Transcript Clinical Governance in Infusion Management

Harry Basdeo
Clinical Consultant
RN RM RPN RT RCHN BTech IMM WCC
 Clinical
practice management is a area of
increasing medico legal risks.
 The patient profile is changing to
incorporate the new age techno savvy
patient who is constantly web surfing his or
her condition and treatment
 The emergence of a multi million dollar
medico – legal industry is enforcing the
implementation of core clinical skills
competency at practice level.
 Rapid migration of nurses back to public
sector due to more attractive packages
R 6 million claim
R500 000
 What
went wrong????
 How did this happen??
 Who is responsible?? Doctor/nurse
 Are the personnel adequately trained??
 Blame game
 Million dollar claims
 What is the core clinical skills competency of
staff at ground level?
 Agency vs permanent staff ongoing dilemma
who is accountable.
Scientific
foundations
Leadership
attributes
Quality
management
Clinical
practice
Ethical
attributes
Independent
practitioner
Technology
competence
Policy
competency
Financial
integration
 Core
Clinical governance dictates that risk
management reduces the chances of patients
being harmed.
 This will also reduce the risk of complaints or
litigation against the nurse /organization
 Audit is a key tool in effective clinical
governance.
 An ongoing core clinical skills competency
programme is imperative to prevent such
adverse incidents.
 Current
iv practices fall to a large extent
into the nurses domain including the act of
vein cannulation.
 Currently this process is not well defined by
the SANC Scope of Practice R2598
 This is placing an increasing burden of
litigation on the nurses performing
cannulation.
 Clinical skills competency then become
imperative for infusion management
 Identify
the key personnel who will head up
the clinical skills competency programme.
 The lead role could be rotated between team
members.
 Could be any member of the MDT
 The leader must have access to all relevant
resources to implement a core clinical skills
competency programme.
 Resource allocation to roll out an effective
clinical skills competency programme.
 The
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job description
A plan for clinical skills competency in
infusion management.
In house training on infusion management
Infusion nursing standards
Training needs assessment
Local support database
Linking with academic and clinical expertise
 Current
cannulation procedures
 Instutional policy guidelines
 Internationally recognized guidelines
 The clinicians vascular practice
 Nursing /medical personnel cannulation
practice
 Other categories of staff performing vascular
access
 Devices/ accessories /trays
 Internal
wards stats
 Infection control officers data
 Inpatient records
 Laboratory data
 Ward meetings / handover rounds
 Patient surveys
 Significant event audit
Other
14%
RTI
6%
CVC
31%
UTI
10%
PIV
7%
Unknown
27%
SSI
5%
Surveillance of hospital
acquired bacteraemia
Pa
ed
ea
tri
Ne
c
ph
ro
lo
Ha
gy
em
at
ol
og
On
co
lo
gy
Pa
ed
IC
Ge
U
ne
ra
Ca
lI
rd
CU
io
Th
.S
ur
Ca
g
rd
io
lo
gy
Ge
n.
Su
rg
Ge
ria
t ri
c
Ne
ur
ol
og
y
90%
80%
70%
CVC
PIV
60%
50%
40%
30%
20%
10%
0%
Surveillance of
hospital acquired
bacteraemia
 Once
problems have been identified
 Swot analysis on IV practices
 Team meetings
 Past practice analysis
 Future planning
 Implementing research findings
 Shared best practices
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Improvement process must be integrated –
Must be part of daily practice.
Lessons learned from failure – Implement the
“Best Practices” learned from these lessons
I.V Clinical Policies must be evidence based
– Research must be on going
Spread good practice – Forum i.e. ICU and
Neonatal/conferences. Implementation
across the spectrum in the Hospital
 Identifying
areas where increase number of
problems in iv management occurs may occur
 Implementing strategies /mechanisms to
prevent or reduce the extent of damages
 Implementing best and safest products/policies
 Risk prevention by review, maintenance and
training
 Risk acceptance to identify financial
consequences
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Increase in core clinical skills competency of staff
performing vascular access.
The team using the Clinical governance approach are
monitored and the results published
The results showed an increase in clinical skills expertise.
Lower IV infection rates
Patient and staff satisfaction.
Budget allocation for Implementation of a clinical skills
programme.
Ongoing process for the successful implementation of Core
clinical skills competency programme.
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