back to normal.
