Organisational Quality Assurance Standards

Organisational Quality Assurance Standards
Australian Health and Community Service Standards:
Alcohol, Tobacco & Other Drugs Service Module

The standards and indicators below form part of a national quality assurance project, formally known as CHASP (Community Health Accreditation and Standards Program). They are primarily used by drug specialist agencies as a bench mark to measure and improve organisational performance and to gain national accreditation.

The manual from which these standards come, include:
- examples of indicators which can be used with the standards;
- a service development workbook: and
- other useful material to assist in the accreditation process.

These standards are one of the service delivery modules which are to be used as an attachment to generic core standards of Quality Improvement Council (QIC) review and accreditation.

They are provided here to prompt consideration of domains of organisational and clinical review of practice. Agencies wishing to undertake formal review and/or accreditation should contact:
Quality Improvement Council Limited - Ph (03) 9479 5630 Fax (03) 9479 5977

Australian Health and Community Service Standards
Alcohol, Tobacco and Other Drug Services Module
(Note: all the following standards and indicators in the manual are prefixed by ATD [Alcohol, Tobacco and other Drugs]. This prefix has been omitted for convenience but should be included if referencing).

Contents and Summary Guide to the Standards

Section 1 Assessment and Care

1.1 Policy and Resources
1.2 Registration, Allocation and Referral of Clients
1.3 Participation in treatment and Care
1.4 Assessment
1.5 Comprehensive Care Including Treatment
1.6 Continuity of Care

Section 2 Early Identification and Intervention

2.1 Policy resources and Planning
2.2 Comprehensive Accurate Early Identification and Appropriate Intervention
2.3 Participation in Early Identification and Intervention

Section 3 Health Promotion and Harm Prevention

3.1 Policy and Resources
3.2 Planning and Coordination
3.3 Comprehensive Approach
3.4 Advocacy for Health

Section 4 Client and Program Records

4.1 Client Record System
4.2 Confidentiality of Client Records
4.3 Adequacy of Content of Client Records
4.4 Program Record System

Section 1 Assessment and Care

Consumer Principle

Clients receive services which improve their health status and quality of life. The physical, emotional, social cultural, spiritual and environmental aspects of their health are addressed in a holistic manner. Harm caused by the use of alcohol, tobacco and other drugs is minimised through the service's intervention.

Service Principle

The drug service operates in a manner consistent the the philosophy of harm minimisation. It provides the opportunity for change in an individual through assessment, treatment and care across the physical, mental and social aspects of health. The involvement of clients in decision-making is emphasised within a multidisciplinary approach. Work culture ensures that staff work practices aim to provide ready access for clients to assessment, treatment and care services.

Key Outcomes

		Assessment is accurate, comprehensive and timely.
		Consumers receive comprehensive and appropriate individual care.
		Harm is minimised.
		Consumers actively participate in their own care.

Standard 1.1 POLICY AND RESOURCES

The drug service has policies and resources which ensure the provision of high quality assessment, treatment and care services.

INDICATORS

1.1.1	The service has written policies on assessment, treatment and care which have been reviewed within the last three years.
1.1.2	All staff are aware of, and implement, the policies of assessment, treatment and care.
1.1.3	The service has the necessary resources to provide high quality assessment, treatment and care.
1.1.4	The service implements an effective model of service delivery to meet the needs of clients with a dual diagnosis.
1.1.5	The service provides or has access to the range of services needed to assess, treat and care for physical, mental and social factors in relation to drug use.
1.1.6	Where there are identified gaps in services, the service assists clients to get the care they need.
1.1.7	The service has minimised waiting times for services.

Needle Availability and Support Programs (NASP)

1.1.8	The service has policies and protocols for NASP services which are comprehensive and based on current research.
1.1.9	The service is able to provide NASP that meet confidentiality, access and safety requirements.

Drug Withdrawal Service

1.1.10	The service has protocols for withdrawal which are consistent with current research.
1.1.11	Appropriate staff use the withdrawal protocols.

Residential and Drug Withdrawal Services

1.1.12	The service has a polity on any restrictions on clients.
1.1.13	The service ahs protocols for the prescribing, administration and monitoring of any drugs used in detoxification, rehabilitation, or relapse prevention.

Opoid Maintenance Service

1.1.14

The service has protocols in place for the safe prescribing and provision of registered opoid maintenance drugs. The protocols are implemented by appropriate staff.

