Transcript National-Safety-Quality-Sue-Greig-August-2

National Safety and Quality
Health Service Standards
Standard 3 – Preventing
and Controlling HAIs
Sue Greig
Senior Project Officer, ACSQHC
August 25, 2014
The NSQHS Standards
Standard 1
Governance for Safety and
Quality in Health
Service Organisations
Standard 2
Partnering with
Consumers
Standard 3
Healthcare
Associated
Infections
Standard 10
Preventing Falls and
Harm from Falls
Standard 4
Medication
Safety
Standard 9
Recognising and
Responding to Clinical
Deterioration in Acute
Health Care
Standard 5
Patient Identification
and Procedure
Matching
Standard 8
Preventing and
Managing Pressure
Injuries
Standard 7
Blood and Blood
Products
Standard 6
Clinical
Handover
National Safety and Quality Standards
• Approved by health ministers
September 2011
• Address areas where:
• Large numbers of patients effected
• Known gap between current situation
and best practice outcomes
• Evidence based, achievable
improvement strategies exist
Key points
1. Standards are about safe patient care
2. Safety and quality is an organisational
responsibility
3. Communicate and plan together
4. Gap analysis and risk assessment
5. Prioritising – decision grid
A patient’s perspective of health care …
I have a right to safe and high quality care.
This means:
- To be free of being infected by my hospital or health
worker
- To be given the right medications at the right time
- To be assessed for the risk of VTE
- To have the correct procedure, operation, test, x-ray
- To be rescued if my condition unexpectedly
deteriorates
The quality and safety problem
• The gap between the delivery of
recommended care and the care that
is actually provided can be as high as
50%.
Why ?
• Is it …
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Ignorance
Lack of training
The lack of applied ‘common sense’
Mobility of HCWs
Inconsistent curriculums and assessment of competence
Inconsistent practices and resources
Lack of access to evidence based information
Care is too complex
Patients are too complex
We are too busy
Not enough staff
Clinicians don’t care
Is it all just too hard????
Standard 3 – Preventing and Controlling
Healthcare Associated Infections
•Applied in conjunction with
• Standard 1, ‘Governance for Safety and
Quality in Health Service Organisations’
• Standard 2, ‘Partnering with Consumers’
• Standard 4, ‘Medication Safety’
• Standard 6, ‘Clinical Handover’
Why have a Standard about preventing
infection?
• preventable
• common
• increase morbidity, mortality, pain &
suffering
• cost to patients, hospital staff, health system
• no single solution
• range of strategies
Criteria for Standard 3
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Governance and systems for IPC and surveillance
Strategies for IPC
Managing patients with infections or colonisation
AMS
Cleaning, disinfection or sterilisation
Communicating with patients and carers
Benefits of Standard 3
• Reduce risk of patient harm and death
• Clarifies roles, responsibilities and
accountabilities
• Improves information
• Antimicrobial stewardship
• Improves organisational governance
• Tracking of invasive, reusable devices
• Increases focus on specific evidence based
strategies
Priorities for Standard 3
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Effective governance
Identifying what is working well
Knowing your risks and/or gaps
Having systems to gather, review and report
evidence
Having a plan to address risks and respond
Aim for the best (either 0 or 100%)
Ability to demonstrate progress/improvement
Engage with others in the organisation
What is different?
• Responsibility of governance and management
systems
• Making a difference to patient safety
• Managing risk
• Evidence of process, systems and outcomes
• Recognition of the consumer as a partner
Top tips for responding to Standard 3
• Assess the current situation
• Risk assessment
• Current governance arrangements
• Current policies, processes and resources
• Data currently collected
• Any audit results
• Current resistance patterns, infections
• Raise awareness
• Share results, ask for interested people to be
involved
How have organisations performed so far?
• 737 organisations assessed against Std 3 organisational wide (275), mid-cycle (445) and
interim assessments (17)
• 1352 public, private and day procedure services
eligible to be assessed in Australia
• In 2013, of the 1352 eligible services >50%
have been surveyed and have met Standard 3
requirements
How have organisations performed so far?
