Initiatives by Category

Acute Care

Endoscopy Information System (EIS)

Aim: To develop a high-quality endoscopy reporting system to ensure that an accurate assessment of NSW endoscopy services can be undertaken against accepted patient safety, quality and utility benchmarks.

Benefits: The implementation of a standard EIS across NSW Health will:Provide accurate statewide information on endoscopic procedures carried out in NSW public hospitals; Inform on issues of productivity, activity, costs, and access to services; Facilitate the comparison of services against critical safety and quality benchmarks; Facilitate electronic reporting to the National Bowel Cancer Screening Program’s Register; Enhance the efficiency and accuracy of clinician procedure-reporting through electronic image capture and customisable reporting templates; Allow endoscopic reports to be electronically stored and accessed...

ACI Ready to Implement Added: 5 November 2013|Last updated: 23 September 2014

State Cardiac Reperfusion Strategy (SCRS)

Aim: To improve care for all patients in NSW with a suspected Acute Coronary Syndrome (ACS) and reduce the time from symptom onset to reperfusion for patients with ST Elevation Myocardial Infarction (STEMI).

Benefits: Care is tailored to specific settings so that all patients, regardless of their geographical location or presentation pathway can benefit from early access to specialist medical advice and appropriate treatment. Timely reperfusion rapidly restores blood flow to the heart, which means patients with STEMI may have better outcomes and fewer days in hospital.

ACI Ready to Implement Added: 11 July 2013|Last updated: 21 May 2015

Blood and Marrow Transplantation Long Term Follow Up (LTFU) Project

Aim: The primary goal of this project is to develop clinical guidelines for management of patients following allogeneic blood and marrow transplant. The guidelines apply to adult patients and patients transitioning between paediatric and adult services, across metropolitan, regional, and rural areas.

Benefits: LTFU assists early recognition of complications, survival and quality-of-life issues for patients post-BMT transplant. These benefits have been supported by recently published guidelines including the Joint Recommendations of the European Group for BMT, the Centre for International BMT Research, and the American Society of BMT (1).

ACI Future Initiative Added: 8 November 2013|Last updated: 5 August 2016

NSW Pain Clinic Referral Form and Process

Aim: To provide a consistent method when making a referral from primary care to a tertiary pain service, irrespective of where the service is located.

Benefits: All services will have the same triage criteria and process for accepting patients from primary care.

ACI Ready to Implement Added: 7 November 2013|Last updated: 17 November 2014

NSW Standardised Pain Charts (adult)

Aim: Development and implementation of statewide charts to be used at the bedside when delivering Patient Controlled Analgesia (PCA), ketamine infusions and neuraxial opioid administration. To standardise practice and reduce error relating to documentation, monitoring and prescription across NSW.

Benefits: Benefits include improved safety and quality of care for patients.

ACI Ready to Implement Added: 7 November 2013|Last updated: 15 December 2014

Reducing Catheter Associated Urinary Tract Infections

Aim: To improve clinical practices associated with urinary catheter insertion, maintenance and removal in acute care settings.

Benefits: Improved practice will:Ensure that urinary catheterisations are undertaken only when appropriately indicated; Reduce the risk of insertion site and drainage device contamination; Reduce the dwell time of catheterisation; and Reduce the risk of acquiring a urinary tract infection due to catheterisation.It is anticipated that reducing the incidence of catheter-associated urinary tract infections will reduce the risk of acquiring an infection caused by a multi-resistant organism and reduces the likelihood of needing complex antimicrobial therapy and prolonged hospitalisation.Other benefits anticipated from...

CEC Ready to Implement Added: 3 September 2014|Last updated: 15 March 2016

Care of Confused Hospitalised Persons (CHOPs) program

Aim: Provide simple strategies to improve the care outcomes of older patients with confusion in NSW hospitals, through:increased staff knowledge and skills to identify, treat and care for older people presenting to their hospitals with confusioninvolvement of carers and families.Achievements, innovation and knowledge will be shared and systems embedded into practice to sustain and spread improvements in care.

