National Safety and Quality Health Service Standards (NSQHSS) Explained

‘Safe and high-quality care requires vigilance and the cooperation of the whole healthcare workforce’

(Australian Commission on Safety and Quality in Health Care 2017a, pp.2)

This article explains the second edition of the NSQHS Standards, which were released in November 2017. The second edition was made in response to gaps identified in the first edition (Australian Commission on Safety and Quality in Health Care 2017b).

What?

The National Safety and Quality Health Service Standards (NSQHS).

Who?

Developed by the Australian Commission on Safety and Quality in Health Care alongside the Australian Government, states and territories, the private sector, clinical experts, patients and carers.

Why?

The NSQHS aims to protect the public from harm and to improve the quality of health service provision.

How?

The NSQHS Standards act as quality indicators to ensure the safety and quality of Australian healthcare services (Australian Commission on Safety and Quality in Health Care 2018).

There are now eight standards (previously 10).

The Eight NSQHS Standards are:

• Clinical Governance
• Partnering with Consumers
• Preventing and Controlling Healthcare-Associated Infection
• Medication Safety
• Comprehensive Care
• Communicating for Safety
• Blood Management
• Recognising and Responding to Acute Deterioration

1. Clinical Governance

Health service organisations ‘have a responsibility to the community’ for the continuous refinement of the safety and quality of their services. ‘Services must be person-centred, safe and effective’ (Australian Commission on Safety and Quality in Health Care 2017, pp. 4).

Purpose: To ensure that organisations to put into effect a clinical governance framework. This is to ensure that there are systems set up within health service organisations to guarantee that patients and consumers experience safe and high-quality care.

What Does This Mean?

Essentially, clinical governance is in place so that the community can be certain that systems exist to provide safe and effective healthcare, and that these systems are not set in stone, but are continuously improved upon by the organisation.

There is ample research to link high-quality clinical governance to health service performance and outcomes (Australian Commission on Safety and Quality in Health Care 2017; Bismark et al. 2014).

This standard contains the following criteria:

Governance, leadership and culture
• Patient safety and quality systems
• Clinical performance and effectiveness
• Safe environment for the delivery of care

(Australian Commission on Safety and Quality in Health Care 2017)

2. Partnering with Consumers

Health service organisations create and maintain systems to ‘partner with consumers’. These partnerships relate to all aspects of care including the planning, design, delivery, measurement and evaluation stages. ‘The workforce actively uses these systems to partner with consumers’ (Australian Commission on Safety and Quality in Health Care 2017, pp. 14).

Purpose: To reinforce the necessity for patients to be partners in every step of the provision of healthcare systems and services. Patients are provided with the opportunity to be partners, rather than simply consumers, of their care. The outcomes of this are mutually beneficial to patients and providers.

What Does This Mean?

This standard places emphasis on the importance of partnership between providers of care and consumers of care. Dignity respect, information sharing and collaboration are key to cementing meaningful partnerships.

Partnerships are needed at three main stages:

1. With the individual (between healthcare staff and patients).
2. With the service, department or program of care.
3. With the health service (consumers are involved in all aspects of care provision).

(Australian Commission on Safety and Quality 2017; IPFCC 2008)

This standard contains the following criteria:

• Clinical governance and quality improvement systems to support partnering with consumers
• Partnering with patients in their own care
• Health literacy
• Partnering with consumers in organisational design and governance

(Australian Commission on Safety and Quality in Health Care 2017)

3. Preventing and Controlling Healthcare-Associated Infection

‘Health service organisations describe, implement and monitor systems that prevent, manage and control healthcare-associated infections and antimicrobial resistance’. This is done with the aim of reducing harm and achieving positive health outcomes for patients. ‘The workforce actively uses these systems’ (Australian Commission on Safety and Quality in Health Care 2017, pp.22).

Purpose: To reduce the risk of patients contracting preventable healthcare-associated infections (HAIs), manage infections effectively, and restrict the development of microbial resistance through the correct prescribing and use of antimicrobials.

What Does This Mean?

In essence, this standard recognises that within Australian healthcare settings, there is a great chance for the spread of infectious agents due to patients being treated in close quarters. It also recognises that HAIs make up a large percentage of all patient complications (Australian Commission on Safety and Quality 2017; Mitchell 2017).

This standard requires an organisation to create standards and transmission-based precautions in healthcare settings, to limit the development of resistant organisms and reduce risk of transmission.

