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Liam Butler interviews Dawn Carey

Liam Butler interviews Dawn Carey, Nursing Advisor at the Office of the Health and Disability Commissioner

Question: Dawn how does the HDC support Nurses to serve older people well?

Dawn Carey: The primary role of the Health and Disability Commissioner (HDC) is to promote and protect health and disability services consumers’ rights and facilitate the fair and efficient resolution of complaints relating to an infringement of those rights. HDC is intent on supporting quality nursing care and the Commissioner encourages a focus on learning from complaints and, where necessary, taking remedial actions to prevent an occurrence of adverse events.

In 2012 I was appointed as the in-house Nursing Advisor to HDC. This is a part time role allowing me to continue to work clinically as a staff nurse at Auckland City Hospital. My role is to review complaints referred to HDC, provide clinical advice on the standard of nursing care, and to advise whether the care provided was consistent with the accepted standards or not.

Over the last year, treatment and communication issues were two strong themes of aged care complaints to HDC. Treatment issues included a lack of or inadequate care being provided to support elderly consumers to maintain their health status, and in some cases a lack of timely treatments being implemented following an adverse event. The communication issues related to the effectiveness and timeliness of the communication within the health care team, and to the elderly consumer or their family members/ representative.

As HDC’s Nursing Advisor, I present at aged care workshops and meetings from time to time. Such invitations give me the opportunity to share complaint themes and explore how the aged care sector can promote and embed a culture focussed on patient safety. Such a culture requires better risk awareness and risk responsiveness at both an individual and organisational level. Often with the desire to be more efficient, a provider can skip a small step in a process. While, there may be no negative connotations associated with this ordinarily, when coupled with an additional risk factor such as an interruption, the likelihood of an adverse event outcome increases. An example of this is missing steps in a medication round. Such an event has the potential to result in tremendous heartache for all concerned, including the vulnerable resident. Being risk aware means that such risks are highlighted during staff medication competency assessments, and care teams support each other to have uninterrupted focus when participating in high risk tasks such as the administration of medications. Being risk responsive also means that nurses are proactive about the evaluation of clinical assessment findings and welcoming wider care staff team input. Nurses need to be supported to consider assessment findings in relation to the trajectory of a patient’s condition, and to share this knowledge, using it to guide communication with family members, to facilitate timely Needs Assessment and Services Co-ordination (NASC) reassessment or referrals to other practitioners.

It is important to acknowledge that there is great care being provided on a daily basis across the aged care sector. The volume of aged care complaints referred to HDC is small relative to the size of the sector, and the percentage of complaints to HDC is not materially changing from one year to the next. The recently published New Zealand Aged Care Workforce Survey (http://www.aut.ac.nz/__data/assets/pdf_file/0004/542155/NZ-Aged-Care-Workforce-Survey-report.pdf) highlights the passion and commitment of those who are employed as aged care workers. Speaking with nurses allows me to learn of innovative practice and strategies that have been implemented to support residents’ wellbeing. Having the opportunity to speak with colleagues and share stories is always a privilege.

About Liam Butler