Primary and Community Healthcare Clinical Safety Standard

• How is your healthcare service’s clinical governance framework used to:
  • support the implementation of policies and procedures for clinical safety?
  • identify and manage risks associated with clinical safety?
  • identify training requirements for clinical safety?

• Develop and implement policies and procedures for clinical safety.
• Use risk management processes established in Action 1.04 to identify, monitor, manage and review risks associated with clinical safety.
• Deliver or provide access to training on relevant clinical safety risks based on the patient population and the specific needs of the workforce. 

The type and comprehensiveness of evidence used is dependent on each healthcare service context. The content and complexity of the policies and processes will likely depend on the size of the healthcare service, but could include:

• Policies and procedures that provide guidance on relevant clinical safety issues
• Risk register entries relating to clinical safety
• Training documents (for example, orientation training plans and records) for members of the workforce relating to clinical safety.

• What data does your healthcare service review to identify clinical safety improvements?
• What clinical safety changes have been made as a result of the data review?
• How is information about your healthcare service’s clinical safety performance documented and reported?

• Identify and collect data within your healthcare service that can be used to inform improvements to clinical safety.
• Take action to address the areas of clinical safety identified for improvement.
• Document clinical safety risks using established processes from Actions 1.03 and 1.05 and action taken.

The type and comprehensiveness of evidence used is dependent on each healthcare service context, but could include: 

• Clinical safety data, for example, from incidents, collected and reviewed to identify safety and quality improvements
• Example of clinical safety changes made within the healthcare service as a result of the review of data and implementations made
• Meetings or communication records where discussion about clinical safety incidents occurred, and the strategies and actions taken to address identified risks
• Reports on clinical safety.

• What processes from the Partnering with Consumers Standard do healthcare providers use to involve patients in relevant clinical safety areas?
• How does your healthcare service ensure that information provided to patients regarding clinical safety are tailored to their needs and health literacy?

• Use processes developed when implementing the Partnering with Consumers Standard to inform implementation of relevant actions in the Clinical Safety Standard.
• Support the workforce to communicate effectively with patients, carers and families about clinical safety tailored to their needs and preferences. 

The type and comprehensiveness of evidence used is dependent on each healthcare service context. The content and complexity of the policies and processes will likely depend on the size of the healthcare service, but could include:

• Examples of information material and resources relating to clinical safety displayed or provided to patients, families and carers in plain language, available in different languages and formats
• Documents outlining processes relating to clinical safety that include how patients are supported to be actively involved in their own health care
• Examples of healthcare records that demonstrate healthcare providers have partnered with patients in shared decision making about clinical safety
• Patient feedback regarding areas of clinical safety.

• How does the workforce in your healthcare service implement standard and transmission-based precautions?
• What jurisdictional laws and policies regarding infection prevention and control are relevant to your healthcare service?

• Identify infection and prevention control jurisdictional laws and policies relevant to the healthcare service.
• Describe how relevant standard and transmission-based precautions will be implemented in the healthcare service.
• Ensure that the equipment, supplies and products required by the workforce to work safely and minimise the risk of infection transmission are accessible, located where required and appropriate to the risks identified for the context and physical environment of the healthcare service.
• Develop or review signage, alert systems, and information/reminder systems and resources to raise awareness of standard and transmission-based precautions.
• Consider how the need for transmission-based precautions are communicated within the healthcare service and with other healthcare services who are providing care to the patient.

The type and comprehensiveness of evidence used is dependent on each healthcare service context. The content and complexity of the policies and processes will likely depend on the size of the healthcare service, but could include:

• Policies and procedures regarding standard and transmission-based precautions
• Evidence that policies and procedures are easily accessible by the workforce
• Observation of the workforce practising standard and transmission-based precautions
• Training documents (for example, syllabus, attendance records, competency assessments) relating to standard and transmission-based precautions
• Examples of improvement activities that have been implemented and evaluated to raise awareness and improve compliance with standard and transmission-based precautions
• Examples of incidents relating to compliance with standard and transmission-based precautions being documented and discussed with appropriate actions taken to address the identified risks or improve clinical safety
• Observation of standardised signage and other forms of clinical communication informing about the need for standard and transmission-based precautions as part of patient care
• Processes to assess infection risk.

• What is your healthcare service’s process for hand hygiene? Is it consistent with the current National Hand Hygiene Initiative and with state or territory requirements?
• How does your healthcare service support the workforce and people who use the service to practise hand hygiene?
• How does your healthcare service promote hand hygiene to the workforce, patients and consumers?

• Define and implement a process for hand hygiene that is consistent with appropriate elements of the National Hand Hygiene Initiative and relevant state or territory requirements.
• Support the workforce to practise hand hygiene by:
  • providing access to training on hand hygiene
  • ensuring the workforce has the necessary consumables and facilities, such as alcohol-based hand rubs, soap products and handwashing basins to comply with hand hygiene processes
  • promoting hand hygiene.
• Display promotional material in the healthcare service to support the workforce and consumers to practise hand hygiene.
• Encourage the workforce to promote hand hygiene to consumers.
• Ensure compliance with the Australasian Health Facility Guidelines specifications for hand washing facility design and other relevant Australian Standards.
• Ensure monitoring and reporting of workforce hand hygiene compliance.

