QuADS Organisational Standards and Professional Competencies in needle exchange N
This briefing paper was funded by the Department of Health as part of their 'Making Harm Reduction Work' initiative. DrugScope/Department of Health Further copies are available from DrugScope 32-36 Loman Street London SE1 OEE 2 7928 1211 www.drugscope.org.uk Further Reading Alcohol Concern and Standing Conference on Drug Abuse (1999) QuADS Quality in Alcohol and Drug Services: Organisational Standards for Alcohol and Drug Treatment Services London: Alcohol Concern and DrugScope Alcohol Concern and Standing Conference on Drug Abuse (1999) QuADS Quality in Alcohol and Drug Services: Professional Competencies for Alcohol and Drug Workers London: Alcohol Concern and DrugScope
i Making harm reduction work QuADS Organisational Standards and Professional Competencies in Needle Exchange DrugScope and Alcohol Concern published quality standards for drug and alcohol services in 1999. Since this time they have also developed nationally agreed professional competencies for specific roles within in drug and alcohol services. This briefing lays out both the professional competencies and quality standards for needle exchange services. This document reflects the forthcoming QuADS organisational standards and professional competencies, both of which will be reviewed and republished in 21. The standards are intended for use by needle exchange services as a tool, to help with the development of quality in needle exchange services. They provide an opportunity for needle exchange services to audit their organisational practice and to determine areas of strength or areas where further development is required. For some organisations the QuADS standards may pose some challenges to current practice. However, services can and should meet the comprehensive needle exchange standards outlined in this booklet. Organisational change and development takes time and has resource implications. Therefore, services will need to plan effectively and timetable their agenda for quality improvements. Professional competencies refer to the consistent performance of a task to a defined, measurable standard. Implicit in this is an 3 understanding of the context within which the task is set. Competence is a finite point that has either been reached or not. It is not usual to regard professional as "nearly" or "very" competent. Competence is measured by examining outcomes, an assessment of competence does not measure or credit training, education or learning. However, the measurement of competence can identify training and learning needs. The needle exchange organisational standards and professional competencies cited in this booklet form only a part of the standards and professional competencies for drug and alcohol services. In order to provide a high quality service staffed by competent practitioners, needle exchange services and their staff will need to meet some of the other standards and competencies in the full QuADS manuals. Additional professional competencies to consider would include: n assessment, n providing advice and information n working with young people. m am X a^ c c CD a) c a^ a> Q- E U a c a a^ d a I `a3 ca m a a c as 21 CO
4 Additional organisational standards to consider would be: n involving and empowering service users n outreach services n services for children and young people n confidentiality n assessment n health promotion and advice n complaints procedures and equal opportunities. There may be other standards or competencies to consider, depending on the practitioner's role within the organisation and other services available in addition to needle exchange. The process for reviewing and attaining the quality of the needle exchange and competence of professional is not a simple process. This booklet is intended to be a starting point. In order to complete a quality audit against QuADs organisational standards DrugScope can provide a consultancy service. This service would involve an approved DrugScope consultant assisting you through the process of self-assessment, audit and action planning to implement change.
QuADS Organisational Standards for Needle exchange Standard Statement The needle exchange service seeks to reduce the transmission of HIV, hepatitis and other infectious diseases, and contributes to the health of service users.' Criteria Evidence Minimum (M) or Criteria Comment Good Practice (GP) met 1 There are clear protocols Assessment M on assessment and on protocol. minimum levels of Staff information provided interview. to service users. The assessment process establishes whether service users are injecting. 2 A variety of equipment Equipment GP is provided to service available users and access to a range of relevant services.- 3 There are written policies Procedure M and procedures on needle and agreements. exchange for those aged under 18 years, which have been consulted on and agreed with the local Area Child Protection Committee and DAT. 4 Service opening times are Leaflets/posters. M widely publicised.' 5 The service provides Staff interview. M advice on injection techniques and sites, based on assessment of service user's needs.