This standard contains the following criteria:

• Clinical governance and quality improvement to prevent and control healthcare-associated infections and support antimicrobial stewardship
• Infection prevention and control systems
• Reprocessing of reusable medical devices
• Antimicrobial stewardship

(Australian Commission on Safety and Quality in Health Care 2017)

4. Medication Safety

‘Health service organisations describe, implement and monitor systems to limit the occurrence of medication-related incidents’. The safety and quality of medication use is to be improved overall. ‘The workforce actively uses these systems’ (Australian Commission on Safety and Quality in Health Care 2017, pp.30).

Purpose: To ensure that clinicians work with appropriate medicines safely, and monitor medicine use. Additionally, it aims to ensure that consumers are informed about medicines and have an understanding of their own medicine needs and associated risks.

What Does This Mean?

This standard focuses on medication: the most common treatment used in healthcare. While medications when used appropriately influence a patient health positively, they have the potential to cause considerable harm (Australian Commission on Safety and Quality 2017; Roughead et al. 2013).

This standard aims to reinforce the correct use of medications, as medications errors create negative health outcomes for consumers and cause greater costs to healthcare. It asserts that medication safety can be improved through standardising and systemising processes.

This standard contains the following criteria:

• Clinical governance and quality improvement to support medication management
• Documentation of patient information
• Continuity of medication management
• Medication management processes

(Australian Commission on Safety and Quality in Health Care 2017)

5. Comprehensive Care

‘Health service organisations set up and maintain systems and processes to support clinicians to provide comprehensive care’. Additionally, they set up and maintain systems to prevent and manage specific risks of harm to patients during the provision of care. ‘The workforce actively uses the systems to provide comprehensive care and handle risk’ (Australian Commission on Safety and Quality in Health Care 2017, pp.38).

Purpose: To ensure that patients receive comprehensive healthcare that meets the requirements of their goals and needs, this care should also consider the impact their health issues will have on their life and wellbeing. This standard also requires targeted strategies to be put in place to ensure that risks to patients during healthcare are prevented and managed.

What Does This Mean?

This standard identifies gaps in safety and quality within Australian healthcare as being a result of the lack of adequate care for specific conditions, or in specific settings, or for certain populations. This standard aims to bridge those gaps with comprehensive care.

The care must be continuous and collaborative, based on a partnership ideology, communicated effectively and carried out as a team. This approach should be flexible to account for local implementation.

This standard contains the following criteria:

• Clinical governance and quality improvement to support comprehensive care
• Developing a comprehensive care plan
• Delivering comprehensive care
• Minimising patient harm

(Australian Commission on Safety and Quality in Health Care 2017)

6. Communicating for Safety

‘Health service organisations set up and maintain systems and processes to support effective communication’ with and between consumers and healthcare staff. This includes patients, carers and families, multidisciplinary teams and clinicians, and across health service organisations. ‘The workforce actively uses these systems to effectively communicate to ensure safety’ (Australian Commission on Safety and Quality in Health Care 2017, pp.48).

Purpose: To ensure timely, purpose-driven and effective communication and documentation that allows for continuous, coordinated and safe care for patients.

What Does This Mean?

Alternative text: This standard emphasises the point that the success of continuous, coordinated and safe care hinges upon communication. This standard highlights the need for effective communication in high-risk scenarios such as clinical handover, and any situation in which a patient’s identity is unclear.

Health service organisations must have systems and processes in place to encourage effective communication and documentation in these high-risk scenarios.

This standard contains the following criteria:

• Clinical governance and quality improvement to support effective communication
• Correct identification and procedure matching
• Communication at clinical handover
• Communication of critical information
• Documentation of information

(Australian Commission on Safety and Quality in Health Care 2017)

7. Blood Management

‘Health service organisations describe, implement and monitor systems to ensure the safe, correct, efficient and effective care of patients’ own blood’. This includes blood and blood products. ‘The workforce actively uses blood product safety systems’ (Australian Commission on Safety and Quality in Health Care 2017, pp.56).

Purpose: To ensure that a patient’s blood is optimised and conserved, and safely and properly managed. It also ensures that any blood and blood products provided to patients are safe and appropriate.

What Does This Mean?

Alternative text: This standard recognises the role that blood and blood products play in improving the health of patients, but flags the potential risks associated with blood and other biological materials.

This standard recommends specific actions to reduce these risks such as, screening blood donors and blood, and carefully weighing the risks of treatment options before transfusing. It is also required for an organisation to have safe and efficient blood management systems in place.