Benefits: Increased screening, improved risk assessment and more appropriate treatment and management of confusion.Increased awareness, knowledge and skills of staff to better care for older patients with dementia/delirium.Minimisation of harm during care and safer and more supportive hospital environments.Improved patient outcomes, including:prevention of functional declinereduced morbidity and adverse eventsreduced length of stayreduced readmissionsreduced rate of admission to a residential aged care facility upon discharge.Greater accuracy of coding for delirium DRGs.Reduced per capita cost.

ACI Ready to Implement Added: 13 August 2015|Last updated: 14 August 2015

Quality Systems Assessment (QSA)

Aim: The Quality Systems Assessment (QSA) is a clinical risk management program designed to provide clinicians and managers at all levels with information relevant to their local systems for clinical quality and patient safety.

Benefits: The QSA is one vehicle that contributes to resilience in our health system. Working directly with local teams and local priorities, the QSA supports continuous learning and improvement to prevent and reduce patient harm. Through the multi-level self-assessment, reporting and site visits the QSA is able to identify risks and support improvements: Locally – through detailed local data returned directly to local teams Systemically – through aggregation of local data to identify high priority themes for action All effort that...

CEC Ready to Implement Added: 24 January 2014|Last updated: 14 October 2014

Pressure Injury Prevention Project

Aim: To foster best practice in the prevention and management of pressure injuries within NSW health facilities.

Benefits: Enhance patient safety by promoting pressure injury prevention and management among health care professionals and patients, in line with the Pan Pacific Clinical Practice Guidelines for the Prevention and Management of Pressure Injury 2012 as evidence based practice.Support local health districts (LHDs) and Networks to meet the Australian Commission on Safety and Quality in Health Care, National Safety and Quality Health Service Standards - Standard 8, Preventing and Managing Pressure Injury.

CEC Pre-implementation Added: 7 November 2013|Last updated: 2 June 2014

Pleural Drains in Adults - Consensus Guidelines

Aim: Improve the standard of clinical practice in the insertion, management, trouble shooting and removal of pleural drains in adults within NSW hospitals.

Benefits: Improve patient experience and outcomes. Increase awareness of ‘good’ practice in relation to pleural drains. Support managers and clinicians to implement processes that will reduce the risks associated with pleural drains.

ACI Ready to Implement Added: 8 November 2013|Last updated: 15 January 2016

Care of Adult Patients in Acute Care Facilities with a Tracheostomy

Aim: To improve the safety and quality of care provided to adult patients with a tracheostomy in NSW hospitals.

Benefits: Reduce number of, and severity of adverse events in adults with tracheostomy Improve patient experience and outcomes Improve staff experience in caring for patients with a tracheostomy Reduce length of stay

ACI Ready to Implement Added: 28 October 2013|Last updated: 26 June 2015

A Clinician’s Guide: Caring for people with gastrostomy tubes and devices

Aim: The Guidelines are a practical resource for clinicians to assist them in providing standardised care for children and adults who have a gastrostomy tube or device.

Benefits: The Guidelines provide a practical, evidence-based approach to the care of patients with gastrostomy tubes and devices in NSW.

ACI Ready to Implement Added: 8 November 2013|Last updated: 13 July 2015

Investigating Clinical Variation in Acute Care

Aim: The aims of the ACI Investigating Clinical Variation in Acute Care project are to identify clinical variation in the inpatient management of COPD, CAP and CHF and then assess if this variation may be unwarranted. This is achieved by:audit tools that empower individual sites to assess their clinical practice and identify areas for improvement in partnership with the ACIcapacity building and access to clinical expertise to support the identification and prioritization of opportunities for improvementsupport for networking across sites to...

Benefits: Unwarranted clinical variation (UCV) is an ongoing barrier to providing safe and effective care for patients. Recognising and addressing UCV has been identified as a shared priority across the NSW Health system.

ACI Pre-implementation Added: 13 March 2017|Last updated: 13 March 2017

Framework for the Statewide Model for Palliative and End-of-Life Care Service Provision

Aim: To inform the development of a comprehensive model of care for equitable palliative and end-of-life care service provision in NSW.

