Implementation of the Quality of Care component and Reform 1 of the National Recovery and Resilience Plan

Implementation of the Quality of Care component and Reform 1 of the National Recovery and Resilience Plan.

Module 5 Romanian HQF indicators into Practice II: Patient Safety Incidents.

Content - Burden and impact of Patient Safety Incidents - Best practices for measuring patient safety incidents-related indicators - Improvement measures to prevent patient safety incidents.

Burden and impact of Patient Safety Incidents. | Title of the presentation.

Prevention of Adverse Events and Mitigation of Patient Safety Risks Main strategic goal for Sustainable Health Systems.

Priority Areas. Significant improvements in treatment to be pursued to reduce mortality and enhance effective management of diseases.

Patient Safety Indicators selected for the Romanian Health System in the frame pf the Health Quality Fund program.

Best practices for measuring patient safety incidents-related indicators:.

Patient safety incidents’ related indicators - Methodology.

Sensible Simple Feasible Meaningful Validated easily.

Attribute Accuracy Completeness Uniqueness Consistency Timeliness Validity Confidentiality (additional requirement based on the General Data Protection Regulation) Definition Data measure what they were intended to measure, minimizing errors or confusion in metrics. Data contain all the records and all essential values in a record, representing the complete domain of eligible individuals or events/cases. Data contain only one record for each entity represented, and each value is stored once. Duplicated values are identified and excluded. Data do not contradict other data in another dataset. Data are up to date, generated without much delay, and available when needed. Data are generated in a traceable manner, and are protected from deliberate bias or manipulation. Data are in the range and format expected, as they are generated based on consistent application of standardized protocols and procedures. Data that contain personal information are not disclosed inappropriately, are treated with appropriate levels of security, whether in hard copy or in electronic form..

Indicator 3: Percentage of in-hospital patients assessed for fall risk through applied protocols.

Indicator 3: Percentage of in-hospital patients assessed for fall risk through applied protocols.

Indicator 4: Rate of patient falls during hospitalization.

Indicator 4: Rate of patient falls during hospitalization.

| Title of the presentation. 16. Useful notes Patient files are sampled at regular intervals to ensure reliability. Compare the monthly indicators and monitor the trend over time using a run chart Falls under the responsibility of the Clinical Assessment Team Communicate the results to initiate improvement actions Set a performance target for the indicator per month and per year that will be included in the annual action plan of the Hospital. A correlation can be made between this indicator and Patients falls rate.

Indicator 5: Percentage of in-hospital patients assessed for pressure ulcer risk through applied protocols.

Indicator 5: Percentage of in-hospital patients assessed for pressure ulcer risk through applied protocols.

Indicator 6: Rate of new pressure ulcers acquired during hospitalization.

Indicator 6: Rate of new pressure ulcers acquired during hospitalization.

Pressure Ulcer Reporting Form Use this forrn to a ulcer or suspected deep tissue injury that was I) not present adrnission (i-e-, — developed) or 2) durmg patient's stay- Report an event that occurred prior to patient discharge- If a ulcer is at a certain stage and gets wo se before discharge, please do not cornplete a new Pressure Ulcer Report*lg For-rn- Instead. edit existing event report to reflect the after the re—evaluation and re—stagülg of the pressL•e ulcer. of Incident Date Of identification: Tirne: Ward/ Departrnent: Reporter Name: Reporter Job title/Role: Date Of reporting: inforrmation should remain confidential and it cannot be transferred to a third part-y. Patient Gender: Patient Registered Treating Physician: Patient Age: Patient ID No: Patient ICD 10 H •talisation.

Pressure Ulcers (process and outcome indicators).

Indicator 7: Percentage of patients undergoing surgery where the WHO Surgical Safety Checklist was applied.

Instructions for using the WHO Surgical Safety Checklist.

Useful Notes Make the staff aware of the burden of complications and mortality following surgeries. Raise awareness of the importance of WHO Surgical Safety Checklist. Educate the involved healthcare professionals on how to use WHO Surgical Safety Checklist in accordance with the related WHO guidelines. This indicator falls under the responsibility of the Clinical Assessment Team (see the relevant notes and guidelines) Witnessing the real time implementation of the Checklist is one option to actually monitor compliance with the Surgical Safety checklist. The application of a digital WHO Surgical Safety Checklist can save time under the condition that there is access to the digital (hospital information) system in the OR as the checklist should be applied real-time. Analyze common answers and use the collected information to improve surgical safety in the healthcare provider. Compare compliance percentages and track the trend over time. Feedback to the administration and all staff of the operating room, surgeons, anesthesiologists. Set a performance target for the indicator per quarter and per year to be included in the Hospital's annual action plan. Development of actions focused on improving the safety of surgical procedures..

Indicator 7: Percentage of patients undergoing surgery where the WHO Surgical Safety Checklist was applied.

Indicator 7: Percentage of patients undergoing surgery where the WHO Surgical Safety Checklist was applied.

