The desire for quality services by the
consumers is considered all throughout the world as an essential component of
any services. As such, targeting for high-quality service is easier said than
done as the healthcare service is an incorporeal object that cannot be measured
such as manufactured products. However quality healthcare is defined as providing
efficacious, effective and efficient healthcare services according to the
latest clinical guidelines and standards, which meet the patient’s needs and
satisfies providers (Mosadeghrad 2013). Focusing on the term “standards”, the
Australian Commission on Safety and Quality in Health Care had built their
standards in aiming to ensure that the standards of safety and quality are met
all throughout the states and territories covered by the country. This paper
will explain the rationale for development of the standards, specifically the
following: Clinical Governance; Partnering with Consumers; Preventing and
Controlling Healthcare-Associated Infection; Medication Safety, and Recognising
and Responding to Acute Deterioration as well as what it strives to achieve in
relation to the delivery of patient care. As noted in the 2nd edition of the National
Safety and Quality Health Service Standards, the Clinical governance standard
intends to implement its National Model Clinical Governance Framework
which emphasises on its criteria of governance, leadership and
culture, safety and quality systems integrated with governance process,
performance management, and promoting a safe environment. This ensures that all
members have accountability to the patients and the community for assuring the
reliability, safety, and quality of health care, and improving health outcomes
for patients. In relation to this standard, the role of every nurse is not
solely focused on being a care provider but also one that possess leadership
and these require detecting issues, propose potential solutions, regular client
feedback, and being involved in the decision-making process in
the individualised care plan where the decisions are made to
influence patient outcomes and ensuring accountability.In connection to the first standard which
mentioned the involvement of members such as the nurses in the decision-making
table, the standard of Partnering with Consumers intends to establish an
organisation in which there are mutually valuable outcomes by implementing
shared decision-making with the patients in their own plan of care and consumer
involvement in the policy, health research, and clinical service governance.
The partnership with the patients and consumers have multiple and diverse
practices that reflect the three key partnership at the level of the
individual, of a service/department/or program of care, and of the health
service. The delivery of care is based on these effective partnerships lead to
a positive outcome for the not only for the patient but also for the members of
the organisation and the health system because patient-reported outcome and
experience measures enable services and policy-makers to easily and effectively
capture and understand consumer’s experiences of services. This, in turn, can
result in the reduction of costs made by the hospital and shortened length of
stay of the patients. Tobiano (2016), Bucknall (2016), Marshall (2016),
Guinane (2016), and Chaboyer (2016) all stated that having nurses engage
patients in a patient-centred way, inclusive of building a relationship and
sharing knowledge, is essential to attaining patient participation, which makes
nurses an influential part on their participation and in meeting this standard.With the announcement of the arrival of the
post-antibiotic era by the CDC’s Antibiotic Strategy & Coordination Unit,
Healthcare associated infection or HAI is an ever-present, complex, and varied
factor in every health care system. Approximately 165,000 HAIs occur each
year in Australia and with the ever growing need for improved national health
care-associated infection surveillance program in Australia, the presence of
the standard of Preventing and Controlling Healthcare-Associated Infection was formulated
in systems and strategies that aim to prevent infection, transmission of
pathogens, manage infection upon its occurrence, minimise the development of
multidrug-resistance. The strategies formulated in this standard consists of
clinical governance by placing in systems to promote prevention and control
healthcare associated infection as well as improving antimicrobial stewardship.
Another criteria is risk identification and management in which patients
presenting or may contain factors of infection or colonization of pathogens of
local, national, and even global significance are promptly identified and
receive the appropriate treatment and management. The third criteria in the
Preventing and Controlling Healthcare-Associated Infection Standard is focused
on practicing measurements such as proper reprocessing of reusable medical equipment,
instruments and devices while the last focuses in improvement of the use of
antimicrobial medications which can reduce the resistance to antibiotics and
enhance the health outcomes of patients and consumers. Given that nurses spend
majority of their time catering to the patient at bedside, the need to increase
the precautions of this specific standard is greatly emphasised. As such
evidence-based care are used the nurses to prevent and control of infection in
the healthcare setting such as the practice of aseptic technique and even the
simple practice of hand hygiene. Medications play an essential role in health care
and contribute to significant improvements in patient outcomes when
administered appropriately and correctly. However, since medications are
frequently used, they are also one of the most frequent sources of adverse
events and error in health care. A number of studies have evaluated the
incidence of medication errors and medication-related problems in Australia.
However, limited studies have synthesised the findings to offer an
estimation of the numbers of errors or complications across the range of a
person’s stay at the hospital but it suggests there may be an overall rate of
two errors for every three patients at the time of admission to hospital.
Through the Medication Safety standard the Australian healthcare workforce
follow the systems implemented by the health
service organisation based on the criteria provided which consisted
of systems and strategies to ensure that clinicians safely prescribe,
distribute and administer appropriate medicines to informed patients, and
constantly monitor use of the medicines. In the same way, nurses have a central
role in safe medication administration, including but not limited to the
awareness of the risk and potential for medication errors thus making nurses
also primarily accountable for administering the medications safely, which is
why the evidenced-based knowledge of safe administration of medication such as
the 10 rights of drug administration (Right Drug, Right Patient, Right Dose,
Right Route, Right Time and Frequency, Right Documentation, Right History and
Assessment, Right to Refuse, Right Drug-Drug Interaction and Evaluation, and
Right Education and Information) is aligned with the Standards of NSQHS to
their everyday practice of medication management processes.An existing connection to the everyday practice,
performing assessments is as routinely done to clients as medication and over
the years, track and scoring systems have been formulated to identify the
deterioration of patients. With the development of Recognising and Responding
to Acute Deterioration Standard, there is an increase need to promptly identify
a person’s physiological changes as well as acute changes in cognition and
mental state that suggests acute deterioration. Early identification of
deterioration may improve outcomes and decrease the intervention required to
stabilise a patient. As stated in the criteria the
standard gives importance of the clinical governance and quality
improvement to support recognition and response system, detecting and
recognising acute deterioration, and escalating care and responding care to
acute deterioration with the assistance by the following systems: the National
Consensus Statement: Essential elements for recognising and responding to acute
physiological deterioration, the National Consensus Statement: Essential
elements for safe and high-quality end-of-life care, National Consensus
Statement: Essential elements for recognising and responding to deterioration
in a person’s mental state, and the Delirium Clinical Care Standard. The application
of these systems is undoubtedly present in the nursing professionals and should
be continuously trained to record these observations, understand their clinical
relevance, and act upon them. The main reason is that nurses have the most
frequent patient contact and responsibility for ongoing monitoring of patients.
The same amount of contact and responsibility play a crucial role in
recognising and responding to clinical deterioration.

The National Safety and Quality Health Service
Standards covers much more than what was written in this paper and achieving
the goal of these standards of improving safety and quality across the
Australian Health Care system is a continuous process, much like the ADPIE
process that nurses use to ensure that consumers are provided with individualised
care but with all those standards provided there is a common theme in each of
them, which is a safety and governance. It can be then concluded that safety is
the foundation on which the other aspects of quality care are created and governance
ensures that the quality care provided is implemented and managed. Nevertheless,
the importance of meeting these standards is greatly highlighted in the nursing
profession as 62% of the hospital workforce is composed of nurses. These standards
are influenced by interventions made by the nurse as they play a vital role in
meeting the standards of accreditation. Implementing these standards for all healthcare
settings will pose a challenge due to the predicted nursing shortage in 2025 by
the Australian Department of Health.

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