NZS 8165:2005 New Zealand Standard Rooms/Office-based Surgery and Procedures
COMMITTEE REPRESENTATION Committee P 8164 was responsible for the preparation of this Standard and consisted of representatives from the following nominating organizations: Accident Compensation Corporation (ACC) Anglesea Braemar Hospital Appearance Medicine Society of Australasia Australasian and New Zealand College of Anaesthetists Australian and New Zealand Association of Oral and Maxillofacial Surgeons Australian and New Zealand Society of Paediatric Dentistry Gillies Hospital Ministry of Health New Zealand Dental Association New Zealand Dermatological Society New Zealand Nurses Organisation National Division of Infection Control Nurses New Zealand Nurses Organisation Gastroenterology Section New Zealand Private Hospitals Association New Zealand Society of Anaesthetists New Zealand Society of Gastroenterology Royal Australasian College of Surgeons Southern Cross Health Trust Springlands Dental Practice Women s Health Action ACKNOWLEDGEMENT Standards New Zealand (SNZ) would like to thank the many individuals who have contributed to this document, either in face-to-face consultation, in writing, or by telephone. In particular, SNZ recognizes the significant input provided by the expert committee whose experience and knowledge have made the development of this Standard possible. COPYRIGHT The copyright of this document is the property of the Standards Council. No part of it may be reproduced by photocopying or by any other means without the prior written permission of the Chief Executive of Standards New Zealand unless the circumstances are covered by Part III of the Copyright Act 1994. Standards New Zealand will vigorously defend the copyright in this Standard. Every person who breaches Standards New Zealand s copyright may be liable to a fine not exceeding $50,000 or to imprisonment for a term not to exceed three months. If there has been a flagrant breach of copyright, Standards New Zealand may also seek additional damages from the infringing party, in addition to obtaining injunctive relief and an account of profits. Published by Standards New Zealand, the trading arm of the Standards Council, Private Bag 2439, Wellington 6020. Telephone: (04) 498 5990, Fax: (04) 498 5994. Website: www.standards.co.nz AMENDMENTS No. Date of issue Description Entered by, and date 4
New Zealand Standard Rooms/Office-based Surgery and Procedures ISBN 1-86975-023-3
Preface NZS 8165:2005 Rooms/office-based surgery and procedures makes a major contribution to the provision of surgery and treatment for the care of New Zealanders. During 2004, an expert committee has developed the Standard to align it with current best practice in this sector of health service delivery. The outcome, NZS 8165:2005 Rooms/office-based surgery and procedures is a major step forward in the ongoing quest for best quality surgery and treatment nationwide. This will, however, be a dynamic document and reflect the health sector changes that will occur over the next months. For this reason, the Standard will be reviewed within two years. This Standard has been developed for facilities which, in the main, limit their care to providing rooms/office-based surgery or procedures only. It does not apply to general practices that may undertake, from time to time, minor surgical procedures under local anaesthetic. Emergency procedures are excluded from the requirements of this Standard. David Rankin General Manager ACC Healthwise 2
Contents Committee representation... IFC Acknowledgement... IFC Copyright... IFC Preface...2 Referenced documents... 4 Foreword... 7 Scope of application... 8 Interpretation... 8 Key definitions... 8 Review period... 9 Health and Disability Commissioner s Code of Health and Disability Services Consumers Rights... 9 PART 1 Consumer/Patient-Focused Services... 11 1.1 Consumer rights... 11 1.2 Cultural safety... 11 PART 2 Facility Management... 12 2.1 Governance... 12 2.2 Facility management... 12 2.3 Advertising and marketing strategies... 12 2.4 Human resource management... 12 2.5 Quality and risk management... 13 PART 3 Pre-entry to Services... 15 3.1 Patient selection process... 15 3.2 Declining entry to services... 16 PART 4 Service Delivery... 17 4.1 Service provision requirements... 17 4.2 Clinical records management... 17 4.3 Sedation and anaesthesia... 17 4.4 Clinical emergency response... 19 4.5 Discharge management... 19 4.6 Referrals, relationships and links... 20 PART 5 Managing Service Delivery... 21 5.1 Medicine management... 21 5.2 Infection control management... 21 5.3 Management of waste and hazardous substances...23 5.4 Management of surgically removed tissue/body parts...23 PART 6 Safe and Appropriate Environment... 24 6.1 Facility specifications... 24 6.2 Environment management... 24 Appendix A Glossary (Normative)... 26 B Related resources (Informative)... 29 3
