Quality Health Service Standards Research Articles

Implementation of the Australian National Safety and Quality Digital Mental Health Standards.

Following the release of the Australian National Safety and Quality Digital Mental Health (NSQDMH) Standards in November 2020, our objective was to ensure effective implementation of the Standards. This included the development of an accreditation scheme to allow digital mental health services to be formally assessed against the Standards and provide service users with an assurance of safe and high-quality services. The accreditation scheme was adapted from the one used for the National Safety and Quality Health Service (NSQHS) Standards. As the digital mental health sector was largely unfamiliar with standards and accreditation, the scheme was pilot-tested with a range of service providers and further consultation took place to refine it. The accreditation scheme was launched in November 2022 with support resources published to aid implementation. The NSQDMH Standards accreditation scheme provides an assurance of safety and quality for digital mental health service users.

A patient journey audit tool (PJAT) to assess quality indicators in a nuclear medicine service

PurposeTo develop a nuclear medicine specific patient journey audit tool (PJAT) to survey and audit patient journeys in a nuclear medicine department such as staff interaction with patients, equipment, quality of imaging and laboratory procedures, patient protection, infection control and radiation safety, with a view to optimising patient care and providing a high-quality nuclear medicine service.MethodsThe PJAT was developed specifically for use in nuclear medicine practices. Thirty-two questions were formulated in the PJAT to test the department’s compliance to the Australian National Safety and Quality Health Service Standards, namely clinical governance, partnering with consumers, preventing and controlling health care infection, medication safety, comprehensive care, communicating for safety, blood management and recognising and responding to acute deterioration. The PJAT was also designed to test our department’s adherence to diagnostic reference levels (DRL). A total of 60 patient journey audits were completed for patients presenting for nuclear medicine, positron emission tomography and bone mineral density procedures during a consecutive 4-week period to audit the range of procedures performed. A further 120 audits were captured for common procedures in nuclear medicine and positron emission tomography during the same period. Thus, a total of 180 audits were completed. A subset of 12 patients who presented for blood labelling procedures were audited to solely assess the blood management standard.ResultsThe audits demonstrated over 85% compliance for the Australian national health standards. One hundred percent compliance was noted for critical aspects such as correct patient identification for the correct procedure prior to radiopharmaceutical administration, adherence to prescribed dose limits and distribution of the report within 24 h of completion of the imaging procedure.ConclusionThis PJAT can be applied in nuclear medicine departments to enhance quality programmes and patient care. Austin Health has collaborated with the IAEA to formulate the IAEA PJAT, which is now available globally for nuclear medicine departments to survey patient journeys.

Australian National Standards of Care for Childhood-onset Heart Disease (CoHD Standards). 1st Edition

These first Australian National Standards of Care for Childhood-onset Heart Disease (CoHD Standards) have been developed to inform the healthcare requirements for CoHD services and enable all Australian patients, families and carers impacted by CoHD (paediatric CoHD and adult congenital heart disease [ACHD]) to live their best and healthiest lives. The CoHD Standards are designed to provide the clarity and certainty required for healthcare services to deliver excellent, comprehensive, inclusive, and equitable CoHD care across Australia for patients, families and carers, and offer an iterative roadmap to the future of these services. The CoHD Standards provide a framework for excellent CoHD care, encompassing key requirements and expectations for whole-of-life, holistic and connected healthcare service delivery. The CoHD Standards should be implemented in health services in conjunction with the National Safety and Quality Health Service Standards developed by the Australian Commission on Safety and Quality in Health Care. All healthcare services should comply with the CoHD Standards, as well as working to their organisation's or jurisdiction's agreed clinical governance framework, to guide the implementation of structures and processes that support safe care.

A system for developing reasonable adjustments to the application of the National Safety and Quality Health Service Standards for adult patients with intellectual disability in Australian hospital settings.

