Benefits of Standardized Risk Management Framework for Infection Prevention and Control

1. Benefits for using a standardised risk management framework to risk assessInfection Prevention and Control Sue Greig Senior Project Officer National HAI Prevention Program

2. Who might benefit from this presentation? Organisation governance – improve their understanding of their role in infection prevention and control and risk management Quality and safety managers or departments Infection prevention and control professionals

3. Key message – infection control is everybody’s business To make this message meaningful it requires a governance structure and key people to drive and direct the infection prevention and control programme and all staff to have a basic understanding of: Effective governance to support implementation, monitoring, reporting activities Effective work practices to minimise risk of transmission of infectious agents Modes of transmission of infectious agents Legislation, regulation and standards to be applied

4. A risk management framework • Provides a nationally consistent approach that is robust enough to be applied across the health continuum • How do we use risk assessment and management principles for Infection Prevention and Control? • Infection should not be considered an unpredictable complication but a potentially preventable adverse event

5. The risk assessment and management flowchart Source: Australian Guidelines for the Prevention and Control of Infections in Health Care (NHMRC 2010) - Adapted Collaboration

6. A risk matrixSource: Australian Guidelines for the Prevention and Control of Infections in Health Care (NHMRC 2010)

7. Who owns the risk? Governance of the organisation or service From where can risks come? • the system • the organisation • the team who are delivering the care • the individual

8. Who is at risk? Patients – some patients more than others, e.g. elderly, surgical patients, neonates, patients with indwelling devices HCWs – they are health consumers as well and they have extensive exposure to the risk The organisation

9. Firstly, we need to understand the principles of risk management Avoid risk – if a risk cannot be eliminated then it must be managed Identify risk – what is the risk and who is involved? Analyse risks – how did it occur , what is the likelihood and what are the consequences? Evaluate risk – can the risk be reduced or eliminated? Treat risks – who will do this, how and when will it be monitored?

10. What do we do to minimise risk We need to identify: Who is at risk? What infectious agent is involved? How is the agent transmitted? Why can it happen? How likely is it? What are the consequences? What can be done? How is it applied to the situation?

11. Successful risk management includes • A range of strategies that will be influenced by • a base-line review or gap analysis • review of the current governance arrangements, systems, processes, practices and their effectiveness • Development of an action plan to prioritise response strategies and resources

12. A risk assessment tool - example

15. To find out more, go to: Standard 3 Preventing and Controlling Healthcare Associated Infections The Healthcare Associated Infection (HAI) Prevention Program www.safetyandquality.gov.au/hai Accreditation and the NSQHS Standards http://www.safetyandquality.gov.au/our-work/accreditation-and-the-nsqhs-standards/ Accreditation Advice Line: Email accreditation@safetyandquality.gov.au Phone1800 304 056

17. Risk Management and NSQHS Standards, Standard 3 – Preventing and Controlling Healthcare Associated Infections Sue Greig Senior Project Officer National HAI Prevention Program

18. Risk Management and NSQHS Standard 3 This presentation outlines how the principles of risk management will support an organisations response to NSQHS Standard 3 For each element of risk management discussed in this presentation, relevant examples from NSQHS Standard 3 have been included

19. IP&C and Governance (3.1, 3.3, 3.4, 3.14, 3.16) • Policies and procedures should utilise a risk management approach and • Demonstrate evidence of regular review, monitoring, audit and assessment of infection prevention and control activities • Determine priorities based on risk assessment • Evaluate effectiveness at least annually • Minimise risks to patients of HAIs

20. Prioritising risk (3.8, 3.9, 3.10) • Scope of activity and services offered will influence risk • Is the origin of the risk internal or external or both? • What are the risks and opportunities for transmission? • What existing controls are in place? • Identify the opportunities for transmission • Identify those risks that are high so they can be prioritised both for likelihood and consequence

21. Collaboration to reduce risk (3.7, 3.18, 3.19) • Recognition of how infection prevention and control risks impacts upon other areas – WH&S, HR, education, consumers and clinicians • Utilising a standardised tool for identification and analysis of risk • Evaluation of risk management strategies will require collaboration • Minimise duplication

22. Evaluating the risks (3.12, 3.13, 3.17) • To identify how this can happen in your organisation • When evaluating the risk how are you going to prioritise activities? • identify where the risks are high • the simplest intervention • greatest impact in the shortest time period. What is the balance between likelihood and consequences?

23. How will we know how likely it is to happen? From the risk assessment - are the risks common or rare severe or mild How likely will risk occur? monitoring and audit results surveillance complaints observation Establish a context for the clinical environment

24. Establishing a context – what do we need to consider? The scope of the services provided Availability of policies and procedures relevant to the intended audience? Consultation with HCW during development and review? Literacy issues and comprehension of risk Do HCW understand what the risks are and what actions will minimise those risks?

25. Communication and consultation Be proactive when developing protocols and procedures. Identify regular intervals for revision and updating – this can also be a reactive response. Consider clinicians, managers and non-clinical staff when communicating how policies, procedures and protocols apply to them. Target the audience when providing information on the risk of infectious agents

26. How can communication and consultation support the risk management process? Provide a plan and systems for risk notification, assessment, management and resolution Celebrate achievements Encourage and facilitate collaboration Utilise appropriate message media including signage, websites, posters, charts, agenda items Provide patient and consumer information in areas where it is accessible Education is provided for HCW on infectious agents, means of transmission and interventions that need to be applied

27. Monitor and review Are the interventions making a difference to the corporate and/or clinical risk? Is risk being reduced? How do we know? mechanisms are implemented to ensure identification of risks methods of demonstrating how good the care is including surveillance, quality improvement activity results, audit results, education

28. In Summary Infection prevention and control needs: effective governance resources risk management to ensure a safe environment for both HCW and patients Prevent preventable infections Success can be measured by addressing risks with a standardised framework “Breaking the chain of infection transmission”

29. To find out more, go to: Standard 3 Preventing and Controlling Healthcare Associated Infections The Healthcare Associated Infection (HAI) Prevention Program www.safetyandquality.gov.au/hai Accreditation and the NSQHS Standards http://www.safetyandquality.gov.au/our-work/accreditation-and-the-nsqhs-standards/ Accreditation Advice Line: Email accreditation@safetyandquality.gov.au Phone1800 304 056