Referenced Documents Reference is made in this Standard to the following: New Zealand Standards NZS 3003.1:2003 NZS 4304:2002 NZS 8134:2001 NZS 8141:2001 NZS 8142:2000 NZS 8153:2002 NZS 8164:2005 Electrical installations Patient areas of hospitals and medical and dental practices Testing requirements Management of healthcare waste Health and disability sector standards Restraint minimization and safe practice Infection control Health records Day-stay surgery and procedures Australian and New Zealand Joint Standards AS/NZS 1336:1997 Recommended practices for occupational eye-protection AS/NZS 1337.5:2004 Eye-protectors for adjustment work on lasers and laser systems (laser adjustment eye-protectors) AS/NZS 2211.1:2004 Equipment classification, requirements and user s guide AS/NZS 2500:2004 Guide to the safe use of electricity in patient care AS/NZS 3003:2003 Electrical installations Patient areas of hospitals, medical and dental practices and dialyzing locations AS/NZS 3551:2004 Technical management programs for medical devices AS/NZS 3760:2003 In-service safety inspection and testing of electrical equipment AS/NZS 4146:2000 Laundry practice AS/NZS 4187:2003 Cleaning, disinfecting and sterilizing reusable medical and surgical instruments, and equipment and maintenance of associated environments in health care facilities AS/NZS 4815:xxxx Office-based health care facilities Reprocessing of reusable medical and surgical instruments and equipment, and maintenance of the associated environment (in preparation) Australian Standard AS 3789.2:1991 Textiles for health care facilities and institutions Theatre linen and prepacks Other Publications Australian Safety and Efficacy Register for New Interventional Procedures Surgical (ASERNIP- S). Australian Safety and Efficacy Register of New Interventional Procedures Surgical. Stepney, S.A. Code of Health and Disability Services Consumers Rights 1996. Office of the Health and Disability Commissioner, Wellington. Hauora o te Tinana me ona Tikanga A Guide for the Removal, Retention, Return and Disposal of Mäori Body Parts and Organ Donation. 1999. Te Puni Kokiri, Wellington. Health Information Privacy Code 1994. Revised June 2000. Office of the Privacy Commissioner, Auckland. Ministry of Health Guidelines for TB Control in New Zealand. 2003. Ministry of Health, Wellington. Ministry of Health Guidelines for the Control of MRSA in New Zealand. August 2002. Ministry of Health, Wellington. Ministry of Health Laundry Guidelines for Rest Homes and Small Hospitals 1997. Ministry of Health, Wellington. 4
New Zealand Legislation Ministry of Health Operational Standard for Ethics Committees. March 2002. Ministry of Health, Wellington. New Zealand Dental Association Guidelines and Codes of Practice NZDA Advertising Guidelines NZDA Code of Ethics NZDA Code of Practice - Advanced Areas of Dentistry (under development) NZDA Code of Practice - Continuing Professional Development and Competency NZDA Code of Practice - Control of Cross Infection in Dental Practice NZDA Code of Practice - Cultural Safety (under development) NZDA Code of Practice - General Anaesthetics in Dentistry - Monitoring (under review) NZDA Code of Practice - Informed Consent (under review) NZDA Code of Practice - Medical Emergencies in Dental Practice (under review) NZDA Code of Practice - Patient Information and Records NZDA Code of Practice - Sedation for Dental Procedures (under review) NZDA Complaints and Criticism NZDA Consumer Complaints Manual NZDA Occupational Safety and Health Guidelines NZDA Practice Guideline - Controlling Dental Amalgam Waste and Wastewater Discharges NZDA Quality Plan Guide New Zealand Patient Handling Guidelines. 2003. Accident Compensation Corporation, Wellington. Therapeutic Advertising Pre-Vetting System (TAPS), Advertising Standards Authority. January 2002, Advertising Standards Authority, Wellington. When interpreting this Standard it may be helpful to refer to the following legislation and amendments: Acts Building Act 2004 Children, Young Persons, and Their Families Act 1989 Companies Act 1993 Consumer Guarantees Act 1993 Electricity Act 1992 Employment Relations Act 2000 Fair Trading Act 1986 Food Act 1981 Hazardous Substances and New Organisms Act 1996 Health Act 1956 Health and Disability Services (Safety) Act 2001 Health and Disability Commissioner Act 1994 5
Regulations Health and Safety in Employment Act 1992 Health Practitioners Competence Assurance Act 2003 Human Rights Act 1993 Human Tissue Act 1964 Injury Prevention, Rehabilitation and Compensation Act 2001 Local Government Act 2002 Medicines Act 1981 New Zealand Bill of Rights Act 1990 New Zealand Public Health and Disability Act 2000 Privacy Act 1993 Protection of Personal and Property Rights Act 1988 Resource Management Act 1991 Smoke-free Environments Act 1990 Transport Act 1962 Transport (Vehicle and Driver Regulation and Licensing) Act 1986 Treaty of Waitangi Act 1975 Tuberculosis Act 1948 Replaced by the Health Practitioners Competence Assurance Act 2003: Chiropractors Act 1982 Dental Act 1988 Dietitians Act 1950 Medical Auxiliaries Act 1966 Medical Practitioners Act 1995 Nurses