Implementing the National Safety and Quality Health Service Standards

Margaret BanksProgram Director

June 2, 2015

What is, and what is to come.

The system

2013 and 2014 Comparison

2013 2014

Total no. of services assessed 750 1,072

Public health services 44% 55%

Private health services 56% 45%

Mid cycle assessments 60% 40%

Organisation wide assessments 37% 58%

Interim assessments 2% 2%

Percentage facilities assessed

43%

81%

100%

57%

19%

0% 20% 40% 60% 80% 100%

2013

2014*

Total no.

All Health Service Organisations

Assessed To be assessed

Distribution of not met actions

747

Rating at initial assessment for core actions all assessment types for 2013 and 2014

Total

2013

Health service with all actions met 56%

Health service with actions that need to be re-assessed within 120 days

44%

Health services not accredited 0%

2014

Health service with all actions met 63%

Health service with actions that need to be re-assessed within 90 days

37%

Health services not accredited <1%

Top core not met actions for all types of assessments 2014

Action Requirement

Number of services with not met core actions

Public Private Total

3.10.2 Auditing of compliance to aseptic technique 27 80 107

3.10.3Taking action to increase compliance to aseptic technique

24 75 99

3.14.3 Monitoring of antimicrobial usage and resistance 24 67 91

3.14.4Taking action to improve antimicrobial stewardship

25 63 88

3.15.3 Undertaking regular environmental cleaning audits 11 61 72

1.1.1Organisation-wide management system is in place for development, implementation and review of protocols

20 41 61

1.11.2Participation of clinical workforce in regular performance reviews

8 47 55

3.1.3Regularly reviewing the effectiveness of the infection prevention and control systems

14 41 55

1.12.1 Access to ongoing S&Q training for the workforce 11 42 53

3.10.1 Training in aseptic technique 19 34 53

Core actions not met at organisation-wide assessment as a percentage of total number of actions in each Standard

Developmental actions not met at organisation-wide assessment as a percentage of total number of actions in each Standard

Evaluation of the NSQHS StandardsFormal external evaluation• Consumer survey pre and post accreditation• Cost-benefit analysis• Interrogation of State and Territory administrative data sets pre and

post Standards implementation• Longitudinal survey of attitudes

Ongoing evaluation• Ongoing review of accreditation outcome data and feedback from

the system• Review of approved accrediting agencies and the approvals

process

What people have said:

“Quality used to be ‘quality’s’ job, but now it’s everyone’s job.”

“Overall the standards are positive in effect. The real clinically important issues have been chosen.”

“Having an independent person reviewing your practice is a very good way of ensuring quality.”

Evaluation – where are we up to:

• High degree of awareness of the NSQHS Standards

• Driving clinical engagement

• Too early to be able to make direct links with improvements in patient care

• Broad agreement the standards are having a positive effect on health care

• Standards provide a consistent framework for defining good care and monitoring improvement

• The Standards provide consistency for staff working across multiple sites and sectors

 

Review of the NSQHS Standards

• Commence 2015 • Collating and interpreting information from the

informal and formal evaluation processes• Consulting with consumers, technical experts,

nurses, doctors and allied health• Consider national and international issues

emerging in safety and quality

Guiding Principles

• The aim of the Standards to protect the public from harm and improve the quality of health service will be retained.

• Universal patient safety standards that can be applied across all health care settings

• Focus on areas of known risk to patients, where there is good evident of safer care

• Focus on implementation of systems to prevent harm

• Reduce duplication • Address concerns with version 1

Feedback on version 1 NSQHS StandardsPositive feedback•Address major safety and quality issues •Are clinically focused•Are patient-centred•Are making a difference to safety and quality in health services

Negative feedbacks•Are applicable but difficult to interpret across all health care sectors•Burden of audit•Auditing demonstrates gap, but it can be difficult to address these gaps•Variable levels of engagement of medical staff•Difficulty implementing Standard 2•Duplication of actions and evidence required at accreditation •Burden associated with increased documentation•Nutrition, end of life, bariatric, mental health and cognitive impairment not covered.

Issue for nurses

• the Standards are not just the responsibility of nurses

• medical practitioners are difficult to engage

• the Standards need interpreting for services such as

community, multi-purpose services

• don’t want auditing for auditing sake

• the burden of auditing takes nurses away from patient care

• Commission resources are too dense for frontline staff

• language used in the resources doesn’t resonate with

clinicians

Research into safety and quality

• Mental health• Cognitive impairment• End of life care• Health literacy• Aboriginal health

National Safety and Quality Health Services Standards

Standard 7Blood and Blood

Products

Standard 10Preventing Falls and

Harm from Falls

Standard 1Governance for Safety and

Quality in Health Service Organisations

Standard 2Partnering withConsumers

Standard 4Medication Safety

Standard 3Healthcare AssociatedInfections

Standard 8Preventing and

Managing Pressure Injuries

Standard 9Recognising and

Responding to ClinicalDeterioration in Acute

Health Care

Standard 5Patient Identificationand ProcedureMatching

Standard 6ClinicalHandover

New areas introduced intoversion 2 of the NSQHS Standards

• Leadership • Safe environment• Organ and tissue donation• Malnutrition and dehydration • Diversity of consumers provided with care• Social, economic and geographic

circumstances of consumers

 

National Safety and Quality Health Services Standards

NSQHS Standards

NSQHS Standards version 1 NSQHS Standards version 2

1.Governance for Safety and Quality in Health Service Organisations

GS Governance for safety and quality

2. Partnering with Consumers PC Partnering with consumers

3.Preventing and Controlling Healthcare Associated Infections

ICPreventing and controlling healthcare associated infections

4. Medication Safety MS Medication safety

5.Patient Identification and Procedure Matching CS Communicating for safety

6. Clinical Handover

- CC Consumer-centred care

- RH Reducing harm where risks are high

7. Blood and Blood Products BP Blood and blood products

8.Preventing and Managing Pressure Injuries

-

9.Recognising and Responding to Clinical Deterioration in Acute Health Care

RRRecognising and responding to acute deterioration

10. Preventing Falls and Harm from Falls -

Feedback from

stakeholders

Resources reviewed, updated, approved and distributed

NSQHS Standards

Education and training

Resources

Drafting Piloting Endorsement Finalising draft

Review of the NSQHS Standards – key milestones and activities

Regulatory Impact Statement

Cost benefit assessment

Implementation requirements

Proposed deliverables from the review process

1. NSQHS Standards, version 2

2. Revised Safety and Quality Improvement Guides

3. Accreditation workbooks tools

4. Translation of the NSQHS Standards for consumers

5. Identification of the training requirements of the NSQHS Standards for education bodies and health service organisations

6. Associated safety and quality measures for each Standard

7. Train the trainer package for accrediting agencies and surveyor and information packages for health services

Recently released

• Consultation draft: Guide to the NSQHS Standards for community health services

• Guide to the NSQHS Standards for health service boards

• National Consensus Statement: Essential elements for safe and high-quality end-of-life care 

• Consultation draft: Delirium Clinical Care Standard• Consultation draft: Hip Fracture Care Clinical Care

Standard• App resource: for clinicians “A better way to care” for

dementia and delirium • Release of the National Strategy to address antibiotic

overuse