The Australian Commission of Safety and Quality in Health Care mandates the application of the eight National Safety and Quality Health Service Standards to minimise high-risk adverse events in hospital settings for all Australian patients. It acknowledges that adults with intellectual disability require reasonable adjustments to the application of the standards to optimise the impact of the quality and safety measures for this group. The paper proposes a system whereby reasonable adjustments can be developed for this population. First, particular criteria, items or actions of a standard are selected for the formulation of reasonable adjustments. Second, the adjustments are broken down into categories of alterations to usual knowledge, process, content and organisation involved in compliance with the chosen aspect of the standard. Third, the categories of reasonable adjustments are simultaneously influenced and shaped by aspects of living with intellectual disability, disability supports and a health-disability sectoral interface.

Putting Indigenous Cultures and Indigenous Knowledges Front and Centre to Clinical Practice: Katherine Hospital Case Example.

The inclusion of Indigenous cultures, known as the cultural determinants of health, in healthcare policy and health professional education accreditation and registration requirements, is increasingly being recognised as imperative for improving the appalling health and well-being of Indigenous Australians. These inclusions are a strengths-based response to tackling the inequities in Indigenous Australians' health relative to the general population. However, conceptualising the cultural determinants of health in healthcare practice has its contextual challenges, and gaps in implementation evidence are apparent. In this paper, we provide a case example, namely the Katherine Hospital, of how healthcare services can implement the cultural determinants of health into clinical practice. However, to be effective, health professionals must concede that Australia's Indigenous peoples' knowledges involving cultural ways of being, knowing and doing must co-exist with western and biomedical knowledges of health practice. We use the Katherine Hospital ABC Radio National Background Briefing interview, which was mentioned by two research participants in a 2020 study, as an example of good practice that we can learn from. Additionally, the six Aboriginal and Torres Strait Islander Health actions contained in the 2nd Edition of the Australian National Safety and Quality Health Service Standards provide governance and accountability examples of how to enable Indigenous people's cultures and their knowledges in the provision of services. The role of non-Indigenous clinical allies and accomplices is imperative when embedding and enacting Indigenous Australians' cultures in service systems of health. When Indigenous Peoples access mainstream hospitals, deep self-reflection by allies and accomplices is necessary to enable safe, quality care, and treatment that is culturally safe and free from racism. Doing so can increase cultural responsiveness free of racism, thereby reducing the inherent power imbalances embedded within mainstream health services.

Addressing the end-of-life actions in the National Safety and Quality Health Service Standards (2nd edn): a national survey.

Objectives To describe current and planned processes and outcome measures to address implementation of the six end-of-life actions in the National Safety and Quality Health Service (NSQHS) Standards (2nd edn) and explore associated barriers and enablers. Methods This study used an exploratory mixed methods national survey of acute healthcare facilities between September 2018 and March 2019. This study involved public and private facilities (N = 765) that provided end-of-life care, which are required to be accredited to the NSQHS Standards. Participants include those responsible for reporting implementation of end-of-life care actions at a facility providing end-of-life care. Participants were asked what processes and outcome measures were implemented or being planned to address the end-of-life care actions, and the associated barriers and enablers. Results Fifty respondents (6.5% response rate) from across Australia contributed data, reporting greater confidence in addressing Actions 5.16: Clinicians have access to Specialist Palliative Care Services; 5.17: Advance care plans can be received from patients and stored in medical records; and 5.18: Supervision and support is available for workforce providing end-of-life care. Barriers associated with the actions that were the most challenging to address included: competing clinical priorities, and insufficient resources to provide best practice end-of-life care; and the burdensome nature of conducting audits. Enablers included: (1) local, jurisdictional, and national strategic plans and policies; (2) support from Specialist Palliative Care Services; (3) access to resources and data; (4) standardised approaches to implementation and measuring outcomes; and (5) clinician, consumer and community engagement and education on end-of-life care. Conclusion Enablers and barriers in implementing the six end-of-life care actions were identified. Respondents reported that high-level support and direction, system-wide approaches, practical clinical support, and widespread community and clinician engagement would enable their facility to better address the end-of-life actions.

Emerging health and social policy considerations for safe and quality end-of-life care in Australia - the evidence, gaps and challenges.

