Unsustainable and costly for aged care providers – these were among the findings of the eagerly anticipated ‘Lessons Learned’ review of the implementation of interRAI in the residential aged care sector.
The findings of the independent review, carried out by Evaluation Consult, were released today and confirmed the vexations many providers have experienced throughout the implementation of the assessment tool.
interRAI was introduced to the residential aged care sector in July 2011 and made compulsory in July 2105. While providers are keen to see the benefits of interRAI, in many cases their enthusiasm has been dampened by frustrations associated with the costs and time of interRAI training and implementation of the tool in their facilities.
The review found the interRAI project met its intended target of 2,370 registered nurses trained and competent in use of the interRAI LTCF assessment tool. Needs assessment and service coordination managers were also found to be generally positive about the introduction of interRAI, indicating it had improved their relationship with facilities and has led to more consistent assessments.
However, the key findings related to communication, training and efficiency. The report noted that clearer communication around expectations around the timing of the realisation of any benefits would have alleviated some of the negative perceptions during implementation, particularly when interRAI became mandatory.
The review acknowledged that access to training has been problematic for facilities due to the long waiting times and extra costs associated to training new RNs when an RN leaves.
It also found that interRAI is not as efficient as it could be, due to a lack of interoperability with other patient management systems – particularly paper-based systems – and duplication of assessment information.
InterRAI Services has taken on board the findings and recommendations of the review and says “actions have already begun” to make improvements. It has published a response to the review, outlining how it intends to address each recommendation.
InterRAI Services is in the process of improving communication and collaboration with the aged care sector to further embed the tool, improve efficiency and help realise its benefits, as well as provide more training.
“The interRAI Informer regular newsletters will continue to keep the aged care sector up to date and a suite of data reports will be published soon.”
Associate Health Minister Nicky Wagner has welcomed the review.
“Like any rollout on this scale, there will always be teething issues, but this review identifies challenges and makes recommendations to improve sustainability and efficiency,” she says. “It’s important that InterRAI collaborates with the aged care sector to ensure assessments are efficiently integrated into care planning processes.”
Key findings from the Lessons Learned review
- The process by which interRAI was introduced and then made mandatory had a negative impact on how the tool is viewed. The sector was mandated to use a tool that only some of them had implemented.
- Lack of interoperability between interRAI and other patient management systems as well as duplication of assessment information, is having an impact on its efficiency.
- Communication was effective around the implementation of the interRAI system and what was required from facilities, but lacking in conveying the actual benefits of the assessment tool and how the data collected via online assessment can be used to improve quality of care.
- The project met its set objectives including training the required number of RNs based on the ratio of one nurse to 15 beds
- interRAI has had a negative impact on RNs, taking them away from resident care, adding workload stress and working in their own time to complete interRAI assessments or competency training requirements.
- The true extent of the costs of implementing interRAI does not seem to have been anticipated or acknowledged.
- NASC managers have seen an improvement in their relationships with facilities since interRAI was introduced and have reported consistency in the terminology when discussing residents. They also found it more efficient as it enabled remote acceptance of a change in level of care.
- While interRAI looks set to provide value for money for DHBs and NASCs, this is not the case for providers due to the costs of implementation.
- Providers felt that interRAI is not sustainable long term due to its current impact on cost and time.