Week 5: Quality and Safety Frameworks for Nursing Practice

What is quality of care?

(What) Doing the right thing. (When) At the right time. (Who) To the right person

Which are the two overarching standards?

1 & 2

Describe the factors that have influenced the development of quality in healthcare. (not completed yet)

1. Critical Thinking 2. Patient-centred care 3. Evidenced based practise 4. Looking at quality from a systems approach 5. Creating a culture of quality and safety 6. Development of Standards and guidelines 7. Implementing strategies

What are the 10 National Safety and Quality Health Service Standards? (learn standard 1 and 2)

1. Governance for Safety and Quality in Health Service Organisations: framework required for health service organisations to implement safe systems. 2. Partnering with Consumers: create a consumer-centred health system by including consumers in the development and design of quality health care. 3. Preventing and Controlling Healthcare Associated Infections: prevent infection of patients within the healthcare system and to manage infections effectively when they occur to minimise the consequences. 4. Medication Safety: ensure clinicians safely prescribe, dispense and administer appropriate medicines to informed patients. 5. Patient Identification and Procedure Matching: identify patients and correctly match their identity with the correct treatment. 6. Clinical Handover: effective clinical communication whenever accountability and responsibility for a patient's care is transferred. 7. Blood and Blood Products: safe, effective and appropriate management of blood and blood products so the patients receiving blood are safe. 8. Preventing and Managing Pressure Injuries: prevent patients developing pressure injuries and best practice management when pressure injuries occur. 9. Recognising and Responding to Clinical Deterioration in Acute Health Care: systems and processes to be implemented by health service organisations to respond effectively to patients when their clinical condition deteriorates. 10. Preventing Falls and Harm from Falls reduce the incidence of patient falls in health service organisations and best practice management when falls do occur.

How is healthcare a complex system?

1. Many interacting parts 2. Increasing use of technology 3. Increasing complexity of treatment 4. Difficult to predict what will happen based on components.

Standards 3 - 10 exist because they address what?

1. The impact of poor safety or quality of care impacts a large number of people 2. The gap between current practise and known best practise 3. Evidence based and achievable strategies to improve safety and quality of care.

In combatting human error in healthcare, there are two approaches.

1. Traditional or person approach 2. New or system approach

With regards to human error the system approach does not excuse for what?

1. Willful ignoring of evidence 2. Poor professional communication 3. Disregard and willful violation of rules 4. Intended acts of omission

What is a standard?

A standard is a nationally set level of care expected from nurses. It sets a minimum achievable performance expectations for nursing activities.

Why are accreditation and standards important?

Accreditation is recognised as an important driver for safety and quality improvement. The Standards are important for the accreditation process as they determine how and against what an organisation's performance will be assessed.

Identify the quality and safety frameworks that apply to nursing practice.

Australian Commission in Safety and Quality in Healthcare composed the 10 National Safety and Quality Health Service (NSQHS) Standards.

Define Patient Centred Care

Care that is respectful and responsive to individual patient preferences, needs and values, ensuring that the patient guides all clinical decisions.

The Australian Safety and Quality Framework for Health Care specifies 3 core principles for safe and high quality care. These are:

Consumer/ Person Centered Evidence based Practice Organised for safety

What is the difference between an error and an adverse effect?

Errors are failures of planned actions to be completed as intended, or the use of wrong plans to achieve what is intended. Adverse events are injuries caused by medical intervention, as opposed to the health condition of a patient. A large proportion of adverse events are the result of errors. When the adverse event is the result of an error, it is considered a preventable adverse event.

Identify and describe the factors which create a culture of safety

Factors that create a culture of safety: 1. Safety is seen as a priority by everyone in the organization 2. There are shared goals and values 3. Teamwork across professional groups is the norm 4. Patient and carer involvement is encouraged and welcome 5. Openness/transparency and accountability are evident and promoted 6. Promotion of safety through education

Quality and Safety are separable. T or F?

False

Quality care = Safe care. T or F?

False

How should errors in a person approach be dealt with?

Name, Blame, Shame, Retrain

What is the primary aim of the NSQHS standards? What are the two secondary aims?

Primary aim is public safety Secondary aim: 1. Improve quality of health service provision 2. Provide a framework for improvement

In the person approach, errors are seen as what?

Products of carelessness

What are clinical practise guidelines?

Recommendations to assist with the care of patients in a specific condition or circumstance.

What is safety?

Reducing the harm or risk of harm from practise and the practising environment.

An organizational culture of safety and quality acknowledges what?

The influence of: 1. complex systems 2. human factors within healthcare delivery systems in general and within nursing practice specifically

Using the system approach, when human error is made, where is the responsibility and accountability allocated?

The problem was with the system. Putting it down to multiple factors including patient, provider and task factors.

Who is the Australian Commission into Safety and Quality in Healthcare? And what do they do?

They are a Government organisation. Lead and coordinate improvements into quality and safety in healthcare across Australia.

Define quality in the health care setting

the extent to which a health care service or product produces a desired outcome & can be used to determine how well the health system is performing to improve the health of all Australians

With regards to errors what are Human Factors?

the science of the interrelationship between humans and: - the technology they use - the environment in which they work

The clinical workforce can make health systems safer and more effective if they do what? (4)

• understand their broad responsibility for safety and quality in health care • follow safety and quality procedures • supervise and educate other members of the workforce • participate in the review of performance procedures individually, or as part of a team