Recognition of the importance of end-of-life care will enable improvements in the quality of care delivered to patients and their families. Australia is experiencing an increasing number of deaths, (many expected), with an aging population who are living longer, often with multimorbidity. This makes end of life care a priority. The last year of someone's life takes place in a complex healthcare system, with increasing pressures on care delivery, placing the spotlight on health service providers to ensure that teams and individuals are supported and enabled to provide such care. Two rapid literature reviews identified best practice principles and processes for delivering safe and high-quality end-of-life care in acute care, aged care and community settings. The reviews identified that end-of-life care is experienced within the whole health and social care system, including hospital admissions interspersed with care in the community, outpatient and emergency department visits and potentially admission to a hospice. Much of this last year of life is spent at home, which may be a personal residence, an aged care facility, prison, supported accommodation or even on the streets. Transitions across settings requires seamless care, as well as organisational readiness to deliver safe and culturally appropriate care. This is more important now with end-of-life care subject to quality assurance mechanisms within the National Safety and Quality Health Service Standards (2nd edn): Comprehensive care. This requires all sectors to work collaboratively when caring for someone at the end of their life in order to see positive changes in care outcomes.

Emergency pharmacology for the CT technologist.

The scope of practice of the medical radiation practitioner demands knowledge and understanding of the indications, contraindications, warnings, precautions, proper use, drug interactions and adverse reactions of a variety of medications. The risk of patient deterioration or acute emergent event, particularly following contrast administration, makes the command of crash cart medications particularly important. This article explores the pharmacological principles of medications most likely to be required in a medical emergency in the medical radiation department and in particular by the computed tomography (CT) technologist. The article also outlines early warning signs to assist in identifying the emergent or deteriorating patient. The learning outlined is designed to equip medical radiation practitioners with the capacity to identify and respond to a medical emergency typical of the medical radiation department, and to respond to that situation with the appropriate use of emergency medications where appropriate. The ability of medical radiation practitioners to recognise and respond to (including the use of medicines) the deteriorating patient or circumstances of a medically urgent nature are key capabilities required to meet minimum standards for Medical Radiation Practice Board of Australia registration and National Safety and Quality Health Service standards.

Association between use of clinical governance systems at the frontline and patient safety: a pre-post study

PurposeTo investigate the association between implementation of clinical governance and patient safety.Design/methodology/approachA pre-post study was conducted in an Australian health service following the implementation of clinical governance systems (CGS) in the inpatient wards in 2016. Health service audit data from 2017 on CGS implementation and the rate of adverse patient safety events (PSE) for 2015 (pre-implementation) and 2017 (post-implementation), across 45 wards in six hospitals were collected. CGS examined compliance with 108 variables, based on the Australian National Safety and Quality Health Service standards. Patient safety was measured as PSE per 100 bed days. Data were analysed using odds ratios to explore the association between patient safety and CGS percentage compliance score.FindingsThere was no change in PSE between 2015 and 2017 (MD 0.04 events/100 bed days, 95% CI -0.11 to 0.21). There were higher odds that wards with a CGS score >90% reported reduced PSE, compared to wards with lower compliance. The domains of leadership and culture, risk management and clinical practice had the strongest association with the reduction in PSE.Practical implicationsGiven that wards with a CGS score >90% showed increased odds of reduced PSE health service boards need to put in place strategies that engage frontline managers and staff to facilitate full implementation of clinical governance systems for patient safety.Originality/valueThe findings provide evidence that implementation of all facets of CGS in a large public health service is associated with improved patient safety.

Australian health service organisation assessment outcome data for the first 2 years of implementing the Comprehensive Care Standard.

Objective To review implementation of the Comprehensive Care Standard (CCS) by evaluating assessment outcome data of Australian health service organisations (HSOs) from January 2019. The CCS was introduced with the National Safety and Quality Health Service (NSQHS) Standards (second edition). It has 36 actions and over 40 resources to support implementation. Methods Retrospective assessment outcome data submitted by accrediting agencies were examined to gauge progress of CCS implementation by considering met or other ratings of the CCS actions. Results There were 495 assessments completed between January 2019 and December 2020. Most (71% n = 352) HSOs met the requirements of the CCS after initial assessment. Seventy-four (15%) of the HSOs did not meet all the requirements and a further 58 (12%) HSOs were provided with recommendations to meet the actions. Conclusions There was indication of underperformance related to some actions in the CCS. The assessment data highlighted common issues for organisations including difficulties implementing governance processes, demonstrating effective care planning, implementing the end-of-life care actions and some minimising harm actions. Future evaluation of the implementation of the CCS may benefit from strengthening links between other safety and quality programs.