Benefits: The Framework is the foundation for advancing work towards the Network’s vision that all NSW residents have access to quality care based on assessed need as each approaches and reaches the end of their life.

ACI Ready to Implement Added: 11 November 2013|Last updated: 20 January 2014

Collaborating Hospitals’ Audit of Surgical Mortality (CHASM)

Aim: To improve the quality and safety of surgical care in NSW hospitals. To reduce the number of preventable surgical deaths in NSW hospitals.

Benefits: All surgeons who are in operative practice are required to report the clinical management of their patients who die while under their care to CHASM for peer review. CHASM provides feedback on the peer review findings to surgeons to facilitate reflective learning and improvement in surgical care.

CEC Ready to Implement Added: 30 October 2013|Last updated: 30 May 2014

Medication Safety and Quality Unit

Aim: To support the safe and quality use of medicines by identifying and addressing emerging medication safety risks.

Benefits: The CEC Medication Safety and Quality unit oversees four programs, Continuity of Medication Management, High-Risk Medicines, Medication Safety Self Assessment and VTE Prevention. The Continuity of Medication Management program provides tools and resources to support medication reconciliation; the process of ensuring that patients receive all intended medicines and that accurate, current and comprehensive medicine information follows them at all transfers of care. The High-Risk Medicines program heightens awareness of the harm that can be caused and assists in improvements to...

CEC Ready to Implement Added: 8 December 2014|Last updated: 9 November 2015

Reducing Unwarranted Clinical Variation (UCV) Taskforce

Aim: To oversee the development and implementation of a system-wide approachto identify, address and reduce Unwarranted Clinical Variation (UCV).

Benefits: To refine care processes and implement evidence-based models of care tosupport improved patient outcomes.

ACI Ready to Implement Added: 8 November 2013|Last updated: 17 November 2013

Hepatitis C: A guide to current treatment and care

Aim: To provide health care managers and staff with information to help design and implement services for the best care for patients with hepatitis C in their own environments.

Benefits: Improvements in clinical practice and patient care.

ACI Pre-implementation Added: 8 November 2013|Last updated: 9 December 2014

Acute Myeloid Leukaemia (AML) Model of Care

Aim: To optimise the quality of care for patients with AML and enable a consistent approach to the provision of care. It provides a set of principles and outlines the key requirements at each stage of the patient’s journey based on evidence of best practice. It incorporates guidelines related to various components of the model.

Benefits: Key points included in this model are:Mechanisms to ensure early identification and referral to an AML treatment centreA multidisciplinary team (MDT) approach to treatment planning and the provision of care in an appropriate settingThe use of ambulatory care services to enable early discharge programs in a safe and efficient wayEffective follow-up and supportive care for all patients with AML

ACI Pre-implementation Added: 5 November 2013|Last updated: 10 July 2015

Blood and Marrow Transplant Environmental Cleaning (BMTEC) Project

Aim: To measure level of cleanliness provided in NSW BMT program. Establish baseline level of environmental cleanliness informed by three external environmental cleaning audits per facility. To ascertain the methods by which units are cleaned (e.g. frequency and process), resourcing, training, and education of environmental service personnel and clinical governance; To pilot and validate the CEC NSW environmental cleaning audit tool against an established standard; To inform quality improvements in environmental cleaning standards in BMT/Haematology units (an extreme-risk functional area). Monitor...

Benefits: With the support of the BMT Network Council and ACI, the BMTEC project provides the following benefits: (i) Enhanced compliance with the Environmental Cleaning Policy NSW (PD2012_061, Nov 2012). Authored by the Clinical Excellence Commission (CEC), this policy was released as a policy directive by the NSW Ministry of Health in November 2012 (1). The categorisation of risk in the Policy provides a basis for recommendations of frequency and minimum cleaning standards for each functional area.Additionally, the policy outlines measures...

ACI Ready to Implement Added: 8 November 2013|Last updated: 5 August 2016

Improving the Medical Inpatient Journey with Criteria Led Discharge

Aim: To reduce delays when a patient is medically ready to return home from hospital.

