Direcção-Geral da Saúde Ministério da Saúde

(1)

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The Portuguese Strategy

for Quality In Health

Ana Cristina Costa

December 2010

(2)

The Portuguese Strategy for Quality In Health

Created by the Health Ministry Order nº

y

55/2009, of 8

th

_June

T

f

l

The ministry of health aims to potentiate

quality of the healthcare delivery to assure the

citizen’s rights in the relationship with the

citizen s rights in the relationship with the

healthcare system.

(3)

The Portuguese Strategy for Quality In Health

Mi i

Mission

To promote and disseminate a

culture of

improving health care quality

p

g

q

y

in the

health care organizations

(4)

The Portuguese Strategy for Quality In Health

STRATEGIC PRIORITIES

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gy

Q

y

STRATEGIC PRIORITIES

1 Clinical and organizational Quality

1. Clinical and organizational Quality

2 Clear information to citizens

2. Clear information to citizens

3 Patient Safety

3. Patient Safety

4 Qualification & accreditation of the national

4. Qualification & accreditation of the national

Healthcare Units

(5)

The Portuguese Strategy for Quality In Health

STRATEGIC PRIORITIES

g

5. Integrated Disease Management &

g

Innovation

6. Management of the international mobility of

citizens

7. Evaluation of complaints and suggestions of

the citizens of the National Healthcare

System.

(6)

The Portuguese Strategy for Quality In Health

TARGET POPULATION

1. The citizen as user and owner of the

Healthcare System

2 The healthcare professional as responsible

2. The healthcare professional as responsible

for delivering a skilled, safe and qualified

health care

(7)

Th P

S

f Q li I H l h

The Portuguese Strategy for Quality In Health

FIRST ACTIONS

1 T di

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i ti

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id li

1. To disseminate clinical and organizational guidelines

2. To implement a national system of quality indicators

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y

3. To create the national reporting and learning system

4. To promote patient safety by issuing guidelines to avoid

clinical, surgical and medication errors

(8)

The Portuguese Strategy for Quality In Health

FIRST ACTIONS

The Portuguese Strategy for Quality In Health

FIRST ACTIONS

5. To improve the monitoring system of the healthcare

p

g y

associated infections

6 To create the Health Accreditation Programme

6. To create the Health Accreditation Programme

7. To conceive and monitor experimental models of integrated

di

diseases management

(9)

The Portuguese Strategy for Quality In Health

FIRST ACTIONS

The Portuguese Strategy for Quality In Health

9. To create clear information on quality in health for citizens

10. To monitor the satisfaction level of patients and healthcare

professionals

11. To make a qualitative evaluation of the users' complaints of

the healthcare system

(10)

The Portuguese Strategy for Quality In Health

10 YEARS STRATEGY (2009-2019):

(

)

5 YEARS TO IMPLEMENT

+

5 YEARS TO CONSOLIDATE

(11)

The Portuguese Strategy for Quality In Health

The Health Quality Department:

_{Created at the Directorate General for Health in}

February 2009

To develop the Strategy for

Quality in Health

(12)

The Health Quality Department

p

HEALTH

QUALITY

DEPARTMENT

CLINICAL

AND

ORGANIZATIONAL

QUALITY

PATIENT

MOBILITY

INNOVATIVE AND

INTEGRATED

DISEASE

MANAGEMENT

PATIENT

SAFETY

QUALITY

MANAGEMENT

(13)

The Health Accreditation Programme

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LEGAL BACKGROUND

• The Strategy for Quality in Health

gy

Q

y

• Health Ministry Order nº 69/2009, of 31st

August

Approves the Accreditation Model developed by

pp

p

y

Agencia de Calidad Sanitaria de Andalucía (ACSA

Model) as the Portuguese accreditation model for

)

g

Healthcare Units

(14)

The Health Accreditation Programme

Defines the strategic guidelines and the

main actions for the implementation of

the

National Model of Health Accreditation

(15)

The Health Accreditation Model

BASED ON 3 BASIC PILLARS

• Processes Management

• Clinical Management

(16)

The Health Accreditation Model

TOOLS

Accreditation of Services and Healthcare Units

ME_ jora C

ME_ jora P

Accreditation of Clinical Competencies

P

UTER

_A

TIONS

Accreditation of Continuous Training Programs

ME_ jora F

COM

P

A

PPLIC

A

ME jora W

Health Web Sites Accreditation

A

_ j

U

ALS

MAN

U

(17)

The Health Accreditation Model

TOOLS

ME jora C

The

The accreditation

accreditation process

process is

is supported

supported by

by

ME_ jora C

The

The accreditation

accreditation process

process is

is supported

supported by

by

aa computer

computer application

application conceived

conceived to

to

support

all

the

phases

of

the

accreditation

accreditation process

process

accreditation

(18)

The Health Accreditation Model

Who can apply?

