Clinical Governance National Optometric Conference 2006 Geoff Roberson Optometric Adviser,...

Clinical GovernanceClinical GovernanceNational Optometric Conference 2006National Optometric Conference 2006

Geoff RobersonGeoff RobersonOptometric Adviser, Association of OptometristsOptometric Adviser, Association of Optometrists

Clinical GovernanceClinical Governance

Clinical GovernanceClinical Governance

• BackgroundBackground

• Current situationCurrent situation

• Work of the Professional bodiesWork of the Professional bodies

• Proposed frameworkProposed framework

• SummarySummary

Definition: Definition:

"A framework through which NHS "A framework through which NHS organisations are accountable for organisations are accountable for continually improving the quality continually improving the quality of their services and safeguarding of their services and safeguarding high standards of care by creating high standards of care by creating an environment in which an environment in which excellence in clinical care will excellence in clinical care will flourish."flourish."

QualityQuality

• What the public would regard as a good What the public would regard as a good thingthing

• Quality ControlQuality Control Major supermarket chain on suppliers eg.Major supermarket chain on suppliers eg.

• ConsistentConsistent– SizeSize– WeightWeight– RipenessRipeness

CAA on aircraft safety eg.CAA on aircraft safety eg.• Regular verifiable maintenanceRegular verifiable maintenance• Pilot trainingPilot training

• Why not HealthcareWhy not Healthcare

QualityQuality

• Need to define what is importantNeed to define what is important RipenessRipeness Clinical careClinical care

• Abstract concept without means of Abstract concept without means of assessingassessing

• Need to define scaleNeed to define scale• Need to define what is acceptable levelNeed to define what is acceptable level

STANDARDS!STANDARDS!

StandardsStandards

• User/Client/Patient ExpectationsUser/Client/Patient Expectations

• Peer Group ViewPeer Group View College GuidelinesCollege Guidelines

• Other interested partiesOther interested parties OphthalmologistsOphthalmologists GPsGPs GovernmentGovernment PCTs?PCTs?

StandardsStandards

• DoH EnglandDoH England Decided to set ground rulesDecided to set ground rules Provided basic structure under Provided basic structure under

which CG could developwhich CG could develop Original ApproachOriginal Approach

• Standards definedStandards defined• Standards grouped into broad areasStandards grouped into broad areas• So called “7-pillars”So called “7-pillars”

Seven PillarsSeven Pillars

• Clinical Risk ManagementClinical Risk Management

• Clinical Audit and EffectivenessClinical Audit and Effectiveness

• Education, Training & CPDEducation, Training & CPD

• The Patient ExperienceThe Patient Experience

• Research & DevelopmentResearch & Development

• Staffing and Staff ManagementStaffing and Staff Management

• Using InformationUsing Information

Standards for Better Standards for Better HealthHealth

• Published by DoH in 2004 following Published by DoH in 2004 following public consultationpublic consultation

• Applicable to ALL healthcare Applicable to ALL healthcare organisations providing NHS care from organisations providing NHS care from 20052005 Includes optometric practicesIncludes optometric practices

• Sets level of quality expected to be met Sets level of quality expected to be met across the NHS in Englandacross the NHS in England

• Defines CG scope and structureDefines CG scope and structure(Currently)

Standards for Better Standards for Better HealthHealth

• A standards driven systemA standards driven system• Seven “Domains”Seven “Domains”

Designed to cover the full spectrum of health Designed to cover the full spectrum of health carecare

Encompass all facets of health careEncompass all facets of health care Described in terms of outcomesDescribed in terms of outcomes

• Core StandardsCore Standards– Meeting the core standards “not optional”Meeting the core standards “not optional”

– Health care organisations must complyHealth care organisations must comply

• Developmental StandardsDevelopmental Standards– Aspirational - to meet increasing patients expectationsAspirational - to meet increasing patients expectations

– Broad and comprehensiveBroad and comprehensive

Seven DomainsSeven Domains

• SafetySafety

• Clinical and Cost EffectivenessClinical and Cost Effectiveness

• GovernanceGovernance

• Patient FocusPatient Focus

• Accessible and Responsive CareAccessible and Responsive Care

• Care Environment and AmenitiesCare Environment and Amenities

• Public HealthPublic Health

Domain 1 – SafetyDomain 1 – Safety

Domain OutcomeDomain Outcome

““Patient safety is enhanced by the use Patient safety is enhanced by the use of health care processes, working of health care processes, working practices and systemic activities that practices and systemic activities that prevent or reduce the risk of harm to prevent or reduce the risk of harm to patients.”patients.”

