How to use the pathways

These pathways are intended as clinical support tools for management of the acutely unwell patient living in residential aged care facilities.

The pathways are designed for use by residential aged care facility (RACF) Registered Nurses in collaboration with General Practitioners (GPs).

The recommendations within these pathways do not indicate an exclusive course of action. They do not replace the need for application of clinical judgement to each individual resident nor variations based on local policies and procedures. The pathways should not replace the clinical judgement of users. If concern exists regarding a resident’s well-being these concerns should be appropriately escalated.

Users should always stay within their scope of clinical practice.

It is recommended that RACFs ensure that they have clinical competency processes for common clinical procedures such as (but not limited to) infection control, indwelling catheter insertion, wound assessment and management, subcutaneous fluid administration and tracheostomy care. These pathways do not replace need for such clinical competency processes. It is the responsibility of the RACF provider to ensure that there is a robust system of clinical governance operating within the RACF - these pathways should be reviewed by the RACF clinical governance committee prior to implementation at local level to ensure appropriate alignment to and integration with clinical systems within the RACF.

Potential uses of the pathways include:

A. As a clinical support tool for management of residents of aged care facilities who are acutely unwell:

1. Don appropriate Personal Protective Equipment (PPE) and assess residents’ current vital signs
2. Consult Recognition of the deteriorating resident and determine whether vital signs are:
   1. Unstable = vital signs are in the red or danger area - refer to Management of Resident with unstable vital signs pathway; also consult the relevant pathway for additional important management information e.g. in an unstable resident with an acute respiratory illness consult the Management of Resident with unstable vital signs pathway and the Acute respiratory illness (potential COVID-19 or Influenza) pathway
   2. Stable = vital signs in the green or caution area - refer to the pathway most relevant to the residents’ symptoms
3. Take a directed history (if cognitively impaired, review additional history from other staff or family)
4. Undertake a focused physical examination using appropriate PPE
5. Select appropriate pathway in consultation with GP

*** Where these pathways suggest medications, these MUST be prescribed by a GP or Nurse Practitioner for the individual patient and do not constitute standing orders.

B. As an educational resource for clinical staff across the continuum of care

These pathways are not designed for use by residents or their families and should not be relied on by residents or families as professional medical advice.