Aged Care GP Panels Initiative Nutrition Quality Assurance Project 25 RACFs offered project Take-up to date is 9 facilities, 3 of which have more than one unit Survey, report and education completed with 1facility Survey and report completed with 1facility Further 7 surveys scheduled by end of June 2008

Aged Care GP Panels Initiative Nutrition Quality Assurance Project Project developed in response to 2007 RACF survey and needs assessment Initiated as part of allied health expansion program RACFs self nominate and make staff and management time available Project Team – Dietitian, Speech Pathologist, Division Program Manager

Process 1.Project Team meets with RACF to explain, plan and gain consent 2.Visit – starts around 10am with review of policy and procedures, documentation, discussion with key staff, observation of meal service and delivery. 3.Preparation of report – observations of P&P and implementation, recommendations for change. 4.Project Team meets with RACF to discuss process, flag concerns, set date, times, logistics. 5.Presentation of findings to RACF and discussion of options for addressing concerns. 6.Training and support program for RACF to address outcomes 7.Revisit RACF three - six months after training completed to monitor change

RACF Profiles 1.30 bed high care facility, privately operated 2.57 high care and 33 low care beds, split into 3 units, religious community based, governed by board of management which includes GPs

RACF 1 - Positive Points Weight information found easily Diet forms easily accessible Cook and catering aide committed, experienced and helpful, willing to improve Consistency of staff leading to fewer mistakes and more personalised service Food looked good and was well presented Dining are was relaxed with caring staff

RACF 1 – Problem Areas Documentation inconsistent and confusing with dated terminology, lacks information on diet, incorrect records. Weight loss audit found 48% of residents had lost >2kg over 12 months or since admission. 65% were those on texture modified diets. Textures served not matching patient record, food not at correct temperature. Staff had poor understanding warning signs of dysphagia, food handling, modified diets and correct fluid consistency and of how to feed residents.

RACF 1 - Suggestions Documentation and record keeping Kitchen services and records Food preparation and delivery Weight recording, monitoring and response

RACF 1 - What happened next? RACF provided with resources, eg weight graph template, flowchart, standards information Dietitian helping RACF review forms. Staff training on assisting residents with eating RACF purchased new equipment, eg whiteboard, utensils. GPs to be involved in training Review at end of July

RACF 2 - Positive Points Lovely homely atmosphere – very organised and relaxed Food plated attractively and aroma very appetising All residents eat in dining area – none eat in bed One course served at a time Kitchen only makes changes to individual diets if written down Good dental and oral assessment form

RACF 2 – Problem Areas Documentation confusing and conflicting with incorrect terminology, showing random diet changes with no clear authorisation. Lack of action on weight loss. Weight audit – 22% of residents had weight loss but large weight losses with little or no intervention. Poor compliance with allied health recommendations and poor pattern of referral for swallowing difficulties and weight loss Supplements and thickeners used randomly and incorrectly Staff had poor understanding warning signs of dysphagia, food handling, modified diets and correct fluid consistency Failure to stick to menu and portions inadequate

RACF 2 - Suggestions Documentation and record keeping Kitchen services and records Food preparation and delivery Weight recording, monitoring and response

What’s the cost? Surveys and Reporting RACF 19.5 hours x $240 2,280 RACF 215 hours x $240 3,600 Estimated cost for the other 7 RACFs 21,600 SUB TOTAL $27,480 Education and Support (if required) Approx 4 hours per RACF 8,640 ESTIMATED TOTAL $36,120

What’s the value? 975 residential aged care residents will have a better quality of life if observations and recommendations acted upon. RACFs will have better documentation that works for both staff and residents. Staff will be more skilled and have better work practices. Can involve GPs and AHPs Ticks the RACF’s QA box for accreditation VERY big RACF brownie points for division

What now? Deliver project in 7 remaining RACFs Market to others Provide follow-up education and support Write up Southcity model Train the trainer Publish in professional journals