Health Prevention Agency Announced: Commencing in 2011!

 As  health care professionals, it is interesting to note that on the 17th November 2010 Parliament passed  the  historic Australian National Preventive Health Agency Bill 2010. You can read  more at the  Department of Health and Aging

The agency is being established to  lead Australia’s fight against preventable diseases through campaigns targeting obesity, alcohol, tobacco and other substance abuse.The Government has allocated $17.6 million to establish and operate the Agency which is to  open from early 2011 and will be responsible for three specific programs under the National Partnership Agreement on Preventive Health:

•  National social marketing programs relating to tobacco and obesity ($102 million over four years);
•  A preventive health research fund focusing on translational research ($13.1 million over four years); and
• A preventive workforce audit and strategy ($0.5 million over two years).

Potentially avoidable diseases account for around 20 per cent of Australia’s total health care expenditure. The media release has highlighted that;

More than 60 per cent of Australians aged over 18 are overweight or obese.
More than 813,000 Australians aged 15 years and older were hospitalised for alcohol-related injury and disease between 1996 and 2005.
Currently, smoking kills about 15,000 Australians each year and costs Australia $31.5 billion each year.

Minister for Health and Ageing Nicola Roxon  has said the agency will be critical in combating preventable diseases, which affects the lives of millions of Australians.

"We know that preventative health measures work and that’s why we sought to establish the Agency so for the first time in Australia, we will have one independent body to coordinate prevention campaigns across the country."

 

  We will continue to observe with interest the role out and practical implementation of this agency and its associated  programs.

 

Accreditation: Tips for Assisting when 'Its all Happening"

As the Aged Care Standards and Accreditation Agency states on its web site, it exists to
Manage the residential aged care accreditation process using the Accreditation Standards

• Promote high quality care and assist industry to improve service quality by identifying best practice, and providing information, education and training
• Assess and strategically manage services working towards accreditation
• Liaise with the Department of Health and Ageing about services that do not comply with the relevant Accreditation Standards

The Agency is an independent company limited by guarantee, and subject to the Corporations Act 2001 and the Commonwealth Authorities and Companies Act 1997. It is the body appointed by the Department of Health and Ageing as the accreditation body under the Aged Care Act 1997.
The Agency fulfils its functions using processes and principles set down in legislation, notably the Aged Care Act 1997, the Accountability Principles 1998, and the Accreditation Grant Principles 1999.

 If you are unfamiliar with all the steps in the accreditation process, its worth taking the time to visit the agency web site Aged Care Standards & Accreditation Agency and in particular check out the section  Assessor resources as it will give you a good idea of what is really being looked at and how.

If  you find yourself in a situation where  the organisation you work for  is  non compliance, at serious risk and /  or sanctioned & you are  actively part of the team addressing the deficits consider the following;

• Very carefully read the accreditation reports- take note of key words and phrases e.g. staff 'unpredictability'-   remember you need to provide evidence that proves that the staff are no longer  'unpredictable'
• Put an action plan together that mirrors at a minimum the deficits identified in agency report - its often a good idea to create a plan that allows for all 44 criteria as more often than not when you are rectifying deficits, they are not in isolation with other criteria
• Nominate someone to keep track of all the daily improvements and Yes it takes time - but update the plan daily  until all is on track , then you can cut back to weekly etc.
• Communicate to ALL the key stakeholders - morale is often low and staff ,residents and relatives are often very concerned - keep up  the positive displays of good will and encouragement- balance the hard jobs with something a little easier for staff  & yourself ; treat your staff to Pizza/ BBQ for each key step forward!
• After each visit by the agency - which for some circumstances may be daily e.g. if serious risk has been identified - feed the progression and news back to the staff
• Ensure there is strong clinical governance and oversight
• Keep tasks simple - break down the jobs for others - if you delegate - remember to check the person knows what to do and ensure you / another  go back to check it has been done
• Don't get lost in all the work that needs to be done - stay focused on addressing the specific areas identified by the Agency  and where applicable  identified by the Dept of Health & Aging.
• If you are unclear with any communication / feedback from the agency or department - don't wait and assume - pick up the phone and ask
• Don't pretend to know if you don't - seek clarification

          Remember to breathe and refocus - there are good times ahead & yes its all worth it!