Initial ReactionsInitial Reactions

• ConfusionConfusion

• Difficulty comprehendingDifficulty comprehending

• Difficulty seeing relevanceDifficulty seeing relevance

• ““Not sure what to do”Not sure what to do”

• ““Seems very complicated”Seems very complicated”

• ““Why should we bother”Why should we bother”

Domain 1 – Core Domain 1 – Core StandardsStandards

• C1C1 Health care organisations protect patients through systems that:Health care organisations protect patients through systems that:

a) identify and learn from all patient safety incidents and other reportable a) identify and learn from all patient safety incidents and other reportable incidents, and make improvements in practice based on local and national incidents, and make improvements in practice based on local and national experience and information derived from the analysis of incidents; andexperience and information derived from the analysis of incidents; and

b) ensure that patient safety notices, alerts and other communications b) ensure that patient safety notices, alerts and other communications concerning patient safety which require action are acted upon within required concerning patient safety which require action are acted upon within required time-scales.time-scales.

• Relevance to OptometryRelevance to Optometry PCTs should include optical practices in Adverse Critical Incident reporting PCTs should include optical practices in Adverse Critical Incident reporting

procedures.procedures. Practices should record adverse incidents which occur within the practice.Practices should record adverse incidents which occur within the practice. Practices should feed back to their staff.Practices should feed back to their staff. Practices may wish to assess their practice for risksPractices may wish to assess their practice for risks

• C1bC1b PCTs maintain a Safety Alert Broadcast System (SABS). PCTs should PCTs maintain a Safety Alert Broadcast System (SABS). PCTs should

ensure that optical practices are included in the circulation of patient safety ensure that optical practices are included in the circulation of patient safety notices, alerts and related communications and that they are aware of how notices, alerts and related communications and that they are aware of how to acknowledge themto acknowledge them


• C2C2 Health care organisations protect children by following Health care organisations protect children by following

national child protection guidance within their own activities national child protection guidance within their own activities and in their dealings with other organisationsand in their dealings with other organisations

• Relevance to OptometryRelevance to Optometry Optical practices should have a chaperone policy. A model policy is available at:Optical practices should have a chaperone policy. A model policy is available at:

www.aop.org.uk/uploaded_files/chaperoning_policy.pdfwww.aop.org.uk/uploaded_files/chaperoning_policy.pdf

Further information is included in the College Guidelines, particularly the section Further information is included in the College Guidelines, particularly the section on dealing with Children and Vulnerable Adults – available from the College:on dealing with Children and Vulnerable Adults – available from the College:www.college-optometrists.orgwww.college-optometrists.org

PCTs should ensure optical practices know where to report concerns about PCTs should ensure optical practices know where to report concerns about children. Practitioners should take advice before reporting any concerns and children. Practitioners should take advice before reporting any concerns and keep careful records of their actions and observations.keep careful records of their actions and observations.


• C3C3 Health care organisations protect patients by Health care organisations protect patients by

following NICE Interventional Procedures guidancefollowing NICE Interventional Procedures guidance

• Relevance to OptometryRelevance to Optometry This is the responsibility of any organisation to This is the responsibility of any organisation to

which NICE Procedures relate. Primarily this will be which NICE Procedures relate. Primarily this will be larger NHS organisations such as PCTs and Hospital larger NHS organisations such as PCTs and Hospital TrustsTrusts

NICE guidance awareness eg. PDT and Laser NICE guidance awareness eg. PDT and Laser refractive Surgeryrefractive Surgery


• C4C4 Health care organisations keep patients, staff and visitors safe Health care organisations keep patients, staff and visitors safe

by having systems to ensure that:by having systems to ensure that:a) the risk of health care acquired infection to patients is reduced, a) the risk of health care acquired infection to patients is reduced,

with particular emphasis on high standards of hygiene and with particular emphasis on high standards of hygiene and cleanliness, achieving year-on-year reductions in MRSAcleanliness, achieving year-on-year reductions in MRSA

• Relevance to OptometryRelevance to Optometry This principally applies to hospitals, but practitioners may have patients attend with 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:known or unknown cases of MRSA. The College has advice on infection control:www.college-optometrists.org/objects_store/infection.pdfwww.college-optometrists.org/objects_store/infection.pdf