The development of National Safety and Quality Digital Mental Health Standards.

Digital mental health services offer innovative ways for individuals to access services but are not without risk. Our objective was to develop National Safety and Quality Digital Mental Health (NSQDMH) Standards that improve the quality of digital mental health service provision and protect service users from harm. The NSQDMH Standards were developed by adapting the National Safety and Quality Health Service (NSQHS) Standards and adding components highlighted through a national consultation process as critical to the safety and quality of services. Further public consultation and pilot testing assisted in refining the NSQDMH Standards. The NSQDMH Standards comprise three standards-Clinical and Technical Governance, Partnering with Consumers, and Model of Care-and were launched in November 2020. The NSQDMH Standards provide a quality assurance mechanism to improve digital mental health care in Australia.

Designing Tag Team Patient Safety Simulation: An instructional design approach

Tag Team Patient Safety Simulation (TTPSS) draws on cognitive, social, and constructivist theoretical perspectives to inform and provide contemporary simulation teaching practice that address the challenges associated with providing large numbers of learners with engaging simulation experiences. In doing so, TTPSS fosters critical conversations about patient safety that empower students and build resilience. Popularity of the method has seen its use extend from clinically based education addressing the Australian National Safety and Quality Health Service Standards to broader application of theoretical concepts informing practice internationally. The success of the method lies in understanding the theoretical perspectives informing design and the careful construction and alignment of methodological attributes that come together to facilitate learning. This discussion paper adds to the scholarship of simulation by describing the underpinning theoretical foundations of the methodology and offers a design framework to facilitate constructive alignment and guide the development of quality learning experiences using this methodology. This paper translates the principles of learning and instruction that apply to TTPSS materials, activities, resources, and evaluation and provides direction to those seeking to design effective educational simulations using the TTPSS methodology.

Developing Mental Health-Related Simulation Activities for an Australian Undergraduate Nursing Curriculum.

Although simulation-based learning experiences have been widely used in nursing curricula to develop confidence, knowledge, and skills, the use of mental health-related simulation in undergraduate nursing education is sparse. This project aimed to develop a simulation activity that incorporated the National Safety and Quality Health Service standards in acute mental health for undergraduate nursing students to prepare them for their clinical practicum in mental health. Clinical confidence was evaluated using the Mental Health Clinical Confidence scale. Mental health clinical confidence increased in students following the activity. The findings show simulation activities that build on existing knowledge improve student confidence in providing care for people with mental health conditions. This article reports on the development and implementation of a mental health-related simulation-based learning experience in an undergraduate nursing program and builds on the existing knowledge of simulation-based learning in health care education. [J Nurs Educ. 2021;60(6):356-361.].

Does implementation of a tailored intervention increase adherence to a National Safety and Quality Standard? A study to improve delirium care.

Delirium is commonly detected in older people after hip fracture. Delirium is considered to be a multifactorial disorder that is often seen post-operatively (incidence ranging from 35% to 65%). Hospitals in Australia are required to meet eight standards including the comprehensive care standard to be able to maintain their accreditation. The standard includes actions related to falls, pressure injuries, nutrition, mental health, cognitive impairment and end-of-life care. Delirium prevention was identified as an area for improvement in our Orthopaedic unit in a Level 1 University Trauma Centre in Australia. This implementation research project aimed to understand the efficacy of a delirium prevention intervention within an existing orthopaedic speciality care system. Implementation of the tailored intervention will increase adherence to National Safety and Quality Health Service Standards, thereby reducing rate of delirium. In this study, we used an interrupted time series design to examine changes in practice over time in people admitted to hospital with a hip fracture. Clinical staff caring for patients with hip fracture in an acute care setting in Adelaide, South Australia, participated in the project. In brief, intervention included education, environmental restructuring, change champions, infographics and audit feedback reports. The primary outcome of interest was rate of delirium. The secondary outcome was compliance with the use of delirium 4AT screening tool, duration of delirium and hospital length of stay. The rate of change per month in patients with delirium decreased significantly by 19.2%. There was no significant change observed in trend for duration of delirium and length of hospital stay between pre-intervention and post-intervention phases. A significant increase in the use of screening tool was observed from 4.7% in the pre-intervention phase to 33.6% in the post-intervention phase. Translation of evidence-based intervention model incorporating well-considered implementation strategies had a mixed impact on decreasing the rate of delirium. The scheduled hospital accreditation enhanced the use of validated screening tool to recognize delirium. This project highlights the importance of aligning implementation goals with the wider goals of the organization as well as making clinicians accountable by consistent auditing.

