Release of Newmarch House COVID-19 outbreak review
The Australian Government today releases the review findings into the spread of COVID-19 at Sydney aged care facility Newmarch House, April – June 2020.
Minister for Aged Care and Senior Australians, Richard Colbeck said lessons learned are being implemented as we continue to combat the COVID-19 pandemic.
“The outbreak at Anglicare’s Newmarch House was incredibly challenging and underlined the impact this infection can have within an aged care facility,” Mr Colbeck said.
In June 2020, the Chief Medical Officer and now Secretary of the Department of Health, Professor Brendan Murphy, commissioned Professor Lyn Gilbert and Adjunct Professor Alan Lilly undertook the independent review.
They consulted with stakeholders, including family members of residents, to provide a comprehensive break down of what led to the outbreak and how authorities responded to it.
Mr Colbeck said the review is an important resource for all levels of government which would improve the management of potential future outbreaks and inform advice and guidance to support the aged care sector.
Changes already implemented include:
- Ensuring early identification of all COVID-19 cases via immediate and repeated testing of all residents and staff as soon as the first case is identified
- Actions to reinforce compromised management
- Immediate engagement of advocacy group Older People’s Advocacy Network (OPAN) to ensure services and information are available to providers, residents and their families
- The provision of support from the Victorian Aged Care Response Centre (in Victoria) to improve communication, staff and management support
- Expansion of surge workforce providers for facilities affected by outbreaks
- Practical additional infection control training, including support from AUSMAT.
The Communicable Diseases Network Australia (CDNA) outbreak guidelines are supported by a ‘First 24 hours’ document, published by the Department of Health, which provides aged care facilities with practical steps they should take in order, following the identification of a positive COVID case.
The Government’s measures to tackle COVID-19 in aged care now exceeds $1 billion.
The review report Newmarch House COVID-19 Outbreak [April-June 2020] Independent Review can be found at https://www.health.gov.au/sites/default/files/documents/2020/08/newmarch-house-covid-19-outbreak-independent-review-newmarch-house-covid-19-outbreak-independent-review-final-report.pdf
Summary of key Review learnings (p.30)
1. Problems with management need to be addressed as soon as possible after they are recognized;
2. To ensure the earliest possible identification of all COVID-19 cases,the immediate and repeated testing of all residents and staff should be implemented as soon as a single case is identified (as occurred at Newmarch House);
3. At the outset, there must be a clear operating protocol in place, outlining the relevant stakeholders, their respective roles and the hierarchy of decision making,noting that the Approved Provider retains its obligations under the Aged CareAct 1997,unless there is a superordinate provision or order in place. The protocol should also address:meeting agenda, objectives, identification of participants, administration, documentation and meeting etiquette;
4. (i) the Approved Provider shouldidentify and be ready to deploy its OutbreakResponse Team (however titled); (ii) the Approved Provider shoulddesignate the leader of its Outbreak Response Team who is duly authorised to lead and make decisions on behalf of the Approved Provider; (iii) the Approved Provider must nominate its clinical leader who will provide clinical leadership and advice to the Approved Provider as part of its Outbreak Response Team;
5. Access to advocacy services should be a priority during an outbreak. Advocates can assist providers and residents (or their legally appointed representatives) to resolve issues expeditiously;
6. (i) the Approved Provider should be responsible for maintaining an Emergency Contact Register for each resident. A minimum of three contacts may be registered. These contacts must be confirmed by the resident or their legally appointed representative; (ii) there must be a legally enforceable provision to share this Emergency Contact Register information with the Aged Care Quality and Safety Commission,in the event that this is required to assist with improving emergency management;
7. Communication is a key priority and yet it is often underestimated. A communication protocol should be developed and highlight stakeholders, types of communication and frequency;
8. (i) Approved Providers should consider surge workforce capacity on the premise that a minimum of 50% of its staff may be furloughed; (ii) The Department of Health should consider expanding its surge workforce capacity providers in order to provide scaled support for individual Approved Providers;
9. Orientation for all new staff during the course of an outbreak is required and must include practical infection control training, instruction and a competency-based assessment of PPE donning and doffing,on abackground of regular infection control training.
10. Deconditioning of older people is a known complication of reduced activity and isolation. Approved Providers should consider specialist staffingrequirements and activities to specifically address and enable maximum independence and reablement during an outbreak;
11. Misunderstandings and gaps in information exchange between doctors and patients or their relatives are common. Information often needs to be repeated and/or provided in written form. These misunderstandings are likely to be amplified in the context of an outbreaks crisis and especially when they touch on end-of-life care;
12. HITH is an attractive model of care for management of a COVID-19 outbreak in an aged care facility but the precondition of resident safety is only likely to be met if the outbreak is limited to a small number of cases in residents and staff;
13. Decisions about the management of COVID-19 cases should be made by an expert panel. The panel should at minimum include membership fromexperts in infectious diseases, infection control, geriatric medicine, clinical leadership from the approved provider and a local general practitioner. This panel should consult with the relevant Commonwealth and jurisdictional health agencies, the Aged Care Quality and Safety Commission and the designated representative of the Approved Provider. As the soon as an outbreak is declared: (i) the expert panel should be convened and (ii) residents should be transferred to hospital until the residential aged care facility is deemed safe and appropriate for those residents to return.NB:Implications of such decisions will need to be considered in light of individual resident’s personal preferences.
14. GPs are an underused resource during a COVID-19 outbreak in anaged care facility but their participation (and interaction with families) requires good communication and access to patient information;
15. Approved Providers should consider the implications of a loss of Electronic Records as part of its Business Continuity Plan. Access and implications for all parties using the electronic records should be considered;
16. Establishing effective infection prevention and control is time-critical. Lack of consistent expert IPAC guidance at the start of the outbreak led to inconsistent use of PPE and uncertainty about exposure of staff contacts to COVID-19 positive cases;
17. Providers should develop and be ready deploy a dedicated team of staff to act in the capacity of a Family Support Program (however titled), providing person-centred, structured interactions with family members of residents affected during an outbreak. Protocols should be established to determine the frequency and type of contact with the nominated contact persons. Consideration should be given to the availability of furloughed staff to support this program to provide optimum levels of support to family members;
18. Residents’ families consistently advocatedand endorsedimprovements in the number, mix and training of staff, supporting improved delivery of care to residents.The outbreak identified a pressing need to lift the standards of education and training in infection control.This feedback should be considered in light of relevant reviews previously undertaken and those currently underway;
19. Consideration of how to facilitate improved closer physical contact with family members duringend of life care must occur as a priority;
20. Protocols should be developed to provide an authoritative source of guidance on the storage, decontamination and return of desired personal effects to family members following the death of a loved one.
NSW Health's response to Newmarch House independent review is at https://www.health.gov.au/sites/default/files/documents/2020/08/newmarch-house-covid-19-outbreak-independent-review-nsw-health-response-to-newmarch-house-independent-review.pdf
24 August 2020.