The Royal College of Nursing also has a wealth of information on MRSA and The Royal College of Nursing also has a wealth of information on MRSA and infection control in generalinfection control in general

A key to infection control is effective handwashingA key to infection control is effective handwashing

Where frequent handwashing is impractical or undesirable alcohol-based Where frequent handwashing is impractical or undesirable alcohol-based disinfectant hand gel is an acceptable alternativedisinfectant hand gel is an acceptable alternative


• C4C4 Health care organisations keep patients, staff and Health care organisations keep patients, staff and

visitors safe by having systems to ensure that:visitors safe by having systems to ensure that:b) all risks associated with the acquisition and use of medical b) all risks associated with the acquisition and use of medical

devices are minimiseddevices are minimised

• Relevance to OptometryRelevance to Optometry It is good practice to wipe down instrument chin and It is good practice to wipe down instrument chin and

headrests and trial frames. Alcohol or Chlorhexidine headrests and trial frames. Alcohol or Chlorhexidine based disposable wipes are useful for thisbased disposable wipes are useful for this

Dispensing (including contact lenses) should only Dispensing (including contact lenses) should only be done by competent persons bearing in mind the be done by competent persons bearing in mind the restrictions on certain groups of patients (who restrictions on certain groups of patients (who should only be dispensed by a registered should only be dispensed by a registered practitionerpractitioner))


• C4C4 Health care organisations keep patients, staff and visitors safe Health care organisations keep patients, staff and visitors safe

by having systems to ensure that:by having systems to ensure that:c) all reusable medical devices are properly decontaminated prior to c) all reusable medical devices are properly decontaminated prior to

use and that the risks associated with decontamination facilities use and that the risks associated with decontamination facilities and processes are well managedand processes are well managed

• Relevance to OptometryRelevance to Optometry Main hazard of concern to optometry is vCJD as it requires the Main hazard of concern to optometry is vCJD as it requires the

most stringent decontamination procedures; however risks are most stringent decontamination procedures; however risks are also posed by a variety of bacterial and viral contaminants. also posed by a variety of bacterial and viral contaminants. Procedures should be in place to ensure that cross-Procedures should be in place to ensure that cross-contamination does not occur or single devices usedcontamination does not occur or single devices used

Advice is available from the College covering disinfection Advice is available from the College covering disinfection procedures and when single use devices are appropriateprocedures and when single use devices are appropriatewww.college-optometrists.org/objects_store/cjd.pdfwww.college-optometrists.org/objects_store/cjd.pdf

Developmental Developmental StandardsStandards

• D1D1 Health care organisations continuously Health care organisations continuously

and systematically review and improve all and systematically review and improve all aspects of their activities that directly aspects of their activities that directly affect patient safety and apply best affect patient safety and apply best practice in assessing and managing risks practice in assessing and managing risks to patients, staff and others, particularly to patients, staff and others, particularly when patients move from the care of one when patients move from the care of one organisation to another.organisation to another.

Impact on OptometryImpact on Optometry• Why does clinical governance;Why does clinical governance;

Cause conflicts in some areas?Cause conflicts in some areas? Result in complaints and enquiries to both the AOP Result in complaints and enquiries to both the AOP

and the College?and the College?

• Underlying tensionsUnderlying tensions PCTs required to engage in CG with and collect PCTs required to engage in CG with and collect

information from:information from:• All contractorsAll contractors

Performance monitored by Healthcare CommissionPerformance monitored by Healthcare CommissionBUTBUT GOS terms of service impose no requirement for GOS terms of service impose no requirement for

clinical governance on optometryclinical governance on optometry• No fundingNo funding

Impact on OptometryImpact on Optometry

• PCTs can make CG reporting a condition in shared care PCTs can make CG reporting a condition in shared care schemesschemes Fees paid should reflect thisFees paid should reflect this

• Many PCTs engaged with “light touch” in conjunction Many PCTs engaged with “light touch” in conjunction with their LOCwith their LOC 2-way benefits perceived2-way benefits perceived Practices often co-operate for little or no feePractices often co-operate for little or no fee

• Other PCTs have paid for particular aspects of clinical Other PCTs have paid for particular aspects of clinical governance such as audit or attendance at meetingsgovernance such as audit or attendance at meetings

• Problem is areas where CG level is imposed sometimes Problem is areas where CG level is imposed sometimes with veiled threats and with no financial recompensewith veiled threats and with no financial recompense

Clinical GovernanceClinical Governance• CG encompasses different areasCG encompasses different areas

Health and Safety Health and Safety Practice management Practice management Clinical practice Clinical practice

• Many aspects of CG are happening already;Many aspects of CG are happening already; Legal requirements eg.Legal requirements eg.

