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NSW Government: Keep Patients Safe Topics

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NSW Government: Keep Patients Safe Topics

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https://www.cec.health.nsw.gov.au/keep-patients-safe

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NSW Government: Clinical Excellence Commission: Keep Patients Safe

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NSW Government: Clinical Excellence Commission: Keep Patients Safe

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1. Infection Control, including Hospital-Acquired Infections (HAI) Complications

2. Older Persons' Patient Safety Program:

Falls prevention

Pressure injury prevention

3. Sepsis

4. Blood Watch

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Keep patients safe - Clinical Excellence Commission

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Safer care, for every patient, every time

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Australian Commission on Safety and Quality in Health Care: National Safety and Quality Health Service Standards (PDF)

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Australian Commission on Safety and Quality in Health Care: National Safety and Quality Health Service Standards (PDF)

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Reference:

Australian Commission on Safety and Quality in Health Care. (2021). National Safety and Quality Health Service Standards (second edition). https://www.safetyandquality.gov.au/publications-and-resources/resource-library/national-safety-and-quality-health-service-standards-second-edition

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National Clinical Care Standards (ACSQHC)

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National Clinical Care Standards (ACSQHC)

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Some of the Items Discussed:

Management of Peripheral Intravenous Catheters

Venous Thromboembolism Prevention

Sepsis

Hip Fracture

Low Back Pain

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Clinical Care Standards | Australian Commission on Safety and Quality in Health Care

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10th Anniversary of Clinical Care Standards To mark the 10th anniversary of the Clinical Care Standards in Australia, the Commission is inviting clinicians and health services to share their stories about successfully implementing Clinical Care Standards and improvements in patient care. Find out more

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VTE Prevention Clinical Care Standard (ACSQHC)

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VTE Prevention Clinical Care Standard (ACSQHC)

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Reference:

Australian Commission on Safety and Quality in Health Care. (2020). Venous thromboembolism prevention clinical care standard. https://www.safetyandquality.gov.au/standards/clinical-care-standards/venous-thromboembolism-prevention-clinical-care-standard

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Venous Thromboembolism Prevention Clinical Care Standard | Australian Commission on Safety and Quality in Health Care

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Reference:

Australian Commission on Safety and Quality in Health Care. (2019). Hospital-acquired complication: Pressure injury. https://www.safetyandquality.gov.au/sites/default/files/2019-05/saq7730_hac_factsheet_pressureinjury_longv2.pdf

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Surgical Site Infection Surveillance (ACSQHC)

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Surgical Site Infection Surveillance (ACSQHC)

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Reference:

Australian Commission on Safety and Quality in Health Care. (2017). Approaches to surgical site infection surveillance: For acute care settings in Australia.

https://www.safetyandquality.gov.au/sites/default/files/2019-06/approaches-to-surgical-site-infection-surveillance.pdf

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Reference:

Australian Commission on Safety and Quality in Health Care. (2018). Hospital-acquired complications fact sheet. https://www.safetyandquality.gov.au/sites/default/files/migrated/Short-Hospital-Acquired-Complications-Factsheets-all-HACs.pdf

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National Sepsis Program | Australian Commission on Safety and Quality in Health Care

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New resources - ‘Could it be Sepsis?’ These new sepsis resources for World Patient Safety Day (17 September) encourage health care workers to make diagnostic excellence integral to their practice with three simple actions:

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Delirium Clinical Care Standard (ACSQHC)

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Delirium Clinical Care Standard (ACSQHC)

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Delirium Clinical Care Standard | Australian Commission on Safety and Quality in Health Care

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Delirium is an acute change in mental status that is often triggered by acute illness, surgery, injuries or adverse effects of medicines.

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Keep patients safe - Clinical Excellence Commission

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Safer care, for every patient, every time

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Quality Improvement Toolkits - Clinical Excellence Commission

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Quality Improvement Toolkits support local healthcare teams to start and sustain a quality improvement (QI) project

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The programs run by SA Health’s Safety and Quality unit that are aligned to the 10 National Safety and Quality Health Service Standards

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Consent to medical treatment and healthcare | SA Health

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People over the age of 16 with decision making capacity have the right to consent or refuse to consent to their own medical treatment and/or healthcare.

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Clinical risk management introduces systems that improve the quality and safe delivery of healthcare to Victorians.

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Search or browse our clinical guidance and supporting resources.

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Reference:

Department of Health Victoria. (2023). Informed consent and presumption of capacity. https://www.health.vic.gov.au/mental-health-and-wellbeing-act-handbook/supported-decision-making/informed-consent-and-presumption

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Key messages

The informed consent of a person must be sought before they are given any treatment or medical treatment under the Act.