Benefits: A formalised criteria-led discharge process has the potential to: Improve patient experience: patients are able to get home sooner; Enhance patient safety: criteria led transfers of care through a checklist; Reduce unnecessary length of stay: not being in hospital when patients can actually return home; Reduce bed days: elimination of unnecessary days in hospital; Minimise waste: reduction of costs as a result of eliminating unnecessary lengths of stay in hospital; Improve staff satisfaction: staff are not pressured to transfer patients...

ACI Ready to Implement Added: 8 November 2013|Last updated: 30 May 2014

AMBER Care Bundle

Aim: The AMBER care bundle provides clinical teams a framework to develop a management plan that may include end of life decisions in collaboration with the patient and family for patients whose recovery is uncertain while continuing with treatment in the hope of a recovery.

Benefits: Early identification of people who may have end of life care needs is the foundation of excellent end of life care. If early identification does not occur then appropriate planning, transfer, interventions and communication with the person and their family cannot take place The AMBER care bundle: Provides a tool to help clinicians identify people for whom recovery is uncertain and who may have end of life care needs Simplifies key interventions to support best practice Supports staff to start...

CEC Ready to Implement Added: 25 June 2013|Last updated: 9 November 2015

Community Update on Patient Safety and Quality

Aim: The Community Update is designed to provide consumers with information on the progress of NSW public hospitals across key areas including: handover, hand hygiene, medication safety, falls, healthcare associated infections, sepsis and incident management. A template of the Community Update is available for Local Health Districts who would like to report on their safety and quality data locally.

Benefits: By engaging the community and partnering with patients, family and carers as team members we can improve quality in health care. The Community Update supports the Australian Commission for Safety and Quality in Health Care National Safety and Quality Health Service Standard 2.7.

CEC Ready to Implement Added: 6 November 2013|Last updated: 5 March 2015

Hand Hygiene

Aim: Through sustained improvement in hand hygiene by healthcare staff reduce the risk of healthcare associated infections.

Benefits: Improved health outcomes for patients (reduced morbidity and mortality); Reduced risk transmission of pathogenic organisms to patients, visitors and staff.

CEC Ready to Implement Added: 2 June 2014|Last updated: 2 June 2014

Service Quality and Communication in Emergency Department Waiting Rooms

Aim: The Clinical Excellence Commission (CEC) funded research into service quality and communication in emergency department waiting rooms. The research team was comprised of staff from Southern Cross University with applied skills and knowledge in organisational communication, culture, history, structures and operations.

Benefits: The CEC and Southern Cross University are collaborating on developing educational materials to further progress this area in NSW. Sites interested in being pilot sites for this work are encouraged to email the Directorate of Patient Based Care and express interest.

CEC Pre-implementation Added: 6 November 2013|Last updated: 5 March 2015

5x5 Antimicrobial Audit

Aim: The 5x5 Antimicrobial Audit is an initiative of the Clinical Excellence Commission that aims to improve communication and selection of empirical antimicrobial therapy among clinical teams.

Benefits: The 5x5 Antimicrobial Audit provides a platform for introducing regular, frequent and directed measurement and reporting of antimicrobial prescribing indicators in NSW local health districts and networks. The auditing process encourages clinically appropriate interventions where indications are unclear and/or empiric antimicrobial prescribing is found to be non-concordant with local guidelines. The 5x5 Antimicrobial Audit also facilitates rapid feedback of ward or unit-level antimicrobial prescribing indicators by providing tools and support to enable simple reports to be generated and discussed with...

CEC Ready to Implement Added: 2 June 2014|Last updated: 9 November 2015

Non-Invasive Ventilation (NIV) Guidelines for Adult Patients with Acute Respiratory Failure

Aim: Provide clinicians in critical care areas and specialist respiratory care units with best practice guidance regarding the provision of NIV for appropriately selected patients detailing clinical assessment, NIV therapy management and patient care. Ensure safe and effective NIV is provided to patients and they are managed in the appropriate clinical settings in NSW hospitals.

