Treatment Injury & Patient Safety

1. Treatment Injury& Patient Safety NZIHM Conference 2006 1 July 2006 Louise Campbell

2. Why change to Treatment Injury? Medical Misadventure legislation was: • Confusing • Arbitrary • Inconsistent • Slow Treatment Injury legislation is: • Simpler • Faster • Fairer • In partnership with health sector

3. How has the legislation changed things?

4. How things going? • Number of claims steadily increasing • @ 20th June 2006, 4454 Treatment Injury claims lodged • 2189 accepted, 1540 declined and 725 are currently being assessed for cover

5. Cover for Treatment Injury • Personal injury • Injury in the context of treatment • Treatment by a RHP • Clear causal link • Take account of all the circumstances • Necessary part, OR • Ordinary consequence • Other exclusions

6. All circumstances • Focus on only circumstances that had a material impact • Circumstances only meaningful when considered alongside each other

7. Exclusions Claims are not covered if the injury is: • a necessary part of treatment • an ordinary consequence of treatment • a result of a person unreasonably withholding or delaying their consent to treatment • due to the person’s underlying health condition, • where the only basis of the claim is that the treatment did not achieve the desired results • solely attributable to resource decision

8. Clinical knowledge • National & international knowledge recognised by the relevant profession • Knowledge considered in the NZ context • Treating RHP’s knowledge where material to the injury • Advances in treatment

9. Underlying health condition Underlying health condition or general state of health is: • the condition being treated at the time of treatment, and • may include other underlying health conditions • diabetes • allergies • osteoporosis

10. PATIENT SAFETY “Developing relationships and building information to help prevent treatment injury”

11. Who is “Responsible for Patient Safety” ? • Individual health professionals (Professional Codes of Ethics and HPCA Act). • Ministry of Health (Section 3A Health Act 1956) • DHB (Section 22 & 23 New Zealand Public Health and Disability Act 2000).

12. Key outcomes for patient safety • Build Relationships • Deliver excellent information on Patient Safety issues • Key focuses • Staff satisfaction

13. Build Relationships • Establish key strategic relationships to facilitate development of knowledge, information sharing and injury prevention opportunities • Develop excellent health sector relationships • Develop key internal ACC relationships

14. Deliver excellent information on Patient Safety issues • Building data – capability, analysis and information sharing • Managing and maintaining treatment injury database information • Building capability (AIMS) • Regular Reporting

15. AIMS database • AIMS = Advanced Incident Management System • Developed by Patient Safety International (PSI) based on the work of Prof William Runciman • Utilises robust taxonomy for classifying incident types • Uses root-cause analysis type framework

16. Harm Policy key principles ACC is : • Working alongside the health sector to foster an environment of trust. • a safety net, not the safety net for patient safety • not an investigative agency in relation to harm reporting

17. ACC responsibility – Harm Reporting Where ACC has a reasonable belief that there is a risk of harm to the public then ACC must report the risk of harm to the authority responsible for patient safety in relation to the treatment that caused the personal injury. (IPRC 2001 (2) section 284)

18. Harm process objectives • To fulfil the legislative requirement to report where “believe risk of harm to the public” • Use information collected in the course of processing claims • Assess and consider current and future risk of harm to public

19. Definition of Risk Sentinel events An event during care/treatment that has resulted in an unanticipated death or major permanent loss of function not related to the natural course of the consumer’s illness or underlying condition Serious events An event or pattern of events that has the potential to result in death or major permanent loss of function, not related to the natural course of the consumer’s illness or underlying condition Definitions align with Ministry of Health reportable events framework

20. Harm reporting - “Authority responsible for Patient Safety”

21. Key Points for Harm Notification • Section 284 – the legislative process for harm reporting • Release of relevant information – naming the registered health • ACC disclaimer (when naming)

22. Working with Regulatory Authorities • Joint commitment from ACC and MoH to work in partnership with regards to Patient Safety • Clarity needed around claim process and harm process

23. Number of Harm Cases Reported by Context

24. Emerging Patient Safety Trends • Adverse Drug Events (ADE) • Bowel perforations related to laparoscopic surgery and colonoscopy • Hypoxic Ischaemic Encephalopathy (HIE) • Nerve injuries related to Orthopaedics and General Surgery • CVAs related to Cardiology

25. Summary of Patient Safety Focuses for 2006 • Establishing the Patient Safety net • Key priorities as defined by Harm reporting process • Data collection/monitoring /analysis • Presentations/conferences • Patient Safety Magazine • “Get Involved” campaign empowerment of the Patient • Research • Web site

26. Questions?