Jelica Ltd 

When Quality Care Counts



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Posted on May 19, 2017 at 2:30 AM Comments comments (1029)

Posted on Thursday, 2 December 2010 8:16 a.m.

Enduring Powers of Attorney or EPOA for short. With the recent newspaper article and investigation going on it is worth looking into this.

What follows is my understanding of what is required.

If a resident does not have the capacity to make a decision and has an EPOA then this must be legally activated and the facility must receive a copy of this activation (it is not enough to just have the EPOA paperwork it must be activated) prior to the admission or accepting resident for admission.

If a resident does not have the capacity to make a decision and does NOT have an EPOA then facilities must insist on one being applied for through the family courts (PPPr) and family will have to wait for it to be done which can take some months. You should not accept the admission until it is through.

If a resident has the capacity to make decisions then ask that they sign admission agreement and all other paperwork themselves – if unable due to physical capacity they must be present when such paperwork is signed and have a witness to say they were in agreement.

Only the resident and/or Doctor (acting in the resident’s best interests) can sign the Resus orders never relatives or EPOA.

This means that everybody should relook at their practice to ensure that residents are not placed against their wishes.

Thought for today:

'Be kinder than necessary because everyone you meet is fighting some kind of battle'

Integrated audit process

Posted on May 19, 2017 at 2:30 AM Comments comments (1539)

Posted on Monday, 6 December 2010 10:54 p.m.

So far there haven't been too many problems around this process other then some of the auditors not interpreting the contract as it should be. For that reason it is important that you know the contract in case the auditor gets it wrong. The progress reports are now being managed by the DHB designated person and once again not a lot of feedback either way.

I have had a couple of discussions regarding the resuscitation orders and advance directives. To clarify it little bit more:

If a resident is deemed not to have ‘testamentary capacity’, then, in line with The Health & Disability Commissioner and Health Cert directive, the Whanau / EPOA / agent etc., CANNOT sign the Resuscitation form and it becomes a medical decision with invited input from the residents agents.

The Health & Disability Commissioner’s view is that only ‘the person’, has the capacity to consent to resuscitation themselves.

Section 18 (1) of the ‘Protection of Personal & Property Rights Act 1988’provides that the holder of an EPOA cannot refuse consent to the administering to that person of any standard medical treatment or procedure intended to save that person’s life or to prevent serious damage to that person’s health.

The resident is the only person who can consent to any resuscitation order and if they have made an advance directive regarding their resuscitation status then this will suffice unless the resident changes the orders or is deemed to no longer to have testamentary capacity.

That is it for yet another day.

Your mind is like a functions only when open.

Good report writing

Posted on Comments comments (1481)

Posted on Monday, 13 December 2010 8:10 a.m.

Good report writing is important.

Progress notes, incident, accidents and infection control reports all become part of resident’s file. These records are saved for 10 years after the person passes away. The writer of these entries can be questioned about their report years after the event and if the report is not clear nobody would be able to recall an event so many years later if the report is not written in a factual, objective manner.

I have read reports where I could gather exactly how the writer felt at that moment because all I read is the emotion of the writer. The writer wasn’t able to give clear facts about the event when asked a couple of months later.

It is a very worthwhile training session to have with staff on a regular basis. Good report writing takes training and practise, taking in account that a lot of staff have English as a second language.

Reports should state what the writer could see, hear, feel, smell, and touch, without giving judgment.

Writing: “John was angry and aggressive this morning” does not mean a lot or can be interpreted in different ways by different people.

Writing: “John walked up and down the corridor waving his walking stick calling out that he was going to hit Mike for taking his book”. Any person reading this, even years later, will know what happened and the people involved.

All entries need to have a date noted and there should be a way of establishing a timeline. If your policy states that progress report are written an hour before each shift finishes you have established a time line. In that case your progress notes have date and am, pm of night written in front of the entry. If the exact time is important to explain the event then it is also documented in the progress notes.

It is good practice to write the date and the time in front of the entry.

All exception reports (incident/accident etc) have the exact time noted as this is important for investigations.

Ensure all entries are signed and designation of writer noted.

There should be a signature verification log so that initials and signatures can be verified.

I am sure the following is not new for anybody but it is worth repeating:

“If it is not written down it didn’t happen!!”

My favourite: “if it is not written down good it is not worth writing down!