Everyone must be presumed to have capacity to make decisions about their treatment and medical treatment and to give informed consent, and a person can make a decision that others may regard as unwise, regardless of their age or legal status under the Act.

The Act describes the circumstances in which treatment can be provided to a patient without their informed consent and the processes that must be followed before providing that treatment.

The Act also sets out the process for providing medical treatment to a person who does not have capacity to give informed consent.

Informed consent

The informed consent of a person must be sought before they are given any treatment or medical treatment under the Act. This includes giving treatment to a person who is subject to an order authorising compulsory assessment or treatment.

A person gives informed consent if they:

have capacity to give informed consent

have been given adequate information to enable them to make an informed decision

have been given a reasonable opportunity to decide whether or not to consent

have given consent freely without undue pressure or coercion

have not withdrawn consent or indicated any intention to withdraw consent.

Note: A person may give informed consent for medical treatment by instructional directive. An instructional directive is an advance care directive made under the Medical Treatment Planning and Decisions Act 2016 and is a legally binding statement in which the person who completes it consents to, or refuses, particular forms of medical treatment or a medical research procedure, or a course of treatment.

Presumption of capacity

A clinician proposing treatment or medical treatment for a person must presume that the person has capacity to give informed consent.

However, informed consent does not need to be sought if the clinician reasonably considers the person does not have capacity at the time the particular decision needs to be made.

Capacity to give informed consent

A person has capacity to give informed consent to a decision if they can:

understand the information given to them about the decision - a person should be supported to understand the information

remember the information - a person need only be able to remember information necessary to make the decision, a general recollection is sufficient

use or weigh the information - a person must be able to assess the information and understand the impact of making, or not making a decision

communicate their decision - this can be through speech, gesture or any other means.

Deciding if a person has capacity to give informed consent

In deciding whether a person has capacity to give informed consent, the following must be considered:

capacity to give informed consent is specific to the decision that needs to be made

a person's capacity to give informed consent may change over time. Just because a person does not have capacity to give informed consent on one day, it cannot be assumed that they do not have capacity to make a comparable decision on another day

it should not be assumed that a person lacks capacity to give informed consent based only on their age, appearance, disability, condition or behaviour

a person doesn't lack capacity to give informed consent only because the person makes a decision that could be considered unwise

whether they may be enabled to give informed consent by providing them with the appropriate supports.

A patient without capacity should be supported to be involved in the decision-making process as far as possible.

Adequate information to give informed consent

The Act describes adequate information to enable a person to make an informed decision as:

an explanation of the proposed treatment or medical treatment, including the purpose, type, method and likely duration of the treatment or medical treatment

an explanation of the advantages and disadvantages of the treatment or medical treatment including information about the associated discomfort, risks and common or expected side effects

an explanation of any beneficial alternative treatments that are reasonably available, including any information about the advantages and disadvantages of these alternatives

an explanation of the advantages and disadvantages of not undergoing the treatment; and

answers to any relevant questions they have asked and any other relevant information likely to influence their decision.

Reasonable opportunity to make a decision

The Act describes reasonable opportunity to make an informed decision as:

a reasonable period of time to consider

a reasonable opportunity to discuss matters with the relevant health practitioner

appropriate supports to make the decision

reasonable opportunity to obtain advice or assistance in making the decision.

Application of the informed consent requirements will vary depending on the nature and effect of the treatment for which informed consent is being sought. For example, the type of information and support that should be provided to a person when seeking informed consent for treatment that involves medication will be different to what is required when seeking informed consent for a talking therapy session.

Given consent freely

Informed consent must be freely given. A person must not feel they have to give informed consent simply because the clinician believes it is necessary for their treatment or in their best interests or to please a family member or carer.

Have not withdrawn consent

A person can withdraw consent at any time. A person can withdraw consent verbally or in writing.

A person can withdraw consent before the treatment starts or during a course of treatment. If the person withdraws consent, the treatment must stop.

A person withdraws consent if they say or indicate by their behaviour that they do not consent to the treatment.

Providing treatment when a patient does not give informed consent

Patient is a term used in the Act to refer to a person who is:

subject to

an assessment order; or

a court assessment order; or

a temporary treatment order; or

a treatment order; or

is a forensic patient; or

is a security patient.

Only the patient can give or refuse informed consent for treatment. No other person can give informed consent to treatment. This means that a guardian or Medical Treatment decision maker under the Medical Treatment Planning and Decisions Act 2016 cannot give or refuse informed consent to treatment on behalf of a person who is subject to a compulsory order.

Orders authorising compulsory assessment

A person who is on an assessment order can only be given treatment without consent if a registered medical practitioner employed or engaged by the responsible designated mental health service is satisfied that urgent treatment must be given to the person to prevent serious deterioration in the patient's mental or physical health or to prevent serious harm to the patient or another person.

