NSW Artificial Limb Service

Introduction

· Historically there has been no formal mechanism for accrediting Amputee Units, Prescribing Medical Specialists, Prosthetists or Prosthetic Manufacturers practicing within the pre 1997 Artificial Limb Service (ALS) or subsequently the NSW ALS.

· As a result the NSW Department of Health, on the advice of the Prosthetic Advisory Committee directed the NSW ALS to develop an accreditation process to be used for those operating within the service.

· To this end an accreditation committee was established in June 1999. The committee has 2 representatives of the NSW ALS who also act as chairperson and secretary. The committee otherwise has wide stakeholder representation including representatives of both metropolitan, rural, public and private clinics, medical and allied health clinic members, the Australasian Faculty of Rehabilitation Medicine (AFRM), the Prosthetic Manufacturers Association (PMA) and the Australian Orthotic and Prosthetic Association (AOPA).

· The following guidelines for accreditation of Amputee Units and Prescribing Specialists and Prosthetists are a result of the committee’s work. Accreditation Guidelines for Prosthetic Manufacturers are still being finalised and are to be published within the next 3 months.

· The Accreditation Committee will continue to operate and any questions regarding its operation or the accreditation guidelines in general can be directed to the ALS Manager: Ph (02) 9553 3032

· A list of current Accreditation Committee members is available from the ALS Manager and issues related to accreditation can also continue to be raised with the various stakeholder representatives on the committee at any time.

· The decision to grant accreditation or re-accreditation for Amputee Units, Prescribing Medical Specialists, Prosthetists and Prosthetic Manufacturers for operation within the NSW ALS remains with the NSW ALS Manager. The NSW ALS Manager is able to consider the following guidelines and seek the advice of the NSW ALS accreditation committee in this regard.

Accreditation Committee

Terms of Reference

The ALS accreditation committee will:

· Set standards for the initial and continuing ALS accreditation of:

1. Prescribing doctors

2. Prosthetic Manufacturers

3. Amputee Units

· Ensure ongoing evaluation and approval of applicants for accreditation and re-accreditation.

The committee will meet at Calvary Hospital, Kogarah on a monthly basis during the initial planning and implementation stage and thence every second month.

Committee Membership

NSW ALS Manager nominated representatives (including the Chair and the Secretary)

Representative fellow(s) of the NSW branch of The Australasian Faculty of Rehabilitation Medicine

Representative member(s) of the Australian Orthotic and Prosthetic Association (AOPA)

Representative member(s) of the Prosthetic Manufacturers Association (PMA)

Metropolitan Amputee Unit Team Representative(s)

Country Amputee Unit Team Representative(s)

Amputee Units

“Preliminary” Accreditation

· All Units (formerly “Clinics”) that were previously functioning under the ALS, as administered by the Commonwealth Department of Veterans Affairs may be granted 12 months “preliminary” accreditation initially if they meet the criteria below. This process will be completed by 1^st January 2000.

· Other Units subsequently applying for accreditation may in the first instance, be granted 12 months “preliminary” accreditation initially if they meet the criteria below.

· In order to see patients regarding NSW ALS, ALS services Units will need formal NSW ALS Accreditation as of 1/1/2000.

Criteria for “Preliminary” Accreditation

In order to obtain “preliminary” accreditation with the NSW ALS, Amputee Units[*] will be required to:

1. Function within a public or private Hospital that has Australian Council of Health Care Standards (ACHS) Accreditation.

2. Function within a multidiciplinary rehabilitation service classified as level 5 or 6 under the NSW Role Delineation Guidelines according to current best practice.

3. Be able to provide service on both an in-patient and outpatient basis.

4. Nominate the site(s) of each individual Clinic run by the Unit.

5. Have appointed to the Amputee Unit “core members” ie:

5.1. A prescribing doctor(s)

5.2. A visiting prosthetist(s)

5.3. A Physiotherapist(s)

6. Nominate all of the Amputee Unit’s prescribing doctors individually to the NSW ALS.

7. Have one of the Amputee Unit’s prescribing doctors nominated to the NSW ALS as Director of the Unit.

8. Have access to an occupational therapist and social worker as required.

All Amputee Units granted “preliminary” accreditation are required to submit themselves for re - accreditation within 12 months from the date of gaining “preliminary” accreditation and thereafter every 3 years.

It is the responsibility of the Director of the Amputee Unit to inform the NSW ALS of any change in the Unit’s status, regarding the above criteria that may affect the Unit’s accreditation with the NSW ALS.

Criteria for Re-accreditation:

In order to obtain re-accreditation with the NSW ALS, Amputee Units will be required to:

1. Function within a public or private Hospital that has Australian Council of Health Care Standards (ACHS) Accreditation.

2. Function within a multidiciplinary rehabilitation service classified as level 5 or 6 under the NSW Role Delineation Guidelines according to current best practice.

