| TOPIC | Dignity of Risk and Duty of Care Procedure | ||
| AREA | Service Delivery | TYPE | Procedure |
1. Purpose
Mobility recognises that occasions will arise when a person exercises their full rights or their independent participation in everyday life, will involve taking risks. Consumers have a right to safe care without reducing personal choice and control over their own lives. This may conflict with what staff, families and others see as their own duty of care to the person they support.
Being treated with dignity and respect is essential to quality of life. It includes actions to recognise consumer’s strengths and empower them to be independent. It means communicating respectfully and recognising and respecting a consumer’s individuality in all aspects of care and services.
Having dignity of risk discussions with consumers and or their nominated person creates an opportunity for meaningful dialogue around risk and facilitates consumer directed shared decision making. [i] It is important to document consumers dignity of risk discussions.[ii]
Positive risk taking has the following benefits:
- Improved autonomy
- Improves social interaction
- Improves health
- Live independently
- Construct their lives in accordance with their values and personality.
- Self-determination and feelings of worth
2. Scope
All employees, contractors and sub-contractors are responsible for implementing this procedure. Respecting the identity, culture, and diversity of a consumer, means understanding their needs and preferences. Mobility provides care and services that reflect a consumer’s social, cultural, language, religious, spiritual, psychological, and medical needs.
3. Definitions
| Dignity of Risk | Dignity of risk means respecting everyone’s autonomy and self-determination (or dignity) to make risk-taking choices even if these, on occasion, may be a threat to their well-being. |
| Duty of Care | Is the obligation of healthcare professionals to take reasonable care to avoid causing harm towards a consumer. |
| Choice | The consumer’s right to make informed choices, to understand their options, and to be as independent as they want, all affect quality of life. Providing choice also includes care and services that the organisation might not provide itself, that it could help the consumer to access. These services could be from other specialist providers or individuals, or they could be services from other organisations that are better placed to support the consumer’s needs. |
| Cultural Safety | The consumer defines what cultural safety is. It is their experience of the care and services they are given and how able they feel to raise concerns. The key features of cultural safety are understanding a consumer’s culture, acknowledging differences, and being actively aware and respectful of these differences in planning and delivering care and services. |
| Safeguarding | Means doing everything possible to keep people who are vulnerable safe without diminishing their basic human rights. |
| Negligence | Failure of a responsible person to provide the necessities of life or the refusal to let others provide these. |
| Could reasonably be foreseen | Refers to acts and omissions, which a reasonable person in that situation should predict could lead to harm. |
| Harm | Can include physical, psychological harm and financial harm or ‘loss’(not loss of reputation) |
4. Procedure
A meeting or choice discussion will be set up and may occur as a series of meetings with the appropriately qualified staff member/s and other professions as required (e.g., Registered Nurse, the consumers General Practitioner, Occupational Therapist, Speech Pathologist) or a Choice Support meeting. The appropriately qualified staff member (s) will:
- Identify and source nominated support person (s) or advocate (s) if required
- Ensure that the appropriately qualified staff member (s) are present where the topic of discussion is within their scope of practice
- Ensure required professionals are informed and engaged
- Where the decision relates to medical consent, advanced care or financial affairs, check if a Substitute Decision Maker has been appointed and is legally enacted. In these cases, this person must be involved in the discussion and is responsible for the final decision/choice.
- Confirm communication needs of the consumer and source relevant support
- Ensure the appropriate resources are available e.g., Consumer Risk Choice Form, written material if available.
In the event that a consumer and or their nominated person or substitute decision maker (decision maker) declines assessment, review or any advice provided by mobility staff, the appropriately qualified mobility staff member will partner with the decision maker:
To Assess the risks of their decision from the choice discussion
If there is a risk to the safety of staff or other consumers from that decision, staff will:
- Advise the decision maker that in line with legislation they cannot honor their decision and explore alternative strategies.
- Implement the strategies where possible.
- Monitor the risk and report to the Clinical and Risk Specialist (CRS) as required.
- Ensure appropriate documentation in the mobility portal and follow the direction of the CRS if any concerns.
If there is no risk to the safety of staff or other consumers, however a risk to the consumer from that decision, staff will:
- Fully inform the decision maker of strategies identified to reduce any risks.
- Implement the strategies where possible.
- Monitor the risk and report to the CRS as required.
- Ensure appropriate documentation in the consumer file
Staff are to progress the following if the consumer refuses to participate or complete the Consumer Risk Choice Form.
- If preference is to not discuss the risk:
- Document in the consumer’s file, information given to the consumer or nominated representative and reason for refusal including in the consumer file
- Communicate preference to other services providers who need to know (e.g., General Practitioner)
- If preference is to discuss risk but not sign a Consumer Risk Choice Form for serious risk:
- The Consumer Risk Choice Form can still be completed and preference to not sign documented in consumer file, signature is preferred but not essential due to right of refusal.
Consumers will be given options regarding how they receive information including:
- TIS
- Auslan
- advocacy
- Carer, family member support, and
- through various information systems; including phone, email, SMS, app, writing.
Monitoring, Review and Reporting
Consumer risks and capacity to make decisions must be regularly reviewed depending on the level of risk and or consumer condition or circumstances. A review date is to be included in the Consumer Risk Choice Form.
The appropriately qualified staff member will monitor reports on consumer risks and ensure reassessments are undertaken as required.
5. Related Documents
- Consumer Risk Choice Form
- Choice and Decision Making Procedure
- Intake and Referrals Procedure – Internal
- Advance Care Planning Procedure
- End of life care Procedure – Internal
- Supporting Consumer Significant Relationships Procedure
- Risk Management Framework
- Privacy Policy
External Documents
- Charter of Aged Care Rights (Clth)
- Australian Aged Care Act 1997 (Clth)
- Privacy Act 1988, Schedule 1, (Clth)
- Australian Privacy Principles 2014 (Clth)
- Controlled Substances Act 1984 (SA)
- Regulation 9 (Poisons) 2011
- Health Practitioner Regulation National Law (SA) Act 2010 and Regulation 2018
- Aged Care Act 1997
- Australian Privacy Principles 2014
- Charter of Aged Care Rights
- Disability Discrimination Act 1992
- Freedom of information Act 1982
- Privacy Act 1988
- Work Health and Safety Act 2011
- NDIS Code of Conduct
- NDIS Act 2015
6. Version control:
| Version | Date | Change |
| 1 | 01/09/21 | New |
| 2 | 01/08/2022 | Updated and included new procedure |
[i] Marsh, P and Kelly, l. (2018) Dignity of risk in the community: a review of and reflections on the literature, in Health, risk and Society. Vol. 20, Nos. 5-6, 297-311
[ii] Mukherjee, D (2015) Discharge Decisions and the Dignity of Risk, in in practice. Hastings Centre Report. May-June