黑料吃瓜群网

[hr]National Safety and Quality Health听Service Standards (NSQHS Standards)听were introduced in January 2013 to听set out minimum standards for safety听and quality, and provide quality听assurance guidelines and improvement听mechanisms to achieve them.听[hr]
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[link to="Standard 2: Partnering with Consumers"]Standard 2: Partnering with Consumers[/link]
[link to="Standard 4:听Medication Safety"]Standard 4:听Medication Safety[/link]
[link to="Standard 8:听Preventing and Managing Pressure Injuries"]Standard 8:听Preventing and Managing Pressure Injuries[/link]
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During 2013, the Commission consulted widely with听health service organisations about the types of concerns听and challenges experienced in implementing the NSQHS听Standards. Feedback has been sought through a variety of听mechanisms including through accreditation agency surveys,听an accreditation hotline, network teleconferences and听meetings with stakeholders.
In this issue, the Australian Commission on Safety and听Quality in Health Care summarises feedback听received from health service organisations in听relation to the implementation of NSQHS听Standards 2, 4 and 8.[hr]
[title from="Standard 2: Partnering with Consumers"]Standard 2: Partnering with Consumers[/title]

NSQHS Standard 2: Partnering with Consumers requires the听engagement of consumers in the processes of developing听and reviewing health services, and is based on the premise听that people 鈥榟ave the right and duty to participate individually听and collectively in the planning and implementation of their听health care.鈥� 1 The actions identified in NSQHS Standard 2 build听on emerging evidence about the benefits that partnerships听with consumers can bring.2 For example, involving consumers听in service planning, delivery, monitoring and evaluation is听more likely to result in services that are more accessible and听appropriate for users3-4, which can contribute to improvements听in patient outcomes.
How consumer partnerships are progressing
Feedback received from health service organisations听implementing the NSQHS Standards indicated some found听the actions in NSQHS Standard 2 particularly challenging. In听response to this, the Commission conducted a survey of health听service organisations to identify:

• which actions were seen to be the most challenging and why听this was the case, and


• what type of materials and resources would help healthcare听organisations to better understand how to meet these more听challenging actions.

Results of the survey indicate the most difficult actions to听achieve were those requiring involvement of consumers听and carers in clinical workforce training (action 2.6.2) and听in governance (action 2.1.1). Establishing partnerships with听consumers and carers to design and redesign health services听(action 2.5.1) was also reported as difficult.
Some respondents provided comments on why they found听these actions challenging. Private hospital and day procedure听respondents reported organisational barriers to achieving the听actions, while those from public hospitals reported problems听with staff acceptance of the actions. All health services,听including community services, cited various difficulties in听involving consumers, many of which are related to knowledge听about identifying and engaging consumers effectively.
There was much clearer agreement over the actions which听were seen as easier to implement. Respondents said that听engaging consumers and carers to provide feedback on patient听information publications and incorporating that feedback听(actions 2.4.1 and 2.4.2) were easier to implement than other actions.
Continuing support for health service organisations
The Commission is looking at the results of this survey and will听be working closely with organisations undertaking accreditation听throughout 2014 to identify and develop tools and materials听to improve understanding of how to meet the actions under听NSQHS Standard 2. These will include fact sheets, case studies听and potentially train-the-trainer materials, as well as materials听tailored to different types of health services organisations, such听as day procedure services and dental services. To contribute听to this process, email mail@safetyandquality.gov.au with your听feedback or case study recommendations.

More information
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More information and resources to support implementation of the NSQHS Standards are available on the Commission鈥檚 web site at or by contacting the Commission鈥檚 Advice Centre on 1800 304 056 or accreditation@safetyandquality.gov.au.
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References

1. Declaration of Alma-Ata; 1978. World Health Organization.
2. Australian Commission on Safety and Quality in Health Care. Patient-Centred Care: Improving Quality and Safety through Partnerships with听Patients and Consumers. Sydney. ACSQHC, 2011.
3. Crawford MJ, Rutter D, Manley C, Weaver T, Bhui K, Fulop N, et al.听Systematic review of involving patients in the planning and development听of health care. British Medical Journal 2002;325(7375):1263.
4. Consumer Focus Collaboration. The evidence supporting consumer听participation in health. Canberra. Consumer Focus Collaboration, 2001.
5. Van Den Bos J RK, Gray T, Halford M, Ziemkiewicz E. The $17.1 Billion听Problem: The Annual Cost of Measurable Medical Errors. Health Afairs听2011;30(4):596-603.
6. Graves N BF, Whitby M. Modelling the economic losses from pressure听ulcers among hospitalised patients in Australia. Wound Repair andRegeneration 2005;13(5):462-467.
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[title from="Standard 4:听Medication Safety"]Standard 4:听Medication Safety[/title]

