4.3.1 RationaleThe growing emphasis on safety in health care and strategies for its improvement highlight the importance of information about the process of health service delivery and its outcomes. Although concerns about consumer rights and prevention of abuse have underpinned the National Mental Health Strategy since its beginnings, the mental health sector is only at an early stage in translating the concepts about patient safety that are being developed within the acute hospital sector.
The Australian Council for Safety and Quality in Health Care provides leadership in this area. Established in January 2000 by agreement of all Health Ministers, the Council's role is to coordinate national efforts to improve safety and quality of health care, with a particular focus on minimising the likelihood and impact of error.
A priority of the Council has been to enhance the collection and use of data to drive safety and quality improvements. Examples of the Council's work in this area relevant to the mental health sector include:
- the development of consensus between State and Territory jurisdictions on an agreed national list of core sentinel events;
- identification of the components of the effective incident management systems for use in Australian health care and agreement by Health Ministers to the introduction by all public hospitals of incident management systems to monitor, investigate, analyse and guide their actions in dealing with patient safety and quality incidents, by June 2005;
- completion of a review of current approaches to reporting and investigation of deaths associated with health care related adverse events;
- improvements in the use of routinely collected hospital mortality and morbidity data for safety improvement;
- agreement by all Health Ministers that, by the end of 2005, public hospitals will report all agreed core sentinel events and contribute to a national report on Sentinel Events to be produced by the end of 2005; and
- working with jurisdictions and relevant expert groups to identify what nationally consistent information should be collected and reported, and to ensure national consistency in data definitions, classifications, and reporting.
- no information is routinely reported across the mental health sector on whether safety protocols exist that make the activities and environment of mental health services safe for consumers, carers, families, staff and the community. Whilst some of this information is provided in a number of different ways including accreditation, there is no agreed information standard;
- reliable national information is not available on the safe and quality use of medicines. This includes information on the extent of education given to consumers, carers and families as well as reporting systems for adverse medication events;
- no nationally agreed information is routinely reported on a number of other sentinel events in mental health; and
- indicators to monitor safety in mental health care are not yet included in the national framework agreed by all States and Territories to monitor the performance of mental health services (see section 4.4).
- reducing suicide and deliberate self-harm in mental health and related settings;
- reducing use of, and where possible eliminating, restraint and seclusion;
- reducing adverse drug events in mental health services; and
- safe transport of people experiencing mental disorders.
4.3.2 Consolidation activities
Monitoring the implementation of national standardsSafety is a core component of the National Standards for Mental Health Services (Standard 2: Safety) and the National Practice Standards for the Mental Health Workforce (Standard 1: Rights, responsibilities, safety and privacy). Systems to monitor and report on the ongoing implementation of the standards, commenced under the Second National Mental Health Plan, will be extended over the 2003-08 period.
Full implementation and use of incident monitoring systemsMost States and Territories have invested in establishing incident monitoring systems within their inpatient services for monitoring and guiding action in response to safety and quality incidents. Further work will be undertaken to make full use of the potential of these systems at the local and national levels, as well as identifying areas where changes may be needed to better reflect the nature of safety issues in mental health care. For example, adverse events associated with electro convulsive therapy (ECT), involuntary status (absconding/ absence without leave), and the use of restraint and seclusion are not well catered for in existing incident management systems. Services will need to pay particular attention to each of the nationally agreed priority areas.
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4.3.3 New initiatives
Development of national indicators of safety in mental health careThe Information Strategy Committee and the Safety and Quality in Mental Health Partnership Group will work together to develop nationally agreed performance indicators and associated data sets for the safety domain of the National Health Performance Framework. Indicators will be chosen based on their ability to support safety improvement initiatives and improve information on adverse events in mental health care.
Using local information collections and related data sources in safety and quality improvement processesData collections on incidents and adverse events maintained by individual States and Territories will be examined for their potential to contribute to a national approach to improving safety in mental health care. These include mandatory reporting to the various State and Territory Chief Psychiatrist offices or equivalent internal review units, complaints data, and reports from external scrutiny bodies (such as Australian Council on Healthcare Standards clinical data, accreditation reports, or official/community visitors). The feasibility for record linkage to make better use of this information will be explored.
24 Australian Council on Health Care Standards (2003). Determining the Potential to Improve Quality Care 4th Edition: ACHS Clinical Indicator Results for Australia and New Zealand 1998-2002. ACHS, Ultimo, NSW.