Indications of urgency include circumstances where the person is suffering significant distress or where their health or mental health is seriously deteriorating or where a delay in treatment would result in serious harm to the person.

Similar restrictions apply for a person who is subject to court assessment order, however, if the person is also subject to a temporary treatment order or treatment order, then treatment may also be provided in accordance with that order.

Orders authorising compulsory treatment

The Act requires that a person who is subject to an order for compulsory treatment, such as a temporary treatment order or a treatment order, is to be given treatment for their mental illness. Compulsory treatment can be given on such orders, however, treatment with consent is preferred.

The Act permits an authorised psychiatrist to make a treatment decision for a patient who is subject to an order for compulsory treatment and who:

does not have capacity to give informed consent to the treatment proposed by the authorised psychiatrist; or

has capacity to give informed consent to the treatment proposed by the authorised psychiatrist but has not given informed consent to that treatment.

The authorised psychiatrist can make a treatment decision for the patient if the authorised psychiatrist is satisfied that:

the treatment is clinically appropriate; and

there is no less restrictive way for the patient to be treated other than the proposed treatment.

An authorised psychiatrist cannot make a treatment decision about electroconvulsive treatment or neurosurgery for mental illness for a patient. See and for more information.

Deciding the least restrictive treatment

In deciding whether there is no less restrictive way for the patient to be treated, the authorised psychiatrist must, to the extent reasonable in the circumstances, have regard, to all of the following:

the patient's views and preferences about the proposed treatment, including

views and preferences in the person's advance statement of preferences, if they have one

views of the person's nominated support person if they have one

the reasons the person has those views and preferences, including any recovery outcomes they would like to achieve

any beneficial alternative treatment that is reasonably available

the likely consequences for the patient if the treatment is not administered

the likely consequences if the treatment is provided without consent

any second psychiatric opinion that has been given to the authorised psychiatrist in relation to the patient's treatment

the views of any , if the authorised psychiatrist is satisfied that the treatment decision will directly affect the

the views of the Secretary to the Department of Families, Fairness and Housing if the person is the subject of a relevant child protection order.

These obligations to have regard to the views of others will be fulfilled if reasonable attempts are made to find out the views of those listed above even if they are not able to obtain the views of all. What is reasonable in the circumstances will vary on a case-by-case basis as will the weight that should be given to these views in making the determination.

Before making a treatment decision, the authorised psychiatrist must give proper consideration to the decision-making principles for treatment and interventions

When a treatment decision is not consistent with an advance statement of preferences

not clinically appropriate; or

is clinically appropriate but is unable to be provided to the patient by the designated mental health service despite the designated mental health service making all reasonable efforts to do so.

If an authorised psychiatrist makes a treatment decision that is not in accordance with the treatment preferences set out in an advance statement of preferences, the authorised psychiatrist must inform the patient and provide reasons for that decision.

Providing medical treatment when a patient does not give informed consent

Substitute consent to medical treatment

The Act sets out requirements for who can provide substitute consent for patients for medical treatment. The requirements differ for adult patients (18 years or older) and patients who are under 18 years of age.

Adult patients

If a patient who is 18 years or older does not have capacity to give informed consent to medical treatment, medical treatment can be provided with the consent of the first person in the following list who is reasonably available, willing and able to make a decision about the proposed medical treatment:

the patient's medical treatment decision maker

a person appointed by the Victorian Civil and Administrative Tribunal to make decisions about the proposed medical treatment

a person appointed under a guardianship order within the meaning of the Guardianship and Administration Act 2019 with power to make decisions concerning the proposed medical treatment (the patient's guardian)

the authorised psychiatrist.

Patients under 18 years of age

If a patient who is under 18 years old does not have capacity to give informed consent to medical treatment, medical treatment can be provided with the consent of:

a person who has the legal authority to consent to the medical treatment for the patient and who is reasonably available, willing and able to make a decision about the proposed medical treatment; or

if that person is not reasonably available or is not willing and able to make a decision about the proposed medical treatment, the authorised psychiatrist.

Requirements if the authorised psychiatrist is consenting to medical treatment for a patient

The authorised psychiatrist can only consent to medical treatment for a patient if they are satisfied the medical treatment will benefit the patient.

If the authorised psychiatrist is of the opinion that the patient does not currently have capacity to give informed consent to medical treatment but is likely to have that capacity within a reasonable period of time the authorised psychiatrist must not consent to the medical treatment, unless the delay in giving consent could result in serious harm to, or deterioration in, the mental or physical health of the patient.