This standard contains the following criteria:

• Clinical governance and quality improvement to support blood management
• Prescribing and clinical use of blood and blood products
• Managing the availability and safety of blood and blood products

(Australian Commission on Safety and Quality in Health Care 2017)

8. Recognising and Responding to Acute Deterioration

‘Health service organisations set up and maintain systems for recognising and responding effectively and promptly to acute deterioration’ (changes to physiology nature, mental or cognitive state). ‘The workforce actively uses recognition and response systems’ (Australian Commission on Safety and Quality in Health Care 2017, pp.62).

Purpose: To ensure that acute deterioration in a patient’s physical, mental or cognitive condition is recognised immediately, and appropriate action is taken.

What Does This Mean?

Alternative text: This standard aims to curb the prevalence of unexpected death and cardiac arrest that could have been avoided had physiological and clinical differences been observed at an earlier stage. The standard recognises that the factors contributing to the failure to see early signs happen at both an organisational and workforce level (Australian Commission on Safety and Quality 2017; Buist et al. 2004).

This standard requires an organisation to design systems to detect and respond to deterioration early and that these systems are applied across the entire healthcare facility.

This standard contains the following criteria:

• Clinical governance and quality improvement to support recognition and response systems
• Detecting and recognising acute deterioration and escalating care
• Responding to acute deterioration

(Australian Commission on Safety and Quality in Health Care 2017)

Additional Resources

• National Safety and Quality Health Service Standards, 2nd ed, https://www.safetyandquality.gov.au/sites/default/files/2019-04/National-Safety-and-Quality-Health-Service-Standards-second-edition.pdf

References

• Australian Commission on Safety and Quality in Health Care 2017a, National Safety and Quality Health Service Standards, 2nd ed, ACSQHC, Sydney, viewed 15 October 2019, https://www.safetyandquality.gov.au/sites/default/files/2019-04/National-Safety-and-Quality-Health-Service-Standards-second-edition.pdf
• Australian Commission on Safety and Quality in Health Care 2017b, National Safety and Quality Health Service Standards Second Edition Overview, ACSQHC, Sydney, viewed 15 October 2019, https://www.safetyandquality.gov.au/sites/default/files/migrated/Overview-of-the-NSQHS-Standards-second-edition.pdf
• Australian Commission on Safety And Quality In Health Care 2018, Consumer Fact Sheet 1: Introduction To The National Safety and Quality Health Service (Nsqhs) Standards (Second Edition), ACSQHC, Sydney, viewed 15 October 2019, https://www.calvarycare.org.au/rehabilitation-private-hospital-adelaide/wp-content/uploads/sites/10/2018/06/fact-sheet-1-intro-to-the-national-safety-and-quality-in-health-service-standards-2nd-ed.pdf
• Australian Commission on Safety and Quality in Health Care 2019, National Safety and Quality Health Service Standards Roles and Responsibilities of Governing Bodies, ACSQHC, Sydney, viewed 15 October 2019, https://www.safetyandquality.gov.au/sites/default/files/2019-09/nsqhs_standards_roles_and_responsibilities_for_governing_bodies_sep_19.pdf
• Bismark MM and Studdert DM 2014, ‘Governance of Quality of Care: a Qualitative Study of Health Service Boards in Victoria, Australia’, BMJ Qual Saf., 23(6), pp.474–82https://qualitysafety.bmj.com/content/...
• Buist M, Bernard S, Nguyen TV, Moore G, Anderson J 2004, ‘Association Between Clinical Abnormal Observations and Subsequent In-hospital Mortality: a Prospective Study’, Resuscitation, 62(2):137–41 https://doi.org/10.1016/j.resuscitation
• Institute for Patient- and Family-Centered Care (US) 2008, 'Advancing the Practice of Patient-and Family-centered Care in Primary Care and Other Ambulatory Settings: How to Get Started', IPFCC, Bethesda (MD) https://www.ipfcc.org/resources/GettingStarted-AmbulatoryCare
• Mitchell BG, Shaban RZ, MacBeth D, Wood CJ, Russo PL 2017, ‘The Burden of Healthcare-associated Infection in Australian Hospitals: A Systematic Review of the Literature’, Infect Dis Health, 22(3):117–28 https://www.idhjournal.com.au/article/...
• Roughead EE, Semple SJ, Rosenfeld E 2013, ‘Literature Review: Medication Safety in Australia’, Australian Commission on Safety and Quality in Health Care, Sydney https://www.safetyandquality.gov.au/sites/.../Literature-Review-Medication-Safety-in-Australia