Act 1977 Nurses Regulations 1986 Occupational Therapy Act 1949 Optometrists and Dispensing Opticians Act 1976 Pharmacy Act 1970 Physiotherapy Act 1949 Psychologists Act 1981 Building Regulations 1992 First Schedule: The Building Code Electricity Regulations 1997 Fire Safety and Evacuation of Buildings Regulations 1992 Food Hygiene Regulations 1974 Health (Infectious and Notifiable Diseases) Regulations 1966 Health Information Privacy Code 1994 Health (Quarantine) Regulations 1983 Health (Retention of Health Information) Regulations 1996 Health and Safety in Employment Regulations 1995 Human Rights Regulations 1993 Land Transport Rule: Dangerous Goods 1999 Medicines Regulations 1984 The users of this Standard should ensure that their copies of the above-mentioned New Zealand Standards or of overseas Standards approved as suitable for use in New Zealand are the latest revisions or include the latest amendments. Such amendments are listed in the annual Standards New Zealand Catalogue which is supplemented by lists contained in the monthly magazine Standards issued free of charge to committee and subscribing members of Standards New Zealand. 6
Foreword This Standard is the result of collaboration between service users, providers, Accident Compensation Corporation (ACC), the Ministry of Health (MoH), and Standards New Zealand. This Standard has been developed in parallel with NZS 8164:2005 Day-stay surgery and procedures and has similar content to, and is based on the requirements of NZS 8134:2001 Health and disability sector standards. NZS 8134:2001 can be seen as charting a journey through the healthcare system for all users. NZS 8165:2005 Rooms/office-based surgery and procedures focuses on the special needs of patients or people undergoing rooms/office-based surgery and procedures and aims to assist clinicians who frequently perform rooms/office-based surgery and procedures. The Standard is not intended to replace existing professional codes or guidelines; rather it should be seen as promoting national consistency and safety in the delivery of rooms/officebased surgery and procedures to consumers. Professional Codes and Guidelines recognized by Registration Authorities will continue to take precedence over this Standard. Additionally, the Standard provides a framework for the continuous quality improvement of the facility and establishes the minimum requirements for providers who contract with ACC for the provision of rooms/office-based surgery and procedures. The criteria and outcomes of this Standard are based on the facility type ; e.g. an office or a consulting room, rather than being procedure-based. The specific focus is on the systems and processes required to ensure a safe and responsive service. Many differing patient groups access healthcare services from facilities providing rooms/officebased surgery and procedures. Each group may have specific needs and considerations that when recognized and met, make a significant positive contribution to their healthcare experience. For example, children and young people suffer disease processes and have responses to illness, injury and disability that are fundamentally different from those of adults. They also have unique traits of development and growth. Together these factors may render them physiologically and psychologically vulnerable with potential for ongoing harm if the experience is negative. Consequently, service providers need to consider and wherever possible meet the particular needs of each distinct patient group with regard to family involvement, preferred methods of communicating information, obtaining appropriate consent, availability of suitable equipment and the design of the environment. Many factors influence the decision to provide a surgical or similar procedure in a rooms/ office-based setting. These include: (a) The choice of patient; (b) The procedure to be performed; (c) The equipment and facilities available; (d) The experience and competence of health practitioners available; and (e) The method of sedation or local anaesthetic used. The rooms/offfice-based setting can present additional risks, as emergency backup, including staff, equipment and medication support may not be readily available. Consequently, there are factors that should exclude specific procedures from being conducted in this environment. These include: (1) The use of sedation in such a way that the patient could lose consciousness or be unresponsive to verbal commands; (2)The nature of the procedure, particularly in relation to complexity and the need for a high standard of sterility; (3) Factors in the patient s general health that make extra monitoring highly desirable. 7
Rooms/Office-based surgery and procedures This is a free sample only. Purchase the full publication here: https://shop.standards.govt.nz//catalog/8165%3a2005%28nzs%29/view Or contact Standards New Zealand using one of the following methods. Freephone: 0800 782 632 (New Zealand) Phone: +64 3 943 4259 Email: enquiries@standards.govt.nz