HOSPITALS

PRIMARY

CARE

UNITS

OTHER

(19)

The Patient Safety Division

a) To coordinate the prevention and the control of

Healthcare Associated Infections (HAI);

b) To coordinate the prevention of Antimicrobial

Resistance (AMR);

(

);

c) To manage the adverse events reporting;

d) To manage the ‘SIM-Cidadão’( the reporting of the

complaints and suggestions of the citizens of the

National Healthcare System)

(20)

The prevention and control of HAI

Surveillance

Intensive Care Units

Surgery

“

“Hospitals

Hospitals in

in Europe

Europe Link for

Link for Infection

Infection

Control

th

h

th

h S

S

ill

HELICS”

European network

Su ge y

through

through Surveillance

Surveillance –

– HELICS”

HELICS”

Neo

Neo--nates

nates Intensive

Intensive Care

Care Units

Units

Bactaeremias

National network

(21)

(22)

Training the trainers

(23)

Portuguese pledge

8 Outober 2008

(24)

(25)

Safe

(26)

Council Recommendation on patient

safety and prevention and control of

healthcare associated infections

June 2009

Members States Recomendations

National Level

Local Level

(27)

The Council Recommendation invites

the Commission to…

Within 2 years – guidelines

Within 3 years – to release an implementation report

Evaluation of struture and process indicators

HAI surveillance results of ICU infections, Surgical site infections and

Prevalence Point Survey 2011

Results of the accreditations processes

(28)

Healthcare

Associated

Infections

Antimicrobial

Resistance

Community Adquired

Infections

(29)

National Programme to Prevent Antimicrobial

g

Resistance

Strategies:

Prudent

Prudent use

use of

of antimicrobials

antimicrobials

avoiding

avoiding the

the unecessary

unecessary use

use and

and its

its misuse

misuse

avoiding

avoiding the

the unecessary

unecessary use

use and

and its

its misuse

misuse

infection

infection control

control

to

to prevent

prevent infections

infections

to

to prevent

prevent infections

infections

to

to prevent

prevent infection

infection transmission

transmission and

and the

the transmission

transmission of

of resistant

resistant

microorganisms

(30)

National Programme to Prevent Antimicrobial

Resistance

Aims

To evaluate the prevalence of antimicrobial resistance in the healthcare units;

To reduce cross infections due to resistents microorganisms;

Prudent antibiotic prescribing;

(31)

ee--Bug Project

Bug Project

ee Bug Project

Bug Project

3º Ciclo / 9º Ano / Ciência

Um Recurso Educacional

2º Ciclo / 6º Ano / Ciência

(32)

B P j t

ee--Bug Project

Bug Project

Aims to promote:

Prudent antibiotic use

Hand hygiene

Caught

Caught etiquette

etiquette

(33)

HALT

Healthcare Associated

Infections in Long Term Care

g

Prevalence

Prevalence Point

Point Survey

Survey (HAI

(HAI and

and antibiotic

antibiotic consumption

consumption))

Prevalence

Prevalence Point

Point Survey

Survey (HAI

(HAI and

and antibiotic

antibiotic consumption

consumption))

Infection

Infection Control

Control Strutures

Strutures evaluation

evaluation

P

i di t

l

ti

Process

Process indicators

indicators evaluation

evaluation

(34)

R

h P j

t

5 working areas

network:

Research Project

supported by DG SANCO

in May 2007

network:

Patient Safety Culture

Education and Training

Reporting and Learning S stems

Reporting and Learning Systems

Safe medications

Promotion and dissemination

(35)

EUNeTPaS:

Good Medications Safety Practices – Results of the

implementation

14 Hospitals implemented 18 Practices:

BEST PRACTICES

Number of

Hospitals

Bed dispensation

p

3 Bed dispensation 2

0 Safety vest

4 Medication reconciliation at admission

and discharge

5 Discharge medication list for patients 1

3 Medication reconciliation at discharge

3

(36)

EUNeTPaS:

Good Medications Safety Practices – Results of the implementation

Further information of

all the national results

nd th fin l

and the final

recommendation at

(37)

To promote the gathering between the State and the

Citizen

Processes

Processes and

and decisions

decisions transparency

transparency

A

A management

management tool

tool

P

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th

th th

th

li

ti

ff iti

iti

Promote

Promote patient

patient involvement

involvement througth

througth the

the on

on--line

line reporting

reporting of

of citizens

citizens

expositions

Improve

Improve care

care delivery

delivery regarding

regarding system

system indicators

indicators

(38)

Nacional Reporting and Learning System

p

g

y

To build an organizational patient safety culture

To adress risk assessment and risk management

To promote awareness and learning about patient safety

WHO Taxonomy – translation and validation (adapted to

portuguese reality)

A law to protec the notifying healthcare workers

Patient Safety Indicators

(39)

Patient

Patient Safety

Safety Observatory

y

Observatory

y

Platform

To deliver the best information on patient safety to

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lth

k

d iti

th h

lth

k

d iti

the healthcare workers and citizens;

To learn about safety in the delivery of care and

to

to implement

implement preventive

preventive measures

measures

;;

(40)

Safe

Patient Safety

Observatory

Reporting and

Learning System on

Medications

Observatory

g

y

Patient Safety

HALT

H

lth C

A

i t d

H

lth C

A

i t d

HAI Prevalence

AMR

Health Care Associated

Infections in Long Term

Care

Point Survey

_{Prevention and}

Control

HAI Prevention and

Hand Hygiene

Campaign

HAI

HAI Prevention and

Control

Campaign

_Surveillance

Safe Surgery Saves

Lives

_B

Lives

Sim

(41)