Swine Flu (H1N1) Human Swine Influenza: Remain Vigilant!

Swine Flu 'News' has ebbed , yet its interesting to note that the Queensland Health website relating to swine flu continues to be reguarly updated e.g. 5th October 2010. It's worth checking out- lots of  resources, As we know  the human swine influenza virus was reported in Mexico in April 2009. Its now been reported in most countries according to the World Health Organisation (WHO).On the 10 August 2010 the  WHO declared that the Pandemic (H1N1) 2009 has now moved to  a post pandemic phase  

Quick Facts:

• Human swine flu is not the same as seasonal influenza. 
•  Over 18,000   swine flu associated deaths worldwide have been reported  Europe and the Americas experienced a second outbreak of human swine flu  in winter.
•  Human swine flu continues to circulate in the Australian population.
• Laboratory data underestimates the extent of the pandemic. However to date:
•        there have been over 38,000 confirmed cases in Australia
•        almost 200 people have died
• The virus that causes this illness is the most common influenza virus in the current 2010 influenza season.
•  Can cause death due to viral pneumonia and lung failure  30% of deaths have occurred in previously healthy people.
• High risk groups have been identified e.g. those  with chronic respiratory conditions, pregnant women, people  who are obese (BMI >30), indigenous people and patients with chronic cardiac, neurological and immune conditions.
• Children and younger people have also been identified to be at increased risk of serious complications and have been shown to be rapid spreaders of the virus
• .Australia, including Queensland, is  currently in the Protect Phase, The  Protect  phase  is focused on protecting  people  from human swine 'flu by vaccination and by the early use of antivirals.
• Vaccination against Swine flu is now available for all people including children greater than six months of age. Having the vaccination as soon as possible gives the best protection against Swine flu for each individual.
• Human Swine Influenza is spread from person to person by respiratory secretions e.g coughing and sneezing when in close proximity (less than one metre).
•  Human Swine Influenza viruses are not spread by food. Good "flu hygiene" is important to reduce transmission.

Reading the  info  is timely reminder to ensure our organisations and staff have access to appopriate  handwashing facilities and genuinely understand the imprtance of adhering  to apply standard and additional precautions!

Tuberculosis - Old Disease - New Queensland Web Site !

 Whilst we work in the Health Care Industry, there is the potential for complacency when it comes to communicable diseases  that many of us  don't see or treat regularly.When we  consider Tuberculosis (TB) Australia has one of the lowest rates of TB in the world, due to strict controls for the diagnosis and treatment of TB  within our country. Over the last 10 years there has been between 5 - 6 cases of TB per 100,000 people. In QLD the risk to the general public is very low with only 3 cases diagnosed per 100,000 people each year. To assist in ensuring ongoing containment and appropriate management Queensland  Health has a specific Queensland Tuberculosis Control Program. Check the  new web site out - it has great resources  and easy to understand information for consumers and health care workers!

                  Mycobacterium tuberculosis bacteria using acid-fast Ziehl-Neelsen stain ( CDC Public Health Library)

Reminders:

Tuberculosis (TB) is a bacterial infection that can affect almost any part of the body but most commonly affects the lungs. TB found in the lungs is called pulmonary tuberculosis. TB found in other parts of the body is called extrapulmonary tuberculosis. Examples of extrapulmonary TB are lymph node TB, abdominal TB, tuberculous meningitis, TB of bones and joints and genitourinary TB. These forms of tuberculosis can cause many different symptoms and mimic various other diseases.

Symptoms:Tuberculosis seldom begins with striking signs or symptoms, and may progress for weeks or even months before suspicion is aroused.

