Accreditation: meeting 4 th edition standards

1. Accreditation: meeting 4th edition standards 22 February 2012

2. Acknowledgement of Country I would like to show my respect and acknowledge the Awabakal people who are the traditional custodians of this land and the owners of its cultural knowledge I would also like to pay my respect to the Elders past and present of the Awabakal nation and extend that respect to any other Aboriginal or Torres Strait Islander people present today. Thank you.

3. business unit title no caps arial 24pt

4. business unit title no caps arial 24pt Major changes • Three less criteria and 38 less indicators • Less prescriptive about the level/type of proof required i.e. “demonstrate” or “provide evidence” rather than “document review” or “interview” previously stated. This means that practices can use multiple methods to prove they meet the standards • Removed references to legislation and knowledge of Occupational, Health and Safey low, Australian standards for building codes etc is expected

5. business unit title no caps arial 24pt Major changes continued • Suggested methods of demonstrating that standards have been achieved include: • Policy and procedure manual • Staff records (immunisation, CPD records) • Review of patient notes • Discussion with staff members about usual procedures within the practice • Observation • Case studies • Review of health promotion strategies

6. business unit title no caps arial 24pt Major changes continued • Review of logs (sterilsation, vaccine fridge temperature logs, S8 book, drug date check etc) • Review of data extraction • The surveryor will ask “Can you demonstrate how you..?” you must use methods to show how you meet the standards

7. business unit title no caps arial 24pt Resource assistance • RACGP has additional resources to assist practices which can be ordered from their website • RACGP infection control standards for office based practice (4th edition) • RACGP patient feedback guide: learning from our patients • RACGP computer and information security standards (CISS) • 10 tips for safer patient care • RACGP red and green books

8. business unit title no caps arial 24pt 4th edition standards sections • Practice services • Rights and needs of patients • Safety, quality improvement and education • Practice management • Physical factors • Each section is broken down into criterion. Within each criterion indicators are either “flagged” which are essential that they are met or “unflagged” which are recommended

9. business unit title no caps arial 24pt

10. business unit title no caps arial 24pt Section 1: Practice services • 1.1 Access to care • Scheduling appointments hasn’t changed • Triaging component • Increase demand that administrative and clinical staff have an “awareness” of triaging and provided with training to fulfil their role • Is now expected to be recorded in the patient file (including tele-triaging by administrative staff) • Administrative staff to ask “is the matter urgent or may I put you on hold?” and wait for the answer • Emergency contact details proved on call waiting and answering machine (not flagged)

11. business unit title no caps arial 24pt Section 1: Practice services • When providing results over the phone, patient details must be check using three forms of identifying information. For example name, date of birth, gender, address or patient record number, not Medicare number • After hours care arrangements and evidence of handover between after hours service and practice is needed with a clear understanding of follow up on “seriously abnormal and life threatening results”

12. business unit title no caps arial 24pt Section 1: Practice services • 1.2 Information about the practice • Increased emphasis on informed patient decision making and financial outlay • Clinical teams are expected to discuss with the patient diagnosis, treatment, investigations, referrals and medications • Practices will need to show methods of communication with hearing and sight impaired and intellectually disabled patients

13. business unit title no caps arial 24pt Section 1: Practice services • 1.2 information about the practice • Practice information sheet (PIS) • No longer has to include the name of clinical staff • Information still required on billing and patients costs, communication and patient health information policy, process for follow up of test results and how to provide feedback and complaints

14. business unit title no caps arial 24pt Section 1: Practice services • 1.3 Health promotion and preventative care • All flagged indicators have been removed and discusses a systematic approach to health promotion, preventative care, early detection and intervention. • Suggests take home information is up to date on health promotion and applicable to the practice’s own population • Reminder systems should be in place and focus on systematic health promotion and prevention

15. business unit title no caps arial 24pt Section 1: Practice services • Patient information should be kept up to date in their health summary • Health assessments should be conducted by clinical staff to identify risk factors and disease. Risk factors include: • Smoking • Nutrition • Alcohol • Physical activity