Standard 1.2 REGISTRATION, ALLOCATION AND REFERRAL OF CLIENTS

The drug service has written procedures for registration, allocation and referral which ensure that people and their personal details are dealt with appropriately and confidentially (whether by telephone, letter, or in person).

INDICATORS

1.2.1	The drug service uses a uniform system to identify and register clients of the service.
1.2.2	All staff use written procedures for the registration, allocation and referral of clients. The procedures include the legal requirements for the registration of mandatory clients.
1.2.3	The service implements effective allocation and referral practices to meet the needs of clients with a dual diagnosis.
1.2.4	The service records all contacts (by phone or in person) with potential clients.
1.2.5	Staff who assess and register people have had appropriate initial and ongoing training.
1.2.6	Appropriate information is given to clients at the time they are registered.
1.2.7	The service is responsive to clients' requests regarding choice of therapist.

Opoid maintenance service

1.2.8

The service has a protocol in place for transfer of clients of opoid maintenance into or out of the service. The protocol is consistent with legislation and relevant state guidelines.

Standard 1.3 PARTICIPATION IN TREATMENT AND CARE

The drug service ensures the participation of clients in their treatment and care through a collaborative approach between clients and staff.

INDICATORS

1.3.1	The service makes sure there is a co-operative approach between clients and staff at all stage of contact including during the development of the management plan.
1.3.2	Staff discuss with clients the impact of their drug use on different areas of their life.
1.3.3	Staff discuss with clients any possible legal or confidentiality problems if they mention illegal drug activities or crimes.
1.3.4	Clients are supported in making informed decisions about their health care and management plan.
1.3.5	Staff explain to clients the purpose, value and consequences of diagnostic and/or treatment methods that are available.
1.3.6	Language-appropriate pamphlets, booklets and articles on various health and drug issues are available in the service's reception area, and are given to clients as part of their care.
1.3.7	The service offers opportunities for clients to participate in self help/support or user groups.
1.3.8	The service ensures that the only people who are suitably registered, prescribe and dispense medication, including opoids.
1.3.9	Staff involved in the prescribing and dispensing of medication, including opoid maintenance, give clients easy-to-understand verbal and/or written information about its use.
1.3.10	Staff explain to clients the activities that are available at the service.
1.3.11	The service informs clients of the availability and suitability of other services and agencies that provide additional or alternative programs.
1.3.12	Clients are given feedback on their progress in treatment.

Standard 1.4 ASSESSMENT

People using the drug service receive an appropriate, accurate, comprehensive and prompt assessment of their needs.

INDICATORS

1.4.1	The initial assessment of clients gathers relevant and sufficient information to develop an initial management plan.
1.4.2	The service ensures that clients are assessed promptly any by the most appropriate team members.
1.4.3	Client consent is routinely sought for staff to consult with multidisciplinary team members to help with comprehensive assessment.
1.4.4	Provision is made for ongoing assessment, which is structured and staged in a way that is sensitive to clients' readiness to discuss sensitive information.
1.4.5	Staff ensure that clients have access to a general health assessment for the early identification of health problems.
1.4.6	Staff use specific protocols, which are up-to-date with current professional practice, to guide assessment.
1.4.7	The service ensures that assessment of Aboriginal and Torres Strait Islander people or people from diverse cultures, is appropriate to their language and culture.
1.4.8	The service uses reliable and valid mental health screening procedures that are routinely administered at assessment or admission.

Standard 1.5 COMPREHENSIVE CARE INCLUDING TREATMENT

The drug service provides access to the range of services required to ensure clients' needs are comprehensively addressed.

INDICATORS

1.5.1	The service has access to a range of activities and interventions within the program to enable a comprehensive management plan to be available to the client.
1.5.2	The activities and interventions offered by the service are supported by evidence based research.
1.5.3	The service uses specific protocols and guidelines to carry out activities and interventions. These protocols are consistent with current professional practice.
1.5.4	The service assesses whether the activities and interventions delivered to clients are of benefit.
1.5.5	The service ensures that activities and interventions ere appropriate to the language and culture of Aboriginal and Torres Strait Islander people and people from diverse cultures.
1.5.6	There are opportunities for staff to discuss and review management plans.
1.5.7	The service provides access and referral to specialised groups, run by suitably qualified people.
1.5.8	The service uses harm reduction strategies in its activities.
1.5.9	All staff providing services to individuals comply with codes of ethics and standards of professional practice.
1.5.10	Staff acknowledge and respond appropriately to the difficulties clients experience during treatment.
1.5.11	The service provides access to programs that assist clients to develop necessary skills for life in the wider community.
1.5.12	The service provides information and referral to appropriate programs for family/friends of clients.

