BackgroundBackground Current situationCurrent situation Work of the Professional bodiesWork of the Professional bodies Proposed frameworkProposed framework SummarySummary
Definition: "A framework through which NHS organisations are accountable for continually improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish."
Quality What the public would regard as a good thingWhat the public would regard as a good thing Quality ControlQuality Control Major supermarket chain on suppliers eg. ConsistentConsistent –Size –Weight –Ripeness CAA on aircraft safety eg. Regular verifiable maintenanceRegular verifiable maintenance Pilot trainingPilot training Why not HealthcareWhy not Healthcare
Quality Need to define what is importantNeed to define what is important Ripeness Clinical care Abstract concept without means of assessingAbstract concept without means of assessing Need to define scaleNeed to define scale Need to define what is acceptable levelNeed to define what is acceptable levelSTANDARDS!
Standards User/Client/Patient ExpectationsUser/Client/Patient Expectations Peer Group ViewPeer Group View College Guidelines Other interested partiesOther interested parties Ophthalmologists GPs Government PCTs?
Standards DoH EnglandDoH England Decided to set ground rules Provided basic structure under which CG could develop Original Approach Standards definedStandards defined Standards grouped into broad areasStandards grouped into broad areas So called “ 7-pillars ”So called “ 7-pillars ”
Seven Pillars Clinical Risk ManagementClinical Risk Management Clinical Audit and EffectivenessClinical Audit and Effectiveness Education, Training & CPDEducation, Training & CPD The Patient ExperienceThe Patient Experience Research & DevelopmentResearch & Development Staffing and Staff ManagementStaffing and Staff Management Using InformationUsing Information
Standards for Better Health Published by DoH in 2004 following public consultationPublished by DoH in 2004 following public consultation Applicable to ALL healthcare organisations providing NHS care from 2005Applicable to ALL healthcare organisations providing NHS care from 2005 Includes optometric practices Sets level of quality expected to be met across the NHS in EnglandSets level of quality expected to be met across the NHS in England Defines CG scope and structureDefines CG scope and structure (Currently)
Standards for Better Health A standards driven systemA standards driven system Seven “Domains”Seven “Domains” Designed to cover the full spectrum of health care Encompass all facets of health care Described in terms of outcomes Core StandardsCore Standards –Meeting the core standards “not optional” –Health care organisations must comply Developmental StandardsDevelopmental Standards –Aspirational - to meet increasing patients expectations –Broad and comprehensive
Seven Domains SafetySafety Clinical and Cost EffectivenessClinical and Cost Effectiveness GovernanceGovernance Patient FocusPatient Focus Accessible and Responsive CareAccessible and Responsive Care Care Environment and AmenitiesCare Environment and Amenities Public HealthPublic Health
Domain 1 – Safety Domain Outcome “Patient safety is enhanced by the use of health care processes, working practices and systemic activities that prevent or reduce the risk of harm to patients.”
Initial Reactions ConfusionConfusion Difficulty comprehendingDifficulty comprehending Difficulty seeing relevanceDifficulty seeing relevance “Not sure what to do”“Not sure what to do” “Seems very complicated”“Seems very complicated” “Why should we bother”“Why should we bother”
Domain 1 – Core Standards C1C1 Health care organisations protect patients through systems that: a) identify and learn from all patient safety incidents and other reportable incidents, and make improvements in practice based on local and national experience and information derived from the analysis of incidents; and b) ensure that patient safety notices, alerts and other communications concerning patient safety which require action are acted upon within required time-scales. Relevance to OptometryRelevance to Optometry PCTs should include optical practices in Adverse Critical Incident reporting procedures. Practices should record adverse incidents which occur within the practice. Practices should feed back to their staff. Practices may wish to assess their practice for risks C1bC1b PCTs maintain a Safety Alert Broadcast System (SABS). PCTs should ensure that optical practices are included in the circulation of patient safety notices, alerts and related communications and that they are aware of how to acknowledge them
Domain 1 – Core Standards C2C2 Health care organisations protect children by following national child protection guidance within their own activities and in their dealings with other organisations Relevance to OptometryRelevance to Optometry Optical practices should have a chaperone policy. A model policy is available at: www.aop.org.uk/uploaded_files/chaperoning_policy.pdf Further information is included in the College Guidelines, particularly the section on dealing with Children and Vulnerable Adults – available from the College: www.college-optometrists.org PCTs should ensure optical practices know where to report concerns about children. Practitioners should take advice before reporting any concerns and keep careful records of their actions and observations.
