INTRODUCING A NEW PROCEDURE USING A CLINICAL GOVERNANCE FRAMEWORK

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INTRODUCING A NEW PROCEDURE USING A CLINICAL
GOVERNANCE FRAMEWORK

• Independent Use of Nasendoscopy to Assess and
  Manage Swallowing and Voice Disorders
• Joanne Sweeney, Manager, Speech Pathology
• Michelle Cimoli, Speech Pathologist

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OUTLINE

• What is nasendoscopy?
• Rationale for using a Clinical Governance
  Framework
• Austin Health Clinical Governance Framework with
  its 4 elements
• How we considered each element when introducing
  our new procedure
• Outcomes of introducing this new procedure - use
  of nasendoscopy by Speech Pathologists

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WHAT IS NASENDOSCOPY?

• Use of nasendoscopy by SPs
• assess and manage swallowing disorders
• treat voice disorders
• Used in US UK, but not widely used in Australia
• Scope of practice

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WHY DID WE USE A CLINICAL GOVERNANCE FRAMEWORK?

• Ensure new procedure introduced safely and with
  maximum benefit to patients
• Proactive rather than reactive
• not widely used in Australia
• potential for controversy
• Test case for Clinical Governance Unit
• ?

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WHAT IS CLINICAL GOVERNANCE?

• Clinical governance is a system through which
  organisations are accountable for continuously
  improving the quality of their services and
  safeguarding high standards of care, by creating
  an environment in which excellence in clinical
  care will flourish. Scally and Donaldson, 1998
• Clinical governance refers to the accountability
  for ensuring a framework and rigorous systems are
  established so health care safety and quality is
  monitored and continuously improved
• Clinical governance ensures
• systems are in place to monitor safety and
  quality of clinical practices
• clinical practice is regularly reviewed and
  improved as a result
• clinical care meets standards

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Austin Health Clinical Governance Model
Openness and Accountability
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CLINICAL RISK MANAGEMENT

• Are there any clinical risks associated with
  performing the procedure?
• Has a risk management strategy been devised to
  manage adverse events associated with performing
  this procedure?
• Have Occupational Health Safety requirements
  been considered?

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CLINICAL RISK MANAGEMENTRisk Management Framework
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CLINICAL EFFECTIVENESS

• Has the procedure been used elsewhere?
• How will the procedure improve patient care?
• What are the expected outcomes of the procedure?
• Does the tool replace current tools/procedures?
• How will the procedure be monitored? (include
  events monitored, process, timeframes)

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CLINICAL EFFECTIVENESS

• Development of Evidence Based Resource Manual
• Development of clinical policies
• Inter and intra-rater reliability study

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EDUCATION AND TRAINING

• Is this procedure considered by the
  practitioners professional body to be within the
  practitioners scope of practice?
• Which practitioners will adjust their practice
  (all or a defined group)?
• Are there training requirements for the proposed
  procedure?

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EDUCATION AND TRAINING

• Competency training program
• Credentialling and clinical privileges
• Professional supervision/peer review
• Continuing professional development
• ?

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EDUCATION AND TRAINING

• Competency training program developed in
  conjunction with Head of ENT, Head Neck
  Surgical Unit
• Facility/context-specific clinical privileges
• Maintaining competency clinical privileges

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CONSUMER PARTICIPATION

• How will consumers be informed and educated about
  the procedure and its risks?

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CONSUMER PARTICIPATION

• Informed consent
• ?
• Patient education materials

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INTRODUCING NEW PROCEDURES INTO CLINICAL PRACTICE

• In 2004, the Speech Pathology Department at
  Austin Health introduced the use of nasendoscopy
  by Speech Pathologists into clinical practice
• 3 Speech Pathologists trained in the use of the
  tool for the assessment and management of
  swallowing, and management of voice disorders
• 60 procedures performed to date, with nil
  adverse events reported
• Clinical utility of the well tool established
• Well accepted by key stakeholders including ENT,
  Clinical Governance Unit, hospital executive

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RECOMMENDED READING

• Austin Health Clinical Governance Program Final
  Discussion Paper Purpose, Roles and Priorities
  (2003)
• Better Quality, Better Health Care A Safety and
  Quality Improvement Framework for Victorian
  Health Services (2003) Victorian Quality Council
• Clinical Governance An International Journal
  (previously British Journal of Clinical
  Governance)
• Epstein R.M Hundert E.M. (2002), Defining and
  assessing professional competence. Journal of the
  American Medical Association 287 (2) 226-235
• Halligan, A Donaldson, L (2001) Implementing
  clinical governance turning vision into reality.
  BMJ 3221413-1417
• Health Service Circular 1999/065 Clinical
  Governance Quality in the New NHS
• Langmore, S.E., Schatz, K. Olsen, N. (1988)
  Fiberoptic endoscopic examination of swallowing
  safety A new procedure. Dysphagia 2216-219
• Langmore, S.E., (2001), Endoscopic Evaluation and
  Treatment of Swallowing Disorders. New York
  Thieme
• McAdams C.C. Montgomery K.A. (2003), Narrowing
  possibilities using quality improvement tools to
  decrease competence assessment overload. Journal
  for Nurses in Staff Development 19(1) 40-46
• Scally, G Donaldson L.J. (1998) Looking
  forward clinical governance and the drive for
  quality improvement in the new NHS in England.
  BMJ 31761-65