HAVING TROUBLE UNDERSTANDING NZS ?

2001–2008 The four previous standards were reviewed with the aim of: Reducing duplication between standards Updating content to reflect current accepted good practice.

INTERPRETATION Not all standards or criteria within NZ 8134 are relevant to your service A standard or criterion assessed as being not relevant to a service will be recorded as being ‘not applicable’ on your audit report For example, some parts of NZS 8134 will apply only to: a)Intellectual disability services b)Mental health and addiction services; or c)Acute, secondary, or tertiary services. The notations ‘ID’, ‘MHA’, and ‘S’ identify those parts of the standard which only apply to those particular services.

KEY TERMINOLOGY The definition of ‘Good Practice’ is: “The current accepted range of safe and reasonable practice that results in efficient and effective use of available resources to achieve quality outcomes, and minimise risk for the consumer.”

DETERMINING WHAT IS GOOD PRACTICE Good practice can be reflected in policies and procedures or documentation for service delivery, for example: a)Codes of practice b)Research, evidence, or experience-based practice c)Professional standards d)Good practice guidelines e)Recognised or approved guidelines f)Benchmarking The 2008 standards concentrate more on the outcome to be achieved.

AMENDED 2008 CRITERIA INCLUDE KEY WORDS The 2008 criteria have been updated to be more outcome-focused 2001 HDSS Relevant standards are identified and implemented to meet current accepted good practice in the relevant service area or setting HDSS The service develops and implements policies and procedures that are aligned with current good practice and service delivery, meet the requirements of legislation, and are reviewed at regular intervals as defined by policy.

AMENDED 2008 CRITERIA INCLUDE KEY WORDS 2008 requires more evidence to meet this criterion. a)Scope and content of P&Ps are relevant to type and complexity of service b)P&Ps reflect accepted good practice c)Legislative requirements are included d)Processes in place to develop and approve new P&Ps e)Systems for regular review of P&Ps f)Processes implemented to educate staff on new policies g)Document control policy to describe implementation of P&Ps.

NEW CRITERIA There are very few criterion that are “Entirely New” There are some criteria that are ‘amended’ and have some different aspects Some criteria appear to be just “updated” Some are so closely related to previous criteria that the new standard has stated what would have been “evidence” under the previous.

SOME AMENDED CRITERIA – TO WATCH OUT FOR? HDSS A medicines management system is implemented to manage the safe and appropriate prescribing, dispensing, administration, review, storage, disposal, and medicine reconciliation in order to comply with legislation, protocols, and guidelines. This criterion has one new requirement that HDSS did not include, around ‘medicines reconciliation’. So what does that mean for updating policies and processes? Having systems in place to ensure the medication and medication instructions were provided to you before admission.

WHAT EVIDENCE COULD AUDITORS BE LOOKING FOR? HDSS The service provides an environment that encourages good practice, which should include evidence-based practice. Some examples include: – The education programme includes internal and external training – Some education is delivered by external specialists in their field – Access to professional networking opportunities – Clinical pathways – Treatment protocols – Access to professional development (including mentoring and supervision) – Resources are available and link to P&Ps.

FOUR NEW CRITERIA AND POSSIBLE EVIDENCE HDSS Services have policies and procedures to ensure consumers are not subjected to discrimination, coercion, harassment, and sexual or other exploitation. Evidence that may assist to meet this criterion: – Policies and procedures include: Abuse and neglect Code of rights Complaints management – Human Resource policies include: House rules Code of Ethics – Organisational policies include: Management of finances Services provided to clients.

FOUR NEW CRITERIA AND POSSIBLE EVIDENCE HDSS Service providers maintain professional boundaries and refrain from acts or behaviours which could benefit the provider at the expense or well- being of the consumer. Evidence that may assist to meet this criterion: – Policies and procedures around Code of Ethics for staff – Professional boundaries and job descriptions include the above – Clients state that privacy is ensured – Performance appraisals / supervision is implemented – Staff and management interviews reinforce professional boundaries – House rules.

FOUR NEW CRITERIA AND POSSIBLE EVIDENCE HDSS Adverse, unplanned, and untoward events are addressed in an open manner through an open disclosure policy. Evidence that may assist to meet this criterion: – Open Disclosure Policy links to incident reporting and responsibilities – Risk/hazard identification is in place and reviewed – I&A policy, investigation and closure of the quality loop – Families are informed, identified in incident reporting process – I&A form demonstrates family involvement Note: ‘Guidance on Open Disclosure Policies’ can be found at

FOUR NEW CRITERIA AND POSSIBLE EVIDENCE HDSS Consumers have a right to full and frank information and open disclosure from service providers. Evidence that may assist to meet this criterion: – Client information packs include open disclosure, code of rights, and open door approach – Internet sites including information on service – Easy access to community information, advocacy – Access to client records – Implemented informed consent policies – Resident / family meetings

RESTRAINT MINIMISATION Restraint standard NZS now consists of 3 main documents: – Restraint Minimisation – Safe Restraint Practice – Seclusion When considering which standards are important for your service, note that: – All services must meet – All services where restraint (including seclusion) is used shall meet – All services which use seclusion shall meet Therefore where restraint is not used, and.3 will be assessed as being not applicable. Note: You still need to meet

RESTRAINT MINIMISATION NZS includes one standard and 6 criteria These key areas need to be in place and implemented: 1.You will need a Restraint minimisation policy and procedure 2.Risk assessment processes and resident care plans support interventions that avoid use of restraint 3.Enabler use has clear guidelines for safe and appropriate use 4.Enabler use shall be voluntary and the least restrictive option 5.Education provided relevant to service setting – around Restraint P&Ps, Enabler use P&Ps, alternative interventions, and de-escalation. 6.Systems / processes need to be in place for meeting if and when a restraint event occurs.