Decision-making Tool: Supporting a Restraint Free Environment in Residential Aged Care

2012 ◽  
Keyword(s):  
Decision Making ◽  
Aged Care ◽  
Residential Aged Care ◽  
Free Environment ◽  
Decision Making Tool

Challenges faced by residential aged care staff in decision-making for residents with dementia

Dementia ◽  
2020 ◽  
pp. 147130122092915
Author(s):  
Nadine Cameron ◽  
Deirdre Fetherstonhaugh ◽  
Michael Bauer
Keyword(s):  
Decision Making ◽  
Aged Care ◽  
Self Determination ◽  
Care Staff ◽  
Residential Aged Care ◽  
Organisational Support ◽  
Care Facilities ◽  
Aged Care Facilities ◽  
Residential Aged Care Facilities ◽  
National Framework

Care staff in residential aged care facilities (nursing homes) in Australia are obligated, under the Australian National Framework for Action on Dementia 2015–2019, to support residents to exercise choice and make decisions. Research indicates, however, that care staff are often given little guidance regarding which residents’ decisions should be supported or how to make decisions on their behalf. This lack of guidance can result in a denial of residents’ rights and inconsistent treatment by staff, placing residents’ wellbeing at risk. Through providing an analysis of the responses of staff at RACFs in Victoria and Queensland to two case scenarios, this study seeks to provide some understanding of the difficulties staff face in supporting residents’ self-determination and their own need for greater organisational support.

scholarly journals Managing older people's money: assisted and substitute decision making in residential aged-care

2010 ◽  
Vol 31 (1) ◽  
pp. 93-109 ◽  
Author(s):  
CHERYL TILSE ◽  
JILL WILSON ◽  
LINDA ROSENMAN ◽  
DAVID MORRISON ◽  
ANNE-LOUISE MCCAWLEY
Keyword(s):  
Decision Making ◽  
Older People ◽  
Aged Care ◽  
Decision Makers ◽  
Cognitive Capacity ◽  
Residential Aged Care ◽  
Financial Assets ◽  
Aged Care Facilities ◽  
Financial Decision ◽  
Managing Risk

ABSTRACTCurrent approaches to the assessment of cognitive capacity in many jurisdictions seek to balance older people's empowerment with their protection. These approaches incorporate a presumption of capacity, a decision-specific rather than global assessment of that capacity, and an obligation to provide the support needed for adults to make or communicate their own decisions. The implication is that older people are assisted to make decisions where possible, rather than using substitute decision makers. For older people, decision making about financial matters is a contentious domain because of competing interests in their assets and concerns about risk, misuse and abuse. In residential-care settings, older people risk being characterised as dependent and vulnerable, especially in relation to decisions about financial assets. This paper reports an Australian study of the factors that facilitate and constrain residents' involvement in financial decision making in residential settings. Case studies of four aged-care facilities explored how staff interpreted the legislative and policy requirements for assisted and substitute decision making, and the factors that facilitated and constrained residents' inclusion in decisions about their finances. The observed practices reveal considerable variation in the ways that current legislation is understood and implemented, that there are limited resources for this area of practice, and that policies and practices prioritise managing risk and protecting assets rather than promoting assisted decision making.

Decisions and Dilemmas: The Context of Prioritization Dilemmas and Influences on Staff Members’ Prioritization Decisions in Residential Aged Care

2021 ◽  
pp. 104973232199829
Author(s):  
Kristiana Ludlow ◽  
Kate Churruca ◽  
Louise A. Ellis ◽  
Virginia Mumford ◽  
Jeffrey Braithwaite
Keyword(s):  
Decision Making ◽  
Structured Interview ◽  
Aged Care ◽  
Residential Aged Care ◽  
Staff Members ◽  
Lower Priority ◽  
Conflicting Demands ◽  
Aged Care Facilities ◽  
Residential Aged Care Facilities ◽  
Missed Care

Staff members in residential aged care facilities (RACFs) make prioritization decisions to determine which aspects of care are most important and thus should be attended to first. Prioritization can potentially result in substandard care if lower priority tasks are delayed or left undone, known as “missed care.” This study investigated the contexts in which prioritization dilemmas arise in RACFs and the influences on prioritization decision-making. Thirty-two staff members participated in a think-aloud task during a prioritization activity, a demographic questionnaire, a post-sorting interview, and a semi-structured interview. Data were analyzed using inductive content analysis. Prioritization dilemmas occurred in response to high workloads, inadequate staffing, unexpected events, and conflicting demands. Seven influences on prioritization decision-making were identified. In some instances, these influences were seen to be in conflict, making prioritization decision-making challenging. Efforts to prevent missed care should consider the influences on staff members’ decision-making and aim to reduce prioritization dilemmas.

scholarly journals Medication omission rates in New Zealand Residential Aged Care Homes: a national description

2019 ◽  
Author(s):  
Stephanie M Garratt ◽  
Ngaire M Kerse ◽  
Kathryn Peri ◽  
Monique F Jonas
Keyword(s):  
Decision Making ◽  
New Zealand ◽  
Clinical Decision Making ◽  
National Level ◽  
Clinical Decision ◽  
Medication Administration ◽  
Aged Care ◽  
Care Staff ◽  
Care Homes ◽  
Residential Aged Care

Abstract Background Medication administration is a key service offered to individuals residing in residential aged care homes (RAC homes). A medication omission is an event where a prescribed medication is not taken by a resident before the next scheduled dose. Medication omissions are typically classed as errors, they have the potential to lead to harm if poorly managed, but may also stem from good clinical decision-making. Studies that critically appraise or support medication omissions in healthcare settings are limited. There is uncertainty around which medication omissions are problematic and how many on average a patient should experience. There have been several hospital-based studies, with limited sample sizes, timeframes, and inconsistent reporting of omissions. As the first population-level, RAC Home-specific study of its kind, this study quantifies the incidence, prevalence, and types of medication omissions in RAC homes on a national scale. Methods A retrospective review of de-identified, medication administration e-records from December 1 st 2016 to December 31 st 2017 was conducted. Demographic details of residents, care staff competency levels, medications, and RAC ownership types were included in the review and analysis. Results A total of 11, 015 residents from 374 RAC homes had active medication charts; 8,020 resided in care over the entire data collection period. A mean rate of 3.40 medications doses were omitted per 100 dispensed medications doses per resident (s.d. 7.27). Approximately 73% of residents had at least one dose omission. The most common selected omission category was ‘not-administered’ (49.9%), followed by ‘refused’ (34.6%). The mean rate of omission was found to be slightly higher in corporate operated RAC Homes (3.73 versus 3.33), with greater variation. The most commonly omitted medications were Analgesics and Laxatives. Forty-eight percent of all dose omissions were recorded without a comment justifying the omission. Conclusions Compared to other studies medication omissions within RAC homes in New Zealand are not as common as previously proposed. This study sets out the first national-level rate of medication omissions per resident over a one-year timeframe. Subsequent studies will address the medications omitted, the clinical significance of omissions and the place of medication omissions within clinical decision-making.

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