NSQHS Standard 4: Medication Safety describes the elements of a safe medication management system with the aim of reducing the prevalence of avoidable adverse medication incidents. The intention is to ensure competent clinicians safely prescribe, dispense, and administer appropriate medicines to informed patients and carers. In May 2013, the Commission held a workshop to discuss issues for health service organisations meeting the requirements of NSQHS Standard 4. The key challenges identified, solutions and guidance are summarised below.
Undertaking quality improvement activities to enhance the听safety of medicines use (action 4.5)
Health service organisations should prioritise areas for听improvement (as identified in risk assessments) to those of听highest risk to patients. Audits should be conducted to measure听the effect of quality improvement activities undertaken.听Small, more frequent, audits targeted at high risk patients,听medicines or processes are appropriate. The Indicators for听Quality Use of Medicines in Australian 黑料吃瓜群网s are a useful听resource for undertaking baseline audits and measuring quality听improvement.
The clinical workforce reviewing the patient鈥檚 current听medication orders against their medication history听and prescriber鈥檚 medication plan, and reconciling any听discrepancies (action 4.8)
This action is particularly challenging for smaller health听service organisations with no onsite pharmacy service. Health听professionals other than pharmacists, such as nurses, doctors,听and pharmacy technicians, can reconcile medicines provided听they receive appropriate training. A multidisciplinary approach听is recommended with responsibilities assigned to the relevant听professional groups, including responsibility at weekends and听after hours when there may be no pharmacy service. Health听service organisations with limited resources should prioritise听medication reconciliation for patients at higher risk of medicine听misadventure. The Commission recommends that the National听Medication Management Plan (MMP) be used to document听medication histories and reconcile medicines on admission,听during intra-hospital transfer and on discharge from the health听service. It should be kept with the current National Inpatient听Medication Chart (NIMC) during the episode of care. The MMP is听available from the Commission鈥檚 web site.
Ensuring a current comprehensive list of medicine, and the听reason(s) for any change, is provided to the receiving clinician听and the patient during clinical handover (action 4.12)
Where there is no pharmacist on site to prepare and provide听a medicines list to the patient on discharge, the list may be听provided through a number of different mechanisms. Each听health service organisation needs to determine what system听best serves their needs. Examples of systems are provided in听the workshop outcomes in the Accreditation section of the听Commission鈥檚 website.
Identifying high-risk medicines in the organisation and听ensuring they are stored, prescribed, dispensed and听administered safely (action 4.11)
Some organisations are not familiar with the term highrisk听medicines and the process of identifying them within听their organisation. Information about high risk medicines听is available from the Commission鈥檚 web site in Medication听Safety, Medication Alerts. The APINCH mnemonic for high risk听medicines i.e. anti-infectives, potassium, insulin, narcotics,听chemotherapy and heparin (and other anticoagulants) is a good听place to start. Actions to address risks identified with high-risk听medicines can be prioritised.
General guidance for implementing NSQHS Standard 4
Health service organisations are encouraged to use a risk based听approach to identify areas in which the organisation does not听meet NSQHS Standard 4 action items. All hospitals should use听the Medication Safety Self Assessment (MSSA) Tool to assess听the safety of their medication management system irrespective听of their size and whether public or private (action item 4.2). The听identified gaps can be prioritised according to risk (using the听Commission鈥檚 risk matrix tool) and serve as a focus for quality听improvement activities. Day procedure services can use the Day听Procedure Services Accreditation Workbook as the basis for听their risk assessment.
黑料吃瓜群网s and day surgery services are required to use the听relevant National Inpatient Medication Chart (NIMC) for their听setting. Services using medication charts that have been听modified from the NIMC should check whether their changes听comply with the NIMC Local Management Guidelines produced听by the Commission. They will need to transition to the NIMC if听the changes do not comply.
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[title from="Standard 8:听Preventing and Managing Pressure Injuries"]Standard 8:听Preventing and Managing Pressure Injuries[/title]