The type and comprehensiveness of evidence used is dependent on each healthcare service context. The content and complexity of the policies and processes will likely depend on the size of the healthcare service, but could include:

• A demonstrated hand hygiene process that is consistent with the current National Hand Hygiene Initiative and state or territory requirements
• Training documents (for example, syllabus, attendance records or competency assessments) relating to the hand hygiene program
• Observation of hand hygiene promotion within the healthcare service.

• How does your healthcare service support the workforce to practise respiratory hygiene, cough etiquette and physical distancing?
• How does the environment in your healthcare service promote physical distancing between people moving around the service?
• How does your healthcare service promote key messages regarding respiratory hygiene, cough etiquette and physical distancing to consumers in a way that is easily understood?

Support the workforce and consumers to practise respiratory hygiene, cough etiquette and physical distancing by:

• providing the resources and environment to achieve respiratory hygiene, cough etiquette and physical distancing
• promoting key messages regarding respiratory hygiene and cough etiquette in the healthcare service
• reviewing and adjusting the environment to maximise distance between people, for example, separating seating and furniture
• promoting good indoor air quality and effective ventilation to help reduce circulating infectious particles in the air.

The type and comprehensiveness of evidence used is dependent on the context of each healthcare service. The content and complexity of the policies and processes will likely depend on the size of the healthcare service, but could include:

• Processes or resources that are available to the workforce regarding respiratory hygiene, cough etiquette and physical distancing
• Observation of promotional material such as posters in the healthcare service, for example, in waiting rooms or treatment rooms, audiovisual material or brochures
• Observation of resources made available to the workforce, patients and consumers, for example, such as face masks, tissues and waste receptacles
• Completion of training that supports the workforce to practise respiratory hygiene, cough etiquette and physical distancing and how to perform these actions correctly
• Examples of documentation where respiratory hygiene, cough etiquette and physical distancing has been discussed with patients or their carer
• The design of the healthcare service provides for sufficient space to maximise physical distancing where possible.

• What procedures are performed in your healthcare service that require aseptic technique?
• Who performs these procedures and what types of training and competency assessment is available to the workforce?
• What processes do the workforce use to support correct aseptic technique?
• How does the healthcare service ensure healthcare providers routinely follow aseptic technique when required?

• Identify the procedures carried out by the healthcare service for which aseptic technique is required. These include, but are not limited to
  • intravenous or invasive device insertion, access and maintenance
  • wound dressings
  • collection of clinical specimens (blood, swabs or urine)
  • parenteral medication preparation.
• Facilitate access to training to address gaps in compliance. Training programs for aseptic technique may either be specific to individual clinical procedures or may apply to many different procedures. These programs need to incorporate all the principles of aseptic technique.
• Consider the appropriateness of technological advances to improve aseptic technique in practice, such as
  • equipment bundles
  • sterile ‘starter’ packs. 

• What procedures are delivered in your healthcare service that require the use of invasive medical devices?
• How does your healthcare service identify risks associated with the different invasive devices?
• What processes does your healthcare service use to ensure appropriate use and management of invasive medical devices, consistent with the current edition of the Australian Guidelines for the Prevention and Control of Infection in Healthcare?
• How is your workforce supported to use and manage invasive medical devices appropriately?

• Identify procedures where invasive medical devices are used in the provision of health care.
• Develop processes to support the workforce appropriately use and manage invasive medical devices.
• Review incident reports relating to invasive medical devices for appropriateness, infection, referral, inconsistency or noncompliance with organisational policy, equipment failure and other adverse events.
• Provide the workforce with training for the appropriate use and management of invasive medical devices.

The type and comprehensiveness of evidence used is dependent on each healthcare service context, but could include:

• List of the invasive medical devices in use in the healthcare service and where they are used
• Documents outlining the process for appropriate use and management of invasive medical devices, including the selection, insertion, maintenance and removal of invasive medical devices
• Examples of records in which use of invasive medical devices was discussed
• Observation of use of invasive medical devices as per the healthcare service’s processes
• Actions taken to manage identified risks with the selection, insertion, maintenance and removal of invasive medical devices
• Records of workforce training and competency in the insertion/maintenance and removal of invasive devices.

• What processes does your healthcare service use to ensure a clean and hygienic environment?
• What processes are used to evaluate that the environment is clean and hygienic?
• How does your healthcare service ensure the appropriate workforce is trained in cleaning processes for routine and outbreak situations, and novel infections?