In 2013:
• 55% were private organisations
• 45% were public organisations
• 60% of public organisations met all core actions at initial
assessment
• 55% of private organisations met all core actions at initial
assessment
• 90% of organisational wide surveys had core and
developmental actions to be addressed within 120days
• 32% of organisational wide surveys had core only actions to
be addressed within 120days
Where to from here
• Review of the current Standards by 2017
• Ongoing accreditation of health service
organisations
• Review of the accrediting agencies accreditation
scheme
• Improve on inter-ratter reliability
• Further review of the data received on the first 12
months
• Ongoing support for organisations and agencies
with development of resources to assist with
responding to the Standards
Criteria for Standard 3
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Governance and systems for IPC and surveillance
Strategies for IPC
Managing patients with infections or colonisation
AMS
Cleaning, disinfection or sterilisation
Communicating with patients and carers
Cleaning, disinfection and sterilisation
Links between Standard 1 and Standard 3 as well as within Standard
3 with criteria – Governance and Cleaning, Disinfection and
Sterilisation
• 3.15 – Environmental cleaning
• 3.16 – Reprocessing reusable medical equipment, instruments and
devices
• 3.17 – Identification of patients on whom reusable medical devices
have been used (traceability)
• 3.18 – Competency based training for those who are involved in
decontamination of reusable medical devices
How times have changed….
• 1941 – “Husbands are like Kleenex –
soft, strong and dependable” Ball of Fire
• 1985 – “Husbands are like Kleenex –
soft, strong and disposable” Clue
• Sterilising services are an area that has experienced change in the
last 30 years both with technology and scope of services.
“I am a pushover for Streptococcus”
Sugarpuss O’Shea (Barbara Stanwick), Ball of Fire, 1941
3.16.1 - Reprocessing reusable medical equipment, instruments and
devices in accord with relevant national or international standards and
manufacturer instructions.
Why?
• Minimise risks of infection to patients and the workforce
How?
• Governance - 3.1.1 organisational risk assessment and policy,
procedures and/or protocols
3.16.1 When looking at risk consider:
• What reprocessing the organisation needs to consider
based on services provided
• Are there policies, procedures and protocols to cover the
scope of services provided
• How will the organisation achieve this – equipment and
consumables
• Outsourcing to external providers
• Single use items
• Purchase of sterile stock
• Providing reprocessing services to other
organisations/individuals
What other evidence supports 3.16.1
• Product selection
• Equipment and environmental maintenance that
includes schedules, fault and variance reporting
• Quality control systems that include document control,
audit and compliance reports
• Incident reports
• Education or training for the introduction of new products
and equipment
“Tag ‘em and bag ‘em” Platoon 1986
3.17.1 - Identification of patients on whom reusable
medical devices have been used (traceability)
Why?
• Minimise risk to patients of contracting infection from
reusable medical devices
How?
• Look at what current systems are and can they be
improved?
“Dobby didn’t mean to kill – Only maim
and seriously injure” Harry Potter and the Deathly
Hallows, 2011 – Dobby the house elf
What are the risks relating to traceability?
• Can the organisation identify reusable medical devices?
• Can the organisation identify on which patient these
items were used?
• Can the organisation do this retrospectively?
“ Practice makes perfect” Clue 1985
3.18.1 - Competency based training for those who are
involved in decontamination of reusable medical devices.
Why?
• Appropriate and correct decontamination is critical to
reprocessing of reusable medical devices to reduce risk
of infection
How?
• Provision of appropriate training to those who undertake
decontamination and assessing competence of the
relevant workforce.
“What we’ve got here is a failure to
communicate” Cool Hand Luke, 1967– Paul Newman
What are some of the risks to consider:
• Look at where decontamination occurs and who
undertakes the task?
• Have they been trained?
• How and by what method?
• Is the training current and in line with best practice?
• Is the training consistent?
• Do they have the resources to safely undertake
decontamination?
• Is competency assessed and if so – by whom/how?
“The subconscious does not make mistakes”
Ball of Fire, 1941- Gary Cooper, Barbara Stanwick
The key points for an organization to consider for cleaning,
disinfection and sterilization of reusable medical devices
are:
• Risk assess the scope of services in the organisation
• Engage with governance to respond to identified risks
• Have policies, procedures and protocols to cover the scope of
services
• Have a system to identify patients on whom reusable medical
devices have been used (traceability)
• Identify and then provide or access competency based
training for those who are involved in decontamination of
reusable medical devices.
Last ‘classic’ quote……
Let whoever is in charge keep this simple
question in her head – not how can I
always do this thing right myself, but
how can I provide for this right thing to be
always done?
Florence Nightingale
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