Pressure injuries are a major source of harm to patients听within the health system.5-6 In the majority of cases,听pressure injuries are preventable. The intention of NSQHS听Standard 8 is to prevent patients from developing avoidable听pressure injuries and to ensure effective management of听pressure injuries when they do occur.
In the following case study, Tracy Nowicki, Clinical Nurse听Consultant, shares her tips and experience from the听implementation of NSQHS Standard 8 at Prince Charles听黑料吃瓜群网 in Queensland.
Case study: The highs and lows of implementing NSQHS听Standard 8
鈥淲hen the NSQHS Standards were introduced in January听2013, we at The Prince Charles 黑料吃瓜群网 wondered 鈥榳here do听we start?鈥� when we saw Standard 8. Getting our strategies听together was essential. Once these were in place, the actions听seemed much more manageable.听
Key practice development initiatives highlight the importance听of a sustained and strategic focus on education, the use of听appropriate pressure injury prevention devices and strategies,听together with committed executive support.
The first priority is to establish your team. Reflect on the听great work you have done and what you are currently doing.听Accreditation is all about demonstrating the great work you are听doing and looking at how you can improve your quality. Keep听all your evidence: measure, measure, measure.
Governance (action 8.1)
Our journey goes back to the 1990鈥檚. There were many听highlights in relation to nurse-led quality improvement projects.
Some years ago we established a Tissue Viability Committee.听The strength of this group is that is it multi-disciplinary and hassustainability.
Key performance indicators are identified in the Nursing Services听Strategic Plan which identifies PI prevention as a priority research听area. Ensure you have strong leadership and executive buy-in.
Prevention (action 8.2)
Standard 8 requires a 鈥楥omprehensive Skin Inspection鈥�. This is not听a quick look at the patient鈥檚 sacrum. It is a head-to-toe anterior听and posterior skin inspection. To meet the standards, we need听to remember the patient is at the centre of care. We need to also听remember that staff are met with many competing priorities. Skin听inspection needs to be built into daily care. This is all about cultural听change: where the fundamental basics are important to all of us.听At The Prince Charles 黑料吃瓜群网, we developed a skin inspection听form. This promotes clear communication on admission, between听transfers and on discharge. There is little writing required. To听encourage thorough skin inspection and correct completion of听the form we also launched an educational campaign, 鈥楲ook, Listen听& Feel鈥�. The adjunct posters direct staff to look at the skin,听listen to the patient and feel the skin. Damaged skin will feel听different. This campaign took the mystery out of anatomical听locators, sites of higher risk and what to do for 鈥榓t risks鈥� sites.
We also reviewed our high-risk units (i.e. Adult Intensive Care).听For patients who we knew would be bed bound for long听periods of time, we commenced the 鈥楬ips, Heads and Heels鈥櫶齝ampaign. The aim of this was to ensure that the high-risk听sites were protected before the patient was intubated and听sedated. It was also a reminder to staff who care for these听patients that the risks are always present.
We standardised an evidenced based skin care program, moving听away from ritualistic practice to evidenced based practice. This听included eliminating surplus continence and skin care products.听Ensuring that all areas use the same products regardless听of where the patient is situated in the hospital. Continence听education was woven into the PI and Falls education.
Management (action 8.3)
When PI are documented through the Incident Reporting听System, an immediate response to review the incident report听was initiated. This ensured that staff saw a timely response to听the documentation, a review of best practice, engagement of听the patient and analysis of the incident to ensure credibility.
Consumer Engagement (action 8.4)
The Prince Charles 黑料吃瓜群网 conducts regular courses for PI/Falls and Continence courses. We ensure that each of these听features a presentation from a consumer. This has been听invaluable in the enhancement of staff knowledge. Patient听stories have a strong impact and can instigate change at the听frontline of care.
At a state level, we have worked to standardise the patient听handout on 鈥楰eeping Bedsores at Bay鈥�. However it is one听thing to distribute a patient leaflet, it is another to ensure the听patient understands it. At The Prince Charles 黑料吃瓜群网 we are听continuing to work in this space.鈥�
There are many resources available on the Commission鈥檚 website to assist hospitals听implement the NSQHS Standards and provide evidence that each standard is听being met. 鈥澨�
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