Needle Availability and Support Programs (NAPS)

1.5.13

The NASP service follows guidelines, and services are provided by staff in a sensitive, confidential and safe manner.

Drug Withdrawal Service

1.5.14

Staff respond sensitively to the physical and emotional pain and discomfort that occurs during the process of withdrawal.

Residential and Drug Withdrawal Services

1.5.15

The residential or drug withdrawal service provides or refers to a transitional program to assist in reintegration of the resident back into their family and/or the wider community.

Standard 1.6 CONTINUITY OF CARE

The drug service assists clients to receive services in a timely and appropriate order and takes steps to ensure continuity when more than one service provider is involved.

INDICATORS

1.6.1	Where there are multiple providers of services, arrangements are made for one staff member to have responsibility for co-ordination. the client is consulted when these arrangements are being made.
1.6.2	Guidelines are in place which describe the circumstances under which broken appointments should or should not be followed up.
1.6.3	the service has processes in place to provide assistance to clients when waiting times interfere with continuity of care.
1.6.4	Processes are in place to facilitate the appropriate and timely referral of clients between services.
1.6.5	The service has procedures to ensure adequate information is passed on, with client consent, when referrals are made from the service.
1.6.6	Contact is maintained, where appropriate, with medical practitioners and other relevant professionals about progress of clients they have referred to the service.
1.6.7	The service is involved in shared care programs with other agencies in the area.
1.6.8	The service participates in meetings addressing continuity of care issues.
1.6.9	The service assesses the suitability of other agencies to whom they may refer clients.
1.6.10	The service provides for multiple episodes of care. Information from previous episodes is utilised to ensure continuity of care.
1.6.11	The service has a formal discharge process.
1.6.12	The service provides access to support and aftercare.
1.6.13	When clients leave the service, they are given information which could help them reduce harm associated with future drug use.

Section 2 Early Identification and Intervention

Consumer Principle

The client receive services that detect, monitor and intervene in early stage health problems to improve his/her health and quality of life.

Service Principle

The drug service identifies potential and early stage health problems in individuals, including those related to drug use, to enable effective early intervention to improve health status.

Key Outcomes

		Health and social problems of the community of interest are systematically identified.
		Interventions are timely and effective.
		There is improved targeting of harm reduction strategies.
		Clients have improved health status and quality of life.

Standard 2.1 POLICY, RESOURCES AND PLANNING

The drug service has policies, resources and plans for activities which aim to prevent or reduce the harm related to drug use.

INDICATORS

2.1.1	The service has a written policy on early identification and intervention, which as been reviewed within the last three years. Dual diagnosis issues are addressed as a key priority within the early identification and intervention policy.
2.1.2	The service has a plan that includes early identification and intervention activities.
2.1.3	The service uses written procedures, evidence from current research and validated benchmarks to guide its early identification activities.
2.1.4	All staff identify possibilities for early identification within their area of work.
2.1.5	The service uses client and other data to identify common problems in the community and plan appropriate early identification and intervention programs.
2.1.6	Staff have access to appropriate equipment.written materials for early identification.
2.1.7	The drug service receives assistance from the funding body/health authority in its early identification and intervention programs and activities.

Standard 2.2 COMPREHENSIVE, ACCURATE EARLY IDENTIFICATION AND APPROPRIATE INTERVENTION

The drug service uses comprehensive and accurate early identification methods and offers appropriate interventions to help individuals maintain or improve their quality of life.

INDICATORS

2.2.1	The service uses a range of methods for the early identification of health problems in clients.
2.2.2	The service promptly refers people with identified problems or contributing factors to the appropriate services.
2.2.3	The service conducts early identification activities for groups in the community.
2.2.4	The service works with other organisations to help them identify individuals whose use of drugs is potentially harmful.
2.2.5	The service's early intervention activities include a range of approaches.
2.2.6	Staff explore with clients strategies that can prevent or reduce the harm associated with their drug use.

