Supervision on the borderline of health and social care. Nordic Supervisory Conference Helsinki oktober 2015

Transcription

1 Nordic Supervisory Conference Helsinki oktober 2015

2 Parallel supervisory visits in Denmark Treatment areas with supervisory visits from the Danish health and medicines authority and the Danish social supervisory authority Psychiatric care institutions incl. medicine administration and associated psychiatric Out of home care for children and adolescents incl. medicine administration and associated psychiatric Institutions for of alcohol abuse and alcoholism Institutions for of drug abuse and drug addiction Institutions for of simultaneous alcohol and drug addiction Nursing homes and rehabilitation centers

3 The supervision visit from the Danish Health and Medicines Authority Every private hospital, specialist clinics and other institutions with medical and medicine administration are due to the health legislation obligated to register their activities at the Danish Health and Medicines Authority. The supervisory activities are financed by a fee payed directly to the Danish Health and Medicines Authority. The clinics will receive one supervisory visit every 3 years. We have developed a guidance for the registered clinics The guidance consist of a set of generic benchmarks and indicators, which all clinics have to fulfill. In addition separate specialist areas such as psychiatric care or children's psychiatric care and other activities such as for alcohol and drug abuse have specific specialist and area benchmarks The supervision cannot be ended before all measures have been met fulfilled. The authority cannot close down a clinic or an activity. The Supervisory Authority otherwise has the possibility of sanctioning the medical doctor in charge on his or hers medical authorization and in this way securing the patient safety under the responsibility of certain health care persons.

4 The Danish social supervisory authority The Danish social supervision authority grant a license to, and implement supervisory visits at all the social care institutions in Denmark on behalf of the around 100 municipalities. In every of five regions one of the municipalities has the responsibility for approving the implementation of the social supervision. The purpose of the law for Social Supervision is to ensure that the citizen receive social care in accordance with objectives outlined in the Law of Social Welfare. The social supervision authority approves the social care institution and conducts a supervisory visit once a year. The social supervision authority has the possibility of sanctioning with injunctions, intensified inspection visits or revoking the license of the institution.

5 Anonymous real case institution as illustration of a supervision visit on a private institution with alcohol and drug addiction selected items Profile of case institution The core of the is the twelve step program in the Minnesota concept, in which addiction to alcohol and other mind altering substances is considered as a disease, which requires permanent abstinence. The focus is on the patients physical and psychological condition and the consequences that the addiction has had for the patients emotional, social, economical, employment and relational situation. The includes cognitive therapy and the therapy called Somatic Experiencing (body and soul) The institution does outpatient as well as inpatient most of the latter. The institution treats patients from the entire region and occasionally from other regions. Referrals are often from job centers and other municipal administrative departments, and also from hospital wards, but only rarely from general practitioners. Treatment usually last for 6 to 8 weeks. Registration The institution is registered as specializing in psychiatric care, of alcoholism and drug addiction. Therefore we check on of generic benchmarks and indicators and specific specialist and area benchmarks for psychiatric care, alcohol and for drug addiction.

6 Generic benchmarks (selected) Patient identification and other misconceptions Referrals and unreffered contacts Medicine administration Call for doctor, transferal and resuscitation Requirements for instructions in general Need for assisting staff Storage of sterile utensils Understandable records Identification of patient and health care professionals in the record Recorded indication of medical Recorded pharmacological prescriptions Recorded informed consent Medicine storage Hygiene and personal protection

7 Generic benchmarks (selected) Patient identification and other misconceptions Referrals and unreffered contacts Medicine administration Call for doctor, transferal and and resuscitation Requirements for instructions in general Need for assisting staff Storage of sterile utensils Understandable records Benchmark Identification unfulfilled of patient and health care professionals in the record Written instructions insufficient Recorded No recommendations indication of medical for assisting staff Recorded At revisit pharmacological still unfulfilled prescriptions Recorded informed consent Medicine storage Hygiene and personal protection

8 Generic benchmarks (selected) Patient identification and other misconceptions Referrals and unreffered contacts Medicine administration Call for doctor, transferal and resuscitation Requirements for instructions in general Need for assisting staff staff Medicine storage Storage of sterile utensils Understandable records Identification of patient and health care professiona in the record Recorded indication of medical Benchmark unfulfilled Recorded No written pharmacological instructions prescriptions Internal education insufficient Insufficient day to day instruction and Recorded supervision informed of consent assisting staff At revisit still unfulfilled Hygiene and personal protection

9 Specialist- and other areas benchmarks Alcohol (selected items) Detoxification and abstinence Investigation of alcohol abuse history Pharmacological Offering non pharmacological i phases without alcohol Drug addiction (selected items) Investigation of drug abuse history Doctors plan for Psychiatric care (selected items) Treatment with antipsychotic medicine Doses, polypharmacologic and combined pharmacologic Investigation and of depressive disease Plan for monitoring pharmacological Systematic suicide risk assesment Choice of substitution therapy Treatment of combined and polydrug use

10 Specialist- and other areas benchmarks Alcohol (selected items) Detoxification and abstinence Investigation of alcohol abuse history Pharmacological Offering non pharmacological i phases without alcohol Drug addiction (selected items) Investigation of drug abuse history Doctors plan for Choice of substitution therapy Psychiatric care (selected items) Treatment with antipsychotic medicine Doses, Benchmark polypharmacologic unfulfilled and combined pharmacologic Insufficient documented Investigation plans and of depressive Records disease without precisely described individual assessments and monitoring program under Plan for monitoring pharmacological No systematic medical involvement Insufficient instruction of assisting staff and inappropriate health care Systematic suicide risk assesment background for handling medicine and starting up At revisit still unfullfilled Treatment of combined and polydrug use

11 Specialist- and other areas benchmarks Alcohol (selected items) Detoxification and abstinence Investigation of alcohol abuse history Pharmacological Offering non pharmacological i phases without alcohol Drug addiction (selected items) Investigation of of drug drug abuse abuse history history Doctors plan for Psychiatric care (selected items) Treatment with antipsychotic medicine Doses, polypharmacologic and combined pharmacologic Benchmark unfulfilled Investigation and of depressive disease Insufficient documentation of clinical objective examination, comorbidity of Plan psychiatric for monitoring disease, pharmacological assessments of acute medical problems and somatic, psychological and social issues Systematic suicide risk assesment At revisit still unfulfilled Choice of substitution therapy Treatment of combined and polydrug use

12 Specialist- and other areas benchmarks Alcohol (selected items) Detoxification and abstinence Benchmark Investigation unfulfilled of alcohol abuse history Insufficient Pharmacological documented and plans Non Offering documented non pharmacological continued Non documented i phases need without for s alcohol monitoring Drug addiction (selected items) At Investigation revisit the psychiatric of drug abuse specialist history was terminated and psychiatric passed Doctors to plan the for patients general practitioner Psychiatric care (selected items) Treatment with antipsychotic medicine Doses, polypharmacologic and combined pharmacologic Investigation and of depressive disease Plan for monitoring pharmacological Systematic suicide risk assesment Choice of substitution therapy Treatment of combined and polydrug use