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Clinical GovernanceNational Optometric Conference 2006 Geoff Roberson Optometric Adviser, Association of Optometrists
Clinical Governance • Background • Current situation • Work of the Professional bodies • Proposed framework • Summary
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 thing • Quality Control • Major supermarket chain on suppliers eg. • Consistent • Size • Weight • Ripeness • CAA on aircraft safety eg. • Regular verifiable maintenance • Pilot training • Why not Healthcare
Quality • Need to define what is important • Ripeness • Clinical care • Abstract concept without means of assessing • Need to define scale • Need to define what is acceptable level STANDARDS!
Standards • User/Client/Patient Expectations • Peer Group View • College Guidelines • Other interested parties • Ophthalmologists • GPs • Government • PCTs?
Standards • DoH England • Decided to set ground rules • Provided basic structure under which CG could develop • Original Approach • Standards defined • Standards grouped into broad areas • So called “7-pillars”
Seven Pillars • Clinical Risk Management • Clinical Audit and Effectiveness • Education, Training & CPD • The Patient Experience • Research & Development • Staffing and Staff Management • Using Information
Standards for Better Health • Published by DoH in 2004 following public consultation • Applicable to ALL healthcare organisations providing NHS care from 2005 • Includes optometric practices • Sets level of quality expected to be met across the NHS in England • Defines CG scope and structure (Currently)
Standards for Better Health • A standards driven system • Seven “Domains” • Designed to cover the full spectrum of health care • Encompass all facets of health care • Described in terms of outcomes • Core Standards • Meeting the core standards “not optional” • Health care organisations must comply • Developmental Standards • Aspirational - to meet increasing patients expectations • Broad and comprehensive
Seven Domains • Safety • Clinical and Cost Effectiveness • Governance • Patient Focus • Accessible and Responsive Care • Care Environment and Amenities • Public 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 • Confusion • Difficulty comprehending • Difficulty seeing relevance • “Not sure what to do” • “Seems very complicated” • “Why should we bother”
Domain 1 – Core Standards • C1 • 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 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 • C1b • 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 • C2 • Health care organisations protect children by following national child protection guidance within their own activities and in their dealings with other organisations • Relevance 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 – CoreStandards • C3 • Health care organisations protect patients by following NICE Interventional Procedures guidance • Relevance 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 • C4 • 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 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 – CoreStandards • C4 • 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 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 – CoreStandards • C4 • 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 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 • D1 • 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; • Cause conflicts in some areas? • Result in complaints and enquiries to both the AOP and the College? • Underlying tensions • PCTs required to engage in CG with and collect information from: • All contractors • Performance monitored by Healthcare Commission BUT • GOS terms of service impose no requirement for clinical governance on optometry • No funding
Impact on Optometry • PCTs 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 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 meetings • Problem is areas where CG level is imposed sometimes with veiled threats and with no financial recompense
Clinical Governance • CG encompasses different areas • Health and Safety • Practice management • Clinical practice • Many aspects of CG are happening already; • Legal requirements eg. • Terms of Service • Employment law • Data protection law • Good clinical practice eg. • Rx checking before issue • Device decontamination • Doing it anyway!
Professional Organisations • 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 framework • Not onerous • Useful and relevant to optometry • Recognisable to PCTs and “ticks right boxes” • Part of negotiations during the GOS review
Clinical Governance Standards for Better Health – Workbook Level 1 – Legal or mandatory requirement
Key Messages • CG is a good thing • If you comply with the Terms of Service and law you are doing it already • No requirement to disclose CG activities • Information is your property • Collecting, collating and passing on information time consuming • Providing information to assist PCTs in meeting Quality targets requires funding.