Update on the Australian Commission on Safety and Quality in Health Care Update on the Australian Commission on Safety and Quality in Health Care Presentation.

Update on the Australian Update on the Australian Commission on Commission on

Safety and Quality in Health CareSafety and Quality in Health Care

Presentation to CoNNO

Chris Baggoley 9 October 2009

ACSQHCACSQHC

• 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

ACSQHCACSQHC

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

ACSQHCACSQHC

Our Programs1. Australian Charter of Healthcare Rights

2. Open Disclosure

3. Basic Care Issues

• Healthcare Associated Infection

• Patient Identification

• Medication Safety

• Clinical Handover

• Recognition and Response to Clinical Deterioration

• Falls Guidelines

4. Tools

• Accreditation and Credentialing

• Information Strategy

Australian Charter of Healthcare RightsAustralian Charter of Healthcare Rights

ACSQHC and Health Ministers’ Decisions: ACSQHC and Health Ministers’ Decisions: 20082008

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

Reducing harm to patients: the role of surveillance

SurveillanceSurveillance

ACSQHC and Health Ministers’ Decisions: ACSQHC and Health Ministers’ Decisions: 20082008

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: ACSQHC and Health Ministers’ Decisions: 20082008

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 National Hand HHygiene Initiative ygiene 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 - Consumers

- Aged care facilities

2008-2010

Infection Control GuidelinesInfection Control Guidelines

Maintenance of governance structures that support the implementation, monitoring and reporting of infection control work practices

Compliance with legislation, regulations and standards relevant to infection control

6 Basics of infection control 6.1 Standard precautions 6.2 Additional precautions 6.3 Risk management approach 7 Handwashing and

personal hygiene 7.1 Handwashing 7.2 Handwashing products 7.3 Other methods of hand

cleaning 7.4 Hand care 8 Personal protective

equipment 8.1 Protective clothing and

equipment 8.2 Gloves 8.3 Protective eyewear and

face-shields 8.4 Masks and personal

respiratory protection devices

8.5 Gowns and plastic aprons 8.6 Footwear 8.7 Uniforms 9 Handling and disposal of

sharps 9.1 Handling of sharps 9.2 Retractable devices 9.3 Disposal of sharps 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

Establishment of effective work practices that minimise the risk of transmission of infectious agents

23 Standards of practice 23.1 Compliance standards and accreditation 24 Ethical issues 24.1 Duty of care 24.2 Referral 24.3 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 Regulated practice and

processes 26.1 Use of SUD’s 26.2 Standards Australia

guidance on equipment reprocessing

26.3 Linen laundry and food service

26.4 Water 26.5 Clinical and waste

management 26.6 Hospital design/

refurbishment

11.3 Risk of transmission of bloodborne viruses

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) 12 Management of Therapeutic

devices 12.2 Indwelling urinary devices 12.3 Intravascular access devices

(catheters) 12.4 Intubation 12.5 Entral feeding tubes 13 Processing of re-usable

instruments and equipment 13.2 Cleaning, disinfection and

sterilisation 13.3 Diagnostic ultrasound

transducers 13.4 Thermometers 13.5 Cryotherapy 13.6 Ophthalmic and optometry

equipment 13.7 Implantable items 13.8 Single-use devices 13.9 Instrument tracking

14 Instruments and equipment requiring special processing

14.2 Endoscopes 14.3 Bronchoscopes 14.4 Other fiberoptic scopes and

associated equipment 14.5 Respiratory and anaesthetic

apparatus 14.6 Resuscitation manikin face

pieces and accessories 14.7 Asthma spacers used with

tered-dose inhalers (MDIs)

15 Management of patients

with MRO’s 15.2 Hand hygiene 15.3 PPE 15.4 Isolation 15.5 Specialised health care

settings 16 Management of physical

environment 16.2 Environmental cleaning and

spills management 16.3 Routine environmental

cleaning 16.4 Management of blood and

body substance spills 16.5 Room placement 16.6 Patient accommodation 16.7 Waiting areas

1 Overview of diseases 2 Viral diseases 3 Bacterial diseases 4 MRO’s 5 Other diseases

Understanding modes of transmission of infectious agents

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 Responsibilities 18.2 Health care establishments 18.3 Health care workers 18.4 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 Antibiotic stewardship 21.2 Antibiotic use 21.3 Antibiotic prophylaxis 21.4 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

Antimicrobial stewardshipAntimicrobial stewardship

Capacity Building

Clinician capacity buildingClinician capacity building

ACSQHC and Health Ministers’ Decisions: ACSQHC and Health Ministers’ Decisions: 20082008

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 The OSSIE Guide to Clinical Handover

Medical Journal of Australia - June 2009Medical Journal of Australia - June 2009

ACSQHC and Health Ministers’ Decisions: ACSQHC and Health Ministers’ Decisions: 20082008

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: ACSQHC and Health Ministers’ Decisions: 20082008

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: ACSQHC and Health Ministers’ Decisions: 20082008

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 Windows into Safety and Quality in Healthcare 2008Healthcare 2008

THE PROPOSED THE PROPOSED NATIONAL NATIONAL

SAFETY AND QUALITY SAFETY AND QUALITY FRAMEWORKFRAMEWORK

The Role of a National Safety and Quality The Role of a National Safety and Quality FrameworkFramework

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 AAQHC Conference: 9 September 2009September 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 Correct patient, correct site, correct procedureprocedure

Figure 3: Proportion of cases complying with site marking and time out steps, by surgical specialty

0

10

20

30

40

50

60

70

80

90

100

Gener

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Plastic

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Obste

trics

/Gyn

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Neuro

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Orthop

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Vascu

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Urolog

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Ophth

almic

Endoc

rine

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Surgical specialty

% C

om

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Site marked correctly Time out performed properly

WHO – Surgical Safety ChecklistWHO – Surgical Safety Checklist