Minimum Core Standards

Best Practice

Surgical Safety

• Provision of safe surgical care includes careful pre-operative evaluation, safe surgical and anesthesia management, and optimal post-operative care with properly trained and equipped healthcare professionals following agreed protocols for emergency care and anesthetic complications.
• Surgical safety checklists should be used and adapted as necessary.

• Every effort should be taken to ensure the safety of the patient in all aspects of his/her medical care.

Quality Control

• Outcomes should be reviewed and analyzed on a regular basis.
• Complications and adverse events should be documented, reviewed periodically by the team and measures should be put in place to minimize occurrences.
• Complete and accurate records should be kept and made available to the local medical team.

• Routine assessment of outcomes and complications should be in place with suggestions to improve care. Protocols should be available to maximize safety and optimize outcomes.

Patient Education

• Patients and their families or caregivers should be provided with appropriate education and information about their diagnosis and treatment. This should include feeding, speech, orthodontics, dental care, psychological needs, surgery, post-operative care and long-term follow up, and any complications.

• Fully informed and culturally appropriate consent should be obtained prior to the delivery of any care.
• Patient privacy should be respected and in line with internationally accepted ethical codes.

• Patients should have clear information about all healthcare professionals delivering care.

Patient Selection

• Rigorous anaesthetic and surgical safety standards should be applied pre- operatively by qualified persons to ensure patient safety and minimize risk.
• Screening should be carried out before any type of healthcare intervention.

• Screening systems should be established to ensure safe intervention and where deemed unsafe a pathway should be made available to facilitate care.

Patient Follow Up

• Provision for post-operative follow up care and management of complications must be included in the treatment program.
• Patients should have clear information about the healthcare professionals

responsible for their follow up and any planned or needed subsequent treatment(s).

• Follow up care that includes all subspecialists is optimal.

Comprehensive Care

• Treatment programs should be multidisciplinary, addressing all aspects of the patient’s care. The aim is to enable patients to become fully integrated into their societies and to enjoy the same opportunities as their peers. Treatment programs should also address the family’s needs and provide community education regarding cleft care from infancy through adulthood.
• A multidisciplinary cleft team should include, as a minimum to include:

  Anesthesiology, dentistry, nursing, orthodontics pediatrics, psychosocial care, speech-language pathology, and surgery, with overall coordination provided.

• In addition to the minimum core team members (above), the team should demonstrate access to healthcare professionals including, but not limited to, audiology, pediatric and restorative dentistry, genetics, otolaryngology, psychology, and social work.

Partnership with host nation and professionals

• Involvement, agreement and cooperation of host nation, local healthcare professionals and applicable government agencies should be established to ensure sustainability of healthcare services.
• There should be a commitment to building medical and other cleft treatment capacities through training, provision of equipment, and ongoing support

Training for Sustainability and Local Capacity Building

• Training plans should include engagement with host nation professionals and must ensure that training is appropriate given the local structures and resources.
• Any training opportunities should be provided under the senior healthcare professional’s strict and continuous supervision.

• Programs should seek ongoing exchange of knowledge with local healthcare providers to support the establishment of local capacities that can deliver high quality comprehensive care.
• A multidisciplinary approach should be projected to the local hosts as the best model of care and efforts to train all specialties involved in cleft care should be established.
• Innovative EBP & technology approaches for training, provision of comprehensive care, and/or ongoing treatment should be considered as opportunities arise.