16. business unit title no caps arial 24pt Section 1: Practice services • 1.4 Diagnosis and management of health problems • Need for evidence based practice and uses rather than the access to currant clinical guidelines. These guidelines may be sourced from text books, peer review journals etc that are consistent with current practice • Consistent approach with in the clinical care team, which can be achieved through • Clare planning for the patient • Clinical meetings and communication books • Electronic notice boards etc

17. business unit title no caps arial 24pt Section 1: Practice services • 1.5 Continuity of care • 1.5.2 Clinical handover “The practice can demonstrate an accurate and timely handover of patient care” • Handover of “professional responsibility and accountability” to: members of the same practice, external care providers: • Locum • Member of the same practice • General Practitioner in local area • Deputising service for example GP Access After Hours

18. business unit title no caps arial 24pt Section 1: Practice services • What does the General Practitioner tell their palliative or seriously ill patients, or those waiting for results • How does the General Practitioner provide information as part of a TCA or referral? • A clear documented method of receiving, processing and following up on tests and results. This includes reviewing, signing, initialing, acting on them in a timely manner and incorporating them into the patients record • Results can be signed or initialed electronically

19. business unit title no caps arial 24pt Section 1: Practice services • Each staff member should be aware of their role in the recall system and answer questions about how the system is maintained and works • Recall system must encompass following up patients who do not attend tests referred to where the General Practitioner suspects they are clinically significant

20. business unit title no caps arial 24pt Section 1: Practice services • 1.6 Coordination of care • Practice team to be able to communicate how they engage with the community and disability services such as: • Diagnostic • Hospital • Allied Health • Pharmacy • Disability and community services

21. business unit title no caps arial 24pt Section 1: Practice services • If the referral is transmitted electronically it must be via a secure messaging service not emailed • Referral documents have sufficient information to ensure optional patient care • Name • Address • Date of birth • Gender • Patient record number

22. Collecting and Recording Indigenous status :what do I need to know

23. business unit title no caps arial 24pt Collecting and recording Indigenous status • Most practices have more Aboriginal and Torres Strait Islander patients than they think. • Is your practice accurately collecting and recording Indigenous status? • What needs to be done for accreditation and to ensure you are complying with new national guidelines?

24. business unit title no caps arial 24pt Our local Aboriginal and Torres Strait Islander population • Local Indigenous population by Local Government Area

25. business unit title no caps arial 24pt Some facts to consider • New South Wales has the highest percentage of Australia’s Indigenous population • Many areas in the Hunter have the highs population of areas in the state • 60% of all Indigenous Australians visit mainstream general practices • Only one Aboriginal Medical Service: Awabakal in our area

26. business unit title no caps arial 24pt Collecting and recording Indigenous status • AIHW guidelines for collecting and recording Indigenous status in health data sets • Supporting resources • Posters • Fact sheets for patients • Brochures for health staff • Staff training tips and tools

27. business unit title no caps arial 24pt Relevant 4th edition standards • 1.7 Content of patient health records • 1.7.1 Patient health records (pg 49) • 1.7.2 Health summaries (pg 52) • 2.1 Collaborating with patients • 2.1.1 Respectful and culturally appropriate care (pg 58) • 3.2 Education and training • 3.2.3 Training of administrative staff (pg 8)

28. business unit title no caps arial 24pt Other benefits • For patients • Improving quality of care (cultural and clinical considerations) • Being able to access initiatives or services relevant to the patient • PIP IHI, PBS, CCSS, Outreach Worker, transport • For practice: • Incentives such as PIP IHI • Reduced burden on practice through care coordination, outreach services etc

29. business unit title no caps arial 24pt Other resources to support accreditation • Welcome and acknowledgement • Health assessment poster • Pap test brochures and posters • BreastScreen brochures and posters • Outreach magnets

30. business unit title no caps arial 24pt Section 1: Practice services • 1.7 Content of patient health records • 1.7.1 (Flagged indicator) Routinely record the person the patient wishes to be contacted in an emergency • To be updated regularly • 1.7.1 (Flagged indicator) Routinely record Aboriginal and Torres Strait Islander status in our active patient health records • All patients to be asked country of birth irrespective of appearance, country of birth or whether the staff know the client or their family background

