Catherine Scott

Sundale Ltd

Ensuring clinical effectiveness and utilising research is integral to robust clinical governance. It involves fostering a collaborative environment among all healthcare team members to yield the best possible outcomes for our consumers. By building effective leadership, operational processes, and a healthy workplace culture, we can attain optimal results for our consumers.

Encompassing practices like credentialing, clinical audits, performance evaluations, education and training, adherence to established clinical guidelines, and monitoring variations in practice all contribute to the delivery of safe and quality healthcare services.

Establishing and maintaining a clinical governance system leverages the components within its framework to drive enhancements in safety and quality. Clinical leaders play a pivotal role in supporting team members to:

• Grasp and fulfil their delegated roles and responsibilities in promoting safety and quality.
• Operate within the clinical governance framework to enhance the safety and quality of healthcare for consumers.

We all are responsible for ensuring adequate supervision of our healthcare and clinical workforce. Team members with limited experience require more extensive oversight and regular assessment. The purpose of supervision within a clinical governance structure is twofold:

• Ensure less experienced team members maintain an acceptable standard of practice, and
• Identify opportunities for their growth and development.

Empowering our healthcare providers and caregivers to utilise the most current and reliable evidence in delivering safe, high-quality care is paramount. The implementation, monitoring, and evaluation of evidence-based clinical pathways facilitate the provision of effective care. It is important to consider implementing processes:

• Offering clinicians easy access to best-practice guidelines, integrated care pathways, clinical protocols, and decision-support tools pertinent to their clinical domain, and
• Supporting clinicians in utilising the most up-to-date evidence, including relevant clinical care standards established by the Australian Commission on Safety and Quality in Health Care.

Clinicians are responsible for their practice, encompassing compliance with established clinical guidelines or pathways. Oversight of clinical practice enables early detection and management of practices that could potentially endanger consumers.

Effective quality improvement systems identify the extent of deviation from agreed-upon clinical guidelines or pathways and outline how such deviations are addressed. Clinical care standards foster the delivery of appropriate care, reduce unwarranted variations in care, and encourage collaborative decision-making involving consumers, their families, and the healthcare team.

Ensuring the clinical workforce is appropriately supervised further supports safe, high-quality care delivery. Providing supervision for clinicians and caregivers to enable them to safely fulfil their designated roles, including access to after-hours guidance, is also of utmost importance.

*The views and opinions expressed in Knowledge Blogs are those of the authors and do not necessarily reflect those of ARIIA, Flinders University and/or the Australian Government Department of Health and Aged Care.

Marianne Coleman, Bao Nguyen, Lynette Joubert, Allison McKendrick

Australian College of Optometry, University of Melbourne, University of Western Australia

Being able to see well matters to people living with dementia. In our study, we interviewed people living with dementia and carers, and found many activities enjoyed by people living with dementia are visual, such as gardening, seeing friends and family, and arts/crafts. The 2022 World Alzheimer’s Report highlights that looking after sensory health, such as vision and hearing, is really important to help people living with dementia maintain their independence, and to create environments/opportunities for them to be and do what they value.  

While people living with dementia at home and in aged care facilities are not any more likely to develop sight-threatening eye diseases than people without dementia, they are at greater risk of experiencing preventable sight loss. A UK study sent mobile optometrists to assess over 700 people living with dementia at home and in residential aged care facilities. They found one in three people with dementia had reduced eyesight, often due to addressable issues such as cataract or outdated glasses.  

Poor eyesight makes living with dementia harder.  It can increase risk of falls and make it more difficult to engage in tailored activities and programmes to enhance wellbeing.  Therefore, preventing sight loss for people with dementia is important, and regular eye tests considered as part of primary preventive care. Unfortunately, people living with dementia can experience barriers to accessing routine eyecare.  

We wanted to share some key messages from our research about dementia-friendly eyecare with the aged care sector: 

1. Good eyesight is important for people living with dementia.  Regular eye tests should be part of the post-diagnosis care pathway and continue  even when care needs have escalated, such as transitioning to residential aged care, or if glasses are no longer being worn.  Support people with dementia to get their eyes tested once a year with a dementia-friendly optometrist. For people with younger onset dementia, this would be every three years, or more often if the person has an eye condition. We have developed information booklets about eye tests for people with dementia which are available online and can be printed for your use.  
2. Many parts of the routine eye examination can be successfully performed for people with dementia, with adaptations to accommodate communication difficulties and cognitive impairment. Simply telling the optometrist about a dementia diagnosis in advance is a huge help. Useful information about visual function can be obtained even from simple tests, and any vision impairments can be documented for the benefit of other care professionals, to inform person-centred care, rehabilitation or reablement across settings. Examples include visual field defects, reading difficulties, or poor contrast vision due to cataract. 
3. Optometrists can perform eye tests in residential aged care or at home using portable equipment. If you are worried about the eyesight of someone under your care, or their glasses are damaged, broken or missing, an optometrist can perform a check, and this is usually billed under Medicare.  You can use search functions on Optometry Australia to find optometrists servicing aged care, doing home visits or who are dementia friendly. 

You can download the information booklet about eye test for people living with dementia video (3 mins) or  watch the 20 seconds silent video on YouTube. You can also read more about why everybody living with dementia needs regular eye tests on Melbourne University website.

*The views and opinions expressed in Knowledge Blogs are those of the authors and do not necessarily reflect those of ARIIA, Flinders University and/or the Australian Government Department of Health and Aged Care.