Symptoms can include:

       a persistent cough that lasts for more than two to three weeks

       an irritating hoarseness in the throat

       coughing up blood from the lungs

       persistent or recurring chest pains

       fevers

       night sweats

       a steady loss of weight

       poor appetite

       indigestion

       fatigue

Transmission:Pulmonary TB is transmitted from person to person via droplets from the throat and lungs of an infected person. An infected person expels droplets of moisture containing TB germs from their lungs when they cough, sneeze, laugh or speak. You can become exposed to TB by inhaling these droplets. Occasionally, cattle can transmit TB to humans through the milk of infected animals however this is extremely rare due to milk pasteurisation and extensive testing for bovine TB in cattle. Extrapulmonary TB results from dissemination of TB  from the lungs through the blood stream or via lymphatic channels.

X-ray of a patient diagnosed with advanced bilateral pulmonary tuberculosis.( CDC Public Health Library )

Treatment:In many cases, TB can be treated with a six-month course of anti-tuberculosis medications including Isoniazid (INAH), Rifampicin, Ethambutol and Pyrazinamide. Uncomplicated tuberculosis responds readily to treatment in the early stages, but response may be slower if the disease is advanced.  Treatment is longer and more complicated if there is drug resistance or reactions to the major drugs.  Alternative treatment with second-line drugs requires a longer course of treatment (which can be up to two years or more in complicated drug-resistant cases).

If left undiagnosed and untreated, TB can be a very serious disease. However, provided anti- tuberculosis medications are taken exactly as prescribed, patients with active TB disease can be cured. Once treatment is completed, it is unusual for the disease to reactivate with most patients remaining free of TB disease for the rest of their life.
The majority of the population who are infected by inhaling the TB germ (around 80 to 90%) are able to fight the TB infection through their immune system and do not become sick with the disease. Instead, the TB bacteria lays dormant within their body for years, and their body develops immunity to fight off further infection. However, if an infected person’s immune system is weakened (such as during a HIV infection), the chances of becoming sick with TB disease are greater. Only five to ten per cent of people who are infected with TB bacteria become sick with active TB disease with potential for infectiousness to others at some time during their life. Therefore, only a small percentage of the population infected with the TB germ (less than 20%) goes on to develop active TB disease. Left untreated, each person with active infectious TB disease will infect between 10 and 15 people every year (on average).  This is why early diagnosis and effective treatment of TB remain the best preventive measures for controlling TB.

Reference: Queensland Health Web Site

Measles: Reliance on Herd Immunity is not Enough!

In Australia  and generally within our health care system  there is a sense of confidence   that all is under control  in  regard to  most communicable diseases as there is  reliance on Herd immunity. Herd immunity (or community immunity) is  a type of immunity that occurs when the vaccination of a portion of the population (or herd) provides protection to unprotected individuals. Herd immunity theory proposes that, in diseases passed from individual to individual, it is more difficult to maintain a chain of infection when large numbers of a population are immune. The higher the proportion of individuals who are immune, the lower the likelihood that a susceptible person will come into contact with an infectious individual.

On 25 August 2010  Queensland Health put out a media release titled Have you been vaccinated for measles?
The media release and related advice re confirms that we must remain vigilant in our infection control practices and the commitment to eradicating communicable diseases.

Queensland Health is urging all Queensland residents to ensure they have been vaccinated for measles, after cases were confirmed in Tweed Heads, Gympie and Moranbah. The current cases  were identified as  all being highly infectious while out and about in various communities.

Measles is one of the most infectious of all communicable diseases, and can be acquired in public places such as shopping centres or on public transport if infectious people are present.
 Queensland Health Communicable Diseases Branch Senior Director Dr Christine  Selvey recommends anyone born during or since 1966, who has not had two documented doses of Measles, Mumps, Rubella (MMR) vaccine or had proven measles, to visit their local GP for a free extra vaccination.

 Dr Selvey has identified  that  all Queenslanders  should  check if they need to be vaccinated against measles.

 

Basic Facts re  Measles ( Rubeola )

• Measles is extremely infectious and is spread by tiny droplets through coughing and sneezing or through direct contact with secretions from the nose or mouth.. The virus can last for several hours in the environment.
•  Measles can cause serious complications such as pneumonia (lung infection), encephalitis (inflammation of the brain) or otitis media (middle ear infection). Complications are more common and more severe in people with a chronic illness and very young children. Deaths occur mainly in children under five years of age, primarily from pneumonia, and occasionally from encephalitis. Measles should not be regarded as a simple childhood disease.