• Identify infection risks associated with the healthcare environment.
• Develop an environmental cleaning process for the healthcare service, addressing the outcomes described above.
• Facilitate training for the workforce on the healthcare service’s environmental cleaning process.
• Implement the healthcare service’s environmental cleaning process and schedule.
• Evaluate environmental cleaning practices for compliance with policies, procedures and protocols and measure outcomes of cleaning processes.
• Review position descriptions or contract specifications as part of the appraisal or contract review process, and provide feedback to the relevant person or group on achievements or areas for improvement.

The type and comprehensiveness of evidence used is dependent on each healthcare service context. The content and complexity of the policies and processes will likely depend on the size of the healthcare service, but could include:

• Documented cleaning process that includes essential elements
• Cleaning schedule for the healthcare service
• Documented cleaning schedules and evidence of physical observation or audits that indicate that cleaning has been completed
• Evidence that the relevant workforce has undertaken training in infection and prevention control
• Evidence that cleaning equipment and products used are listed on the Australian Register of Therapeutic Goods.

• How are infection risks for new and existing equipment, devices and products determined?
• What processes are in place for minimising infection risks associated with maintaining, repairing and upgrading buildings, equipment, furnishings and fittings?
• What processes are in place for minimising infection risks associated with linen?
• What processes are in place for identifying and mitigating risks associated with novel infections, and risks identified as part of a public health response or pandemic planning?

• Define and implement a process based on a risk assessment of infection risks to evaluate and respond to those risks for:
  • new and existing equipment, devices and products used in the healthcare service
  • clinical and non-clinical areas, and workplace amenity areas
  • maintaining, repairing and upgrading buildings, equipment, furnishings and fittings
  • handling, transporting and storage of linen (if applicable)
  • novel infections, and risks identified as part of a public health response or pandemic planning.

The type and comprehensiveness of evidence used is dependent on each healthcare service context, but could include: 

• Risk assessment of infection risks
• Process to evaluate and respond to infection risks for:
  • new and existing equipment, devices and products used in the healthcare service
  • clinical and non-clinical areas, and workplace amenity areas
  • maintaining, repairing and upgrading buildings, equipment, furnishings and fittings
  • handling, transporting and storage of linen (if applicable)
  • novel infections, and risks identified as part of a public health response or pandemic planning
• Example of changes made to cleaning processes in response to an identified infection risk. 

• What are the recommended and/or mandated vaccinations for the workforce in your healthcare service?
• What additional risk mitigation strategies are implemented when a member of the workforce refuses, or has a medical exemption for, specified vaccinations?
• How is compliance with your healthcare service’s recommendations or requirements for immunisation verified? 

• Develop a process to facilitate workforce immunisation for vaccine-preventable diseases. This process should
  • identify specific risks to the workforce, consumers and patients, including prevalence of certain vaccine-preventable diseases and occupational risks
  • specify recommended and/or mandated vaccinations for the workforce based on identified risks. Ensure requirements are consistent with the current edition of the Australian Immunisation Handbook and state or territory requirements for vaccination
  • specify employer and employee responsibilities regarding immunisation
  • outline additional risk mitigation strategies required where members of the workforce refuse, or have medical exemptions for specified vaccinations       
  • ensure employment agreements, policies, procedures or protocols specify recommended and/or mandated vaccinations.

The type and comprehensiveness of evidence used is dependent on each healthcare service context. The content and complexity of the policies and processes will likely depend on the size of the healthcare service, but could include:

• List of recommended and/or required workforce vaccinations, including the rationale for inclusion
• Evidence of employment agreements, policies, procedures or protocols that outline to both the employer and employee the responsibilities for managing occupational risks for vaccine-preventable diseases or immunisation requirements
• Audit results or records of workforce vaccination compliance
• Evidence of communication with prospective employees or the existing workforce about vaccination requirements
• Workforce vaccination records.

• What is your healthcare service’s process for preventing and managing infections in the workforce?
• Who was consulted in the development of the process?
• How is service provision managed during outbreaks?

• Define and implement a process for preventing and managing infections in the workforce. This should include:
  • circumstances where members of the workforce should refrain from attending the healthcare service and interacting with patients, for example, when an infection is suspected or confirmed, or when they are at greater risk of infection or susceptible to adverse health outcomes
  • whether healthcare providers are able to work via remote-attendance and how this will be facilitated
  • if and how service provision will continue during periods of outbreaks and pandemics, or events where there is an increased risk of transmission of infection is common, for example, seasonal influenza or local outbreaks of viral gastroenteritis
  • how the healthcare service will access or be alerted to local state or territory public health orders or guidelines for the requirements for workforce screening and exclusion periods.
• Provide the workforce with training on preventing and managing exposure to infections.

The type and comprehensiveness of evidence used is dependent on each healthcare service context. The content and complexity of the policies and processes will likely depend on the size of the healthcare service, but could include:

• The healthcare service’s process for preventing and managing infections in the workforce
• Observation of how the healthcare service is alerted to, or can access local state or territory public health orders
• Business continuity plans. 

