Transcript Australian Commission on Safety and Quality in Health Care

Update on the Australian Commission on
Safety and Quality in Health Care
Presentation to CoNNO
Chris Baggoley
9 October 2009
ACSQHC
• The Australian Commission on Safety and
Quality in Health Care
-
Established by Health Ministers in 2005, commenced in 2006
Reports to all Health Ministers
Commissioners diversity
Committee structure:

Inter-Jurisdictional Committee

Private Hospital Sector Committee

Primary Care Committee

Information Strategy Committee
ACSQHC
Health Ministers Established ACSQHC to:
1.
Lead and coordinate safety and quality in health
care
2.
Advocate for safety and quality and report
publicly
3.
Recommend national data sets
4.
Provide strategic advice to Health Ministers
5.
Recommend nationally agreed standards
ACSQHC
Our Programs
1.
Australian Charter of Healthcare Rights
2.
Open Disclosure
3.
Basic Care Issues
4.
•
Healthcare Associated Infection
•
Patient Identification
•
Medication Safety
•
Clinical Handover
•
Recognition and Response to Clinical Deterioration
•
Falls Guidelines
Tools
•
Accreditation and Credentialing
•
Information Strategy
Australian Charter of Healthcare Rights
ACSQHC and Health Ministers’ Decisions: 2008
Open Disclosure
Decisions
- Work towards the implementation of the National Open
Disclosure Standard in all health care facilities
- ACSQHC to support implementation
Ongoing Work
- 100 patient stories
- Legal clear path
Surveillance
Reducing harm to patients: the
role of surveillance
ACSQHC and Health Ministers’ Decisions: 2008
Healthcare Associated Infection
Decisions
- Healthcare Associated Infection surveillance in all hospitals
- Monitoring and reporting of Staphylococcus aureus bacteraemia to
jurisdictions and nationally
- Monitoring and reporting of Clostridium difficile to jurisdictions and
nationally
ACSQHC and Health Ministers’ Decisions: 2008
Healthcare Associated Infection – National Hand
Hygiene Initiative
Decisions
- National approach to the monitoring of hand hygiene standards
- Details are available on the Hand Hygiene Australia website:
http://www.hha.org.au/
National Hand Hygiene Initiative
• Customise WHO Guidelines for Australian use
• Implementation of multimodal strategy
• Education program
• Targeted credentialing modules
• Audit tool with related training program
• Reporting mechanisms for outcome measures
Appropriate for use in:
- Public Sector Hospitals
- Private Hospitals
- General Practice
- Aged care facilities
- Consumers
2008-2010
Infection Control Guidelines
Understanding
modes of
transmission of
infectious agents
1
2
3
4
5
Overview of diseases
Viral diseases
Bacterial diseases
MRO’s
Other diseases
Establishment of effective work practices that minimise the risk of
transmission of infectious agents
6
6.1
6.2
6.3
Basics of infection control
Standard precautions
Additional precautions
Risk management approach
7
Handwashing and
personal hygiene
Handwashing
Handwashing products
Other methods of hand
cleaning
Hand care
7.1
7.2
7.3
7.4
8
8.1
8.2
8.3
8.4
8.5
8.6
8.7
Personal protective
equipment
Protective clothing and
equipment
Gloves
Protective eyewear and
face-shields
Masks and personal
respiratory protection
devices
Gowns and plastic aprons
Footwear
Uniforms
11.3 Risk of transmission of
bloodborne viruses
14
11 Patient related procedures
11.2 Clean, Aseptic and Sterile
techniques
11.3 Skin antisepsis
11.4 Preventing infections related to
procedures
11.5 Preventing infections related to
device insertion
11.6 Disinfectants and sterilants
11.7 Chemical disinfection and
sterilization
11.8 Single-use medications,
solutions
11.9 Single use devices (SUD)
14.2
14.3
14.4
12
12.2
12.3
12.4
12.5
9
10
Needlestick and other
blood or body fluid
incidents
10.1 Occupational exposures to
blood and body fluids
10.2 Management of needlestick
and other blood or body fluid
incidents
14.6
14.7
15
15.2
15.3
15.4
15.5
16
16.2
13
Handling and disposal of
sharps
9.1 Handling of sharps
9.2 Retractable devices
9.3 Disposal of sharps
Management of Therapeutic
devices
Indwelling urinary devices
Intravascular access devices
(catheters)
Intubation
Entral feeding tubes
14.5
13.2
13.3
13.4
13.5
13.6
13.7
13.8
13.9
Processing of re-usable
instruments and equipment
Cleaning, disinfection and
sterilisation
Diagnostic ultrasound
transducers
Thermometers
Cryotherapy
Ophthalmic and optometry
equipment
Implantable items
Single-use devices
Instrument tracking
16.3
16.4
16.5
16.6
16.7
Instruments and
equipment requiring
special processing
Endoscopes
Bronchoscopes
Other fiberoptic scopes and
associated equipment