NEEDLE AVAILABILITY SUPPORT PROGRAMS (NAPS)

2.2.7

The service offers, or has the ability, to refer to NAPS in a timely, efficient and effective manner.

Standard 2.3 PARTICIPATION IN EARLY IDENTIFICATION AND INTERVENTION

The drug service organises accessible early identification and intervention activities which enable people's informed participation.

INDICATORS

2.3.1	The service publicises its early identification and intervention activities and encourages participation.
2.3.2	Staff explain to people participating in early identification and intervention activities the health problem or behaviour being identified, the benefits and associated risks, and that participation in the activity is voluntary.
2.3.3	Early identification and intervention activities take place in locations that are accessible and appropriate.
2.3.4	The service promptly informs individuals participating in early identification activities of their results.
2.3.5	The service ensures that when clients are found to be infected with HIV or Hepatitis, they are appropriately referred on for further testing, treatment and advice.
2.3.6	Following identification of problems, the service involves clients in developing appropriate intervention strategies.

Section 3 Health Promotion and Harm Prevention

Consumer Principle

The capacity of the client and community to protect and promote wellbeing is enhanced through health promotion.

Service Principle

The drug service works in partnership with its community of interests and other stakeholders to achieve improved health and reduction of harm.

Key Outcomes

		Community capacity to protect and promote health and wellbeing is increased.
		Individual skills are developed.
		Health and social outcomes for individuals are improved.
		Productive partnerships are established for the promotion of health and wellbeing.

Standard 3.1 POLICY AND RESOURCES

The drug service has policies and resources to promote and protect health and prevent harm in the community it serves.

INDICATORS

3.1.1	The service has written policies on health promotion and harm prevention, which has been reviewed within the last three years.
3.1.2	All staff use the service's policy on health promotion and harm prevention.
3.1.3	All staff have the opportunity to participate in health promotion and harm prevention.
3.1.4	The service has an identifiable health promotion budget or ready access to funds to support health promotion and harm prevention.
3.1.5	The service has a process to coordinate health promotion or harm prevention activities which it conducts or in which it is involved.
3.1.6	The service investigates opportunities for additional sources of funds to support health promotion activities, and records results of all applications./submissions.
3.1.7	Staff have access to appropriate audiovisual and printed resource materials to support health promotion and harm prevention. Materials are available in appropriate community languages.
3.1.8	The service has access to a Health Promotion Unit or Population Health Unit or Public Health Unit which provides a range of support to facilitate health promotion activities.

Standard 3.2 PLANNING AND COORDINATION

The drug service plans and coordinates its health promotion and harm prevention activities so that clear goals and appropriate strategies are used, and the main drug issues of the community are addressed.

INDICATORS

3.2.1	National/state health promotion and harm prevention priorities have been addressed in planning and adapted where appropriate.
3.2.2	The service's health promotion and harm prevention activities correspond to the identified issues in its community. These activities reflect the service's health promotion and harm prevention policy.
3.2.3	Health promotion and harm prevention is an integral component of all activities of the service.
3.2.4	The service uses a systematic process to inform all staff of relevant current and planned health promotion and harm prevention programs.
3.2.5	Opportunities exist for staff to consult with team members, other agencies and community organisations about the health promotion and harm prevention programs they conduct.
3.2.6	The appropriate authority informs the service of relevant media campaigns in a timely manner.
3.2.7	Information about media campaigns is used to plan supporting activities prior to, during and following the campaign.

Standard 3.3 COMPREHENSIVE APPROACH

The drug service promotes the health and wellbeing of its defined community in a comprehensive way, by using a range of strategies appropriate to the issues being addressed.

INDICATORS

3.3.1	The service conducts or participates in a range of health promotion and harm prevention programs and activities that address physical, mental and social factors in relation to health and drug use.
3.3.2	The service works with local agencies and community groups to strengthen community action in identifying health issues and in promoting health and preventing harm.
3.3.3	The service assists people to develop personal skills for health.
3.3.4	When conducting health promotion and harm prevention activities, strategies are used that acknowledge and value participant' experiences.
3.3.5	The service is involved in activities that seek to create environments supportive to health.
3.3.6	The service is involved in activities that help develop public policies that promote health at the local level.
3.3.7	The drug service orients its services towards health promotion and harm prevention.