• Is there a process for identifying and registering the reusable equipment, instruments and devices that need to be reprocessed?
• How does your healthcare service ensure that reprocessing of reusable medical equipment, instruments and devices follows relevant standards and manufacturer’s instructions?
• How does your healthcare service identify which reusable equipment, instruments and devices have been used during the care of a patient?
• What mechanism does your healthcare service have in place to recall those patients at risk of acquiring an infection as a result of the reusable equipment, instruments and devices used?
• How are the sterile stock and reprocessed equipment, instruments and devices transported, stored and maintained?

• Identify the healthcare service’s need for reusable critical equipment, instruments and devices.
• Develop and implement a process for the reprocessing of reusable critical equipment, instruments and devices used in the healthcare service. This process must
  • be consistent with the relevant Australian Standard and manufacturer’s instructions
  • describe how the healthcare service will record and identify (if required) the patient, procedure and reusable equipment, instruments and devices that were used for the procedure
  • identify situations when processes may need to be reviewed
  • determine how additional controls for novel and emerging infections may be identified and incorporated.
• These processes may also be required for the reprocessing of semi-critical equipment, in accordance with the relevant Australian Standard, for example, where high-level disinfection of a semi-critical medical device is required. 

• The type and comprehensiveness of evidence used is dependent on each healthcare service context. The content and complexity of the policies and processes will likely depend on the size of the healthcare service, but could include:
• Policies, procedures and/or protocols for processing reusable equipment, instruments and devices that are consistent with relevant national or international standards and manufacturer’s instructions for use
• Examples of agreements or contracts in place to manage reprocessing services that include safety and quality measures such as incident and performance monitoring
• A register of reusable medical devices
• Access to, or copies of, manufacturer’s instructions for each device
• Records that verify equipment installation, operation and reprocessing is consistent with the relevant national or international standards
• Maintenance schedules for equipment used to reprocess medical equipment, reusable instruments and devices are monitored and reviewed
• Registers of staff training and competency assessments
• Audits to ensure the integrity of sterile stock integrity and supply
• Relevant documentation where reports on cleaning, disinfection and sterilisation processes are reviewed and discussed
• Risk assessments where there are deviations in the requirements of relevant standards and the manufacturer’s instructions
• Policies or procedures that specify which procedures should be used for single-use items
• Policies or procedures for the use of reusable items that reflect relevant risk management strategies to ensure safe clinical practice and determine when, for which procedures and/or where reusable items should be used
• Register or record of patients who have had procedures using reusable equipment, instruments and devices.

• How do healthcare providers access current therapeutic guidelines or evidence-based, locally endorsed guidelines at the point of care?   
• How are healthcare providers supported to incorporate core elements, recommendations and principles from the current Antimicrobial Stewardship Clinical Care Standard?
• What information is communicated to patients when an antimicrobial is prescribed, supplied or administered? How is this information communicated?
• How are data on antimicrobials collected, reviewed and used for improvement action?

• Ensure healthcare providers have access to, and promote, current guidelines for treatment and prophylaxis for common infections relevant to the patient population, the indications for use and the local antimicrobial resistance profile (if known). Information sources include
  • Therapeutic Guidelines: Antibiotic, one of the key national guidelines for antimicrobial prescribing in Australia
  • Health Pathways in a healthcare service’s local Primary Health Network (PHN)
  • Local evidence-based guidelines, where available.
• Support healthcare providers to incorporate relevant core elements, recommendations and principles from the current Antimicrobial Stewardship Clinical Care Standard, developed by the Commission.
• Review policies, clinical pathways, point-of-care tools and education programs to ensure that they incorporate the principles of the Antimicrobial Stewardship Clinical Care Standard.
• Collect and regularly review data on antimicrobial against the therapeutic guidelines or local pathways. Indicators specified in the Antimicrobial Stewardship Clinical Care Standard may be helpful.
• Use this analysis to identify areas for quality improvement and action to be taken.
• Provide access to and promote resources to educate consumers about the risks, benefits and alternatives to antimicrobials for their condition.

The type and comprehensiveness of evidence used is dependent on each healthcare service context, but could include:

• Observation of healthcare providers accessing electronic or printed copies of endorsed Therapeutic Guidelines: Antibiotic
• Examples of communication materials provided to patients regarding antimicrobials
• Guidance for healthcare providers on providing materials to patients regarding antimicrobials
• Requirements for and/or records of healthcare providers completing NPS MedicineWise antibiotic prescribing modules. 

• How do healthcare providers take a BPMH in your service?
• Where in a patient’s healthcare record is the BPMH recorded?
• How are patients encouraged to keep their own medicine list and to share this with other relevant healthcare providers?
• How is informed consent incorporated into your process for sharing the patient’s medicines list with other relevant healthcare providers on their behalf?