Benefits: Improve patient experience and outcomes Reduced need for invasive ventilation, prolonged mechanical ventilation and tracheostomy Reduce length of stay

ACI Pre-implementation Added: 8 November 2013|Last updated: 26 June 2015

SEPSIS KILLS Program

Aim: To improve the recognition and treatment of sepsis and septic shock in NSW healthcare facilities and to reduce their impact, mortality and financial costs.

Benefits: Successful implementation of the SEPSIS KILLS program is providing significant benefits at both clinical and system levels, including: more timely, standardised and effective detection and management of sepsis; reduced mortality, morbidity and bed-stays from sepsis-related conditions; enhanced clinician skills in sepsis recognition and management; enhanced networking opportunities across the system for clinicians and service teams; improved quality and safety of care; a better and safer patient experience.

CEC Ready to Implement Added: 6 November 2013|Last updated: 5 February 2015

TOP 5

Aim: The TOP 5 program acknowledges the value of carer information for people living with dementia and other types of cognitive impairment to improve patient outcomes and carer and staff experience.

Benefits: Benefits to individuals with dementia and carers include increased compliance, more effective treatment, less distress and shorter lengths of stay.

CEC Ready to Implement Added: 6 November 2013|Last updated: 7 April 2015

Paediatric Clinical Practice Guidelines Audit Project

Aim: To assess compliance with the guidelines and assist local health districts to further improve the care of children in emergency departments.

Benefits: Empower generalist NSW hospitals, which see the majority of children presenting to an emergency department, with tools and resources to deliver the highest quality care, regardless of location.

CEC Future Initiative Added: 6 November 2013|Last updated: 9 April 2015

Fascia Iliaca Blocks for older people with hip fracture

Aim: To develop a toolkit of resources facilitating Fascia Ilaica Block (FIB) as a method of pain management in hip fracture.

Benefits: To assist in the practical application of effective pain management as referred to in the Minimum Standards for Hip Fracture; To reduce the harm arising from overuse of opiate medications; To provide a method of implementing application of the procedure.

ACI Ready to Implement Added: 9 November 2015|Last updated: 9 November 2015

Supervision for Safety

Aim: It is proposed that the Supervision for Safety project address NSW Health system deficiencies related to supervision at the point of clinical care. Specifically related to ensuring patient care plans are appropriate and deterioration in patient condition is escalated to the most appropriate level.

Benefits: The Supervision project aims to ensure the appropriate support is provided to less experienced clinicians.The expected project outcomes include:Supervision of the clinical workforce is built into core work practices; Supervision is structured to allow clinicians to be trained without compromising patient care; Supervision provided by clinicians at the point of care is appropriate for the level of expertise of the clinicians involved; Practices are in place to establish the level of expertise of less experienced staff; Supervision is treated as...

CEC Pre-implementation Added: 2 June 2014|Last updated: 2 June 2014

NSW Subcutaneous Insulin Prescribing Chart

Aim: To standardise an adult subcutaneous insulin chart and minimise risks in insulin prescription, administration and documentation.

Benefits: The chart combines prescription and administration with blood glucose, ketone monitoring and glycaemic management. It links all the necessary information for glycaemic management in one document.The chart is designed to minimise delays in management decisions and provide clinicians with clear guidelines for:Insulin prescription and administrationGlycaemic managementSafe supplemental insulin use.The chart includes:Regular, supplemental, once only, and telephone ordersMonitoring for blood glucose levels (BGLs) and ketonesGlycaemic management guidelines to support clinicians that may not have access to local guidelines, policies or specialist...

ACI Ready to Implement Added: 8 November 2013|Last updated: 16 July 2015

In Safe Hands Program

Aim: The In Safe Hands program aims to build and sustain effective health care teams. It is intended to give these teams the structure and tools to redesign their units into strong, interdisciplinary teams, working together to deliver highly reliable, planned care to all patients.

Benefits: Teams that have implemented In Safe Hands have identified the following benefits: Reduced patient length of stay; Reduced unexpected deaths; Reduced adverse events; More satisfied staff; Improved patient experience; Improved safety culture.

CEC Ready to Implement Added: 6 November 2013|Last updated: 12 January 2015

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