The concluding part of Australian Ageing Agenda’s clinical masterclass, presenting expert advice on the latest evidence and resources for frontline staff.

(Part 1 of the masterclass is available here). 

 Group of students outdoors

Wound care 

Kathy Finlayson
Dr Kathy Finlayson

A suite of simple ‘guidelines summaries’ aim to cover all aspects of wound management, writes Dr Kathleen Finlayson and Dr Patricia Shuter.

In the May-June 2013 edition of Australian Ageing Agenda, aged care facilities across Australia were invited to nominate their own wound care champions to attend a training workshop to adopt and help disseminate the evidence based Champions for Skin Integrity (CSI) Program. The response to this was overwhelming and workshops were fully booked with waiting lists in some states.

Feedback from “train the trainer” workshop participants was extremely positive and indicated the CSI model enabled the implementation of evidence-based prevention and management strategies. As a result of this, the Department of Social Services is supporting a second round of national dissemination of the CSI workshops in the remainder of 2014.

The impetus for the project came from the wealth of evidence highlighting the significant pain and functional disability caused by chronic wounds, and the burden on carers and health system resources. This is aggravated by ‘evidence to practice’ gaps in appropriate assessment and timely use of best practice treatments.

Dr Patricia Shuter
Dr Patricia Shuter

While there are numerous evidence-based guidelines addressing differing aspects of wound management and/or different types of wounds, very few guidelines cover all aspects of wound management.

The CSI project team developed a suite of simple ‘guidelines summaries’ drawn from multiple documents and sources to collate all the different evidence-based guidelines. These summaries were grouped under the three main headings: assessment, management and prevention; and these underpinned all the resources and education for the project.

The pivotal requirement for participating facilities is to identify some clinical leaders willing to act as champions within the facility who have a strong commitment to evidence based practice in skin integrity and wound care.

These champions would attend a train the trainer workshop on the CSI model and use of the resource kit, with the expectation that the skills and the knowledge acquired at the workshops would be used to train a team of champions within their RACF. With support from the CSI team, the champions will also be asked to lead a small project on evidence based wound care, providing feedback to the CSI project team in the few months following the workshop.

Reports from the champions involved in the first round of the CSI train the trainer workshops have demonstrated the value of this initiative. Together with their new team of CSIs, a sample of champions showed that they became a resource for wound management advice, promoting evidence based wound care. To date, outcomes include reductions in prevalence of pressure injuries and skin tears, decreased healing times and changes in wound management practices and equipment to reflect evidence based recommendations.

For more information about the project, contact Bob Jensen, (07) 3138 6113 or r.jensen@qut.edu.au

Dr Kathleen Finlayson and Dr Patricia Shuter are researchers at Queensland University of Technology and project managers on the CSI Program.

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Mental health 

Dr Brian Graetz
Dr Brian Graetz

Dr Brian Graetz encourages staff to undertake beyondblue’s depression and anxiety training.

In October 2013, the Australian Institute of Health and Welfare reported that 52 per cent of all permanent aged care residents had symptoms of depression. beyondblue believes the rate of anxiety, while unconfirmed, may be even higher. In the community, those older people requiring support to remain at home are twice as likely to experience depression compared to their well community counterparts.

To help tackle these concerning rates, beyondblue has developed the Professional Education to Aged Care (PEAC) program, which is being delivered to the aged care sector by specialised training organisations licensed to beyondblue.

The PEAC program provides evidence-based training for aged care staff to improve the detection and management of depression and anxiety in older people in both residential and community settings.

beyondblue has now developed two PEAC workshops – a residential program and a community program. Each has been developed with industry input and tailored to meet the specific needs of those working in each setting. Since it first launched in July 2013, the community workshop has received excellent feedback from staff working in the community.

To expand the PEAC program’s reach, we have also provided funding to our licensees to cover travel and accommodation costs for workshops held outside metropolitan areas. The organisations licenced to deliver the training are Leading Aged Services Australia, McCarthy Psychology Services and Wise Care.

I encourage all aged care agencies to ensure their staff receive this important training, particularly at this time when travel and accommodation subsidies are available.

Click here for more information or call (03) 9810 6138.

Dr Brian Graetz is acting chief executive officer of beyondblue.

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Continence care

Dr Joan Ostaszkiewicz
Dr Joan Ostaszkiewicz

At the forefront of best practice continence care in residential aged care should be residents’ preferences, writes Dr Joan Ostaszkiewicz.

According to a report from Deloitte Access Economics and the Continence Foundation of Australia, 71 per cent of people living in Australian residential aged care facilities are incontinent of urine, faeces, or both.

Similarly, a project funded by the Commonwealth Government’s National Continence Management Strategy found 68 per cent of residents are dependent on staff for assistance to use the toilet. Many residents also experience other bladder and bowel symptoms and conditions, such as constipation, faecal impaction, urinary urgency and frequency, urinary tract infections (UTIs), and nocturia. Therefore, nurses and personal care workers in the residential aged care sector have a critical role to play in promoting and managing residents’ incontinence.

International guidelines about managing incontinence among frail older adults promote an individualised approach to care, and recommend that decisions about continence care should be informed by residents’ preferences for care, as well as by objective information.

Many of the factors that cause incontinence in frail older adults are not directly related to the genitourinary tract (i.e. impaired mobility, constipation, delirium, infection, medications, excess urine output, and environmental factors). Therefore, best practice recommendations involve conducting a comprehensive continence assessment to identify factors that could cause and contribute to residents’ incontinence, and subsequently developing, implementing, and evaluating an individualised continence care plan.

Another important strategy to promote continence for frail older adults in residential aged care facilities involves offering them regular and timely assistance to the toilet. Toileting assistance programs are highly effective in reducing rates of incontinence in residential aged care facilities, however, research from the US reveals it is difficult to implement and sustain toileting assistance programs under usual staffing levels.

My recent grounded theory study about providing continence care in Australian residential aged care facilities suggested current approaches to continence care reflect a concern about the potential for incontinent residents to develop pressure ulcers, and a desire to ‘dignify’ residents and ensure they appear clean, well-groomed, and are able to socialise.

Staff decisions about care are also highly influenced by what is possible within the context of existing staff-to-resident ratios. Staff identified a range of barriers to consistently implementing toileting assistance programs, particularly at night, and observations revealed a routine of checking and changing most residents’ pads at fixed arbitrary intervals.

However, does the practice of promoting the use of continence pads to address residents’ continence care needs reflect good or bad care? Is containing incontinence the best we can offer residents? These are important questions that should invite debate from the nursing profession, the residential aged care service sector, and, more importantly, from consumers themselves.

According to international guidelines, decisions about residents’ continence care needs should be underpinned by multiple factors, including the frequency, severity, and type of their incontinence, their skin health, their sleep/wake status, and their cognitive and functional status. However, first and foremost, continence care should be guided by residents’ preferences for care.

Dr Joan Ostaszkiewicz is Postdoctoral Research Fellow at the Centre for Quality and Patient Safety Research at Deakin University. A fully referenced version of this article is available by emailing editorial@australianageingagenda.com.au

READ NEXT: Part 1 of the masterclass, covering infection control, diabetes, medication management and palliative care.

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