Transcript Slide 1

Clinical Governance
National Optometric Conference 2006
Geoff Roberson
Optometric Adviser, Association of Optometrists
Clinical Governance
Clinical Governance
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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
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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
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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
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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
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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
• C2
Domain 1 – Core
Standards
 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 – Core
Standards
• 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
• C4
Domain 1 – Core
Standards
 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 alcoholbased disinfectant hand gel is an acceptable alternative
Domain 1 – Core
Standards
• 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 – Core
Standards
• 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 crosscontamination 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
Quality
in
Optometry
A framework
for clinical governance
in optometric practice
Clinical Governance
Standards for Better Health
First Domain – 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.
Core Standards
C1
Health care organisations
protect patients through
systems that;
C1a)
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
Relevance to Optometry
Questions
PCTs should include optical practices in Adverse
Critical Incident reporting procedures.
Does the PCT include the practice in
critical incident reporting structures?
Practices should record adverse incidents which
occur within the practice.
Does the practice record adverse
incidents?
If yes:
Does the practice feedback to
the staff?
Practices should feed back to their staff.
Practices may wish to assess their practice for risks
C1b)
ensure that patient safety
notices, alerts and other
communications concerning
PCTs maintain a Safety Alert Broadcast System
(SABS). PCTs should ensure that optical practices
are included in the circulation of patient safety
Does the practice assess risks
from this process?
Does the PCT include the practice in
the circulation of safety alerts?
If yes:
Standard
C4b)
Questions relating to core standards
Yes
Does the practice have glazing facilities?
No
Don’t
Know
Level
1
C4b)
If yes:
C4b)
Have you completed an RG2 document and submitted it to the
MHRA?
C4b)
Do you display a certificate of conformity?
C4e)
Do you dispose of POMs by incineration?
1
C4e)
Do you have a waste contract with your local authority or
landlord?
1
C4e)
Does the practice undertake any blood tests?
1
C4e)
If yes:
C4e)
Are sharps and contaminated products disposed of using a
sharps and clinical waste collection service?
C5b)
Is a supervising optometrist available at all times when the
practice is open?
C5b)
If no:
C5b)
Are systems in place to ensure that patients are not seen
inappropriately?
1
Clinical Governance
Standards for Better Health – Workbook
Level 1 – Legal or mandatory requirement
Standard
C4b)
Question
Yes
Does the practice have glazing facilities?
No
Don’t
Know
Action Plan Reference
Level
If No click 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
C4b)
Do you display a certificate of
conformity?
If No or Don’t Know go to
Action Point 1
C4e)
Do you dispose of POMs by incineration?
If Yes click Here
If No or Don’t Know go to
Action Point 2
1
C4e)
Do you have a waste contract with your
local authority or landlord?
If Yes click Here
If No or Don’t Know go to
Action Point 3
1
C4e)
Does the practice undertake any blood
tests?
If No click 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
If No or Don’t Know go to
Action Point 4
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.