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Managing risk for aging patients in long-term care: a narrative review of practices to support communication, documentation, and safe patient care practices

Authors Ibrahim JE, Holmes A, Young C, Bugeja L

Received 1 August 2018

Accepted for publication 24 January 2019

Published 27 February 2019 Volume 2019:12 Pages 31—39


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Dr Kent Rondeau

Joseph Elias Ibrahim, Alice Holmes, Carmel Young, Lyndal Bugeja

Health Law and Ageing Research Unit, Department of Forensic Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC 3006, Australia

Abstract: Resident safety and welfare in long-term care (LTC) is being redefined as the focus shifts to promoting an optimal quality of life especially in LTC. Achieving this requires contemporary practice to improve the organization and staff’s ability in identifying, communicating, documenting, and managing the risks that arise from the choices a person makes in pursuit of a better quality of life. This article is a narrative realist style review examining the issues of how to manage risks for older residents living in LTC. The issues are examined in six stages: context, identifying, communicating, documenting, enacting, reviewing and reflecting on how choices are made and risks managed. It is important for individuals to be supported in making an informed choice – this requires identifying, providing, and communicating the available options and the potential consequences. Documenting consent, perhaps with formal risk agreements, provides clarity for all involved and assists in determining how and who is responsible for enacting choices. Reviewing and reflecting upon the decisions and actions to enact choices are familiar to prudent LTC managers who implement and monitor robust governance systems. Learning from these experiences is essential to better meet individual resident, staff, organizational, and community expectations. Improving practice at each of the six steps should reduce adverse professional and legal repercussions and enable the resident, families, and staff to better cope with respecting choices when a known harmful outcome eventuates.

Keywords: risk management, choice, long-term care, dignity of risk, quality of life, forensic gerontology

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