Respiratory and anaesthetic
apparatus
Resuscitation manikin face
pieces and accessories
Asthma spacers used with
tered-dose inhalers
(MDIs)
Management of patients
with MRO’s
Hand hygiene
PPE
Isolation
Specialised health care
settings
Management of physical
environment
Environmental cleaning and
spills management
Routine environmental
cleaning
Management of blood and
body substance spills
Room placement
Patient accommodation
Waiting areas
Maintenance of
governance structures
that support the
implementation,
monitoring and
reporting of infection
control work practices
17 Quality management
17.1.1Infection control program
implementation and management
17.2 Roles of ICP
17.3 Policies and procedures
17.4 Auditing
18
18.2
18.3
18.4
Responsibilities
Health care establishments
Health care workers
Patients
19 Education and training
19.2 Universities and training
colleges
19.3 Health care establishments
19.4 Accreditation
20 Surveillance
20.2 Data collection methods,
analysis and reporting
20.3 Outbreak detection and
management
21
21.2
21.3
21.4
Antibiotic stewardship
Antibiotic use
Antibiotic prophylaxis
Antibiotic surveillance
22 Staff health
22.2 HCW health status
22.3 HCW health screening and
vaccination
22.4 HCW with BBV
22.5 Pregnant health care
workers
22.6 Immuno-compromised HCW
22.7 Testing and reporting
22.8 TB
Compliance with
legislation, regulations
and standards relevant
to infection control
23 Standards of practice
23.1 Compliance standards and
accreditation
24
24.1
24.2
24.3
Ethical issues
Duty of care
Referral
Patient decision making and
consent
25 Legal issues
25.1 Occupational health and
safety
25.2 Privacy and confidentiality
25.3 Antidiscrimination
25.4 Liability
25.5 Quarantine
26
26.1
26.2
26.3
26.4
26.5
26.6
Regulated practice and
processes
Use of SUD’s
Standards Australia
guidance on equipment
reprocessing
Linen laundry and food
service
Water
Clinical and waste
management
Hospital design/
refurbishment
Antimicrobial stewardship
Clinician capacity building
Capacity
Building
ACSQHC and Health Ministers’ Decisions: 2008
National Patient Wristband Standard
Decisions
- Implementation of the National Patient Wristband Standard
across Australia
Implementation
- The Standard is being adopted in the private and public
sectors
The OSSIE Guide to Clinical Handover
Medical Journal of Australia - June 2009
ACSQHC and Health Ministers’ Decisions: 2008
Paediatric National Inpatient Medication Chart (NIMC)
Decisions
- Implement for all children in all Australian
hospitals
Implementation
- Paediatric NIMC, implementation, education
and auditing resources available on the
ACSQHC website. Being widely adopted.
ACSQHC and Health Ministers’ Decisions: 2008
Standardised terminology, abbreviations and
symbols for use in hospital prescribing
Decision
- To be adopted Australia-wide
Implementation
- ‘National terminology, abbreviations and
symbols to be used in the prescribing and
administering of medicines in Australian
hospitals’ document is available on the
ACSQHC website
ACSQHC and Health Ministers’ Decisions: 2008
Accreditation of Healthcare Facilities
Decisions
- Endorsed the recommendations for implementation of reforms to
safety and quality accreditation of healthcare facilities
- ACSQHC to develop new model for accreditation
Moving Forward
-Research completed on:
- Short notice surveys
- Patient journey
- Surveyor participation
- Development of preliminary Australian Healthcare Standards initially in:
- Healthcare Associated Infection
- Patient Identification
- Medication Safety
- Governance for Safety and Quality
- National coordination of accreditation
Windows into Safety and Quality in Healthcare 2008
THE PROPOSED
NATIONAL
SAFETY AND QUALITY
FRAMEWORK
The Role of a National Safety and Quality
Framework
Basis of strategic and operational safety and quality
plans
Mechanism for refocusing activities, reviewing
investments and designing goals
Promote discussion with consumers, clinicians,
managers, researchers and policy makers.
AAQHC Conference: 9 September 2009
Panel question: What has worked?
- Leadership
- Standardised approach
- Respect
- Patient and family
centred approach
- Cultural change
- The power of the story
- Education
- Celebrating success
- Data
- Regulation
- Patient experience
Correct patient, correct site, correct procedure
Figure 3: Proportion of cases complying with site marking and time out steps, by surgical specialty
100
90
70
60
50
40
30
20
10
Site marked correctly
Time out performed properly
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% Compliance with policy
80
WHO – Surgical Safety Checklist