Develop and implement a process for healthcare providers to, within their own scope of clinical practice:

• Take a BPMH as early as possible in the episode of care
• Record this information in a patient’s healthcare record, including any adverse drug reactions
• Use structures and systems established in the Partnering with Consumers Standard to partner with patients, carers and families in the management of medicines
• Support patients, carers and families to keep an accurate medicines list
• Encourage patients to share their medicines list with other healthcare providers
• Share a patient’s medicines list with other healthcare providers with a patient’s consent
• Use this information in the planning and delivery of health care
• Make template medicines lists available to patients, carers and families. 

The type and comprehensiveness of evidence used is dependent on the context of each healthcare service. The content and complexity of the policies and processes will likely depend on the size of the healthcare service, but could include:

• Process for obtaining and documenting a BPMH
• Evidence that BPMHs are documented in a patient’s healthcare record
• Information available to patients about the need for maintaining a current list of their medicine.

• How do healthcare providers provide information on medicines, tailored to the patient’s needs and preferences?
• What strategies are in place to support patients and carers to raise concerns about medicine-related risks and clarify the information they are provided?
• What processes are used to identify patients at risk of medicine-related problems or adverse events?
• What action is taken when an adverse event involving medicines is suspected?
• How are suspected adverse events (involving medicines) that are experienced by patients reported to the TGA? 

• Provide patients and carers with enough information about treatment options for them to make informed choices about their medicines, and to adhere to medicine-related treatment plans in the delivery of health care.
• Support healthcare providers to provide medicine-related information when treatment options are discussed and when treatment decisions have been made.
• Implement a process to report all new suspected adverse events involving medicines experienced by patients to the TGA and document these in the patient’s healthcare record.

The type and comprehensiveness of evidence used is dependent on each healthcare service context. The content and complexity of the policies and processes will likely depend on the size of the healthcare service, but could include:

• Observation of the healthcare provider accessing medicines information, or communicating with patients about medicines information in way that is tailored to their needs and preferences
• Samples of medicine-related information resources (for example, Consumer Medicines Information, newsletters or other communication material) for the workforce, patients, carers and families that are tailored to their specific needs and meet the health literacy actions of the Partnering with Consumers Standard (for example, appropriate print size and font of the resource in the patient’s preferred language)
• Examples of medicines lists including where medicines lists have been tailored to the specific needs of recipients (for example, the patient, community pharmacist, general practitioner and rural generalists, nurse practitioner, allied healthcare provider or school nurse)
• Communication to the workforce explaining the process for reporting suspected adverse events involving medicines to the TGA
• Record of suspected adverse drug reaction reports submitted to the TGA
• Register of adverse events involving medicines that includes actions to address the identified risks
• Access to tools for reporting adverse events involving medicines, for example, via the TGA website or using clinical software
• Examples of incident records identifying potential medicine-related risks and associated actions to reduce risk or improve clinical safety outcomes
• Records of patient or carer feedback on medicine-related information provided during care. 

• How does your healthcare service ensure that all medicines (including temperature-sensitive medicines) are stored and handled according to manufacturer’s’ directions?
• How does your healthcare service manage and report risks associated with the storage of medicines?
• How does your healthcare service ensure that processes for medicines disposal are consistent with state or territory requirements and the manufacturer’s instructions?

• Identify relevant legislative, regulatory and state or territory requirements and risks associated with medicines handling, storage and distribution across the organisation, and develop and implement evidence-based strategies to comply with requirements and reduce or mitigate these risks.
• Implement systems for storage and purpose-built equipment that continuously monitors and help to maintain the integrity of temperature-sensitive medicines.
• Implement policies, procedures and guidelines for the disposal of unused, unwanted or expired medicines.

The type and comprehensiveness of evidence used is dependent on each healthcare service context. The content and complexity of the policies and processes will likely depend on the size of the healthcare service, but could include:

• Access to relevant poisons legislation
• Evidence that medicines are stored and secured in accordance with legislation (for example, Schedule 4 medicines out of reach of public, Schedule 8 medicines in a lockable safe)
• Evidence of professional qualifications of workforce handling Schedule 8 medicines
• Process for the management and disposal of unused, unwanted or expired medicines
• Examples of risk management or incident records in which the storage, distribution and disposal of medicines were considered, and action taken to improve clinical safety
• Orientation or training documents about storage, distribution and disposal of medicines
• Examples of action taken to manage identified risks regarding the storage (including secure storage), distribution and disposal of medicines
• Observation of workforce access to infrastructure and equipment necessary to comply with legislative requirements, policy, procedures and/or protocols, or documented agreement (contract) with a facility that provides a compliant disposal service
• Record of routine temperature monitoring and scheduled maintenance of the refrigerators used to store medicines and vaccines
• Records of supply of medicines.

• What processes are in place to identify medicines that are considered to be high risk?
• How does your healthcare service ensure safe and appropriate storage, prescribing, administration, distribution and disposal practices for high-risk medicines?

• Identify high-risk medicines being prescribed, dispensed, stored or administered in the healthcare service.
• Regularly assess the use and misuse of high-risk medicines, relating to storage, prescribing, dispensing and administration.
• Develop and implement risk reduction strategies for the storage, prescribing, dispensing, administration and disposal of high-risk medicines relevant to your health service.

