You put down the phone and look over the notes on your desk from the previous week. A client slipped and fell whilst being supported to shower; a staff member was bitten by a client’s dog when providing domestic assistance; and now a family carer has called to make a complaint about finding bruises on her mother’s arm that she claims were the result of rough handling by a care worker.
What do you do with all these reports? What’s your step-by-step process for addressing the issues raised? What documentation do you keep around your response? And once you’ve addressed the issues identified, how are you going to use the incidents and your response to ensure that the chances of them reoccurring are minimised and are incorporated into your quality improvement planning?
Since 1st April 2021, it’s been a requirement for all aged care providers, including home care providers, to manage and prevent incidents. This change is now reflected in the Aged Care Standards, where Standard 8 (3) (d), which is all about having effective risk management systems and practices, now includes an additional requirement;
(iv) ‘managing and preventing incidents, including the use of an incident management system’.
What is an incident?
Firstly let’s just review what an incident is. By definition, an incident is an event or set of events followed by a chain of reactions.
The original event, which starts the sequence, is called the primary incident. The reactions are called secondary incidents. It's important to identify and understand incidents in order to understand what has happened and why it happened.
When we look at the aged care sector, the primary incident can be an act, omission, event or circumstance that has, or could reasonably be expected to have, caused harm to a client or other person, such as a staff member or perhaps a member of the public. For example, this could be a clinical incident, where a client has been given the wrong medication, or it may be a general incident, such as a client tripping over the kerbside when out shopping with a staff member.
Secondary incidents, or responses, can arise from the primary incident, such as escalating behaviours of concern after a trigger event or incident.
Incidents also include ‘near misses’. A near miss can be either a minor incident (e.g. a small cut on the hand from mishandling a sharp knife, rather than the potential larger injury), or a close call where something could have resulted in injury or harm. For example, perhaps you’ve taken a group of clients out to a busy shopping centre and a client with dementia has wandered off alone. When they are found a short time later, they are standing outside a nearby store talking to someone they know from one of their past social circles. While there is no injury, there was the potential for harm towards the person if the circumstances had been different.
Whatever the incident is, we want to try to limit the chance of it occurring again. This means recognising the incident, identifying what led to the incident occurring and deciding what actions or policies can be put in place to minimise the chance of it happening again. This is where having a formal incident management system makes life easier for all staff, because everyone knows what is expected.
What is an Incident Management System?
An incident management system is not simply a set of templates or a record of incidents, it’s a comprehensive approach to preventing, managing and learning from an incident, or potential incident.
The goal of an incident management system is to minimise the harm or disruption to clients and the organisation, as well as tracking trends in incidents which helps to improve processes and practices and to learn from the experience, which will hopefully mean avoiding the incident reoccurring.
What does an effective Incident Management System look like?
An effective incident management system is one that is clear and easy to understand and accessible to all relevant stakeholders.
The Aged Care Quality and Safety Commission describes an effective incident management system as being:
“A structured set of policies, processes, procedures and staff practices that ensure a systemic approach is taken to minimising the risk of incidents occurring, responding appropriately to alleged, suspected and witnessed incidents, and taking action to prevent the recurrence of similar incidents.”
There are four key components to the system: relevant policies and procedures, a tool to record information about incidents, staff training, and clear governance and accountability arrangements that provide oversight of the system.
Let’s unpack these to see what they might look like in your organisation.
Policies and Procedures
Within your policy suite you should have policies that relate to workplace health and safety, client support and governance. This is likely to include policies that relate to incident management and reporting, as well as other supporting policies that include aspects of incident awareness and management. These might include:
- activities and risk management
- cleaning and chemical handling
- elder abuse and neglect
- challenging behaviours and restrictive practices
- cultural safety
- choice and dignity of risk
These are by no means a definitive list of policies and procedures that relate to your incident management system, but they each include aspects of how the care and management team will identify, respond to, resolve and ultimately, learn from incidents.
One way to ensure that staff and clients are aware of your policies and procedures is to include the information in easy to read staff and consumer handbooks. While many people may be resistant to reading through a ream of policies, they are usually quite happy to read through a well-written, accessible handbook that includes this key information.
Obviously it’s not effective to have loose incident forms or ‘post it’ notes left lying around on the desk gathering dust. You need to have a way of storing and reviewing the incident so that you can address issues and improve service and outcomes for your clients and staff.
Some organisations will utilise a cloud-based or electronic incident management system to record and track responses to risks and incidents, while others will use a simple spreadsheet or paper-based documents to maintain records.
Each service provider is different and there will be a range of approaches to record keeping. Choose a ‘system' that is accessible, clear and easy to use for all relevant staff. If you already have a cloud-based quality mapping and improvement tracking system in place, then this is ideal for tracking improvements that arise out of your review of an incident.
Staff Training and Involvement
There is no sense in having a system in place if staff are not aware of it or don’t know how to apply it. Make sure that all staff, from cleaners through to senior management, receive information on how you manage incidents and your expectations of them in handling incidents during their induction.
Provide regular inservice updates to staff and feedback on the outcomes of an incident review as well as reminding them of the system on a regular basis. Alert them to new processes that have arisen or amendments to policies as a result. And make sure that staff are included in the review process, providing them with opportunities to develop solutions that might be innovative and practical.
Governance and Accountability
Governance and oversight of the policies, practices and processes of a service is an important aspect of managing a quality aged care program. While many providers have policies and procedures in place, are they being monitored? Are they updated as things change?
Consider what is actually happening in your aged care service around the management of incidents, as well as the quality improvements that arise from these; are your practices aligned to your documented processes?
Your executive team (management and Board members) need to understand the need for, and the application of, incident management processes as they are ultimately accountable for the effective operations of the service. It’s important that they are aware of the incident management system and also that they have ‘line of sight’ to improvements and that they are tracking trends in incidents. This can be as simple as ensuring that all incidents and responses are documented in your monthly management report or, where you have an incident management system, ensuring the executive has the ability to view the review and progress of improvements documented in the system. Transparency is an important aspect of a well managed service.
The Aged Care Quality and Safety Commission have developed a well written fact sheet that services can use as an overview of the requirements for an incident management system.
Additionally, you may as well be prepared for the 1st July 2022, when the Serious Incident Response Scheme commences for home care service providers. The Commission has released a best practice guide for the development and operations of an incident management system. While this is currently aimed at residential providers, the information is equally applicable to the home care sector.
How can we help you set up your Home Service Incident Management System?
If you’re looking for help making sure that your policy suite is up to date against the latest legislation, get in touch with us – we have an extensive range of policies, procedures and tools to support quality and compliance.
Email email@example.com for more information or to set up a time to discuss.
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