Criteria Evidence Minimum (M) or Criteria Comment Good Practice (GP) met Staff demonstrate Evidence of suitable M competence in advising qualifications. on injection techniques and sites, primary health care and safer sex messages, and advice and assessment. A range of information is Information GP available on harm provided. reduction (in language and with images relevant to the service user group). The needs of both opiate Protocols and M and non-opiate users staff interview. are reflected in service delivery. 9 The agency has policies Policies and M relating to the procedures. management of equipment that take account of infection control.' 1 The service has an Performance M established monitoring monitoring system, and evaluation system to determine the effectiveness of the service.' 11 Service users are Information M provided with information provided. about, and/or referral to, other relevant services.
Criteria Evidence Minimum (M) or Criteria I Comment Good Practice (GP) met 12 There is a strategy to encourage the return of used needles.' Protocols and staff interview. M Guidance notes 1 There are different models of needle exchange. 2 The equipment may include a range of syringes and condoms. The service will also provide referral to a range of services (where available) which could provide: n primary health care advice n hepatitis B vaccination n HIV and hepatitis B and C counselling and testing facilities n overdose prevention messages n reducing initiation into injecting n drug treatment n other health and social care needs. Messages should be clear and regularly reinforced using a variety of media. 3 Service provision for under 18s should be separate from adults, and there should be separate policies and procedures. 4 Publicity could be displayed in: libraries, leisure centres, health centres, GP surgeries and hospitals. 5 Services should have policies and procedures relating to needle stick injuries, sharps bins, clinical waste, HIV and TB. 7 6 This should include recording: n gender, ethnicity, age, drug use of contacts n all new contacts and injecting behaviour at initial assessment n percentage of injectors who report sharing injecting equipment in previous four weeks. n numbers of; - new attenders per month (ie those who have not used a scheme in the past six months) - exchange packs given out per month per service user - individuals using service (by gender and ethnicity) - service users moving on to treatment elsewhere - percentage of staff trained in giving basic health checks. 7 This may include setting a target minimum expected return rate of used equipment.
{ QuADS Professional Competency : Needle Exchange Practitioner Job Component includes : Establishment of extent and type of injecting behaviour. Provision of harm minimisation advice. Provision of injecting equipment. Monitoring and evaluation of service. Criteria Evidence Criteria Met Comment Establish whether service users are injecting, what substances, and the frequency of injecting. Provide advice on safe or safer injecting techniques and sites. Provide relevant and timely advice on primary health care, safer sex and harm minimisation including, prevention and management, of overdose promoting hepatitis B vaccination, viral testing and preventing initiation into injecting. Provide advice and resources for safer disposal of injecting equipment. Dispense injecting equipment and condoms in line with service user assessment.' Implement needle exchange policies and procedures.' Liase and work with providers of pharmacybased syringe schemes in line with nolicles and nrotocols
Criteria Evidence Criteria Met Comment Ensure adequate stocks of the equipment which is distributed in the needle exchange. Monitor and evaluate needle exchange service provision.' Guidance 1 Equipment may include: n a range of syringes and needles n condoms, lubricant etc. 2 Policies and procedures should include guidance on confidentiality, provision of needle exchange services to under-18s and specifically the under 16s, how to dispose of needles safely, and what to do in the event of a needlestick injury occurring. 3 Monitoring and evaluation should include: n recording by gender, use ethnicity, and drug n recording of all new contacts and injecting behaviour at initial assessment n percentage of injectors who report sharing injecting equipment in previous 4 weeks n Numbers of: n new attendees per month (i.e. those who have not used a scheme in the past 6 months n exchange packs given out per month per service user n individuals using service (by gender and ethnicity n service users moving on to engage in treatment elsewhere n Percentage of staff trained in giving basic health checks. Skills n Communicating n Maximising opportunities to deliver health advice and brief interventions n Monitoring the well being of service users n Collation of monitoring information Knowledge n Needle exchange policies and procedures n Anatomy and physiology n Safe injecting techniques n National Guidelines for Clinical Management n Harm minimisation techniques n Knowledge of local primary health care facilities Knowledge sources of health information n Knowledge of organisational policy n Knowledge of what constitutes adequate stocks
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