Version 2 of the NSQHS Standards

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The Australian Commission on Safety and Quality in Health Care (the Commission) started a review of the National Safety and Quality Health Service (NSQHS) Standards in late 2014, to determine if the NSQHS Standards had achieved their aim of protecting patients from harm and improving quality of care. The review also seeks to address issues that have been recognised during implementation of the NSQHS Standards, including duplication.

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Version 2 of the NSQHS Standards is expected to be released in 2016 and will be used for accreditation from 2017/18.
To review the NSQHS Standards, the following set of principles was developed. Version 2 of the NSQHS Standards will:

• aim to protect the public from harm and improve the quality of health service;


• be applicable across all healthcare settings;


• focus on areas of known risk to patients, including consideration of high-risk preventable complications;


• ensure implementation is on systems to prevent harm;


• be evidence-based and rigorous;


• strive to reduce the number of actions and standards;


• reduce duplication wherever possible.

Version 2 of the NSQHS Standards will also address issues not previously in the Standards that have been recognised as causing harm to consumers, including:
Aboriginal and Torres Strait Islander health
There is considerable evidence of the poor health outcomes for Aboriginal and Torres Strait Islander people. There are also specific and identifiable safety and quality risks for Indigenous people. Closing the gap between Indigenous and non-Indigenous people is a national priority, and version 2 of the NSQHS Standards includes six specific actions to support better safety and quality for this group of people.
Mental health and cognitive impairment
People with lived experience of mental health or cognitive impairment have poorer overall health outcomes and are at greater risk when receiving care. Version 2 of the NSQHS Standards includes actions that specifically address the risks associated with mental health or cognitive impairment when receiving care.
End of life care
Safe and high quality end of life care can help reduce the suffering of the consumer receiving care, and assist in the grieving process for their family members. The use of advance care plans and clear communication between consumers and clinicians assists in consumers at end of life receiving treatment aligned with their values, needs and wishes.
Health literacy
Low levels of individual health literacy contribute to poorer health outcomes, increased risk of an adverse event and higher healthcare costs. Health services can address health literacy issues by providing information in easily understood formats and by using decision aids.
Leadership
The importance of leaders in setting the safety and quality culture of an organisation is well known. New content on leadership and governance that includes explicit statements about the role of leaders and others in safety and quality in health care have been added to version 2 of the NSQHS Standards.
Nutrition and hydration
There is clear evidence that nutrition and hydration are important in preventing safety and quality problems in health care. Malnutrition is associated with a twofold increase in the risk of pressure injuries and hospital-acquired infections, and increased mortality. The estimated prevalence of malnutrition in adults receiving care in acute and subacute settings is 30%.,
Comprehensive care
Safety and quality gaps are frequently reported as failures to provide adequate care for specific conditions or in specific situations or settings, whereas they may occur because of common causative factors. Integrated screening, assessment, risk identification and care planning incorporating the consumer’s preferences can address these factors.
Clinical communication
In version 1 of the NSQHS Standards, NSQHS Standard 6: Clinical handover was often interpreted narrowly as only referring to shift-to- shift handover. However, it is known that to ensure safe and high-quality health care effective communication is critical at all points where information is transferred, and this is reflected in version 2 of the NSQHS Standards.
Recognising and responding to acute deterioration
Version 2 of the NSQHS Standards includes deterioration in mental and cognitive state alongside deterioration in physical state. The scope has also expanded beyond acute care settings to all healthcare settings, with modifications depending on the scope of services provided in each setting.
Organ and tissue donation
Around 1600 people are on Australian organ transplant waiting lists at any one time. One organ and tissue donor can transform the lives of 10 or more people through transplantation. Version 2 includes support for organ and tissue donation as part of end-of-life care.

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References
1 Lim SL, Ong KC, Chan YH, Loke WC, Ferguson M, Daniels L. Malnutrition and its impact on cost of hospitalization, length of stay, readmission and 3-year mortality. Clinical Nutrition 2012; 31(3): 345-50.
2 Agarwal E, Ferguson M, Banks M, Bauer J, Capra S, Isenring E. “Nutritional status and dietary intake of acute care patients: results from the Nutrition Care Day Survey 2010,” Clinical Nutrition 2012; 31(1): 41-7
3 Banks M, Ash S, Bauer J, Gaskill D. “Prevalence of malnutrition in adults in Queensland public hospitals and residential aged care facilities,” Nutrition & Dietetics 2007; 64(3): 172-178.
Further reading
For more information on the NSQHS Standards, visit http://bit.ly/1Tb5J0g