Accreditation standards and evidence-based practice (EBP) both strive to make the healthcare sector a better place, but do the two marry up?
In 2018 the second edition of the National Safety & Quality Health Services standards came into effect.
Included within the governance framework is a Comprehensive Care Standard requiring healthcare leaders to establish and maintain systems and processes to support clinicians; as well as systems to prevent and manage risks of harm to patients.
Whilst requirements for accreditation may be straightforward, it is less clear whether the standards complement current EBP – particularly in the context of falls prevention – argues Dr. Tash Brusco of Monash University.
“The real challenge for health leadership is to find that balance from what’s required from a governance versus EBP perspective, whilst continuing to drive efficiencies and ensure better patient care,” says Dr. Brusco.
“I am concerned about gaps and overlaps between these elements, particularly within falls, which is obviously a major priority for the sector at present.
“Currently the standards expect health service organisations to follow clinical guidelines and put systems in place to prevent falls; supply patients with preventative equipment and devices; as well as information and education regarding falls prevention to those at risk.
“The problem is, only the latter expectation in this list actually has evidence around it, the others don’t.
Inappropriately channelling investment
“In addition, guidelines developed in Australia for the prevention of falls in hospitals are now approaching the ten-year mark and it’s a challenge to ensure the literature and guidelines that support the national standards are keeping pace,” Dr. Brusco argues.
“As an example, the guidelines talk about the use of mobilisation alarms, yet the current evidence does not support the use of these in the context of falls prevention – they have little to no effect.
“In our bid to drive efficiencies in the sector, it is worrying that we may be investing in programs that don’t seem to work.”
Though evidence for falls prevention may be lacking, Dr. Brusco believes that taking a step back and disinvesting from strategies we know not to be effective – and reinvesting to find strategies that are – is the best way forward.
“Disinvestment is a relatively new concept and it can be frightening. To take things away when you have nothing to replace it with is a real challenge – on the ground as well as for health services leadership.
“Having no clear direction is scary, but that doesn’t justify continued investment in strategies which go against EBP,” she says.
Dr. Brusco’s comments come in an era of startling falls statistics. Studies show that in some parts of the country, someone dies every 26 minutes, or is admitted to hospital every 20 minutes, as a result of a fall-related injury.
Dr. Brusco hopes that one day the literature and standards will keep pace.
“We should be focussing our efforts on growing the literature, regularly reflecting on what actually works in clinical practice and updating the standards accordingly,” she concluded.
Dr. Tash Brusco is a Senior Research Officer at the School of Primary and Allied Health Care at Monash University. She is also a Senior Associate: Health Economist (Health Service Research) at Alpha Crucis Group.
She will open up debate on this issue at the Falls, Fractures and Pressure Injuries Conference, due to take place 25-26 November 2019.
Learn more and register.