31. business unit title no caps arial 24pt Section 1: Practice services • 1.7.1 (Flagged indicator) where the practice has a hybrid medical record system for each consultation/interaction, our practice can demonstrate that there is a record made in each system indicating where the clinical notes are recorded • i.e. if General Practitioner uses the computer for scripts and paper for progress notes and correspondence each time the patient is seen, notes in both paper and electronic form must state “patient was seen on that day, see paper/electronic record”

32. business unit title no caps arial 24pt Section 1: Practice services • 1.7.2 (Flagged indicator) demonstrate that at least 75% of active patient health records contain a current health summary • Health summaries and consultation notes should show the practice working towards preventative care. For example • Immunisation • Smoking/alcohol intake • Nutrition/physical activity • Obesity/BMI etc • Complementary medicines should be noted in patient records to minimise drug interactions • Text level 4 • Text level 5 • 1.7 Content of patient health records • 1.7.1 (Flagged indicator) Routinely record the person the patient wishes to be contacted in an emergency

33. business unit title no caps arial 24pt Section 1: Practice services • 1.7.2 (Unflagged indicator) practice has documented standardised clinical terminology which the practice team uses to enable data collection for review of clinical practice • ICPC • Snowmed coding

34. business unit title no caps arial 24pt Section 2: Rights and needs of patients • 2.1 collaborating with patients • Complaints resolution need to be clearly outlined for within the practice and external body • Increased focus on patient feedback • Day to day feedback ie suggestion box • What is the practice process? • Who is responsible to make it happen? • Who responds? • When and how?

35. business unit title no caps arial 24pt Section 2: Rights and needs of patients • At least once every three years, the practice is to seek patient feedback • Patient Feedback Guide – learning from our patients which is available for download from RACGP website

36. Patient feedback • Essential areas for assessment are: • Access and availability • Information provision • Privacy and confidentiality • Continuity of care • Communication skills of clinical staff • Interpersonal skills of clinical staff • Survey • 30 patients per FTE GP no longer 100 max. • Survey must be RACGP approved (Ultra Feedback or cfep). • If practice wants to write their own survey then it must be submitted to the RACGP for approval prior to use Feedback has to = quality improvement activity This is not flagged but recommended that you inform patients of what you do with their feedback • Focus groups • Minimum of two groups with 5 to 10 participants in each group • Participants generally have a common characteristic • Focus group has to be conducted by someone not providing clinical care at the practice and must be recorded • Must be recorded and analysed for themes, topics ,ideas • If practice wants to conduct focus groups then it must submit questions to the • RACGP for approval prior to use • Interview • Minimum of 3 per FTE GP • Can allow you to select patients that will give good insight into a specific area of your practice • Cannot be interviewed by anyone who provides clinical care in the practice • Must be conducted face to face or over the phone • Must be recorded and analysed for themes/ topics/ideas • If practice wants to conduct interviews then it must submit questions to the • RACGP for approval prior to use business unit title no caps arial 24pt • Patient feedback • Essential areas for assessment are: • Access and availability • Information provision • Privacy and confidentiality • Continuity of care • Communication skills of clinical staff • Interpersonal skills of clinical staff

37. business unit title no caps arial 24pt Section 3: Safety, quality improvement and education • 3.1 Safety and quality • Whole practices will participate in Quality Improvement and uses “patient and practice” data • ACIR immunisation numbers • PAP register • PEN CAT data extraction • Recall lists and registers • Case studies using patient HbA1c recordings • System for reporting and managing incidents and near misses

38. business unit title no caps arial 24pt Section 3: Safety, quality improvement and education • Need to show improvements have been made if a risk, incident or near miss is identified and an improvement has been monitored to address the issue • Contingency plan inplace for unexpected events i.e. natural disasters • One staff member must be responsible for all clinical risk management • See clinical governance 3.1.3

39. business unit title no caps arial 24pt Section 3: Safety, quality improvement and education • 3.1.3 Clinical governance (new) • Our practice has clear lines of accountability and responsibility for encouraging improvement in safety and quality of clinical care • Practice identifies clinical leader who are responsible for safety and quality improvement systems • 3.1.2 clinical risk management systems • 3.1.3 clinical leadership • 4.1.1 Quality improvement and risk management • 4.2.1 privacy officer