• Terms of ServiceTerms of Service• Employment lawEmployment law• Data protection lawData protection law

Good clinical practice eg.Good clinical practice eg.• Rx checking before issueRx checking before issue• Device decontaminationDevice decontamination

• Doing it anyway!Doing it anyway!

Professional Professional OrganisationsOrganisations

• Position:Position: Optometrists are doing CGOptometrists are doing CG If PCTs want information for HCC reporting it If PCTs want information for HCC reporting it

should be purchasedshould be purchased

• Optical bodies are working jointly on a Optical bodies are working jointly on a model clinical governance frameworkmodel clinical governance framework Not onerousNot onerous Useful and relevant to optometry Useful and relevant to optometry Recognisable to PCTs and “ticks right boxes”Recognisable to PCTs and “ticks right boxes”

• Part of negotiations during the GOS reviewPart of negotiations during the GOS review

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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 Relevance to Optometry Questions

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

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

Does the PCT include the practice in critical incident reporting structures? Does the practice record adverse incidents? If yes:

Does the practice feedback to the staff? Does the practice assess risks from this process?

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 PCT include the practice in the circulation of safety alerts? If yes:

Standard Questions relating to core standards Yes No Don’t Know

Level

C4b) Does the practice have glazing facilities?

C4b) If yes:

C4b) Have you completed an RG2 document and submitted it to the MHRA?

C4b) Do you display a certificate of conformity?

1

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?

C4e) If yes:

C4e) Are sharps and contaminated products disposed of using a sharps and clinical waste collection service?

1

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 GovernanceStandards for Better Health – WorkbookLevel 1 – Legal or mandatory requirement

StandardStandard QuestionQuestion YesYes NoNo Don’t Don’t KnowKnow

Action Plan ReferenceAction Plan Reference LevelLevel

C4b)C4b) Does the practice have glazing facilities?Does the practice have glazing facilities? If No click If No click HereHere 11

C4b)C4b) If yes:If yes:

C4b)C4b) Have you completed an RG2 document Have you completed an RG2 document and submitted it to the MHRA?and submitted it to the MHRA?

If No or Don’t Know go to If No or Don’t Know go to Action Point 1Action Point 1

C4b)C4b) Do you display a certificate of Do you display a certificate of conformity?conformity?

If No or Don’t Know go to If No or Don’t Know go to Action Point 1Action Point 1

C4e)C4e) Do you dispose of POMs by incineration?Do you dispose of POMs by incineration? If Yes click If Yes click HereHereIf No or Don’t Know go to If No or Don’t Know go to

Action Point 2Action Point 2

11

C4e)C4e) Do you have a waste contract with your Do you have a waste contract with your local authority or landlord?local authority or landlord?

If Yes click If Yes click HereHereIf No or Don’t Know go to If No or Don’t Know go to


11

C4e)C4e) Does the practice undertake any blood Does the practice undertake any blood tests?tests?

If No click If No click HereHere 11

C4e)C4e) If yes:If yes:

C4e)C4e) Are sharps and contaminated products Are sharps and contaminated products disposed of using a sharps and clinical disposed of using a sharps and clinical

waste collection service?waste collection service?

If Yes click If Yes click HereHereIf No or Don’t Know go to If No or Don’t Know go to


Key MessagesKey Messages

• CG is a good thing CG is a good thing • If you comply with the Terms of Service and If you comply with the Terms of Service and

law you are doing it alreadylaw you are doing it already• No requirement to disclose CG activitiesNo requirement to disclose CG activities• Information is your propertyInformation is your property• Collecting, collating and passing on Collecting, collating and passing on

information time consuminginformation time consuming• Providing information to assist PCTs in Providing information to assist PCTs in

meeting Quality targets requires funding.meeting Quality targets requires funding.

Clinical Governance National Optometric Conference 2006 Geoff Roberson Optometric Adviser,...

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