3. Provide service on both an in-patient and outpatient basis.

4. Have appointed to the Amputee Unit “core members” ie:

4.1. An accredited prescribing medical specialist(s).

4.2. A visiting prosthetist(s) with NSW ALS accreditation.
Appointed according to the policies and procedures of the relevant Area Health Service and or Hospital running the clinic

4.3. A Physiotherapist(s).

5. Nominate all of the Amputee Unit’s prescribing medical specialists and other core members of the Unit individually to the NSW ALS.

6. Have one of the Amputee Unit’s accredited prescribing medical specialists nominated to the NSW ALS as Director of the Unit.

7. Have access to an occupational therapist and social worker as required.

8. Show that all Unit personnel have appropriate credentials.

9. Hold a minimum of 6 amputee[†] “Prescribing Clinic Sessions” per clinic per year.

10. Have >80% of “Prescribing Clinic Sessions” attended by the full core membership of the Unit

11. Show formal documented evidence of ongoing commitment to Continuous Quality Improvement / Clinical Audit and Best Practice in the form of multidiciplinary quality and benchmarking activities.

12. Show that each of the core members of the Amputee Unit have, within their own discipline, an ongoing commitment to Continuous Quality Improvement, Best Practice and Continuing Medical Education specifically related to Amputee management.

13. Show a level of prosthetic prescribing for the Artificial Limb Service that would enable maintenance of prescribing skills..

14. Have submitted to the NSW ALS, relevant Amputee Unit related data as requested.

All re-accredited Amputee Units are required to submit themselves for further re - accreditation within three years of their last accreditation.

Prescribing Medical Specialists

Criteria for Accreditation:

Prescribing medical specialists applying for accreditation will be required to:

1. Have General Registration with the New South Wales Medical Board.

2. Be a practicing Rehabilitation Medicine Physician with Fellowship of the Australasian Faculty of Rehabilitation Medicine or be able to show an equivalent level of training and experience in the rehabilitation management of limb amputees and limb prosthetics prescription.

3. Have completed Australasian Faculty of Rehabilitation Medicine accredited courses in Lower Limb and Upper Limb Prosthetics.

4. Participate in the Continuing Medical Education Programme of the Faculty of Rehabilitation Medicine or equivalent.

Criteria for Re-accreditation:

In addition to maintaining the criteria of their initial accreditation (ie “grandfather” and general), in order to obtain reaccreditation, prescribing medical specialists will need to show:

1. Formal, documented evidence of ongoing commitment to Continuous Quality Improvement and Continuing Medical Education in the area of Amputee management since the last accreditation assessment. It is expected that this would take the form of quality activities, conference attendances, research activities, membership of “Special Interest Groups” etc.

2. A level of prosthetic prescribing for the Artificial Limb Service that would enable maintenance of prescribing skills.

All accredited prescribing medical specialists are required to submit themselves for re- accreditation within one year of their initial accreditation and thereafter every three years.

It is the responsibility of the accredited prescribing medical specialists to inform the NSW ALS of any change in their status, regarding the above criteria that may affect their accreditation status with the NSW ALS.

Locum Accreditation

A register of Locum prescribers will be compiled and maintained by the NSW ALS as of May 2002.

Locum prescribers will be able to prescribe in accredited Units in place of absent accredited prescribers for a period of up to 6 months. Only prescribers on the Locum list will be able to be nominated as locums in this way.

It is the responsibility of the accredited prescriber who is taking leave to contact the NSW ALS prior to the commencement of the leave period to indicate:

· The name of the locum.

· The period of the locum.

· The Clinics that will be covered.

Prescribers will generally be nominated to the Locum Register by an accredited prescriber but may apply on his/her own behalf in this regard.

Criteria for Locum Accreditation

1. Have General Registration with the New South Wales Medical Board.

2. Have one of the following.

2.1. Previous accreditation as a prescriber of the NSW ALS.

2.2. Be a practicing Rehabilitation Medicine Physician with Fellowship of the Australasian Faculty of Rehabilitation Medicine or be able to show an equivalent level of training and experience in the rehabilitation management of limb amputees and limb prosthetics prescription; and have completed Australasian Faculty of Rehabilitation Medicine accredited courses in Lower Limb and Upper Limb Prosthetics.

3. Participate in the Continuing Medical Education Programme of the Faculty of Rehabilitation Medicine or equivalent.

The locum list will be updated yearly or as required.

It is the responsibility of the locum accredited prescribing medical specialists to inform the NSW ALS of any change in their status, regarding the above criteria that may affect their accreditation status with the NSW ALS.

Prosthetists

Criteria for Accreditation:

Prosthetists applying for accreditation will be required to:

1. Have eligibility for full AOPA membership.

2. Present references from two prosthetic prescribers (NSW ALS accredited or equivalent) dealing with the prosthetist’s clinical and manufacturing skills.

