The concept of an unexpected death within an aged care facility often resides in a gray area, creating confusion for providers regarding mandatory reporting under the Serious Incident Response Scheme (SIRS). It is critical for all staff and management to understand the precise distinction between a death resulting from the natural progression of life and one that is a direct result of a reportable incident.
Understanding the SIRS Distinction
The core of the issue lies in determining if the death was a foreseeable part of the resident's health decline or if it was caused by a specific, negative event or omission of care.
The Role of Palliative Care
Deaths that occur while a resident is actively receiving palliative care or is clearly in the final stages of a known terminal illness are generally not considered an unexpected death for SIRS purposes. These deaths are often anticipated and managed under a resident’s documented end-of-life care plan.
- Key Consideration: Was the death a foreseeable outcome of the resident's documented health status and care plan? If yes, it is typically not a SIRS matter.
Incidents that Require SIRS Notification
An unexpected death becomes a SIRS matter when it is linked to an alleged or suspected incident that constitutes abuse, neglect, or a high-impact/high-prevalence (HIHP) incident. The death must be a direct consequence of the incident.
Common Incident Types Leading to SIRS Notification
The following types of incidents resulting in death are highly likely to require SIRS reporting:
- Falls Resulting in Death: If a fall leads directly to injuries that cause death, and the fall occurred due to negligence (e.g., failure to use prescribed mobility aids, unsafe environment, or delayed clinical response), it is reportable.
- Choking Incidents: Death resulting from a choking incident, especially if there was a failure to follow documented dietary or swallowing plans (e.g., providing whole foods when a resident requires a minced/moist diet), must be reported.
- Neglect/Omission of Care: Death that occurs because of a significant and deliberate omission of necessary clinical care (e.g., failure to administer life-saving medication, failure to respond to a serious change in condition).
Action Points for Aged Care Providers
If an unexpected death occurs, providers should follow a precise, efficient protocol to determine their reporting obligations.
- Immediate Internal Review: Establish the cause of death and the events leading up to it. Consult the resident's clinical records, care plan, and advance care directives.
- SIR S Criteria Check: Assess if the death was directly caused by an incident that meets the SIRS criteria for high-impact/high-prevalence incidents or neglect.
- Documentation: Ensure all steps, from the discovery of the death to the clinical review, are meticulously documented. This documentation is essential for any future investigation.
- Reporting Timeline: If the death is linked to a reportable incident, the notification must be made to the Quality and Safety Commission within 24 hours of the facility becoming aware of the incident.
Conclusion
Distinguishing between a natural passing and a death that requires a SIRS notification is crucial for compliance and accountability. Palliative care and foreseeable decline mark the boundary for non-SIRS deaths. However, any death linked to an accident, injury, or neglect-such as a fatal fall or choking incident-must trigger a SIRS assessment and, usually, a mandatory report. The focus must always be on whether provider action, or inaction, directly contributed to the fatal outcome.
