Hospital Accreditation in Flanders

Transcription

1 Hospital Accreditation in Flanders Vera De Troyer Dominique Vandijck Katleen Valtin Johan Hellings Q & S Department Zorgnet-Icuro Schaarbeek, February 27 th Nutritional aspects of Hospital Accreditation Zorgnet-Icuro

2 Situation in Flemish department Belgium Some points before I start: Hospital accreditation cannot be seen split from the other quality initiatives A framework to embed quality through the whole organisation Direct link between the inspection model of the Flemish Government and Accreditation (see next slides) Indicators must be useful for professionals and instruments to objectify the quality of care ( as is -situation) 2 Nutritional aspects of Hospital Accreditation Zorgnet-Icuro

3 An integrated and pro-active approach to work on Quality and Safety 3 Nutritional aspects of Hospital Accreditation Zorgnet-Icuro

4 Situation in Flemish department Belgium The situation today 59 general hospitals (n = 63) have chosen for accreditation 7 general hospitals accredited 2 NIAZ-hospitals: Jessa (Hasselt) and St.-Lucas (Brugge) 5 JCI: UZ Leuven (Leuven), AZ Groeninge (Kortrijk), Jan Yperman (Ieper), AZ Sint-Blasius (Dendermonde) en UZA (Antwerpen) 52 hospitals in preparation 25 hospitals have chosen for Joint Commission International (JCI) 33 hospitals have chosen for NIAZ 4 Nutritional aspects of Hospital Accreditation Zorgnet-Icuro

5 Situation in Flemish department Belgium Split between two different kinds of inspection: S Y S T E M System inspection = inspection of the implemented quality system: eg. Process for identification checks patient identity Announced (every 4 years) Preceeded by a self assessment Accredited hospitals with an ISQua-accredited organisation by the end of 2017 are exempted Inspection of compliancy For all hospitals eg. Number of patients with a correct wrist band (2 identifiers) Unannounced Differentiated Care paths (2013: surgical care, 2015: medicine services, : cardiology) 5 Nutritional aspects of Hospital Accreditation Zorgnet-Icuro

6 Hospital Accreditation - definition A self-assessment and external peer assessment process used by health care organizations to accurately assess their level of performance in relation to established standards and to implement ways to continuously improve. 6 Nutritional aspects of Hospital Accreditation Zorgnet-Icuro

7 Julia, 83 years old Admission because of hip fracture Antecedents: type II diabetes with insulin injections Lives in a home care facility Widow 7 Nutritional aspects of Hospital Accreditation Zorgnet-Icuro

8 Paul, 68 years old A very active grandfather Admission because of a stroke incident No medical antecedents Allergic to citrus fruits Actual problem: difficulties with swallowing Lives together with his wife 8 Nutritional aspects of Hospital Accreditation Zorgnet-Icuro

9 Nutritional aspects of hospital accreditation Assessment of patients Q-mentum (NIAZ): The team accurately and appropriately assesses its clients The team assesses the clients physical health which elements? Medical history, allergies, medication profile, health status, and nutritional status and special dietary needs JCI: AOP.1.4 Patients are screened for nutritional status, functional needs, and other special needs and are referred for further assessment and treatment when necessary 9 Nutritional aspects of Hospital Accreditation Zorgnet-Icuro

10 Nutritional aspects of hospital accreditation Assessment of patients How do we do that? Some guidelines or recommendations are provided For example, the initial nursing assessment form may contain basic criteria for a nutritional screen, such as five or six simple questions with a numerical score relating to recent decline in food intake, weight loss during the past three months, mobility, and the like. The patient s total score would then identify a patient at nutritional risk requiring a more in-depth nutritional assessment. 10 Nutritional aspects of Hospital Accreditation Zorgnet-Icuro

11 Nutritional aspects of hospital accreditation Assessment of patients How do we do that? Expectations about qualifications of professionals In each case, the screening criteria are developed by qualified individuals able to further assess and, if necessary, to provide any required patient treatment. For example, screening criteria for nutritional risk may be developed by nurses who will apply the criteria, dietitians who will supply the recommended dietary intervention, and nutritionists able to integrate nutritional needs with the other needs of the patient. 11 Nutritional aspects of Hospital Accreditation Zorgnet-Icuro

12 Nutritional aspects of hospital accreditation Nutrition therapy On initial assessment, patients are screened to identify those patients who may be at nutritional risk. These patients are referred to a nutritionist for further assessment. When it is determined that a patient is at nutritional risk, a plan for nutrition therapy is developed and carried out. The patient s progress is monitored and recorded in his or her record. Physicians, nurses, the dietetics service, and, when appropriate, the patient s family, collaborate to plan and to provide nutrition therapy. 1. Patients assessed at nutrition risk receive nutrition therapy. 2. A collaborative process is used to plan, to deliver, and to monitor nutrition therapy. 3. The patient s response to nutrition therapy is monitored and documented in the patient record. 12 Nutritional aspects of Hospital Accreditation Zorgnet-Icuro

