Standard 4 Clinical Care

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Standard 4 Clinical Care
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Rationale for Standard 4 - Clinical Care
The clinical care provided within the NHS
environment should be of the highest quality. To
support this, robust policies, procedures and
training should be in place for all aspects of
clinical care A number of the higher risk
issues have been selected for assessment by the
NHSLA and are included within Standard 4 -
Clinical Care Through the implementation of
effective risk management policies and
procedures, the NHSLA aim to equip and empower
organisations to minimise the risks to all staff,
patients and the general public
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Overview of Standard 4 - Clinical Care

• Standard 4 contained ten pilot criteria
• Patient identification
• Patient information
• Consent
• Clinical record keeping
• Validation of results

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Overview of Standard 4 - Clinical Care

• Standard 4 contained ten pilot criteria
• Medicines management
• Blood handling and administration
• Resuscitation
• Infection control
• Discharge and transfer

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Pilot Results - Standard 4 - Level 1
Self assessment v Pilot assessment - Level 1
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Pilot Results - Standard 4 - Level 2
Self assessment v Pilot assessment - Level 2
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Hot Spots
The following hot spot areas became
apparent during the Level 1 pilot phase
assessments 1.4.1 Patient identification 1.4.2
Patient information 1.4.5 Validation of
results 1.4.8 Resuscitation 1.4.9 Infection
control
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Hot Spots
The following hot spot areas became
apparent during the Level 2 pilot phase
assessments 2.4.1 Patient identification 2.4.3 Co
nsent 2.4.5 Validation of results 2.4.6 Medicines
management 2.4.9 Infection control 2.4.10 Discharg
e and transfer
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Key Revisions - Patient Identification

• The following revisions have been made to
  criteria
• 1.4.1, 2.4.1 and 3.4.1
• Removed
• System to ensure the correct patient
  identification of samples, diagnostic test
  results etc.
• Specimens etc. are incorrectly/incompletely
  labelled
• Revisions
• At Level 1 the focus of this criterion is all
  patients
• At Levels 2 and 3 the focus is on inpatients only

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Key Revisions - Patient Information

• The following revisions have been made to
  criterion 1.4.2
• Removed
• Ratification
• Revisions
• At Level 1 the focus of this criterion is all
  patient information associated with care,
  treatments and procedures
• Process for the development of patient
  information in all media
• Reviewing process
• At Levels 2 and 3 ratification has been replaced
  with archiving

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Key Revisions - Consent

• The following revisions have been made to
  criteria 1.4.3,
• 2.4.3 and 3.4.3
• Removed
• The need to document on the consent form/health
  record, details of information supplied to the
  patient (verbally and/or in other format)
• Revisions
• At Levels 2 and 3 the above has been replaced
  with procedure-specific training on consent for
  staff to whom the consent process is delegated
  and who are not capable of performing the
  procedure

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Key Revisions - Patient Transfer

• The criterion covering validation of results has
  temporarily been
• removed and replaced.
• New - 1.4.5, 2.4.5 and 3.4.5
• The organisation has approved documentation for
  the management of risks associated with the
  transfer of patients (i.e. transfer between
  inpatient care settings - internally and
  externally)
• Requirements
• Duties
• Transfer requirements which are specific to each
  patient group
• Documentation to accompany the patient when being
  transferred
• Process for transfer out of hours

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Key Revisions - Medicines Management

• The following revisions have been made to
  criteria 1.4.6, 2.4.6 and
• 3.4.6
• Removed
• Including prescribing by a health professional
  other than a doctor and verbal orders
• Dispensing
• Management and reporting of incidents/near misses
  involving medicines
• Revisions
• At Levels 2 and 3 the focus is on prescribing
  responsibilities of all grades of medical staff
• At Levels 2 and 3 management and reporting of
  incidents/near misses involving medicines has
  been replaced with administration

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Key Revisions - Resuscitation

• The following revisions have been made to
  criterion 1.4.8
• Removed
• Initiation of resuscitation in clinical areas,
  including the system for summoning help
• Patient transfer and post-resuscitation care
• Revisions
• The early warning systems in place for the
  recognition of patients at risk of
  cardio-respiratory arrest
• Ensuring the continual availability of
  resuscitation equipment

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Key Revisions - Infection Control

• The following revisions have been made to
  criteria 1.4.9, 2.4.9 and 3.4.9
• Removed
• The organisations expectations in relation to
  infection prevention and control training for all
  staff
• Revisions
• The infection control assurance framework
• Details of, or cross reference to, all twelve
  core clinical care protocols
• At Levels 2 and 3 the organisations expectations
  in relation to infection prevention and control
  training for all staff has been replaced with
  information available to patients and the public
  about the organisations general systems and
  arrangements for preventing and controlling HCAI

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Key Revisions - Discharge

• The following revisions have been made to
  criteria 1.4.10, 2.4.10
• and 3.4.10
• Removed
• Transfer
• Objectives to be achieved when planning the
  discharge or transfer of a patient
• Revisions
• Discharge requirements which are specific to each
  patient group
• Process for discharge out of hours
• At Levels 2 and 3 objectives to be achieved when
  planning the discharge or transfer of a patient
  have been replaced with discharge requirements
  which are specific to each patient group

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Other Key Revisions

• The following criterion has been refined 1.4.4 at
  all three levels
• Clinical record keeping
• Revisions
• The focus is on the quality of the clinical
  record keeping whether hand written or electronic
• Rewording of the requirements for clarity
• At Levels 2 and 3 audit reports have been
  replaced with development of action plans
• New addition
• Development of action plans

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Other Key Revisions

• The following criterion has been refined 1.4.7 at
  all three levels
• Blood transfusion processes
• Revisions
• The focus is on the blood transfusion process
• Rewording of the requirements for clarity
• At Levels 2 and 3 roles and responsibilities has
  been removed and the second existing requirement
  has been spilt into two requirements
• Process for administration of blood and blood
  products
• The care of patient(s) receiving transfusion
• New addition
• Requirements for competency assessment of all
  staff