Symptoms:

 Measles begins with symptoms such as fever, tiredness, cough, runny nose and/or red inflamed eyes. These symptoms usually become more severe over three days. The cough is often worse at night and the affected person may wish to avoid light because of sore eyes. At this stage there may be small white spots on a red base in the mouth on the inside of the cheek (Koplik’s spots).

This is then followed by a blotchy, dark red rash usually beginning at the hairline. Over the next 24 to 48 hours the rash spreads over the entire body, during which time the person generally feels very unwell. Typically with measles, the fever is present and the person feels most unwell during the first couple of days after the rash appears. The rash usually disappears after six days.

 The time from contact with the virus until onset of symptoms is about 10 days but may be from 7 to 18 days.

 A person may be infectious from about five days before the onset of the rash until about four days after the rash appears.

Treatment
There is no specific treatment for measles. The symptoms of measles are usually treated with rest, plenty of fluids, and paracetamol to lessen pain or fever. Do not use aspirin for treating fever in children.
Control
People with measles should be excluded from work, school or childcare centres for at least four days after the appearance of the rash.
People who have not been vaccinated against measles and those who have any condition that compromises their immune system and have been in contact with a person with measles, should be excluded from school and childcare for 14 days from the day the rash appeared in the person diagnosed with measles.

 If unvaccinated contacts are vaccinated with the measles mumps rubella (MMR) vaccine within 72 hours of their first contact with the original person with measles, they may return to childcare, school or work.

Prevention

Vaccination with the MMR vaccine is the most effective way to prevent measles. Two doses are necessary to provide high levels of protection.
The MMR vaccine is recommended for:

•  all children at 12 months of age; and at 4 years of age.
• Vaccination is also recommended for:all children who have not previously received MMR vaccine
• children over 4 years of age who have only received one dose of MMR vaccine
• adults born during or since 1966 who have not received 2 doses of MMR vaccine
• susceptible women should be identified during antenatal counselling and vaccinated with MMR vaccine at least 28 days before pregnancy or immediately after delivery.

For further information contact your local doctor, community health centre, nearest population health unit or the13HEALTH information line (13 432584). Check out Queensland Health  and Government Immunise Australia

 References

  Heymann, D., ed. 2004. Control of Communicable Diseases Manual, 18th edition. Washington, DC: American Public Health Association.

 National Health and Medical Research Council, 2003. The Australian Immunisation Handbook (9th Ed.) Canberra: National Capital Printing.

The Grand Plan for Older Australians -what is it all about?

Despite the area  of health care that we may choose to work in, you will be bound to hear questions about this  national campaign. This campaign is focused on uniting Australians to  solve the issues facing aged care. The key themes of choice, access and sustainability are not new having  been espoused by the  major peak industry bodies, many of whom are identified as being key supporters of this campaign . 

The Grand Vision  which underpins the media focused public awareness campaign states;

 Every older Australian is able to live with dignity and Independence in a place of their choosing with a choice of appropriate and affordable support and care services as and when they need them.


The Grand Plan short term  action  recommendations include;

• An independent study of the cost of care to be undertaken
• Increase funding for residential & community care by restoring/ extending CAP (or a similar mechanism)
• Flexible payment options for accommodation which include refundable accommodation deposits for high care, removing the distinction between high and low care, increasing  accommodation charges ,linking  the accommodation subsidy for concessional residents to the real costs of providing accommodation
• Creating  one community care program
• Addressing  workforce issues-attracting and retaining staff

The website set up to provide a platform for  information surrounding the campaign and includes;

• The ability to send electronic postcards  to older people  you know which in turn auto generates an email to the person receiving the post cards MP
• An email to the Prime Minister, the Opposition Leader and the ministers and opposition spokespeople for health and aging regarding the concerns outlined in the campaign.

