This article explains the second edition of the National Safety and Quality Health Service (NSQHS) Standards, which were released in November 2017 and updated in May 2021. The most recent updates to the Standards were made in response to lessons learned from the COVID-19 pandemic (ACSQHC 2021; 2022).

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, Australian states and territories, private sector, clinical experts, patients and carers.

Why?

The NSQHS Standards aim 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.

(ACSQHC 2021)

What are the Eight NSQHS Standards?

This article will provide a brief outline of each Standard.

1. Clinical Governance

‘Leaders of a health service organisation have a responsibility to the community for continuous improvement of the safety and quality of their services, and ensuring that they are person centred, safe and effective.’

(ACSQHC 2021)

Purpose: To ensure that organisations 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 (ACSQHC 2021).

What Does This Mean?

Essentially, clinical governance is in place so 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 (ACSQHC 2021).

There is ample research to link high-quality clinical governance to health service performance and outcomes (ACSQHC 2021; Bismark & Studdert 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.

(ACSQHC 2021)

2. Partnering with Consumers

‘Leaders of a health service organisation develop, implement and maintain systems to partner with consumers. These partnerships relate to the planning, design, delivery, measurement and evaluation of care. The workforce uses these systems to partner with consumers.’

(ACSQHC 2021)

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 with - rather than simply consumers of - their care. The outcomes of this are mutually beneficial to patients and providers (ACSQHC 2021).

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).

(ACSQHC 2021)

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.

(ACSQHC 2021)

3. Preventing and Controlling Infections

‘Leaders of a health service organisation develop, implement and monitor systems to prevent, manage and control infections and antimicrobial resistance; reduce harm for patients, consumers and members of the workforce; and achieve good health outcomes for patients. The workforce uses these systems to minimise and manage risks to patients and consumers.’

(ACSQHC 2021)

Purpose: To reduce the risk of patients and staff contracting preventable infections, manage infections effectively, restrict the development of microbial resistance through the correct prescribing and use of antimicrobials, and encourage the appropriate and sustainable use of infection prevention resources (ACSQHC 2021).

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 healthcare-associated infections (HAIs) make up a large percentage of all patient complications (ACSQHC 2021; NHMRC 2019).

The updated version of this Standard also acknowledges the challenges posed by novel infections that require rapid responses, such as COVID-19 (ACSQHC 2021).

This Standard contains the following criteria:

• Clinical governance and quality improvement to prevent and control infections and support antimicrobial stewardship and sustainable use of infection prevention and control resources
• Infection prevention and control systems
• Reprocessing of reusable medical devices
• Antimicrobial stewardship.

(ACSQHC 2021)

4. Medication Safety

‘Leaders of a health service organisation describe, implement and monitor systems to reduce the occurrence of medication incidents, and improve the safety and quality of medication use. The workforce uses these systems.’

(ACSQHC 2021)

Purpose: To ensure that clinicians work with appropriate medicines safely, and monitor medicine use. Additionally, to ensure that consumers are informed about medicines and have an understanding of their own medicine needs and associated risks (ACSQHC 2021).

What Does This Mean?

This Standard focuses on medication: the most common treatment used in healthcare. While medications, when used appropriately, influence a patient's health positively, they also have the potential to cause considerable harm. Up to half of medicine-related incidents are potentially preventable (ACSQHC 2021).

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 (ACSQHC 2021).

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.

(ACSQHC 2021)

5. Comprehensive Care

‘Leaders of a health service organisation set up and maintain systems and processes to support clinicians to deliver comprehensive care. They also set up and maintain systems to prevent and manage specific risks of harm to patients during the delivery of healthcare. The workforce uses the systems to deliver comprehensive care and manage risk.’

(ACSQHC 2021)

Purpose: To ensure that patients receive comprehensive healthcare that meets the requirements of their goals and needs. This care should also consider the impact that patients’ health issues will have on their life and wellbeing. This Standard requires targeted strategies to be put in place to ensure that risks to patients during healthcare are prevented and managed (ACSQHC 2021).

What Does This Mean?

This Standard identifies gaps in safety and quality within Australian healthcare as being a result of inadequate care for specific conditions, in specific settings, or for certain populations. This Standard aims to bridge those gaps with comprehensive care (ACSQHC 2021).

This 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 (ACSQHC 2021).

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.

(ACSQHC 2021)

6. Communicating for Safety

‘Leaders of a health service organisation set up and maintain systems and processes to support effective communication with patients, carers and families; between multidisciplinary teams and clinicians; and across health service organisations. The workforce uses these systems to effectively communicate to ensure safety.’

(ACSQHC 2021)

Purpose: To ensure that communication and documentation is timely, purpose-driven and effective, and that it enables continuous, coordinated and safe patient care (ACSQHC 2021).

What Does This Mean?

This Standard emphasises that the success of continuous, coordinated and safe care hinges upon communication. It 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 (ACSQHC 2021).

Health service organisations must have systems and processes in place to encourage effective communication and documentation in these high-risk scenarios (ACSQHC 2021).

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.

(ACSQHC 2021)

7. Blood Management

‘Leaders of a health service organisation describe, implement and monitor systems to ensure the safe, appropriate, efficient and effective care of patients’ own blood, as well as other blood and blood products. The workforce uses the blood product safety systems.’

(ACSQHC 2021)

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 (ACSQHC 2021).

What Does This Mean?

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 (ACSQHC 2021).

This Standard recommends specific actions to reduce these risks, such as screening blood donors and bloo, 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 (ACSQHC 2021).

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.

(ACSQHC 2021)

8. Organisational Governance

‘Leaders of a health service organisation set up and maintain systems for recognising and responding to acute deterioration. The workforce uses the recognition and response systems.’

(ACSQHC 2021)

Purpose: To ensure that acute deterioration in a patient’s physical, mental or cognitive condition is recognised immediately, and appropriate action is taken (ACSQHC 2021).

What Does This Mean?

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. It recognises that the factors contributing to the failure to see early signs happen at both an organisational and workforce level (ACSQHC 2021).

This Standard requires an organisation to design systems to detect and respond to deterioration early. These systems should be applied across the entire healthcare facility (ACSQHC 2021).

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.

(ACSQHC 2021)

References