The Victorian government has introduced amendments to the Health Services Act 1988 (Vic) and the applicable Regulations, following the state-wide review prompted by a series of potentially avoidable newborn and stillborn deaths at Djerriwarrh Health Services in 2001 – 2002, identified in 2015. The amendments focus the legislation on safety as well as quality, rather than the previous focus only on quality. There is a broadening of the premises now regulated, more powers to take action against premises for non-compliance, and stricter registration, reporting, credentialing and governance requirements.
Day procedure centre
The definition of ‘day procedure centre’ is expanded to include premises where the patient is expected to be admitted and discharged on the same day and one of its activities is:
- A service which requires nursing supervision and care; or
- A service which requires the use of anaesthesia; or
- A service which involves the use of surgical instruments and an operating theatre or procedure /treatment room and requires:
- a health practitioner’s attendance; and
- post operative nursing observation.
Anaesthesia intended broadly and is defined as general anaesthesia, major regional anaesthetic blocks, intravenous sedation or high doses of local anaesthetic that have the potential to cause systemic toxicity but does not include dental nerve blocks. The effect of the amendments is to broaden the regulation of ‘day procedure centres’ so that previously unregulated premises such as some used for cosmetic surgery, which did not meet the previous version of the Act’s definition, will be regulated from 1 July 2018.
All health services establishments must be registered. Criteria for registration is now more prescriptive and includes:
- Whether the applicant will provide will provide safe, patient-centred and appropriate health services;
- Will foster continuous improvement in the quality and safety of care and health services provided; and
- Compliance with any guidelines for the design, construction, fittings and equipment of premises.
Registration can now be suspended (if serious risk to patient safety or failure to comply with accreditation scheme) or revoked. Registration will also cover central premises as well as premises associated with a central premise. This will broaden the range of premises requiring registration, and is intended to cover future models of care.
The Department can approve an accreditation scheme and once approved, compliance with it is mandatory, and non-compliance, among other things, can result in revocation of a health service establishment’s registration.
Any unanticipated event in a healthcare setting resulting in death or serious physical or psychological injury to a patient(s) not related to the natural course of the patient’s illness must be reported, and further ‘any serious risk to patient health or safety’ must be reported which is defined as ‘there is a high probability of a substantial adverse impact on the health or safety of a patient’.
The highest level of governance at a health service establishment must include a registered medical practitioner who does not provide services at the premises.
Nurses must be registered and competent, a nurse with at least 3 years’ relevant training and clinical experience must oversee the surgical list and stage 1 post-operative care.
Pre admission and discharge
Patients must have a pre admission clinical risk assessment 24 hours before admission and they must be cross checked against the scope of practice of the medical practitioner treating them. Patients must be discharged with clear written instructions, together with their discharge summary (copy to GP).
A health service establishment must implement rules which include processes for:
- Assessing credentials and defining scope of practice of registered medical practitioners every three years;
- Continuing assessment of the competence and performance of registered medical practitioners;
- Meeting of committees with responsibility for patient safety (i.e. MAC); and
- Management of quality and safety at health services establishments.
Drug registers now must be kept.
The amendments are effected by the Health Legislation Amendment (Quality and Safety) 2017 (Amending Act) and the Health Services (Private Hospitals and Day Procedure Centres) Amendment Regulations 2018 (Amending Regulations). The Amending Act, which amends the Health Services Act 1988 (Vic) (Principal Act) will remain in force until 1 July 2019. The Amending Regulations amend the Health Services (Private Hospital and Day Procedure Centre) Regulations 2013 (Principal Regulations).
This article was written by Sophie Pennington, Partner and Scott Shelly, Senior Associate.