3. Be employed/contracted or have an agreement with a NSW ALS accredited clinic.

4. Participate in a professional development program, including supervision by an identified NSW ALS accredited prosthetist and ongoing education, commensurate with clinical skills and experience. This program should be documented and be aligned with the formal health accreditation system of the facility e.g.: Australian Council of Healthcare Standards.

Criteria for Re-accreditation:

In addition to maintaining the criteria of their initial accreditation, in order to obtain reaccreditation, prosthetists will need to:

1. Show formal, documented evidence of ongoing commitment to Continuous Quality Improvement and Continuing Education in the area of Artificial Limb manufacture and clinical prosthetic practice since the last accreditation assessment. It is expected that this would take the form of quality activities, conference attendances, research activities, membership of “Special Interest Groups” etc.

2. Show a level of prosthetic manufacture and clinical prosthetic practice for the Artificial Limb Service that would enable maintenance of prescribing skills.

3. Be attached to an accredited amputee Unit as one of its nominated consulting prosthetists.

All accredited prosthetists are required to submit themselves for re - accreditation within one year of their initial accreditation and thereafter every three years.

It is the responsibility of the accredited prosthetist to inform the NSW ALS of any change in their status, regarding the above criteria that may affect their accreditation status with the NSW ALS.

Prosthetic Manufacturers

Accreditation

Accreditation will be required for Prosthetic Manufacturers to receive payment from the NSW ALS in return for prostheses manufactured or repaired for NSW ALS clients.

Criteria for Accreditation:

In order to obtain accreditation, prosthetic Manufactures will be required to submit written evidence of the following:

1. Company details:

1.1. Name of Company

1.2. Company contacts including their addresses, telephone, fax and E-mail contacts

1.3. Australian Business Number

2. Expertise

2.1. All persons directly involved in the provision of Prosthetic services for the manufacturer who attend amputee clinics or have contact with NSW-ALS clients must be Prosthetists accredited by the NSW-ALS or must be under supervision of a NSW ALS accredited Prosthetist.

2.2. The standard of craftsmanship of the Prosthetists referred to in point 2.1

2.3. The qualifications, experience, role in the organisation and proportion of time to be spent in work related to the NSW-ALS of the administrative, professional, and manufacturing staff (other than those people referred to in point 2.1).

3. Service Delivery

3.1. The existence of suitable and readily accessible premises for the provision of ongoing services to amputees.

3.2. Details of clinics to be serviced by the Manufacturers employees.

3.3. Evidence of customer service features eg. trading hours and courier services.

3.4. Evidence of links to clinical support services.

4. Insurance

4.1. Third party property damage insurance or comprehensive insurance for all motor vehicles used in the provision of services.

4.2. Product Liability Insurance.

4.3. Worker’s Compensation Insurance.

4.4. Public Liability Insurance including cover for financial or economic loss.

5. Financial Viability:

5.1. Corporate structure:

5.1.1. Identify ownership structure

5.1.2. List any parent or subsidiary companies and outline the business they undertake.

5.2. Board of Directors / Board of Management:

5.2.1. List the Directors / Board Members and their occupations.

5.3. Information verifying that set up and ongoing costs can be met for

5.3.1. Administration costs.

5.3.2. Salaries and on costs for staff.

5.3.3. Equipment.

5.3.4. Componentry and incidental costs in the manufacture and repair of
prostheses.

5.4.Submission of the most recent financial years business plan

5.5.Validation of Company registration

5.6. Banking details

5.7. Referees for credit check

Criteria for Re-accreditation:

In addition to maintaining the criteria of their initial accreditation, in order to obtain reaccreditation, Commercial Limb Manufacturers will need to:

2. Show a level of clinical prosthetic practice and / or prosthetic manufacture for the Artificial Limb Service that would enable maintenance of clinical and manufacturing skills.

All accredited prosthetic manufacturers are required to submit themselves for re-accreditation within one year of their initial accreditation and thereafter every three years.

It is the responsibility of the accredited prosthetic manufacturer to inform the NSW ALS of any change in their status, regarding the above criteria that may affect their accreditation status with the NSW ALS

[*] In the process of reaccreditation in May 2002, the accreditation committee noted that many aligned clinics had a significant overlap in personnel. It was therefore decided at that time that accreditation would henceforth be assigned to Amputee Units

[†] By definition a “Prescribing Clinic Session” is one where a patient(s) is assessed by the core multidiciplinary amputee team, ie the prescribing doctor, prosthetist, and physiotherapist for the purpose of having an ALS script raised if necessary, among other things. It is understood that for reasons of leave, sickness etc the three core members will not all always be in attendance and that at times other team members may attend eg OT, Social worker etc. In order to be classed as a prescribing clinic session a prescribing specialist must be in attendance along with at least one other of the three core team members.