For more info including some interesting stats on Australia's Aged care  check out The Grand Plan

Managers, Paperwork and Compulsory Reporting

Approved Providers and in practical terms Facility Managers must ensure compliance with the compulsory reporting  guidelines which  commenced on 1 July 2007 following amendments to The Aged Care Act 1997 (the Act).
The importance of being timely in reporting, notifying, investigating and documenting can't be underestimated, yet can be difficult to achieve on top of everyday  work demands. Managers who have been through the reporting and investigative processes   often  find it useful to create  a checklist  for future  reference which  may include the following suggestions to reduce the potential to 'forget' or not have timely access to vital information when the investigative team comes to the facility and  / or when you  send  the related information to the Complaints Investigation Scheme (CIS).

Use a template for your internal investigation process:

• Remember to include dates, times, full names,  the  designations and  the physical location of all parties concerned e.g. resident and relevant staff.   Ensure staff member contact  details are enclosed and also  include their  police check number, and expiry dates.
• Remember to save the  current staff roster- have a  copy available, and remember to include the original and a copy with  any  changes in your documentation.
• Notate time of notification to local police station and  job number allocated- notate name of officer initially spoken to.
• Notate date, time and to whom   notification  was made to the  Complaints Investigation Scheme - remember to document the Case ID when allocated.
• Notate timely contact with residents  next of kin  &  medical officer (as required )  include  the next of kins response and agreed action / outcomes.
• Ensure timely  and professionally appropriate discussion with any staff member concerned - provide written evidence of the  initial  and subsequent discussion held with staff member ( if suspected of being a perpetrator to the compulsory reporting event) include e.g. standing  staff member down on full pay pending the investigation. The importance of the staff member being supported throughout the process  must not be forgotten - staff may be offered counselling  etc. Note the staff member may seek Union support during this time.
• Gather evidence of mandatory staff education on Elder Abuse/ Compulsory Reporting - staff training records and education evaluation forms.
• Ensure copies of any related memorandum's and  meeting minutes.
• Ensure copies of all subsequent related correspondence .
• Ensure  copies  of resident care plans, progress notes relative to the event  concerned.
• Ensure copies  of incident report / wound forms/ wound photographs ( if applicable).
• Include internal findings from internal investigation.
• When emailing the interim information to the CIS - include a read receipt for the  email and ask for confirmation of the information being received.
• It is useful to bind the hard copy documentation prior to housing in the Compulsory Reporting Folder at your facility.

The 5 key elements to compulsory reporting requirements  are;

 1 All approved providers of Australian Government subsidised residential aged care must encourage staff to report alleged or suspected reportable assaults to enable approved providers to comply with their responsibility under the Act. This requirement recognises that in many cases, it may be staff who first notice assaults. The legislation therefore requires that approved providers not only give staff information about how to report assault, but also to actively require staff to make reports if they see, or suspect, an assault on a resident.

 A reportable assault as defined in the Act (section 63–1AA) means: unlawful sexual contact with a resident of an aged care home; or
unreasonable use of force on a resident of an aged care home.
2 The Act requires that, except in very specific and sensitive circumstances, all approved providers of residential aged care must report all allegations or suspicions of reportable assaults. The discretion not to report applies to circumstances involving residents affected by an assessed cognitive or mental impairment, and where there are repeated allegations of the same assault. An approved provider should not wait until an allegation is substantiated – the fact that a person has alleged that someone has assaulted a resident is sufficient to trigger the reporting requirements.

 3 Reports must be made to both the Police and the Department within 24 hours of the allegation being made or the approved provider starting to suspect on reasonable grounds, that a reportable assault may have occurred. These tight time frames ensure that alleged assaults are acted upon immediately.

 4 If a staff member makes a disclosure qualifying for protection under the Act, the approved provider must protect the identity of the staff member and ensure that the staff member is not victimised. This is important in encouraging ongoing reporting by staff members.

 5 If an approved provider fails to meet compulsory reporting requirements, the Department may take compliance action.

 

 

More information  can be found at  the  Department of Health and Aging