Domain 1 – Core Standards C3C3 Health care organisations protect patients by following NICE Interventional Procedures guidance Relevance to OptometryRelevance to Optometry This is the responsibility of any organisation to which NICE Procedures relate. Primarily this will be larger NHS organisations such as PCTs and Hospital Trusts NICE guidance awareness eg. PDT and Laser refractive Surgery
Domain 1 – Core Standards C4C4 Health care organisations keep patients, staff and visitors safe by having systems to ensure that: a) the risk of health care acquired infection to patients is reduced, with particular emphasis on high standards of hygiene and cleanliness, achieving year-on-year reductions in MRSA Relevance to OptometryRelevance to Optometry This principally applies to hospitals, but practitioners may have patients attend with known or unknown cases of MRSA. The College has advice on infection control: www.college-optometrists.org/objects_store/infection.pdf The Royal College of Nursing also has a wealth of information on MRSA and infection control in general A key to infection control is effective handwashing Where frequent handwashing is impractical or undesirable alcohol- based disinfectant hand gel is an acceptable alternative
Domain 1 – Core Standards C4C4 Health care organisations keep patients, staff and visitors safe by having systems to ensure that: b) all risks associated with the acquisition and use of medical devices are minimised Relevance to OptometryRelevance to Optometry It is good practice to wipe down instrument chin and headrests and trial frames. Alcohol or Chlorhexidine based disposable wipes are useful for this Dispensing (including contact lenses) should only be done by competent persons bearing in mind the restrictions on certain groups of patients (who should only be dispensed by a registered practitioner)
Domain 1 – Core Standards C4C4 Health care organisations keep patients, staff and visitors safe by having systems to ensure that: c) all reusable medical devices are properly decontaminated prior to use and that the risks associated with decontamination facilities and processes are well managed Relevance to OptometryRelevance to Optometry Main hazard of concern to optometry is vCJD as it requires the most stringent decontamination procedures; however risks are also posed by a variety of bacterial and viral contaminants. Procedures should be in place to ensure that cross- contamination does not occur or single devices used Advice is available from the College covering disinfection procedures and when single use devices are appropriate www.college-optometrists.org/objects_store/cjd.pdf
Developmental Standards D1D1 Health care organisations continuously and systematically review and improve all aspects of their activities that directly affect patient safety and apply best practice in assessing and managing risks to patients, staff and others, particularly when patients move from the care of one organisation to another.
Impact on Optometry Why does clinical governance;Why does clinical governance; Cause conflicts in some areas? Result in complaints and enquiries to both the AOP and the College? Underlying tensionsUnderlying tensions PCTs required to engage in CG with and collect information from: All contractorsAll contractors Performance monitored by Healthcare Commission BUT GOS terms of service impose no requirement for clinical governance on optometry No fundingNo funding
Impact on Optometry PCTs can make CG reporting a condition in shared care schemesPCTs can make CG reporting a condition in shared care schemes Fees paid should reflect this Many PCTs engaged with “ light touch ” in conjunction with their LOCMany PCTs engaged with “ light touch ” in conjunction with their LOC 2-way benefits perceived Practices often co-operate for little or no fee Other PCTs have paid for particular aspects of clinical governance such as audit or attendance at meetingsOther PCTs have paid for particular aspects of clinical governance such as audit or attendance at meetings Problem is areas where CG level is imposed sometimes with veiled threats and with no financial recompenseProblem is areas where CG level is imposed sometimes with veiled threats and with no financial recompense
Clinical Governance CG encompasses different areasCG encompasses different areas Health and Safety Practice management Clinical practice Many aspects of CG are happening already;Many aspects of CG are happening already; Legal requirements eg. Terms of ServiceTerms of Service Employment lawEmployment law Data protection lawData protection law Good clinical practice eg. Rx checking before issueRx checking before issue Device decontaminationDevice decontamination Doing it anyway!Doing it anyway!
Professional Organisations Position:Position: Optometrists are doing CG If PCTs want information for HCC reporting it should be purchased Optical bodies are working jointly on a model clinical governance frameworkOptical bodies are working jointly on a model clinical governance framework Not onerous Useful and relevant to optometry Recognisable to PCTs and “ ticks right boxes ” Part of negotiations during the GOS reviewPart of negotiations during the GOS review
Clinical Governance Standards for Better Health – Workbook Level 1 – Legal or mandatory requirement StandardQuestionYesNo Don’t Know Action Plan Reference Level C4b) Does the practice have glazing facilities? If No click Here Here 1 C4b) If yes: C4b) Have you completed an RG2 document and submitted it to the MHRA? If No or Don’t Know go to Action Point 1 Action Point 1 Action Point 1 C4b) Do you display a certificate of conformity? If No or Don’t Know go to Action Point 1 Action Point 1 Action Point 1 C4e) Do you dispose of POMs by incineration? If Yes click Here Here If No or Don’t Know go to Action Point 2 Action Point 2 Action Point 2 1 C4e) Do you have a waste contract with your local authority or landlord? If Yes click Here Here If No or Don’t Know go to Action Point 3 Action Point 3 Action Point 3 1 C4e) Does the practice undertake any blood tests? If No click Here Here 1 C4e) If yes: C4e) Are sharps and contaminated products disposed of using a sharps and clinical waste collection service? If Yes click Here Here If No or Don’t Know go to Action Point 4 Action Point 4 Action Point 4
Key Messages CG is a good thingCG is a good thing If you comply with the Terms of Service and law you are doing it alreadyIf you comply with the Terms of Service and law you are doing it already No requirement to disclose CG activitiesNo requirement to disclose CG activities Information is your propertyInformation is your property Collecting, collating and passing on information time consumingCollecting, collating and passing on information time consuming Providing information to assist PCTs in meeting Quality targets requires funding.Providing information to assist PCTs in meeting Quality targets requires funding.