Indicator 8: Postoperative bleeding rate requiring surgical re-intervention.

Indicator 8: Postoperative bleeding rate requiring surgical re-intervention.

Indicator 8: Postoperative bleeding rate requiring surgical re-intervention.

Improvement measures to prevent patient safety incidents.

Fall risk assessment.

Reporting falls. F Eitt i. | Title of the presentation.

Pressure ulcers risk assessment.

Reporting pressure ulcers. pti. | Title of the presentation.

| Title of the presentation. 36.

WHO Surgical Safety Checklist. It is essential that a single person leads the Checklist process. This designated Checklist coordinator, who is responsible for checking the boxes on the list, will often be a circulating nurse but can be any clinician participating in the operation. The Checklist divides the operation into three phases, each corresponding to a specific time period in the normal flow of a procedure: the period prior to induction of anaesthesia (Sign In), the period after induction and before surgical incision (Time Out), and the period during or immediately after wound closure (Sign Out). In each phase the Checklist coordinator must be permitted to confirm that the team has completed its tasks before it proceeds onward..

Before the induction of anesthesia. The Checklist coordinator will verbally confirm with the patient (when possible) his or her identity, the surgical site and the procedure, and that consent to operate has been obtained. The coordinator will visually confirm that the operative site has been marked (if appropriate) verbally review with the anaesthesia professional the patient’s risk of blood loss, airway difficulty and allergies, and also whether a safety check of the anaesthesia machine and medications has been completed. Ideally the surgeon will be present for 'Sign In', as the surgeon may have a clearer idea of the anticipated blood loss, allergies or other potential complicating factors. However the surgeon’s presence is not essential to complete this part of the Checklist..

omo zz 080. The team will pause immediately before the skin incision to confirm out aloud that the correct operation on the correct patient and site is being performed; All team members will then verbally review with one another, in turn, the critical elements of their plans for the operation, using the Checklist questions for guidance. They will also confirm that prophylactic antibiotics have been administered within the previous 60 minutes and that essential imaging is displayed as appropriate..

The team will review together the operation that was performed, completion of sponge and instrument counts and the labelling of any surgical specimens obtained. They will also review any equipment malfunctions or issues that need to be addressed. Finally the team will review key plans and concerns for postoperative management and recovery before moving the patient from the operating room..

Perioperative Bleeding Management. Goals: To accomplish preoperative identification by anamnesis (medical history) and laboratory testing of those patients for whom the perioperative bleeding risk may be increased To correct preoperative anaemia and stabilize the macro- and microcirculations to optimize the patient’s tolerance to bleeding To reduce the amount of bleeding, morbidity, mortality and costs.

Perioperative Bleeding Management: Guidelines. European Society of Anaesthesiology (2013) NICE (2020) National Blood Authority of Australia (2012) Australian Anaesthesia Perioperative Care Network and Surgical Services Taskforce (2016) American Society of Anesthesiologists Task Force on Perioperative Blood Management.

Good practice recommendations for clinical assessment procedures.

Clinical auditing structures and functions. Clinical audit/assessment as “a quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change”*.

Clinical auditing: Benefits. To evaluate and improve patient care To check compliance with international standards and applied protocols (national, local and internal) and documenting patient management To identify the areas of possible risk To create a culture of quality improvement in the clinical environment To enhance the satisfaction of health-care workers To provide the continuous training of health-care workers, in accordance with the applied standards of clinical practice To monitor the compliance of the health-care provider with standardized procedures and protocols, and can thus improve the quality and efficiency of health care.

Clinical auditing: System requirements. Aim: to identify the percentage of application and the deviations that can be managed effectively through continuous training and staff engagement. To ensure that the quality of the care provided meets the defined standards, and that all health-care worker teams apply the relevant pathways and guidelines  a comprehensive clinical auditing system is required Clinical auditing/assessment should be performed by properly trained professionals Specific resources are needed, including documented policies, procedures, protocols and instructions, based on which the health-care services are provided; registries and evidence on service outcomes; and documentation of patients’ administrative and clinical management (review of patient records, therapeutic and diagnostic records) among others.

Clinical auditing: Clinical auditing/assessment team.

Clinical auditing: Data Sources. Administrative databases (inpatient registries) Patient files (medical, nursing records) and data Prospective data collection, which involves collecting data specifically for qoc measurements purposes (such as patient incident reports) Data related to the audited processes: patient outcomes, clinical indicators, compliance rates, adverse events, near misses and other relevant data points. Interviews and consultations with health-care workers, other staff members and other relevant individuals involved in the audited processes  additional insights, clarify information and understand the perspectives of different stakeholders. On-site visits to observe the audited processes in action: physically visiting clinical areas, interacting with health-care providers and staff, and assessing compliance with established protocols and guidelines, collaborating with other committees and teams to share information, seek input, and work together to address issues identified during the assessment process.

Procedures for clinical assessment for the Health Quality Fund indicators.

Procedures for clinical assessment for the Health Quality Fund indicators.