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Summer 2018 eNews

In this issue

• Comprehensive Care Standard
• One week until the Third Atlas of Healthcare Variation
• Communicating for Safety resource portal
• Reducing inappropriate use of antipsychotics
• PICMoRS - a framework to assess safety and quality systems
• NSQHS Standards Assessor Orientation Course
• New trend analysis released on significant multi resistant organisms in Australia
• Venous Thromboembolism (VTE) Prevention Clinical Care Standard
• Working in the clinical trials sector? We want to hear from you
• Every week is Antibiotics Awareness Week
• Quick Bites - mental health, EMMS and more
• Working at the Commission

Comprehensive Care Standard

Comprehensive Care is now a specific standard in the second edition of the NSQHS Standards.

The new standard will help ensure that patients receive coordinated care in line with their clinical goals and needs and that the risk of harm is minimised. It incorporates the intent of the first edition’s Preventing Falls Standard and Preventing and Managing Pressure Injuries Standard.

The Commission has developed a number of resources to support the implementation of this new standard, including:

• Three supporting papers that aid understanding of the processes and systems that ensure the delivery of high-quality person-centred comprehensive care
• A new video with members of the Comprehensive Care Nursing and Midwifery Advisory Group explaining what person-centred care means to them
• Supporting fact sheets.

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One week until the Third Atlas of Healthcare Variation

The Third Australian Atlas of Healthcare Variation will be launched next Tuesday by the Minister for Health, The Hon. Greg Hunt.

The third Atlas identifies inequities in the way health care is currently delivered. It examines healthcare use in four clinical areas: paediatric and neonatal health; gastrointestinal investigations and treatments; thyroid investigations and treatments; and cardiac tests.

It also includes the initial findings from a repeat analysis of changes over time in the use of antipsychotics, opioids, antimicrobials and medications for attention deficit hyperactivity disorder (ADHD).

The findings of this Atlas have important implications for a number of widespread health treatments and investigations.

Look out for our Atlas announcement next Tuesday 11 December. The email will contain links to key findings and recommendations for each investigation and materials that you can use to help promote these important findings.

Previous Atlases have identified unwarranted variations in care prompting changes to the delivery of common medical procedures including knee surgery and colonoscopy.

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Communicating for Safety resource portal

To support improvements in clinical communication, the Commission has released a new Communicating for Safety resource portal​.

Communication is integral to all aspects of patient care, and is a core clinical skill that can be developed and improved with practice, experience, continuous learning, mentorship and support.

Effective communication has a significant positive influence on patient experience and satisfaction, whereas poor communication is known to contribute to teamwork failures, errors, misdiagnosis and inappropriate treatment.

The online portal provides clinicians and health service managers with an easily navigable repository of tools and guides to:

• Improve clinical communications
• Implement the NSQHS Standards (second edition).

Clinical communication is an important safety and quality issue – visit the portal to see all of our resources and tools

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PICMoRS - a framework to assess safety and quality systems

The Commission is implementing a range of strategies to improve the effectiveness and reliability of the accreditation process.  This includes describing an Assessment Framework for Safety and Quality Systems that incorporates a structured assessment method, called the PICMoRS Method.

PICMoRS is an acronym for:

• Process
• Improvement
• Consumer participation
• Monitoring
• Reporting
• Safety and quality systems

The PICMoRS Method enables assessors to review the multiple processes that make up each safety and quality system in a way that is structured and standardised.

The role of an assessor is to verify that safety and quality systems are in place by reviewing compliance with the NSQHS Standards.  By asking questions throughout the health service organisation under each of these headings, assessors can determine if the multiple processes that make up the safety and quality systems are in place, are being used and if they are effective.

Assessment using the PICMoRS Method can involve clinicians, managers, consumers and members of the governing body. Find out more on the National Standards website.

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New trend analysis released on significant multi resistant organisms in Australia

The Commission’s Australian Passive AMR Surveillance (APAS) program has released its first report on multi resistant organisms.

Set up with the support of Queensland Health, APAS currently has over 50 million AMR records from 2006 to 2018, enabling trend analysis and examination of patterns across Australia.

The report highlights concerning results for three types of significant resistances in Australia:

Methicillin resistance in Staphylococcus aureus (MRSA):

• Has risen from 8.5% in the community in 2006, to 14.6% in 2014, and 19.1% in 2017
• Is worsening in remote and very remote areas of Australia (40.6% and 40.2%, respectively, in 2017)
• Is worsening in aged care homes (increasing from 25.1% in 2006 to 36.2% in 2014 from long term APAS contributor data; and was 32.1% in 2017 for all contributing laboratories).

Fluoroquinolone non-susceptibility in Escherichia coli:

• Proportion of non-susceptibility to fluoroquinolones in E. coli has risen from 2% in 2006 to 11.8% in 2017 (despite significant restriction of fluoroquinolones in hospitals and the community)
• In 2017 the proportion of fluoroquinolone non-susceptibility in E. coli were highest in aged care homes (18.1%), followed by hospitals (12.1%), and the community (10.2%).

