Welcome to Clinical Insights – a new blog series exploring a range of aged care topics. It’s where I and other senior clinical leaders at the Commission will share our experiences and insights and highlight emerging research to help support you in delivering safe, high-quality aged care.
In future posts, this will include my colleague Loren deVries, the Assistant Commissioner for Behaviour Support, who will relay her years of nursing experience and expertise in supporting older people, including those living with dementia experiencing changed behaviours.
About me
Over the last 3 decades working as a geriatrician, I have provided care to older people in home care, residential aged care and hospital settings. Today, along with my work at the Commission, I continue my clinical practice part time in a lovely little geriatric emergency department, called CARE, in the Southern Adelaide Local Health Network.
As a frontline clinician across the aged and health care sectors, I have gained valuable insights, as well as a compassionate understanding of the challenges faced by providers, clinicians and other aged care workers, when supporting older people to live their best lives.
One of the most rewarding aspects of my work is seeing how the care that I provide makes older people feel truly understood and valued, and I’m keen to share these insights with you in this new blog series.
Variations in clinical practice
In my experience, I’ve seen and heard a wide range of perspectives on what constitutes best practice in clinical care, from planning and delivery through to governance. I hear this in the daily conversations I have with older people, providers, medical, nursing and allied health professionals, as well as aged care board members.
While some diversity in clinical practice can reflect the variety of preferences of older people, significant variations are not a good thing, often accompanied by inequity and poor clinical outcomes. One of the most common reasons for such variations is little or no application of evidence-based clinical guidelines. In contemporary clinical practice, the use of evidence is fundamental to achieving an optimal clinical outcome. It also supports clinicians to involve older people in making informed choices about their care.
But therein lies the problem. There are very few evidence-based clinical guidelines specific to older people living in residential or community care. Although the strengthened Aged Care Quality Standards (the Standards), and other aged care obligations, are clear about what providers should focus on, and the outcomes they should deliver for older people, they rarely go into enough detail for providers to be certain what meeting those obligations looks like in practice. To be fair, they shouldn’t have to. This is because the delivery of safe, high-quality care should neither be prescribed or 'set and forget’.
When it’s effectively person-centered and person-led, the delivery of safe, high-quality care is much more complex and dynamic. Care must be tailored to each older person’s individual choices, their (often multiple) other health issues and level of frailty. At the same time, providers must acknowledge and incorporate the evolving body of aged care research into their clinical practice.
Thankfully, aged care does not exist in a vacuum. There’s a lot of existing research, evidence-based guidelines and protocols from the health care sector that could be judiciously adapted and used in aged care. This could be married with the many other excellent evidence-based care practices that aged care providers have developed themselves. We would all stand to benefit from these being shared across the sector. Where no evidence exists, we should establish it.
As Chief Clinical Advisor, I am passionate about using my role to help you join the dots from paper to practice and implement care in a way that better manages risks and reduces harm. This can only be achieved by drawing on the wealth of expertise and experience at the Commission and across the aged and health care sectors.
Let’s start by using this channel to talk about issues we all face and how better practice guidance can help us to address them. To kick start that conversation, in my next post I will share some key insights from research on frailty.
And if you have a topic or area of interest you'd like us to cover in a future blog, we’d love to hear your ideas. Please send your suggestions to OfficeOfChiefClinicalAdvisor@agedcarequality.gov.au. Your feedback will help us ensure this blog covers the topics that matter most to you.
Until next time…
Mandy