National safety and quality health service standards

Blood and Blood Products; Preventing and Managing Pressure Injuries; Recognising and Responding to Clinical Deterioration in Acute Health Care
This is the third article by the Australian Commission on Safety and Quality in Health Care (the Commission) in a series describing the National Safety and Quality Health Service (NSQHS) Standards. In this edition Amy Winter outlines the purpose and benefits of:
Standard 7. Blood and Blood Products
Standard 8. Preventing and Managing Pressure Injuries
Standard 9. Recognising and Responding to Clinical Deterioration in Acute Health Care
Many health service organisations will already have strategies and systems in place which address these areas. The purpose of the NSQHS Standards is not to replace good systems, but to set out minimum standards for safety and quality, and provide quality assurance guidelines and improvement mechanisms to achieve them.
Each of the NSQHS Standards has been developed by the Commission in collaboration with technical experts, health service organisations and clinicians to ensure they are appropriate and relevant for clinical settings.
More information More information and resources to support implementation of the NSQHS Standards are available on the Commission’s web site at www.safetyandquality.gov.au or by contacting the Commission’s Advice Centre on 1800 304 056 or accreditation@safetyandquality.gov.au.
References
1. Van Den Bos J RK, Gray T, Halford M, Ziemkiewicz E. The $17.1 Billion Problem: The Annual Cost of Measurable Medical Errors. Health Affairs 2011;30(4):596-603.
2. Graves N BF, Whitby M,. Modelling the economic losses from pressure ulcers among hospitalised patients in Australia. Wound Repair and Regeneration 2005;13(5):462-467.
Standard 7
Blood and Blood Products
Blood and blood products are a vital resource. Blood and blood products administered in Australia are sourced from the national and international donors and from commercial manufacture. While the use of blood and blood products can be lifesaving, there are also risks associated with their administration.
The intention of Standard 7: Blood and Blood Products is to ensure that blood and blood products are administered to patients safely and appropriately. It also aims to ensure that patients (and carers) are engaged in decisions about their management and the use of blood and blood products.
The scope of Standard 7 covers all elements in the clinical transfusion process and covers fresh blood components, plasma-derivatives and recombinant products. It also covers principles of patient management including avoiding unnecessary exposure to blood components and consideration of non-blood treatments.
Standard 7 sets out a framework for health services to review current practice, assess risks, identify opportunities for improvement, implement practice improvements and measure the results. This may be in the form of a comprehensive Transfusion Quality Improvement System or, for small health services, be part of broader quality improvement initiatives.
To meet the requirements of Standard 7, health service organisations must be able to demonstrate that:

• Systems are in place for safe and appropriate prescribing and clinical use of blood and blood products


• The clinical workforce accurately records a patient’s blood and blood product transfusion history and indications for use of blood and blood products


• Systems are in place to receive, store, transport and monitor wastage of blood and blood products safely and efficiently, and


• Patients and carers are informed about risks, benefits and alternative options for the use of blood and blood products when a plan for treatment is developed.

For more information about Standard 7: Blood and Blood Products visit www.blood.gov.au/national-standard
Standard 8
Preventing and Managing Pressure Injuries
Pressure injuries are a major source of harm to patients within the health system.^1-2 In the majority of cases, pressure injuries are preventable.
Immobility, such as that associated with extended bed rest in hospital, is the most common cause for the development of a pressure injury. Other factors which put patients at higher risk include suboptimal nutritional status, decreased skin integrity, and decreased blood flow to pressure points. A pressure injury can commence in any setting, including acute areas, and while more common in older patients, pressure injuries can occur in children or adults of any age.
The intention of Standard 8: Preventing and Managing Pressure Injuries is to prevent patients from developing avoidable pressure injuries and to ensure effective management of pressure injuries when they do occur.
Standard 8 sets out a framework for the development of systems and processes to ensure clinicians and other members of the workforce use the appropriate pressure injury prevention and management strategies. This involves the development of an organisation-wide approach where the use of standardised risk assessment tools is embedded into usual practice. When pressure injuries are identified, appropriate resources are required to ensure they are managed according to best practice guidelines. Robust audit and data collection systems should be developed to evaluate the effectiveness of current strategies and identify areas where improvements can be made.
To meet the requirements of Standard 8, health service organisations must be able to demonstrate that:

• Governance structures and systems are in place for the prevention and management of pressure injuries


• Patients are screened on presentation and pressure injury prevention strategies are implemented when clinically indicated


• Patients who have pressure injuries are managed according to best practice guidelines


• Patients and carers are informed of risks, prevention strategies and management of pressure injuries.

For more information about Standard 8: Preventing and Managing Pressure Injuries visit www.safetyandquality.gov.au/our-work/accreditation/
Standard 9
Recognising and Responding to Clinical Deterioration in Acute Health Care
Ensuring that patients who deteriorate receive appropriate and timely care is a key safety and quality challenge. Failing to effectively recognise and respond to clinical deterioration leaves patients at increased risk of experiencing preventable adverse events.
The intention of Standard 9: Recognising and Responding to Clinical Deterioration is to ensure deterioration is recognised promptly, and appropriate action is taken. It builds on the National Consensus Statement: Essential Elements for Recognising and Responding to Clinical Deterioration (the consensus statement) to drive implementation in acute health service organisations.
Standard 9 sets out a framework for health services to establish and maintain systems for recognising and responding to clinical deterioration. Standard 9 applies to all patients in acute healthcare services including adults, adolescents, children and babies, and to all types of patients including medical, surgical, maternity and mental health patients. Acute healthcare services include large tertiary referral centres through to small district and community hospitals. Standard 9 does not apply to deterioration of a patient’s mental state.
To meet the requirements of Standard 9, health service organisations must be able to demonstrate that:

• Organisation-wide systems are consistent with the consensus statement and support and promote recognition of, and response to, patients whose condition is deteriorating


• Patients whose condition is deteriorating are recognised and appropriate action is taken to escalate care


• Appropriate and timely care is provided to patients whose condition is deteriorating


• The effectiveness of recognition and response systems is monitored and evaluated, and


• Patients, families and carers are informed of recognition and response systems and can contribute to the process of escalating care.

For more information on Standard 9 and the consensus statement, visit www.safetyandquality.gov.au/our-work/recognition-and-response-to-clinical-deterioration