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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 as tri c G e oc ri n En d al m ph th O y/ R lo g ro U Surgical specialty ic en al la r Va sc u T EN O rth op ur ge N eu ro s ae c G yn tri cs / ae di c ry y ol og ic s st Pl a bs te O en er al 0 G % Compliance with policy 80 WHO – Surgical Safety Checklist