In deciding if the medical treatment will benefit the patient the authorised psychiatrist must have regard to the extent that is reasonable in the circumstances, to:

the patient's views and preferences about the proposed medical treatment and the reasons the patient has those views and preferences, including any recovery outcomes they would like to achieve

any beneficial alternative medical treatment that is reasonably available

if the medical treatment is likely to remedy the condition or lessen the symptoms of the condition

the likely consequences for the patient if the medical treatment is not administered

any second opinion of a registered medical practitioner that has been given to the authorised psychiatrist

any relevant values directive given by the patient

the views of the patient's nominated support person

the views of the patient's guardian, if they have one

the views of any carer, if the authorised psychiatrist is satisfied that the medical treatment decision will directly affect the care relationship

the views of the patient's parent, if the patient is under the age of 16 years

the views of the Secretary to the Department of Families, Fairness and Housing if the patient is the subject of a relevant child protection order.

Transitional arrangements

If consent to medical treatment is given under the Mental Health Act 2014, and the course of medical treatment consented to has not commenced or been completed by 1 September 2023, the consent to that course of medical treatment is to be taken to be consent given under the Mental Health and Wellbeing Act 2022.

How does this compare with the Mental Health Act 2014?

The Mental Health and Wellbeing Act 2022 does not make any substantive changes to the requirements regarding informed consent and the presumption of capacity in the Mental Health Act 2014.

These requirements apply to all mental health and wellbeing service providers who are providing treatment.

The Act introduces new requirements when a treatment preference in a patient's advance statement of preference is overridden by the treatment decision of an authorised psychiatrist.

Under the Mental Health Act 2014, a treatment decision may override a treatment preference in a patient's advance statement if the patient's preferred treatment is not ordinarily provided by the designated mental health service. Under the Mental Health and Wellbeing Act 2022, there is an obligation for reasonable efforts to be made to provide the preferred treatment. The preference can only be overridden where the treatment is unable to be provided at the designated mental health service despite these reasonable efforts having been made.

Unlike the Mental Health Act 2014, which required the provision of written reasons for overriding an advance statement only when requested, under the Act an authorised psychiatrist must provide written reasons within 10 business days whenever a treatment decision is made that does not accord with treatment preferences expressed in an advance statement of preferences.

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Informed consent and presumption of capacity

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Understand the importance of seeking informed consent of a person's treatment or medical treatment under the Mental Health and Wellbeing Act.

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Find guidance and resources relating to quality standards, care at the end of life, blood management and other topics relating to health professionals duty of care, and patient safety responsibilities.

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Clinical Excellence Queensland | Queensland Health

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Audit tools for National Safety and Quality Health Service Standards

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Clinical Excellence Queensland is strongly committed to supporting our health services in achieving and surpassing the National Safety and Quality Health Service (NSQHS) standards. A range of audit tools have been developed for facilities to use to collect data and evidence of meeting the standards, including:

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Australian Commission on Safety and Quality in Health Care: Hip Fracture Clinical Standards

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Australian Commission on Safety and Quality in Health Care: Hip Fracture Clinical Standards

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Reference:

Australian Commission on Safety and Quality in Health Care. (2023). Hip fracture clinical standards. https://www.safetyandquality.gov.au/sites/default/files/2023-09/hip-fracture-clinical-care-standard-2023.pdf

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Patient Safety Competency Framework (PSCF) for Nursing Students 

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Patient Safety Competency Framework (PSCF) for Nursing Students 

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Reference:

Levett-Jones, T. Dwyer, T., Reid-Searl, K., Heaton, L., Flenady, T., Applegarth, J., Guinea, S., Andersen, P. (2017). Patient Safety Competency Framework (PSCF) for Nursing Students Sydney, NSW. http://psframework.wpengine.com/wp-content/uploads/2018/01/PSCF_Brochure_UTS-version_FA2-Screen.pdf

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Reference: Australian Commission on Safety and Quality in Health Care. (2020). Review: Implementation of the Australian Open Disclosure Framework – Final consultation report. https://www.safetyandquality.gov.au/sites/default/files/2020-12/implementation_of_the_australian_open_disclosure_framework.pdf

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Reference: Levett-Jones, T. (2019). Critical conversations for patient safety: An essential guide for healthcare students. Pearson Education Australia.

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Open Disclosure Flowchart by Levett Jones (2019, p. 277)

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Preventing and managing pressure injuries

Preventing falls and harm from falls

Nutrition and hydration.

and more..

Reference:

Australian Commission on Safety and Quality in Health Care. (2025). Minimising patient harm. https://www.safetyandquality.gov.au/standards/nsqhs-standards/comprehensive-care-standard/minimising-patient-harm

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Minimising patient harm | Australian Commission on Safety and Quality in Health Care

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The screening actions in this standard aim to identify the patients who are at the greatest risk of harm while receiving health care. The specific risks identified in this criterion are areas in which at-risk patients are commonly harmed. Implementing targeted, best-practice strategies can prevent or minimise the risk of these specific harms: Items