The desire for quality services by theconsumers is considered all throughout the world as an essential component ofany services.
As such, targeting for high-quality service is easier said thandone as the healthcare service is an incorporeal object that cannot be measuredsuch as manufactured products. However quality healthcare is defined as providingefficacious, effective and efficient healthcare services according to thelatest clinical guidelines and standards, which meet the patient’s needs andsatisfies providers (Mosadeghrad 2013). Focusing on the term “standards”, theAustralian Commission on Safety and Quality in Health Care had built theirstandards in aiming to ensure that the standards of safety and quality are metall throughout the states and territories covered by the country. This paperwill explain the rationale for development of the standards, specifically thefollowing: Clinical Governance; Partnering with Consumers; Preventing andControlling Healthcare-Associated Infection; Medication Safety, and Recognisingand Responding to Acute Deterioration as well as what it strives to achieve inrelation to the delivery of patient care. As noted in the 2nd edition of the NationalSafety and Quality Health Service Standards, the Clinical governance standardintends to implement its National Model Clinical Governance Frameworkwhich emphasises on its criteria of governance, leadership andculture, safety and quality systems integrated with governance process,performance management, and promoting a safe environment. This ensures that allmembers have accountability to the patients and the community for assuring thereliability, safety, and quality of health care, and improving health outcomesfor patients. In relation to this standard, the role of every nurse is notsolely focused on being a care provider but also one that possess leadershipand these require detecting issues, propose potential solutions, regular clientfeedback, and being involved in the decision-making process inthe individualised care plan where the decisions are made toinfluence patient outcomes and ensuring accountability.In connection to the first standard whichmentioned the involvement of members such as the nurses in the decision-makingtable, the standard of Partnering with Consumers intends to establish anorganisation in which there are mutually valuable outcomes by implementingshared decision-making with the patients in their own plan of care and consumerinvolvement in the policy, health research, and clinical service governance.
The partnership with the patients and consumers have multiple and diversepractices that reflect the three key partnership at the level of theindividual, of a service/department/or program of care, and of the healthservice. The delivery of care is based on these effective partnerships lead toa positive outcome for the not only for the patient but also for the members ofthe organisation and the health system because patient-reported outcome andexperience measures enable services and policy-makers to easily and effectivelycapture and understand consumer’s experiences of services. This, in turn, canresult in the reduction of costs made by the hospital and shortened length ofstay of the patients. Tobiano (2016), Bucknall (2016), Marshall (2016),Guinane (2016), and Chaboyer (2016) all stated that having nurses engagepatients in a patient-centred way, inclusive of building a relationship andsharing knowledge, is essential to attaining patient participation, which makesnurses an influential part on their participation and in meeting this standard.
With the announcement of the arrival of thepost-antibiotic era by the CDC’s Antibiotic Strategy & Coordination Unit,Healthcare associated infection or HAI is an ever-present, complex, and variedfactor in every health care system. Approximately 165,000 HAIs occur eachyear in Australia and with the ever growing need for improved national healthcare-associated infection surveillance program in Australia, the presence ofthe standard of Preventing and Controlling Healthcare-Associated Infection was formulatedin systems and strategies that aim to prevent infection, transmission ofpathogens, manage infection upon its occurrence, minimise the development ofmultidrug-resistance. The strategies formulated in this standard consists ofclinical governance by placing in systems to promote prevention and controlhealthcare associated infection as well as improving antimicrobial stewardship.Another criteria is risk identification and management in which patientspresenting or may contain factors of infection or colonization of pathogens oflocal, national, and even global significance are promptly identified andreceive the appropriate treatment and management. The third criteria in thePreventing and Controlling Healthcare-Associated Infection Standard is focusedon practicing measurements such as proper reprocessing of reusable medical equipment,instruments and devices while the last focuses in improvement of the use ofantimicrobial medications which can reduce the resistance to antibiotics andenhance the health outcomes of patients and consumers.
Given that nurses spendmajority of their time catering to the patient at bedside, the need to increasethe precautions of this specific standard is greatly emphasised. As suchevidence-based care are used the nurses to prevent and control of infection inthe healthcare setting such as the practice of aseptic technique and even thesimple practice of hand hygiene. Medications play an essential role in health careand contribute to significant improvements in patient outcomes whenadministered appropriately and correctly. However, since medications arefrequently used, they are also one of the most frequent sources of adverseevents and error in health care. A number of studies have evaluated theincidence of medication errors and medication-related problems in Australia.
However, limited studies have synthesised the findings to offer anestimation of the numbers of errors or complications across the range of aperson’s stay at the hospital but it suggests there may be an overall rate oftwo errors for every three patients at the time of admission to hospital.Through the Medication Safety standard the Australian healthcare workforcefollow the systems implemented by the healthservice organisation based on the criteria provided which consistedof systems and strategies to ensure that clinicians safely prescribe,distribute and administer appropriate medicines to informed patients, andconstantly monitor use of the medicines. In the same way, nurses have a centralrole in safe medication administration, including but not limited to theawareness of the risk and potential for medication errors thus making nursesalso primarily accountable for administering the medications safely, which iswhy the evidenced-based knowledge of safe administration of medication such asthe 10 rights of drug administration (Right Drug, Right Patient, Right Dose,Right Route, Right Time and Frequency, Right Documentation, Right History andAssessment, Right to Refuse, Right Drug-Drug Interaction and Evaluation, andRight Education and Information) is aligned with the Standards of NSQHS totheir everyday practice of medication management processes.
An existing connection to the everyday practice,performing assessments is as routinely done to clients as medication and overthe years, track and scoring systems have been formulated to identify thedeterioration of patients. With the development of Recognising and Respondingto Acute Deterioration Standard, there is an increase need to promptly identifya person’s physiological changes as well as acute changes in cognition andmental state that suggests acute deterioration. Early identification ofdeterioration may improve outcomes and decrease the intervention required tostabilise a patient. As stated in the criteria thestandard gives importance of the clinical governance and qualityimprovement to support recognition and response system, detecting andrecognising acute deterioration, and escalating care and responding care toacute deterioration with the assistance by the following systems: the NationalConsensus Statement: Essential elements for recognising and responding to acutephysiological deterioration, the National Consensus Statement: Essentialelements for safe and high-quality end-of-life care, National ConsensusStatement: Essential elements for recognising and responding to deteriorationin a person’s mental state, and the Delirium Clinical Care Standard.
The applicationof these systems is undoubtedly present in the nursing professionals and shouldbe continuously trained to record these observations, understand their clinicalrelevance, and act upon them. The main reason is that nurses have the mostfrequent patient contact and responsibility for ongoing monitoring of patients.The same amount of contact and responsibility play a crucial role inrecognising and responding to clinical deterioration.The National Safety and Quality Health ServiceStandards covers much more than what was written in this paper and achievingthe goal of these standards of improving safety and quality across theAustralian Health Care system is a continuous process, much like the ADPIEprocess that nurses use to ensure that consumers are provided with individualisedcare but with all those standards provided there is a common theme in each ofthem, which is a safety and governance. It can be then concluded that safety isthe foundation on which the other aspects of quality care are created and governanceensures that the quality care provided is implemented and managed. Nevertheless,the importance of meeting these standards is greatly highlighted in the nursingprofession as 62% of the hospital workforce is composed of nurses. These standardsare influenced by interventions made by the nurse as they play a vital role inmeeting the standards of accreditation.
Implementing these standards for all healthcaresettings will pose a challenge due to the predicted nursing shortage in 2025 bythe Australian Department of Health.