Safety and quality
Theme: Environment and culture
Setting criteria and requirements
1.1 | The setting has a high standard of medical practice, evaluates its practices and improves the quality of its service.
Training needs to take place where patients are safe, and the care of patients is of high quality.
A setting that values and prioritises high-quality care and safety has:
- a formal system of clinical governance or quality assurance with clear lines of responsibility and accountability, which delivers high-quality medical practice
- applicable health and clinical service accreditation
- a process to regularly review practices and improve quality
Each patient is assigned an identifiable consultant or consultant-led team who is responsible for their care. A patient is treated by a trainee or consultant with the appropriate level of clinical experience. A patient is informed about the role of the trainee(s) in the provision of care. A trainee manages patients, undertakes clinical activities and consent patients for procedure(s) which match their competence. A trainee understands the risks, benefits, costs and options for any intervention proposed.
1.1.1 | Basic Trainees are involved in patient safety and health quality care activities undertaken by the setting.
Acquiring competency in patient safety and quality improvement requires experiential and social learning. A setting provides a trainee exposure to interprofessional system-based solutions on patient safety. A setting actively involves the trainee in medical audits, morbidity and mortality conferences and patient safety event reviews.
1.2 | The setting has a system and culture that enables issues to be raised about the standard of care without fear of consequence.
Trainees and supervisors communicate with patients about any errors or adverse outcomes. Any concern about the standard of care can be raised openly and safely. A process is in place to capture and respond to concerns. The concern is investigated and dealt with promptly and effectively.
Where the concern is about patient safety, it is addressed immediately. Trainees and supervisors are informed about this process and their responsibilities and are encouraged to participate in the process. Learning is facilitated through effective communication and reporting back to the trainees and supervisors.
1.3 | A trainee receives an orientation to each new setting and rotation.
Orientation takes place when a trainee starts working in a new setting or rotation. During orientation, the setting clearly sets out the trainee’s duties, their role and responsibilities in the team, supervision and reporting arrangements, and how they can gain support from an educator.
In addition, a trainee is informed about the local processes for clinical governance and protocols for clinical activities.
Orientation sets out workplace knowledge, practices and processes to be followed, and how to access work and learning resources. As part of orientation, the trainee meets their team and other health professionals with whom they will work.
1.3.1 | The setting ensures Basic Trainees complete an adult or paediatric advanced life support course and are orientated to the setting’s life support protocols.
A setting ensures a trainee receives training in adult or paediatric advanced life support. The training provided adheres to the RACP guidelines.
The training involves theoretical and practical components. Training needs to occur before commencing in a work environment where they require this competence.
A trainee required to provide care to a neonate, child or adult is to complete a relevant advanced life support course which adheres to the RACP guidelines before commencing their duties.
A trainee is orientated into the setting’s medical emergency and cardiac arrest resources and procedures and is supported to complete their responsibilities. The setting’s responses to medical emergencies and cardiac arrests are monitored to check outcomes and ensure suitable quality.
1.4 | Trainee and educator work arrangements enables the delivery of high-quality care and optimises learning and wellbeing.
Training providers naturally focus on the delivery of service. This needs to be balanced with training. Service is delivered in a way that optimises workplace learning opportunities. Both trainee and educator workloads are safe and don’t contribute to burnout.
A trainee’s workload enables them to learn effectively and complete the Basic Training Program requirements. An educator has a workload which enables them to fulfil their training roles and responsibilities.
Training and supervision are not to be compromised by high workload and fatigue. Both trainee and educator duties, hours of work, number of new and ongoing patients, work patterns (including on-call, overtime and secondary employment) and leave are monitored so they are safe, reasonable and equitable.
Where an issue is identified, action is taken. Trainees and doctors are fit for duty, effectively manage their time and accurately report duty hours. They monitor their performance, recognise and report illness, fatigue and impairment in themselves and their peers.
1.5 | Handover occurs when there is a transition in care.
A formal handover is organised and scheduled to provide continuity of care and maximise learning opportunities. Handover occurs between shifts, when responsibility for a patient changes between consultants, patients are transferred or discharged and at the end of a rotation.
1.5.1 | Consultant supported handover occurs at least daily.
Handover is an important tool for patient safety and training. Handover facilitates development of good work practices and provides social learning opportunities. For a trainee on night shift, it can represent their only opportunity to interact with a consultant.
Handover occurs at least once every day. One consultant is required for each formal handover session. Where the setting has a trainee working nights, a handover occurs after each night shift. A consultant facilitates handover at least 5 days a week and an Advanced Trainee can facilitate handover for a maximum of 2 days.
The number of formal handover sessions is to be minimised. The RACP preference is a single session across an entire setting. Settings need to demonstrate an effective system for multiple handover sessions.