Vancomycin non-susceptibility in Enterococcus faecium:

• Strains are now very common across Australia, exceeding 40% of all E. faecium for all specimen types since 2010
• Principally seen in hospitals in urban settings; there is evidence that rates are decreasing nationally over the last three years, from 51% in 2015 to 42% in 2017.

The APAS first report on multi resistant organisms is available on our website.

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Venous Thromboembolism (VTE) Prevention Clinical Care Standard

Did you know that blood clots kill more Australians each year than car accidents?

The Commission’s VTE Prevention Clinical Care Standard, was launched on 11 October at the Alfred Hospital in Melbourne, to the healthcare sector.

With deaths from hospital-acquired venous-thromboembolism considered largely preventable, it offers much needed guidance on the appropriate use of blood clot prevention methods both during and after a stay in hospital.

Commission Clinical Director Amanda Walker explains why VTE prevention measures are so important and outlines some key elements from the clinical care standard in her opinion piece for the Australian Hospital & Healthcare Bulletin.

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Working in the clinical trials sector? We want to hear from you

The Commission, funded by the Australian Government Department of Health, is developing a national Clinical Trials Governance Framework – a first step towards a nationally consistent accreditation of health services undertaking clinical trials.

This framework will improve cohesion and productivity across the clinical trials sector and make Australia a preferred location for trials, giving Australian patients early access to potentially life-saving treatments.

We invite organisations or individuals working in the clinical trials sector to register their interest to participate national stakeholder consultation workshops being held across Australia from next February.

Information gathered during these consultations will inform development of the National Clinical Trials Governance Framework. Information on these workshops will be available on our website later this week.

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Every week is Antibiotics Awareness Week

The Commission was an active participant in global Antibiotics Awareness Week (AAW), held 12-18 November this year. Inappropriate use of antibiotics is a key driver of antimicrobial resistance (AMR), one of the most important risks to our health today.

AAW is a timely reminder that we need to strive year-round to ensure that antibiotics are used only when they are absolutely needed, in the most appropriate way, for the shortest period of time.

The Commission, through its stewardship of the Antimicrobial Use and Resistance in Australia (AURA) Surveillance System, leads this fight in Australia.

The results of the latest 2017 Hospital National Antimicrobial Prescribing Survey, released by the Commission to coincide with AAW 2018, found that in 2017, around one-third of prescriptions for antimicrobials in participating Australian hospitals were assessed as not compliant with treatment guidelines. Almost 1 in 4 antimicrobial prescriptions were assessed as inappropriate.

While the survey highlights instances of both good practice and poor practice within hospitals, it is clear that more work is needed. Find out more about AMR and what can be done to reduce it on our website.

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Quick Bites - mental health, EMMS and more

Communicating Risk
The Commission’s e-modules on Communicating Risk are receiving international recognition. The Winton Centre for Risk and Evidence at Cambridge University has adapted the modules for use in the UK. It’s exciting to see our work assisting clinical staff overseas.

Mental Health
1 in 5 Australians experience mental illness each year. The Commission is pleased to be working with the Department of Health on ways to support ongoing safety and quality for digital mental health services through certification and standards. Learn more about Head to Health.

National Standard Medication Chart (NSMC)
The NSMC audit closed 31 October. Thank you to all who participated. A national report on the medication chart audit is being prepared and will be available in early 2019.

Electronic Medication Management Systems
Are you keen to improve continuity in medication management? The 3rd edition of our guide on implementing Electronic Medication Management Systems draws on 5 years of implementation experience from over 20 hospitals.

Cognitive Impairment and Delirium
The Commission recently consulted on four new resources developed to help improve care of people with cognitive impairment or at risk of delirium. Thank you to all who responded.

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Careers

Working at the Commission

Meet Gillian Giles...

What did you do before working at the Commission?

I am a speech pathologist by background. I’ve also worked at both state and Commonwealth health departments in policy development and service planning. Unfortunately I no longer call on my knowledge of cranial nerves or the anatomy of the larynx, but surprisingly my ability to navigate my way around labyrinthine hospitals still comes in handy.

What do you do now?

I now work in the area of healthcare variation. Our team produces the Australian Atlas of Healthcare Variation series and works on strategies to improve the appropriateness of care.

What do you love about your work?

I love the big picture focus – we have a unique vantage point to be able to look at all levels of the health system across the country. I am also passionate about embedding the concept of equity into healthcare delivery. We strive to provide safe and high quality care, yet there are many inequities in how we currently deliver this care. My work on the Atlas series, where the socioeconomic gradient of health drives the patterns of healthcare use we map, focuses me on how much more needs to be done to ensure we are meeting the needs of our most disadvantaged communities.

What’s something that someone outside the Commission may not know about us?

Given we are a relatively small agency, I think we punch above our weight! It is a privilege to work with so many driven and passionate colleagues.

Gillian Giles, Director Healthcare Variation

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