The contribution of electronic health records to risk management through accreditation of residential aged care homes in Australia

Background The Australian government has implemented a compulsory aged care accreditation system to guide and monitor the risk management approach in registered residential aged care (RAC) homes. This research assessed the contribution of electronic health records (EHR) to risk management in RAC homes in relation to the extent that aged care accreditation fulfils its role. Methods A convenience sample of 5560 aged care accreditation reports published from 2011 to 2018 was manually downloaded from the Accreditation Agency web site. A mixed-method approach of text data mining and manual content analysis was used to identify any significant differences in failure to meet accreditation outcomes among the RAC homes. This took account of whether EHR or paper records were used, year of accreditation, and size and location of the homes. Results It appears that aged care accreditation was focused on structure and process, with limited attention to outcome. There was a big variation between homes in their use of measurement indicators to assess accreditation outcomes. No difference was found in outcomes between RAC homes using EHR and those using paper records. Only 3% of the RAC homes were found to have failed some accreditation outcomes. Failure in monitoring mechanism was the key factor for failing many accreditation outcomes. The top five failed outcomes were Human Resource Management, Clinical Care, Information Systems, Medication Management and Behavioural Management. Conclusions Sub-optimal outcomes have limited the effectiveness of accreditation in driving and monitoring risk management for care recipient safety in RAC homes. Although EHR is an important structure and process component for RAC services, it made a limited contribution to risk management for accreditation in Australian RAC homes. Either EHR was not effective, or the accreditation process was not robust enough to recognize its influence. Aged care accreditation in Australia needs to develop further outcome-based measures that are supported by robust data infrastructure and clear guidance.

[1]  Ning Wang,et al.  Description and comparison of documentation of nursing assessment between paper-based and electronic systems in Australian aged care homes , 2013, Int. J. Medical Informatics.

[2]  C. Clarke.  Risk: Constructing care and care environments in dementia , 2000 .

[3]  Brian J. Taylor,et al.  Risk Management Paradigms in Health and Social Services for Professional Decision Making on the Long-Term Care of Older People , 2005 .

[4]  Ping Yu,et al.  Factors influencing nursing time spent on administration of medication in an Australian residential aged care home. , 2016, Journal of nursing management.

[5]  P. Voutilainen,et al.  Nursing documentation in nursing homes--state-of-the-art and implications for quality improvement. , 2004, Scandinavian journal of caring sciences.

[6]  K. Carnell,et al.  Review of National Aged Care Quality Regulatory Processes , 2017 .

[7]  Ping Yu,et al.  The work pattern of personal care workers in two Australian nursing homes: a time-motion study , 2012, BMC Health Services Research.

[8]  W. Adams.  Changes to National Safety and Quality Health Service Standards: How Will It Impact Us in Our Day Surgery Facilities? , 2011 .

[9]  Ping Yu,et al.  Time spent on daytime direct care activities by personal carers in two Australian residential aged care facilities: a time-motion study. , 2014, Australian health review : a publication of the Australian Hospital Association.

[10]  Hilde van der Togt,et al.  Publisher's Note , 2003, J. Netw. Comput. Appl..

[11]  R. Sharp,et al.  Reciprocity in Caring Labor: Nurses’ Work in Residential Aged Care in Australia , 2013 .

[12]  Ping Yu,et al.  How nursing staff spend their time on activities in a nursing home: an observational study. , 2011, Journal of advanced nursing.

[13]  A Good Life in Old Age? MONITORING AND IMPROVING QUALITY IN LONG-TERM CARE , 2013 .

[14]  Ning Wang,et al.  The quality of paper-based versus electronic nursing care plan in Australian aged care homes: A documentation audit study , 2015, Int. J. Medical Informatics.

[15]  Ping Yu,et al.  The impact of electronic medication administration records in a residential aged care home , 2015, Int. J. Medical Informatics.

[16]  Christine Urquhart,et al.  Nursing record systems: effects on nursing practice and healthcare outcomes. , 2009, The Cochrane database of systematic reviews.

[17]  D Hailey,et al.  Caregivers’ Time Utilization before and after the Introduction of an Electronic Nursing Documentation System in a Residential Aged Care Facility , 2016, Methods of Information in Medicine.

[18]  I. Thorell-Ekstrand,et al.  Development of an audit instrument for nursing care plans in the patient record , 2000, Quality in health care : QHC.

[19]  Bruce K Armstrong,et al.  Challenges in health and health care for Australia , 2007, The Medical journal of Australia.

[20]  Ning Wang,et al.  Description and comparison of quality of electronic versus paper-based resident admission forms in Australian aged care facilities , 2013, Int. J. Medical Informatics.

[21]  Robert Yu,et al.  The Relationship between Using Electronic Health Records and Meeting Accreditation Standards for Client Safety in Residential Aged Care Homes. , 2015, Studies in health technology and informatics.