The type and comprehensiveness of evidence used is dependent on each healthcare service context. The content and complexity of the policies and processes will likely depend on the size of the healthcare service, but could include:

• Processes for identifying, storing, prescribing, dispensing, administering, monitoring and disposing of high-risk medicines, where applicable
• List of high-risk medicines used in the healthcare service
• Orientation or training documents about high-risk medicines
• Results of analysis of incidents involving high-risk medicines
• Feedback to the workforce about incidents associated with high-risk medicines and risk prevention strategies
• Examples of communication (including education) with patients and carers about high-risk medicines
• Examples of improvement activities that have been implemented and evaluated to reduce the risks of storing, prescribing, dispensing and administering high-risk medicines.

• Which other healthcare providers are involved in the patient’s care?
• What information is provided to another healthcare provider when a patient is referred to them?
• How does the workforce identify and record the details of other healthcare providers involved in a patient’s health care?
• What training do healthcare providers undertake regarding multidisciplinary collaboration?

Support the workforce to collaborate with other healthcare providers, when relevant, in the planning and delivery of health care by 

• training (this may be part of formal qualifications or continuing professional development)
• identifying other local healthcare providers
• introducing processes for the workforce to identify and document other healthcare providers involved in a patient’s care in their healthcare record
• establishing processes for referral and/or reporting to a patient’s other healthcare providers when relevant. 

The type and comprehensiveness of evidence used is dependent on each healthcare service context. The content and complexity of the policies and processes will likely depend on the size of the healthcare service, but could include:

• Process for referring a patient to another healthcare provider
• Evidence of training on processes to identify and document other healthcare providers involved in a patient’s care in their healthcare record
• Referral documentation that uses structured communication processes
• Feedback from patients, carers and family members on their experience when seeing different health professionals during single or multiple episodes of care
• List of local healthcare providers
• Observation of collaborative work to plan and deliver care
• Demonstration of shared leadership and collaborative teamwork in multidisciplinary healthcare teams in rural and remote settings.

• What are the priority health issues for the patients and/or the community?
• What lifestyle or other factors can the service promote or provide more information on?
• Are there relevant health promotion events the service can promote, such as cancer awareness events?
• What evidence-based screening tools and referral services exist that might benefit the community?
• What trusted websites or health information can be recommended to support patients? 

• Establish processes for routinely supporting health promotion and prevention in your service. This will include:
  • identifying the health education and promotion priorities relevant to the service’s patient population
  • sourcing reliable and current health information and promotional material to aid discussion with patients or display in your service
  • having a process for conducting evidence-based screening and early intervention or referrals to another relevant healthcare provider, if appropriate.
• Incorporate prompts into assessment processes to discuss preventative health and health promotion with patients and their carers.

The type and comprehensiveness of evidence used is dependent on each healthcare service context, but could include:

• Health promotion or prevention material displayed in the service, including where patients and carers can access additional information
• Information on services available, including handouts, leaflets, QR codes directing patients to online information
• Observation of health promotion and prevention activities and discussions with patients and/or the community
• Records of workforce professional development opportunities to maintain the skills and knowledge of current evidence-based screening, care and treatment.

• What risk screening and assessment tools are used within the healthcare service?
• How are agreed plans for care documented?
• How are patients recalled for follow-up care? Is this process effective?
• How does the healthcare service ensure that, when a patient presents with an advance care plan, these are documented in the patient’s healthcare record and that care is provided in accordance with these plans?

• Identify relevant screening and assessment tools that may be used by the healthcare service.
• Support workforce access to continuing professional development and/or training to ensure planning and delivery of comprehensive care is in line with current best practice.
• Develop and implement a process to document agreed plans for care in a patient’s healthcare record and recall patients for follow-up.
• Define and implement processes to receive, document, provide access to and communicate advance care plans.

The type and comprehensiveness of evidence used is dependent on each healthcare service context. The content and complexity of the policies and processes will likely depend on the size of the healthcare service, but could include:

• Training records or documents relating to screening, assessment, diagnosis, goal setting and delivery of comprehensive care in relevant clinical areas
• Screening and assessment templates or forms
• Examples of documented care plans
• Documents outlining patient recall process
• Reviews of the use of advance care plans to evaluate alignment with actual care given
• Examples of healthcare records with advance care plans documented
• Examples of healthcare records indicating recall of patients. 

• What processes are used to identify patients who identify as Aboriginal and/or Torres Strait Islander?
• How is this information recorded and used in care planning and delivery?
• What training does your workforce undertake to support them in asking the question?

• Establish processes for people to self-identify as Aboriginal and/or Torres Strait Islanders.
• Facilitate access to training the workforce to build cultural safety capacity – training can be provided to the workforce via eLearning such as Asking the Question of Origin elearning module (identification training).

