‘The only person who never makes a mistake is the person who never does anything.’
– Theodore Roosevelt
It is a truth universally acknowledged that we all make mistakes. But how we deal with them – learn from them, apologise for them, and own up to them – that determines if we will continue to make the same errors, or use mistakes as a learning tool, helping us improve situations and outcomes.
A recent post on our Aged Care Workers Support Group left the team at HelloCare shocked and deeply concerned.
An AIN wrote that a resident had developed maggots in a wound, and rather than tell the resident and his family, staff were told not to tell the poor man or his family.
HelloCare immediately informed the AIN of the provider’s obligation to report the matter under open disclosure guidelines, a requirement of complying with the Aged Care Quality and Safety Standards, but according to the AIN, this did not occur.
HelloCare spoke to the AIN, who informed us she has left the organisation where the incident occurred and will not return to the industry. After 10 years in the sector, she said the incident made her feel “turned off” an industry she once loved.
At the time the incident occurred, the AIN and other staff had told an RN there was something wrong with the resident’s leg, but they were repeatedly told it was “fine”. But when a night shift carer discovered the maggots, documented the matter, and informed the RN, the RN said not to tell anyone – including more senior staff, family and the resident himself.
The incident left the AIN traumatised. “We had to keep it quiet,” she said. “It was very hard… I felt useless.”
“I still think about it and get upset.”
She was threatened with being taken to court if she spoke up. “I would have been fired if I told the family,” she said.
The wound eventually cleared up, but the AIN understands it became infected again more recently.
The AIN made a complaint to the Aged Care Quality and Safety Commission but has not heard anything of the outcome.
What is open disclosure?
‘Open disclosure’ is the open discussion an aged care provider must have with people receiving aged care services – and often with their loved ones too – when something goes wrong. In the situation of the AIN who wrote in our support group, the provider did not practice open disclosure.
Aged Care Quality and Safety Commissioner, Janet Anderson PSM, told HelloCare, “Adopting a culture of open disclosure would see staff feeling comfortable and supported to speak up when something has gone wrong.”
A requirement of the standards
Open disclosure is a requirement under the Aged Care Quality Standards.
“There are two specific references to open disclosure in the Standards,” Mr Anderson said.
“Standard 6: Feedback and Complaints, requires providers to use an open disclosure process when things go wrong and Standard 8: Organisational governance, where clinical care is provided, organisations are required to have a clinical governance framework which includes open disclosure.”
The open disclosure framework
The Aged Care Open Disclosure Framework and Guidance document gives providers and staff a framework to help them improve communication with consumers when things go wrong.
According to the document, open disclosure requires communicating with consumers when things go wrong, “addressing any immediate needs or concerns and providing support, apologising and explaining the steps the provider has taken to prevent the error happening again.
“Open disclosure may also involve the consumer’s family, carers, and other support people and representatives when a consumer would like them to be involved.
“It is not only ethically, morally and professionally expected, but also the first stage in promoting and fostering an environment and culture that, through honest discussion, encourages learning needed to improve care and services.”
“It also provides practical guidance to providers to support implementation of open disclosure practices,” Ms Anderson explained.
If open disclosure doesn’t occur, “there are avenues for staff members to take, including making a confidential complaint to the Commission,” Ms Anderson said.
Leading Age Services Australia CEO, Sean Rooney, told HelloCare, “Informing the resident and their families about all elements of care is fundamental to the care relationship and fosters important trust between residents, providers and staff.”
“Staff members should record key elements of care provided in the course of their work. They should clarify whether management has informed the resident and family in the first instance. In the event they have a concern with any element of care provided, they should raise this through existing reporting processes.
“They have the ability to further escalate concerns through complaints and whistleblowing policies, in line with their professional obligations.
“Employees are protected from adverse employer action because they exercise (or propose to) a workplace right. For example, an employee is protected from dismissal as a direct consequence of exercising their workplace right to lodge a complaint or inquiry regarding their employment,” Mr Rooney said.
Age and Community Services Australia CEO, Patricia Sparrow, told HelloCare ACSA was “very concerned” to hear of the incident.
ACSA supports the open disclosure framework that providers must comply with under the standards, she said.
Staff or family members who are not satisfied with the response from aged care providers can take their matter to the Aged Care Quality and Safety Commission, Ms Sparrow said.
If you are concerned about the care of a resident at an aged care facility or a recipient of home care services, you can lodge a complaint through the Aged Care Quality Commission’s website or by calling 1800 951 822.
Image: Sayan Moongklang, iStock.