Making the move to a learning healthcare system: has the pandemic brought us one step closer?

The notion of a learning healthcare system (LHS) is gaining traction to advance the objectives of high-quality patient-centred care. Within such a system, real-world data analysis, clinical research and health service research are core activities of the health system. To support the transition to an LHS, the Australian Government is implementing the National Clinical Trials Governance Framework, which extends health service accreditation standards to the conduct of clinical trials. This initiative encourages the integration of clinical trials into clinical care and the fostering of a culture of continuous improvement. However, implementing this initiative may prove challenging if health system leaders, clinicians and patients fail to recognise the value of clinical trials as a core health system activity. In this article we describe the enduring value of clinical trials and how the COVID-19 pandemic has enhanced their value by addressing longstanding deficiencies in the way trials are conducted. We also summarise best-practice advice on the embedding of trials into routine health care to enable their integration into health system operations. What is known about this topic? Many healthcare organisations seek to transition to a learning health system. In Australia, National Safety and Quality Health Service Standards, which support the embedding of clinical trials as a core health system activity, have been implemented to catalyse the move. What does this paper add? Because there is little practical advice on how to embed clinical trials into health system operations, this paper summarises best practice. It also provides a rationale for embedding trials as a core health system activity, because the creation of a strong research culture is an important determinant of success. What are the implications for practitioners? The successful transition to an LHS would significantly advance the goals of value-based care.

Responsibilities and capabilities of health engagement professionals (HEPs): Perspectives from HEPs and health consumers in Australia.

BackgroundIn Australia, the National Safety and Quality Health Service Standards (2012) stipulates that partnering with health consumers to improve health‐care experiences is one of the criteria health‐care organizations are assessed and accredited against. This standard has given rise to a role: health engagement professionals (HEPs). While there are no standard requirements for recruitment into this role, this study contributes to much needed research into understanding their responsibilities and capabilities, and their contributions to engagement outcomes.MethodsUsing a qualitative, interpretive approach, 16 HEPs and 15 health consumer representatives (who have experiences of interacting with HEPs) participated in an in‐depth phone interview in December 2019. We explored (a) the purposes of the role, (b) the responsibilities and work activities and (c) the capabilities required to carry out the responsibilities.ResultsHealth engagement professionals are specialists in designing engagement mechanisms for health‐care organizations to co‐design health services with health consumers. They facilitate partnerships between health‐care organizations and health consumers. They play significant roles in listening to, facilitating understanding amongst different stakeholder groups (eg hospital management, health‐care workers and health consumers) and navigating the bureaucratic structures to influence outcomes. Four major responsibilities (advocacy, education, facilitation and administration) and four categories of capabilities (relational, communication, professional and personal) were identified.ConclusionA list of job responsibilities and desired capabilities of HEPs is provided to help health‐care organizations better understand the requirements for the role. This would help them decide how applicants to these roles would meet the requirements (eg experience of navigating bureaucratic systems).