13 Nutritional aspects of hospital accreditation Food choices in hospital A variety of food choices, appropriate for the patient s nutritional status and consistent with his or her clinical care, is available. 1. A variety of food choices or nutrition, consistent with the patient s condition, care, and needs, is regularly available. 2. Prior to patients being fed, all inpatients have orders for food in their records. 3. The order is based on the patient s nutritional status and needs. 4. The distribution of food is timely, and special requests are met. 5. When families provide food, they are educated about the patients diet limitations. 13 Nutritional aspects of Hospital Accreditation Zorgnet-Icuro

14 Let me show you some pictures 14 Nutritional aspects of Hospital Accreditation Zorgnet-Icuro

15 Or another route 15 Nutritional aspects of Hospital Accreditation Zorgnet-Icuro

16 Nutritional aspects of hospital accreditation A few questions The transport and storage of food? Do we have guarantees about the storage and transport before the food comes into the hospital? What about the temperature (not to warm or to cold)? What about sanitation? Is it clean enough? Are there requirements about light, moisture, ventilation? Is the storage environment dry enough? Who is responsible for nutrition storage in the hospital? In the central kitchen? On the ward? In the patients rooms? What is the responsability of the patient and his family? Which checks are essential? Which are desirable? Which service do we want to provide? 16 Nutritional aspects of Hospital Accreditation Zorgnet-Icuro

17 Nutritional aspects of hospital accreditation Storage and preparation some requirements The organization prevents contamination of food, linen, equipment, devices, and supplies. Staff and service providers store, prepare and handle food appropriately The organization stores and handles linen, supplies, devices, and equipment in a manner than protects them from contamination. Staff and service providers use aseptic techniques when preparing, handling, and delivering vaccines, parenterally administered medications, total parenteral nutrition, and diagnostic media. The organization follows national and international safety guidelines on work restrictions for staff or service providers with transmissible infections. 17 Nutritional aspects of Hospital Accreditation Zorgnet-Icuro

18 Nutritional aspects of hospital accreditation Storage and preparation some requirements! The hospital reduces the risk of infections associated with the operations of food services. Improperly stored and prepared food can cause illnesses, such as food poisoning or food infections. 1. The hospital stores food and nutrition products using sanitation, temperature, light, moisture, ventilation, and security in a manner that reduces the risk of infection. 2. The hospital prepares food and nutrition products using proper sanitation and temperature. 3. Kitchen sanitation measures are implemented to prevent the risk of cross contamination. 18 Nutritional aspects of Hospital Accreditation Zorgnet-Icuro

19 Nutritional aspects of hospital accreditation What do want to achieve? How far do we want to go? Just an inspiring example Patients can choose what they want to eat (and at what time) Does it fit with the nutritional needs or diet restrictions? Patients can eat together with their family Patients can choose where and when they want to eat Delivery after max. 45 minutes Patients eat better and there is less waste 19 Nutritional aspects of Hospital Accreditation Zorgnet-Icuro

20 Nutritional aspects of hospital accreditation Successful Discharge of patients Returning to Julia and Paul As arrangements for discharge may take some time, the assessment process and planning process are initiated as soon as possible after admission. For example a newly diagnosed Type 1 diabetic patient will need education related to diet and nutrition and insuline injections a patient admitted for an acute myocardial infarction may need cardiac rehabilitation following discharge, as well as nutritional instruction. 20 Nutritional aspects of Hospital Accreditation Zorgnet-Icuro

21 Don t forget the other challenges for you There are also other standards that apply to you How do we guarantee that all care givers have the appropriate skills and education? Do you have a job description? Do you know it? How do you/they evaluate how well you fulfill your job responsibilities Do you know the strategic goals of your organisation? How does your work fit into these goals? What is the policy about hand hygiene? 21 Nutritional aspects of Hospital Accreditation Zorgnet-Icuro

22 Some points to conclude Nutrition is one of human basic needs and extremely important when people get ill (and/or in the prevention of diseases) Accreditation is a hospitalwide phenomenon! Not only the quality department is in charge! If we want to deliver good care, we have to work together with all professionals Also the dietician is in charge for the quality of care! Please don t be a solo player Recommendation to network and share best practices, experiences or points you are struggling with This is a great platform! 22 Nutritional aspects of Hospital Accreditation Zorgnet-Icuro

23 Success! Vera De Troyer 23 Nutritional aspects of Hospital Accreditation Zorgnet-Icuro