40. business unit title no caps arial 24pt Section 3: Safety, quality improvement and education • Responsibilities of clinical leader in each area include: • Educating and supporting other members of the team • Identifying and putting things in place to reduce risk • Sharing information with others about improvements • Delegate responsibilities • Clinical leaders are able to delegate tasks within their area • Clinical leadership in a specific area is to be included in their position description

41. business unit title no caps arial 24pt Section 3: Safety, quality improvement and education • 3.1.4 Patient identification (new) • Patients are correctly identified at each encounter with the practice team • Patient identification is required on all referral documents, outgoing correspondence, and if patients request results or book appointments on the phone • Patients are to provide information, not asked to confirmed. Identifiers include: • Name • Date of birth • Address • Patient record number (eHealth)

42. business unit title no caps arial 24pt Section 3: Safety, quality improvement and education • 3.2 Education and training • Practice supports and encourages quality improvement and risk management through education and training • CPR is a flagged indicator for all staff at least 3 yearly (GPs and PNs recommended annually) • General Practitioners changed from QA&CPD to QI&CPD which increases importance of quality improvement and points now allocated for rapid PSDA cycles • Practice nurses are required to undertake 20 CPD hours which is essential to maintain professional registration

43. business unit title no caps arial 24pt Section 4: Practice Management • 4.1 Human resource system • Emphasis on the team identifying the person(s) responsible for leading the practice in areas of quality improvement, risk management, patient feedback and complaints • General practices are to monitor staff performances against position descriptions (new requirement) • Staff meetings no longer required, instead practice discussions • At least two members of practice staff are to be present during normal practice hours

44. business unit title no caps arial 24pt Section 4: Practice Management • 4.2 Management of health information • Refers to Guidelines on privacy in the national privacy principals • Introduction of a person with primary responsibility for the practice electronic systems and computer security • A continuity plan is required rather than a disaster recovery plan • Required to meet RACGP Computer and information security standards

45. business unit title no caps arial 24pt Section 5: Physical factors • 5.1 Facilities and access • One or more height adjustable bed • Wheelchair accessible or General Practitioner provides home visits • One consulting room for each member of the clinical team • 5.2 Equipment for comprehensive care • Practice requires “timely access to spriometer and ECG” • Surgical masks included in equipment required in the practice

46. business unit title no caps arial 24pt Section 5: Physical factors • Maintenance documented schedule is a flagged indicator, maintenance of equipment must be demonstrated • Recommended the practice has a pulse oximeter • Tongue depressors must be included in doctors bag • S8 references removed as it is presumed practices will follow state legislation

47. business unit title no caps arial 24pt Section 5: Physical factors • 5.3.1 safe and quality use of medicine (new) • Demonstrate how patients are informed about the purpose, importance, benefits and risk of medicines and are aware of their responsibility to comply with recommended treatment plans • Demonstrate to they access current information on medicines and review prescribing patterns in accordance with best available evidence • Demonstrate how patients and health professionals receive accurate and current list of medicines • Text level 4 • Text level 5

48. business unit title no caps arial 24pt Section 5: Physical factors • How they ensure that medicines (including samples and medical consumables) are acquired, stored, administered, supplied and disposed of in accordance with manufactures’ directions and jurisdictional requirements • Do patients and referrers have accurate and up to date medication lists? • Do they understand the importance of what they are taking and do they comply? • Are samples, vaccines etc within their used by date and comply with NSW S8/S4 laws? • Clinical team have recent NPS education on prescribing trends and mediation up dates?

49. business unit title no caps arial 24pt Section 5: Physical factors • 5.3 clinical support processes • Person(s) with primary responsibility for cold chain management and infection control must be identified and reflect in their position description (flagged indicator) • Practice is responsible for “maintaining the potency of vaccines” • Review accuracy of the practices vaccine refrigerator thermometer and complete self auditing • Policy required for environmental cleaning

50. business unit title no caps arial 24pt Section 5: Physical factors • Text level 1 • Practice team to be able to explain how patients are educated in respiratory etiquette, hand hygiene, precautionary techniques to prevent spread of communicable disease • Overlaps in pandemic management, PPE and standard vs additional precautions