Essay: Practise in Domiciliary Health Care Environment, NSQHS

This essay explores the application of National Safety and Quality Health Service (NSQHS) standards within the context of domiciliary health care. It focuses on two key standards: prevention and control of infections and safety in handling blood and blood-related products. The essay uses the case of Mrs. Brown, a patient requiring post-operative care following a laparoscopic cholecystectomy and intravenous antibiotics via a peripherally inserted central catheter (PICC), to illustrate the practical implementation of these standards. The discussion highlights best practices for PICC insertion and maintenance to minimize infection risks, including aseptic techniques, appropriate catheter selection, and the importance of staff training and monitoring. The essay emphasizes the crucial role of nurses in ensuring patient safety and optimizing the quality of care in a domiciliary setting, referencing relevant literature and guidelines to support its arguments. The analysis underscores the significance of adhering to NSQHS standards to enhance patient outcomes and promote a safe healthcare environment.

Practise in the Domiciliary Health Care Environment 1
Practise in the Domiciliary Health Care Environment
Student’s Name:
Instructor’s Name:
Date:

Practise in the Domiciliary Health Care Environment 2
Practise in the Domiciliary Health Care Environment
Assignment 1
– Essay NSQHS-Standards
Introduction:
National Safety and quality health service standards (NSQHS) are typically ten
standards that govern the nursing practice in health care service (NSQHS, 2012)
(Brenner et al., 2015). The standards of NSQHS were essentially put forth by the
Australian commission on safety and quality in health care service (NSQHS, 2012)
(Brenner et al., 2015). The NSQHS primarily focuses on the implementation of safety for
patients and their families and the protection of their interest during their visit to the
hospital (NSQHS, 2012) (Brenner et al., 2015). The delivery of health service is
regarded optimal when the patients are provided an environment free of accidents and
health concerns caused due to lack of care (NSQHS, 2012) (Brenner et al., 2015).
The NSQHS standards for the optimisation of quality and safety in health care service
include:
1. Governance of safety and quality in the organisations of healthcare
2. Partnership with the consumers of health care service
3. Prevention and control of infections caused by the absence of health care attention
4. Safety during medication and pharmacological treatment
5. Identification of the patient and matching the treatment procedure to individual
patients
6. Optimal and accurate clinical handover of patients
7. Safety whilst handling blood and blood-related products

Practise in the Domiciliary Health Care Environment 3
8. Prevention and management of injuries and pressure sores
9. Timely recognition of deterioration in acute health care procedure and appropriate
response
10. Prevention of falls and accidents and related harm
The NSQHS standards govern the determination of quality of health care service
(NSQHS, 2012) (Brenner et al., 2015). The Australian commission on quality and safety
standards has arrived at the above-mentioned standards following consultation with
health care professionals and technical experts (NSQHS, 2012) (Brenner et al., 2015).
Nurses play the most crucial role in the provision of a high-quality and safety-assured
health care service (NSQHS, 2012) (Brenner et al., 2015). The NSQHS standards are
verified in the health care units by conducting regular clinical audits (NSQHS, 2012)
(Brenner et al., 2015). The current article focuses on two of the above-mentioned
NSQHS standards, i.e. guideline no. 3: the prevention and control of infections caused
by the absence of health care attention, and guideline no 7: Safety whilst handling blood
and blood-related products. This article discusses the implementation of these
guidelines of NSQHS with specific reference to the case of Mrs. Brown.
Implementation of two specific NSQHS standards:
Mrs. Brown requires post-operative care for lap cholecystectomy or the surgical removal
of gall bladder. Mrs. Brown is an elderly woman with the history of type 2 diabetes
mellitus, osteoarthritis, and amputated toe. She has several challenges in performing
daily activities due to her arthritis and amputated toe concerns. However, she is
independent and her familial carers aid her in all her mobility concerns.
She has to be administered antibiotics by the intravenous route (IVAB) by means of a
peripherally inserted central venous catheter (PICC) (Boyd et al., 2014) (Tamhankar et
al., 2010). The first NSQHS guideline to be followed in her case is that of prevention of
infections associated with negligence in healthcare (Boyd et al., 2014) (Tamhankar et
al., 2010). The best practice for the use of PICC IVAB include: use of appropriate

Practise in the Domiciliary Health Care Environment 4
dimension of catheter, training for nurses for administration including the insertion and
simulation of catheter, maintenance of hand hygiene, and monitoring and reporting of
bloodstream infections to all stakeholders (Boyd et al., 2014) (Tamhankar et al., 2010).
The nurses using the PICC equipment must follow aseptic cleaning of catheter, lipid
removal, and hair removal at the site of insertion to avoid infections (Boyd et al., 2014)
(Tamhankar et al., 2010). The second NSQHS guideline may be followed by assuring
that the site of insertion of PICC should be aseptic and the position should be affirmed
using X-ray scan (Boyd et al., 2014) (Tamhankar et al., 2010). The catheter used must
have appropriate lumen size and must be made of aseptic material (Boyd et al., 2014)
(Tamhankar et al., 2010). The length of insertion must be appropriate and PICC must
never be trimmed using scissors (Boyd et al., 2014) (Tamhankar et al., 2010). The
prophylactic administration of antibiotics or antifungal agents must be avoided (Boyd et
al., 2014) (Tamhankar et al., 2010). The insertion must be made at the cephalic or the
basilica veins or the brachial veins after visualising and palpation using ultrasound scan
(Boyd et al., 2014) (Tamhankar et al., 2010).
Conclusion:
The most optimal care for postoperative patients of laparoscopic cholecystectomy
primarily focuses on optimising the experience after surgery. The standards of nursing
in these cases include the meticulous monitoring, assessment and evaluation, and
providing appropriate treatment. The optimal care is when nurses can anticipate
problems and requirements along with timely intervention. Postoperative care in this
case involved invasive PICC due to which the NSQHS guidelines of prevention of
infections and blood-related product safety are key factors.

Practise in the Domiciliary Health Care Environment 5
References
Brenner, P. & Kautz, D.D. (2015). Postoperative Care of Patients Undergoing Same-
Day Laparoscopic Cholecystectomy. AORN J, 102, 16-29
Boyd, L. & Sheen, J. (2014). The national safety and quality health service standards
requirements for orientation and induction within Australian healthcare: a review
of the literature. Asia Pacific journal of health management, 9(3), 31-37
National safety and quality health service standards (2012) Australian commission on
safety and quality in health care. Print
Tamhankar, A. P., Mazari, F., & Olubaniyi, J. (2010). Postoperative Symptoms, After-
Care, and Return to Routine Activity After Laparoscopic Cholecystectomy.
Journal of the Society of Laparoendoscopic Surgeons, 14, 484–489
Queensland government (2015). Guideline for peripherally inserted central venous
catheters (PICC).
Available at https://www.health.qld.gov.au/__data/assets/pdf_file/0032/444497/icare-
picc-guideline.pdf [Accessed on 11th Aug 2017]