The Australian Commission on Safety and Quality in Health Care (ACSQHC), which was formed in 2006, is a government funded commission created with the aim to improve the quality and safety of health care. The ACSQHC developed ten National Safety and Quality Health Service (NSQHS) Standards which reflect the ACSQHC’s goals for all health care services to provide a high level of safety and quality of systems.
Issues with the safety and quality of health care in Australian hospitals were identified in several studies during the 1990’s. One example was the 1995 Quality in Australian Health Care Study, which was a review of over 14,000 admissions in 28 hospitals in New South Wales and South Australia.
Of the hospital admissions reviewed, 16.6% were associated with an adverse event that was caused by health care management, and over half of these were considered preventable. From this, and other similar studies, it was estimated that the cost of health care was increased by 15–20% as a result of adverse events.
In 2000, further reviews of health care quality were undertaken, which eventually led to the instigation of reforms in 2005. The reforms saw an agreement between state and federal governments that introduced a national oversight of hospital performance by new independent agencies, including the ACSQHC and the National Health Performance Authority (NHPA). While the ACSQHC focuses on developing a framework for safety and quality, the NHPA has a focus of creating and reporting on national performance standards. Prior to the reforms, approximately 98% of hospitals participated in voluntary accreditation programs offered by a number of non-government agencies, including the Australian Council on Healthcare Standards (ACHS).
The NSQHS Standards define a framework for the provision of high quality health services, and all Australian accredited hospitals must meet these standards. Accreditation includes an independent and external assessment of conformity to the NSQHS Standards. Each standard provides a description of the intended outcome and a list of criteria with which to assess if it is being met. There are both core actions and developmental targets within each standard.
The focuses of the ten NSQHS Standards are:
- To ensure the quality and safety of health care is well managed, which includes confirming that the workforce of the health service is appropriately qualified to provide safe and quality care.
- Providing a framework for interacting with the consumers of health care.
- Infection control, including antimicrobial stewardship.
- Medication safety.
- Provision of measures to ensure accurate patient identification. This includes using at least three patient identifiers to confirm identity before providing any care, therapy or service.
- Clinical handover systems to ensure there is appropriate documentation and structured communication of patient information.
- The safe and appropriate use of blood and blood products.
- The prevention and management of pressure injuries.
- Recognising and responding appropriately to deterioration of a patient’s condition.
- Fall prevention and management to reduce the harm from falls.
Standard 4: Medication Safety
The NSQHS Standard 4: Medication Safety is described as follows:
“Clinical leaders and senior managers of a health service organisation implement systems to reduce the occurrence of medication incidents, and improve the safety and quality of medicine use. Clinicians and other members of the workforce use the systems to safely manage medicines”.
When addressing medication safety, it is important to reflect on adverse events in all settings, rather than focus on events that occur in health care facilities. An estimated 1.5 million Australians experience an adverse medication event each year. As medicines are the most common form of treatment, the incidence of these adverse events is higher than for other health care interventions. These events result in approximately 400,000 visits to general practitioners and 190,000 hospital admissions annually. The estimated cost of hospital admissions related to medication incidents is $660 million.
The ACSQHC noted in 2005 that 90% of medication safety problems are due to the systems in place rather than the 10% which are due to the individual. Not only are medication adverse events costly, many are also potentially avoidable. The goal of Standard 4 is to reduce the prevalence of adverse events by providing a system for actively improving safety and quality in the services of health care providers.
There are many aspects to medication safety that are covered in the Standard. Appropriate policies and procedures for medication safety are integral and need to be consistent with national and jurisdictional legislative requirements. The policies and procedures should be regularly and comprehensively assessed and revised to minimise any identified risks.
A health service should have systems in place to verify that clinicians are authorised to prescribe, dispense and/or administer medicines. Medication incidents are a risk to patient safety and therefore must be reported, investigated and reviewed appropriately.
All adverse drug reactions should be reported to the Therapeutic Goods Administration.
Taking accurate medication histories, documenting a patient’s previous adverse medication reactions and the reconciliation of a patient’s current and previous medication lists are also important. This reduces errors by preventing duplication, interaction, allergic reaction, and omission of critical medications.
Health service providers should have the appropriate information resources available to them. The information resources provided should be reviewed and updated to ensure they are relevant.
The appropriate storage and safe distribution of medicines is essential. Incorrect storage of medicines can endanger patients. Another focus within the Standard is high risk medications. Medicines with a high potential for patient harm should be identified and appropriately stored, prescribed, dispensed and administered. Education on each of these high risk medicine groups is available through the HPS Lecture Series Programme.
A commonly used acronym to identify high risk drugs is A PINCH:
- A – Anti-infectives
- P – Potassium and other electrolytes
- I – Insulin
- N – Narcotics and other sedatives
- C – Chemotherapeutic agents
- H – Heparin and anticoagulants
It is also important that lists of current medicines are provided to patients and clinicians during clinical handover. Patients need to be given the right information to be able to correctly manage their medications
To fully achieve NSQHS Standards, the consumer of health services should be included in medication management. This includes clinicians advising consumers and carers about the risks and benefits of medication and their treatment options to enable the patient to make well informed decisions about their care.
NSQHS Standard 4 offers a valuable framework to ensure the safe and quality use of medications by health service providers in Australia. Through standardisation and systemisation, medication adverse events can be prevented. Adherence to all ten NSQHS Standards is assessed during hospital accreditation. As Australia’s leading pharmacy service provider, HPS Pharmacies has developed programs to assist health care facilities to meet, and surpass, the NSQHS Standards. This includes a dedicated Antimicrobial Stewardship program to allow facilities the opportunity to undertake external audits.
- Australian Commission on Safety and Quality in Health Care. [Internet] 2014 [cited 2014 Nov 2]. Available from: http://www.safetyandquality.gov.au/
- Australian Commission on Safety and Quality in Health Care. National Safety and Quality Health Service Standards. [Internet] 2014 Sept [cited 2014 Nov 2]. Available from: http://www.safetyandquality.gov.au/wp-content/uploads/2011/09/NSQHS-Standards-Sept-2012.pdf
- Hort K, Djasri H & Utarini A. Regulating the quality of healthcare: Lessons from hospital accreditation in Australia and Indonesia. The University of Melbourne: Health Policy & Health Finance Knowledge Hub. May 2013; 28.
- The Australian Council on Healthcare Standards. The National Safety and Quality Health Service Standards [Internet] 2014 [cited 2014 Nov 2]. Available from: http://www.achs.org.au/programs-services/the-national-safety-and-quality-health-service-standards-(nsqhss)/