The type and comprehensiveness of evidence used is dependent on each healthcare service context, but could include:

• Patient record form on which patients can identify as being of Aboriginal or Torres Strait Islander origin
• Communication material displayed in common areas that provides patients with information about why they will be asked if they identify as being of Aboriginal or Torres Strait Islander origin
• Evidence of workforce training on cultural safety and how to ask the question.

• What are the sociodemographic characteristics of the healthcare service’s patient population?
• What strategies are being implemented to optimise health outcomes for these patients?
• What tools and resources are available for the workforce?

• Periodically review local community and patient demographics to identify the diversity of the patients using the healthcare service and incorporate into planning for care.
• Build staff confidence and awareness of the issues for people with disability.
• Identify the reasonable adjustment of strategies or services that can be used when providing comprehensive care for patients who are more likely to face barriers in accessing healthcare services.
• Facilitate access to training to support planning and delivery of health care that is inclusive.
• Identify tools and resources that can be used to support safe care for people with disability and from diverse backgrounds.

The type and comprehensiveness of evidence used is dependent on each healthcare service context, but could include:

• Demographic data for the healthcare service’s patient population and the local community that are used for planning purposes
• Evidence of culturally informed training and comprehensive care planning
• Tools and resources used by the workforce to support the safe care of people with disability and from diverse backgrounds
• Training documents on diversity and cultural awareness
• Consumer information that is available in different formats and languages that reflect the diversity of the patient population
• Observation of healthcare providers communicating with patients in their preferred language
• Equipment and principles of universal design to enable access to care for people living with a disability.

• How does the healthcare service organisation identify patients who are at the end of their life?
• How does the healthcare service ensure that these processes are consistent with the National Consensus Statement: Essential elements for safe and high-quality end-of-life care?
• How does the healthcare service ensure care is provided in accordance with advance care plans?
• How does the healthcare service seek advice from other healthcare professionals including specialist palliative care services?
• How are clinicians supported to share decisions about end-of-life care with patients, carers and families?

• Use the National Consensus Statement: Essential elements for safe and high-quality end-of-life care to implement processes for identifying patients with end-of-life care needs and improving end-of-life care.
• Describe key considerations and actions healthcare providers would take when planning and delivering health care for someone who is at the end of life.
• Where required, the healthcare service should seek specialist palliative care advice through referral pathways or informal contact with specialist palliative care services.

The type and comprehensiveness of evidence used is dependent on each healthcare service context, but could include:

• Communication (for example, posters on clinic walls, emails to clinicians, information on noticeboards) that outlines processes for accessing specialist palliative care advice
• Observation of clinicians accessing specialist palliative care advice
• Resources and tools to help clinicians identify patients who are at the end of life
• Training documents (for example, syllabus, attendance records, competency assessments) about identifying patients who are at the end of life
• Tools and resources for shared decision making with patients, carers and families about end-of-life care
• Observation of discussions on shared decision making about end-of-life care between clinicians, patients, carers and families
• Patient and carer information packages or resources about end-of-life care options.

• How does the workforce confirm a patient’s identity before providing care?
• What patient identifiers are used to confirm the identity of a patient?

• Define a process for the reliable and correct identification of patients when health care, medicine, therapy and other services are provided.
• Agree a list of patient identifiers that can be used by the workforce.

The type and comprehensiveness of evidence used is dependent on each healthcare service context. The content and complexity of the policies and processes will likely depend on the size of the healthcare service, but could include:

• A documented process for patient identification
• Documentation on the agreed patient identifiers to be used
• Observation of the patient and procedure matching process
• Templates, checklists or documentation identifying and matching a patient to their intended care, for example, patient registration forms and healthcare records
• Communication materials or training records for the workforce on correct patient identification.

• In your healthcare service when do you need to match patients to their health care and what processes are used?
• What documentation does your healthcare service require in the patient’s healthcare record?
• What processes are in place to ensure that your patients’ healthcare records are accurate and complete?
• How are healthcare records accessed by all those involved in the patient’s care? 

• Develop and implement processes to correctly match patients with their intended health care using defined patient identifiers.
• Ensure that your healthcare service has relevant, accurate, complete and up to date information about patients’ care documented in their healthcare record.
• Ensure that patients’ healthcare records are available and accessible to those involved in their care.

The type and comprehensiveness of evidence used is dependent on each healthcare service context, but could include: 

• Documents that describe how patients are matched to their care
• Communication materials or training records that demonstrate the workforce has been educated on the relevant protocol for correctly identifying a patient
• Observation of healthcare records where the information used to identify a patient and match them to their care is documented
• Observation of healthcare records being available to clinicians at the point of care.

• What resources or processes does your healthcare service have to support communication and collaboration with other care providers when a patient is being referred?
• How is your workforce supported to develop and maintain skills for effective communication?