Using observational simulation teaching methods in professional development to address patient safety

BackgroundFramed within the National Quality Health Service Standards and using immersive simulation approaches, a series of videos responding to accreditation audit findings were created and used as teaching artefacts for mandatory professional development at a regional hospital in Australia. The scenarios captured a patient's hospital journey and targeted quality standards for medication administration, infection control, patient identification, documentation and preventing falls. AimTo improve patient safety and quality health outcomes. MethodsMixed methods comprising of quality audit data, surveys and interviews were used to evaluate the effectiveness of the simulation video artefacts and to measure the impact of the professional development initiative using simulation artefacts on patient outcomes. FindingsFindings showed high levels of satisfaction with the new education programme, improved understanding of documentation, improved risk management and a significant reduction in the incidence of falls with injury (73%), medication incidents (34%), and infection (61%). ConclusionThis project promoted a culture of safety and learning and demonstrated that using simulation videos in mandatory professional development can positively impact safety and health outcomes.

KHA-CARI guidelines: infection control for haemodialysis units — a summary review

Context The latest KHA-CARI guidelines provide recommendations on screening for and management of blood-borne viruses (BBV) and multi-resistant organisms (MRO). The Guidelines comprise almost 80 pages, and include detailed practical advice related to clinical infection prevention, management considerations, and the working party’s evidence sourcing methodologies. Objectives To outline the format and content of the guidelines, summarising key points as relevant to nursing practice within haemodialysis units. To review the key points in the guidelines in regard to standard precautions, routine and enhanced surveillance screening, management of patients with positive results for BBV and MRO, environmental and equipment use and cleaning, use of personal protective equipment, and suggestions for clinical care. To highlight how the guidelines can support a dialysis unit in meeting relevant standards in the accreditation process. Key findings The KHA-CARI guidelines governing infection control in Australian and New Zealand haemodialysis units are detailed and evidence-based, and if adopted within an appropriate clinical governance framework, provide a comprehensive approach toward unit-based infection control that supports compliance with a number of the eight Australian National Safety and Quality Health Service (NSQHS) standards. Patient-centred care and implementation impact is a key focus of the guidelines, although they highlight limitations imposed by gaps in evidential knowledge. Conclusion The KHA-CARI infection control guidelines provide a high-quality, evidence-focused and detailed review of recommendations in regard to preventing and managing BBV and MRO infections in dialysis units. They align with NSQHS accreditation standards.

Digital transformation of hospital quality and safety: real-time data for real-time action.

The Australian Commission for Safety and Quality in Health Care has created the National Safety and Quality Health Service standards that all hospitals must address in order to remain accredited. This case study details the first known digitisation of the 10 national quality and safety standards mandated in a quaternary integrated digital hospital. A team of clinical informaticians, information technology experts and clinicians was assembled. Data were chosen and the data were then extracted and validated and presented (often in near real time) in an easily consumable dashboard format with appropriate governance to allow clinicians and executives to monitor the quality and safety standards across the hospital. All 10 standards were defined and extracted contemporaneously from the digital hospital for every patient, every time. This is in stark contrast with traditional retrospective point prevalence surveys. This case study details the first known fully digital accreditation in a sophisticated integrated digital hospital. Digitisation of hospital quality and safety to produce real-time data is the future of clinical redesign to improve patient care.

Graduate registered nurses’ reflections on implementing safety and quality improvement projects

ABSTRACTRegistered nurses are required to be involved in quality improvement activities as part of delivering safe, high-quality care for patients. Graduate registered nurses often have limited knowledge and practical application of quality improvement processes and their link to clinical care. Graduate nurse programs provide ideal opportunities to embed knowledge and practice of quality standards and quality improvement processes and for graduates to utilise reflection as an important tool in learning and practice review. An innovative approach was implemented at an Australian private hospital where registered nurses in a graduate nurse program worked in groups to conduct a quality improvement project relating to one of the Australian National Safety and Quality Health Service Standards. As part of the project, reflection was used as a strategy for graduates to understand and learn from their experience. Using a descriptive qualitative approach, the reflections of 20 graduate registered nurses who conducted a quality improvement project as part of a graduate nurse program were analysed. The results showed that reflection enabled the graduate nurses to better understand their experience of implementing a quality and safety project with a team of peers, including reflecting on their own learning and also reflecting on quality improvement projects and how they can contribute to improved practices at the hospital.