A nurse and her colleague are standing in line at an Aged Care Home’s onsite café during their lunch break. The nurse uses the opportunity to share some of her morning reflections and challenges with her colleague, hoping to get some advice. They discuss consumers, their care and the specific clinical services provided.

Assessing the legality of this situation isn’t the first thing that comes to mind for most people. But discussing a consumer within earshot of people who are not privy to the consumer’s personal information, and where that consumer is reasonably identifiable from the information being discussed, is a breach of privacy laws.

This example demonstrates a key challenge of compliance: a breach that is unconscious or unintentional is still a breach as far as the law is concerned. The first step in avoiding these types of breaches is to understand the importance of compliance and the necessity for strict adherence to certain requirements. This can protect organisations and individuals from civil and criminal liability and, more importantly, helps keep people safe.

The following scenarios provide practical examples to help you understand how breaches (often unconsciously or unintentionally) can occur in an Aged Care Home and what you can do to prevent them.

Scenario 1: Work Health and Safety

A care worker is preparing a consumer with specific bariatric needs for their daily shower. The consumer’s care plan directs the use of a lifting machine, which requires two staff to operate. The care worker seeks assistance from other care staff but finds that they are all preoccupied. Worried about time management, the carer decides to operate the machine alone.

What’s Wrong with this Scenario?

The carer is breaching workplace health and safety regulations and the Aged Care Quality Standards (Quality Standards) by operating the lifting machine by themselves. They are compromising their own and the consumer’s safety, which could also subject the organisation to civil liabilities. 

One study, cited by a Department of Health analysis of the aged care workforce, conducted a census on work-related injuries at aged care facilities. It found that, of the residential facilities sampled, 77 per cent reported at least one work-related injury within the three months prior to the census. The most common injury was sprains/strains (44.9 per cent of reported injuries) and the most common cause was lifting, pushing, pulling and bending (43.5 per cent of causes of reported work-related injuries).

Reflection

Does your organisation have systems that support the health and safety of staff and encourage the prioritisation of safety over the timely completion of work tasks?

Scenario 2: Scope of Practice

 A laundry services worker is returning clean linen to a consumer’s room. The consumer asks the laundry services worker for assistance to the bathroom. The consumer says they did not want to bother care staff because they looked busy and attempts to convince the worker that providing the help they need is a quick and easy task.

What’s Wrong with this Scenario?

Assisting a consumer to the bathroom appears to be a simple task. But a worker who isn’t qualified, or hasn’t been adequately trained, might be unaware of the additional safety considerations associated with this task, including the consumer’s mobility requirements, the need for the use of assistive devices or appropriate use of personal protective equipment (PPE). If the worker decides to assist, this constitutes a compliance breach.

The Quality Standards have a broad requirement that consumers must receive safe care that is delivered by sufficiently skilled and qualified staff. Additionally, national and state laws have strict rules about the scope of practice of health care professionals, including nurses and personal care workers.

Reflection

Do all your staff know and understand the scope of their role, including its legal boundaries?

Scenario 3: Documentation

A nurse administers a 2 milligram (mg) oral dose of warfarin, in accordance with the consumer’s prescribed medication order. When documenting the care provided, she incorrectly transcribes the medication metrics in the consumer’s progress notes. Instead of “mg”, she writes “g”.

What’s Wrong with this Scenario?

Firstly, documentation errors compromise the accuracy of consumer records, which is a breach of professional standards and guidelines, applicable to health care professionals.

Secondly, the purpose of accurate documentation is to provide evidence of compliance. If documentation is inaccurate, it can inadvertently provide evidence of breach of compliance, even where no actual breach has occurred. In the above scenario, for example, the documents provide evidence that the nurse breached her duty of care by administering the incorrect warfarin dose, even though she in fact administered the correct dose.

Reflection

Does your organisation have a documentation and record keeping system that supports accuracy and integrity, and minimises opportunities for error?

Scenario 4: Use of Restraints

A care worker observes a consumer becoming tired after continuously walking around the unit area of the Aged Care Home and assists the consumer into a lounge chair to rest. The consumer is unable to reach the handles to adjust the chair, so the worker assists in reclining the chair to a comfortable position. In this position, the consumer is unable to adjust or get out of the chair themselves. The worker is then called away and leaves the consumer in the chair, without a method of calling for assistance.

What’s Wrong with this Scenario?

The care worker has used a restraint on the consumer (albeit inadvertently). Restraint is defined in the Quality of Care Amendment (Minimising the Use of Restraints) Principles 2019 (Restraint Principles) as “any practice, device or action that interferes with a consumer’s ability to make a decision or restricts a consumer’s free movement.” Unless the use of restraints accords with the Restraint Principles, providers risk civil claims and criminal charges such as the charge of false imprisonment.

Reflection

Does your organisation have policies and procedures to govern the use of restraints on consumers including what constitutes restraint? Do staff know and understand their legal obligations regarding the use of restraints?

Preventing Breaches of Compliance Obligations

Are any of the following scenarios familiar to you?

• You’re given a lengthy policy, or terms and conditions, and asked to sign a waiver stating that you’ve read and understood. You sign the waiver as a formality without reading the document.
• You’re completing a training module and skim through the information. You retain just enough to pass the multiple-choice quiz at the end.

As discussed in a previous ACE article, if you’re aiming to prevent breaches, a good starting point is to implement policies and procedures and provide staff training, because these steps are designed to mitigate risk. However, these steps are not enough on their own. A key reason why many organisations’ compliance programs fail is because they lack systems to monitor and report on compliance. Without these systems, policies and procedures become stagnant – they sit unread on a shelf somewhere and soon become out-of-date or unsuitable for the organisation’s unique and changing needs.

But if you support your policies and procedures with robust monitoring and reporting systems, your organisation can:

• adapt to legislative changes and ensure ongoing compliance
• identify areas of non-compliance and analyse the cause
• take corrective action.

Implementing policies and procedures and providing staff training are fruitless and unnecessary tasks if they do not create a culture of compliance. To prevent breach, organisations need to consider whether all of their constituents understand their roles and responsibilities, and whether their systems adequately monitor and report on compliance.