1. Client Centred Practice and Management of Risk Falls Prevention Forum for People with Dementia in Gippsland Monday 15 th September 2014 Nicole Tierney Occupational Therapy Manager, LRH

2. NSQHS Standard 2: Partnering With Consumers Key Messages: Partnering with consumers is essential to patients care Patients and carers should be encouraged to participate in treatment decisions Ensure patients and carers have avenues to provide feedback

3. NSQHS Standard 10: Preventing Falls and Harm from Falls Ensure: Falls risk is assessed and documented Prevention strategies are identified & used Falls are reported and investigated Patient/carer are informed of risk & strategies Patient/carer are engaged in development of appropriate falls prevention plan

4. Australian Charter of Healthcare Rights What can patients expect: My rightsWhat This Means Respect: I have a right to be shown respect, dignity and consideration. The care provided shows respect to me and my culture, beliefs, values and personal characteristics. Communication: I have a right to be informed about services, treatment options and costs in a clear and open way. I receive open, timely and appropriate communication about my healthcare in a way I can understand. Participation: I have a right to be included in decisions and choices about my care. I may join in making decisions and choices about my care and health care planning.

5. Client Centred Practice

6. Client Centred Practice: what? Healthcare that is respectful of, and responsive to, the preferences, needs and values of patients and consumers (NSQHS) Philosophical approach to service development and delivery A partnership with clients and carers Underpins organisational policies, models of care and staff actions Needs consistency and persistence Treating people the way they want to be treated

7. Client Centred Practice – why? Associated clinical benefits include: Decreased mortality 1 Decreased readmission rates 2 Reduced length of stay 3 Improved adherence to treatment regimes 4 Improved functional status 3 Improved healthcare workers’ sense of professional worth 5 1. Meterko, Wright et al (2010) 2. Boulding, Glickman et al (2011) 3. DiGioia, Greenhouse et al (2007) 4. Arbuthnott, Sharpe (2009) 5. Dow, Haralambous et al (2006)

8. Client Centred Practice: how? Get to know the patient as a person: build relationships with patients and carers Share power and responsibility: partnership in setting goals, planning care and making decisions Accessibility and flexibility: sensitive to individual needs, provide information in a way that facilitated informed decision making Coordination and integration: work as a team Environments: supportive physical, organisational and cultural environments Best Care for Older People Everywhere: The Toolkit (2012) Dow, Haralambous et al (2006)

9. Client Centred Practice: barriers Time Dissolution of professional power: staff perceiving loss Staff lacking autonomy Lack of clarity and awareness Clients with communication difficulties Constraining nature of organisations Dow, Haralambous et al (2006)

10. Client Centred Practice: enablers Skilled, knowledgeable and enthusiastic staff Opportunities for involving client and carer Opportunity for staff to reflect & express concerns Staff training and education Feedback from consumers Organisational support Being in the client’s home Dow, Haralambous et al (2006)

11. Client Centred Practice: OT Canadian Association of Occupational Therapists: national guidelines 1983 5 key concepts: -the individual as an important and active participant -view clients holistically -therapeutic use of activity/occupation -consider client’s life stage and role demands Dow, Haralambous et al (2006)

12. Client Centred Practice: OT Canadian Model of Occupational Performance Key concepts include: -Client autonomy and choice -Partnership and responsibility: active roles -Contextual congruence: client’s roles, values, interests and environment are central -Respect for diversity Law, Baptiste and Mills (1995)

13. Risk Management

14. Risk Management: what? Risk: The chance of something happening that will have a negative impact. Measured by consequences and likelihood. Risk management: the design and implementation of a program to identify and avoid or minimise risks to patients, employees, volunteers, visitors and the institution. NSQHS Standards 2011

15. Risk Management 5 Basic Principles: Avoid risk: eliminate or manage Identify risk: screen and assess Analyse risk: examine how and why, potential consequences Evaluate risk: determine how to reduce or eliminate Treat risk: implement prevention strategies

16. Management Programs: Best Practice Cognitive impairment should be identified, assessed and investigated (eg: presence of delirium) Assess risk factors for falls Address risk factors as part of a multifactorial falls prevention program Injury minimisation strategies should be considered Preventing Falls and Harm from Falls in Older People Best Practice Guidelines for Australian Hospitals 2009

17. Between knowledge and action Between evidence and practice Between organisational policy and supported practice/infrastructure

18. Thanks Nicole Tierney 5173 8383 ntierney@lrh.com.au