The type and comprehensiveness of evidence used is dependent on each healthcare service context. The content and complexity of the policies and processes will likely depend on the size of the healthcare service, but could include:

• Documents outlining the process for communicating emerging or changing critical information
• Templates to support clinical communication, such as referral forms, standardised comprehensive care plans, medication lists or checklists for referrals
• Templates or tools that support healthcare providers to partner with the patient to communicate critical information, risks and goals or preferences
• Examples of referrals or communication between healthcare providers and the patient
• Demonstration of shared leadership and collaborative teamwork in multidisciplinary healthcare teams in rural and remote settings.

The type and comprehensiveness of evidence used is dependent on each healthcare service context. The content and complexity of the policies and processes will likely depend on the size of the healthcare service, but could include:

• Process for booking appointments
• Communication processes used prior to an appointment
• Examples of appointment reminders such as phone records in patient healthcare records, text messages or email reminders.

• How does your healthcare service communicate critical information, alerts and risks to other healthcare providers within your healthcare service?
• How does your healthcare service communicate critical information, alerts and risks to healthcare providers in other healthcare services?   
• How is a patient’s preferences determined for sharing their health information within your service, with other services and to their carers and families? 

• Define ‘critical information’ and ‘risks to patient’s care’ for your service.
• Use standardised processes to communicate critical information, alerts or risks to relevant healthcare providers and patients, carers and families in a timely manner.

The type and comprehensiveness of evidence used is dependent on each healthcare service context. The content and complexity of the policies and processes will likely depend on the size of the healthcare service, but could include:

• A document describing the types of critical information likely to be received and actions taken in response
• Processes for communicating critical information (for example, by telephone or secure electronic means) to the relevant healthcare providers including
  • method for communicating critical information to the patient, carer and family
  • time frames for communicating critical information
  • expectations for the healthcare provider and requirements for the patient’s care
• Standardised templates to support communication of critical information, such as referrals, templates or progress notes that are updated in line with identified risks, patient feedback and recommendations
• Observation of critical information being discussed, shared with the appropriate healthcare provider or the patient, and acted upon.

• How are patients, carers and families supported in communicating critical information to healthcare providers?
• What feedback processes are in place to let patients, carers and families know that they have been heard and any action that has been taken?

• Develop and implement processes that describe when and how critical information and risks about a patient’s health need to be communicated to healthcare providers.
• Support patients and carers to understand and use these processes.

The type and comprehensiveness of evidence used is dependent on each healthcare service context, but could include:

• Information provided to patients, carers and families about processes for communicating concerns to the healthcare providers
• Resources and information for patients, carers or families to use to communicate with healthcare providers, such as phone numbers or where to go for emergency assistance
• Patient notes that identify critical information provided by the patient or family and how this information was acted upon
• Results of a patient experience survey or patient, carer and family feedback about their communication with clinicians and, where necessary, how these results have informed improvement
• Information available online detailing the healthcare service’s communication processes or emergency contact processes (for example, on the healthcare service’s website or social media platform).

• What are some examples of serious deterioration in a patient?
• What emergency assistance would be called for in the event of a patient experiencing serious deterioration, and why?
• What training do healthcare providers complete to support them to respond to a patient experiencing serious deterioration?

• Develop a process to support healthcare providers to:
  • recognise deterioration in a patient’s physical, mental or cognitive health
  • respond to a patient within their scope of practice and call for emergency assistance
  • notify a patient’s other relevant healthcare providers, carers or family when health care is escalated.
• Ensure that healthcare providers and the workforce have the necessary skills and equipment to recognise and respond to serious deterioration within their scope of clinical practice.

The type and comprehensiveness of evidence used is dependent on each healthcare service context. The content and complexity of the policies and processes will likely depend on the size of the healthcare service , but could include:

• Healthcare service’s process for recognising and responding to serious deterioration or distress and escalating care
• Training documents about mechanisms for escalating care and calling for emergency assistance
• Posters and other resources such as flow charts that are accessible and displayed in appropriate locations for the workforce.

• How does the workforce respond to patients who are distressed, have expressed thoughts of self-harm or suicide, or have self-harmed?
• What information on other services can the healthcare provider give to patients when their healthcare needs are beyond the scope of the healthcare service?

• Develop and implement a process to:
  • respond to patients who are distressed, have expressed thoughts of self-harm or suicide, or have self-harmed
  • respond to patients who present a risk of harm to others.
• Facilitate training for the workforce to effectively recognise and respond to patients who are distressed or exhibit aggression, have expressed thoughts of self-harm or suicide, or have self-harmed.
• Source and make information available on accessing other mental health services beyond the scope of the service. In most instances this will involve referring a patient to a general practitioner or rural generalist, community mental health service or hospital emergency department.

The type and comprehensiveness of evidence used is dependent on each healthcare service context. The content and complexity of the policies and processes will likely depend on the size of the healthcare service, but could include:

• Processes that outline collaborative processes for identifying and treating patients at risk of self-harm or suicide, or who have self-harmed
• Crisis intervention support processes aligned to relevant legislation
• Training documents about identifying and responding to patients at risk of self-harm or suicide, or who have self-harmed
• Patient resources about strategies for accessing health services beyond the scope of the service.