Standard 3.4 ADVOCACY FOR HEALTH

The drug service acts as an advocate to protect and promote the health of the community in relation to drug issues.

INDICATORS

3.4.1	The service informs community members and organisations about current drug issues and their potential impact on the community.
3.4.2	The service encourages other agencies t adopt a harm prevention and reduction approach.
3.4.3	The service participates in public forums and other activities in order to protect the health of the community
3.4.4	The service provides feedback on issues of local concern to state policy units to influence policy and legislation.
3.4.5	The service uses public relations opportunities to promote health and prevent/reduce drug related harm within the community.
3.4.6	The service advocates for the provision of accessible and appropriate Needle Availability Support Program (NAPS) services.

Section 4 Client and Program Records

Consumer Principle

Clients receive coordinated services and programs which are responsive to individual need. Personal information is documented in a comprehensive, accurate and respectful manner, with confidentiality protected and individual rights to access respected.

Service Principle

The drug service systematically documents its assessment, treatment and care, health promotion and harm prevention, early identification and intervention work to facilitate evaluation and demonstrate effectiveness and accountability.

Key Outcomes

		Records ensure accountability to consumers and funding bodies.
		Individual/community outcomes can be demonstrated through accurate records of all activities.
		Systems for accurate transfer of information ensure integrated, coordinated service delivery.
		Performance is improved following data analysis.
		The service regularly monitors and evaluates its work.
		Client confidentiality is protected.

Standard 4.1 CLIENT RECORD SYSTEM

The drug service has a system that directs the allocation, content and processing of client records.

INDICATORS

4.1.1	The service ensures that all client information is placed in a common client record.
4.1.2	The service has a written policy and procedures to direct its client record system. The policy specifically addresses system security issues regarding dual diagnosis clients, and relationships with other health program areas.
4.1.3	The service observes the appropriate state legal guidelines for client records, and all appropriate staff are aware of these guidelines.
4.1.4	Responsibility has been allocated for maintaining the client record system.
4.1.5	The service makes sure all staff understand and follow the service's system and policy of client records.
4.1.6	All client records are filed and stored so that authorised staff can find them easily. A tracer system is in place.
4.1.7	The service has access to advice and consultation about its client record system from an appropriate person.
4.1.8	The service ensures that notes are completed in client records promptly.

Standard 4.2 CONFIDENTIALITY OF CLIENT RECORDS

The drug service ensures the confidentiality of all its client records.

INDICATORS

4.2.1	There are adequate security arrangements to prevent loss, defacement and unauthorised use of client records.
4.2.2	Procedures are in place to ensure that the confidentiality of client records is maintained, should their removal from the service or transport between sites of a service be necessary.
4.2.3	Procedures are in place to ensure the confidentiality of material which is sent to another service.
4.2.4	Where aspects of the client record system are computerised, systems are in place to ensure confidentiality.
4.2.5	The service ensures that client records are not left unsupervised, and cannot be read by unauthorised people.
4.2.6	The client's signed consent is recorded in his/her client record when information is sent to other agencies or professionals.
4.2.7	The service explains to clients that their client records may be audited or used for data collection.

Standard 4.3 ADEQUACY OF CLIENT RECORDS

The client's record contains sufficient and appropriate information to identify the client, explain the assessment, treatment and care of his/her health, and to document progress and outcomes.

INDICATORS

4.3.1	Each client record contains a data base, identification information, problem list, assessment, and care management plans.
4.3.2	Documentation in the client record is comprehensive, factual and sequential.
4.3.3	Presenting and identified problems or issues are recorded objectively in the client records.
4.3.4	Client record entries are legible and show the date, signature, name and profession of each health worker providing services to the client.

Standard 4.4 PROGRAM RECORD SYSTEM

The drug service has record systems for the documentation of all programs, including group work and activities for early identification and intervention, health promotion, and community development projects.

INDICATORS

4.4.1	The service has a uniform system of registration that identifies the location of program records.
4.4.2	A person has responsibility for maintaining the system for program records.
4.4.3	The service has a policy to guide the implementation of its program records system.
4.4.4	The service ensures staff understand and use the system for program records.
4.4.5	An effective tracer system is used for all program records to ensure that staff can locate and retrieve them as required.
4.4.6	The service has a uniform format to assist staff to plan, implement, evaluate and document health promotion and harm prevention programs.