Quality and safety markers show improved falls assessment and care planning

30 Sep 2014 | Health Quality Intelligence

The Health Quality & Safety Commission’s latest quality and safety markers quarterly report shows more district health boards (DHBs) are achieving the ideal combination of assessing older patients for their risk of falling and then giving them a care plan tailored to that risk.

The report, for April to June 2014, recorded an increase in the number of DHBs offering a high level of both assessment and individualised care planning.

Seven DHBs were in this category, compared with four for the baseline audit period of July to September 2013.

Hospital falls leading to a fractured neck of femur have been static in recent years despite increased admissions of the older people most at risk. As a result, the rate of such falls has gone from 11 to 9.5 per 100,000 hospital admissions for adults between 2011/12 and 2013/14. There have been 10 fewer falls with fractured neck of femur in hospitals in the 13 months since the Open for better care campaign started in May 2013 than would have been expected had the rate remained the same.

In other results:

  • Only three DHBs failed to meet the goal of using all three parts of the World Health Organization surgical safety checklist in at least 90 percent of operations. Two used it in 99 percent. Nationally, the rate was 95 percent, up from 93 percent last quarter and 71 percent in the baseline audit period of December 2012 to February 2013 – an increase of nearly 25 percent. There is, however, concern that the paper-based system of data collection may be making the checklist too compliance-based rather than enhancing team work and communication among surgical teams as intended. Some DHBs are trialling a paperless approach to the checklist and the Commission is reviewing data collection alternatives in consultation with DHBs over the next year.
  • Nationally, there was a continued high level of compliance with use of good-practice central venous line insertion bundles to reduce central line associated bacteraemia (CLAB). The rate was 95 percent. CLAB rates were low, at well below one per 1000 line days, and it was estimated that more than 200 had been avoided in two years, saving over $4 million.
  • In the quarter recorded for surgical site infections (SSIs) involving hip and knee replacement patients (January to March 2014 – earlier than other data because of a 90-day outcome measure), 14 DHBs were administering an antibiotic in the hour before the first incision in 95 percent or more of cases. This compared with five DHBs in the baseline quarter of July to September 2013. The Commission’s threshold is 100 percent, which was satisfied by four DHBs, up from two the previous quarter.
  • Hand hygiene continued to improve nationally, with 73 percent of observed moments compliant with the recommended “five moments of hand hygiene” – 70 percent being the minimum goal. Nine DHBs were at 75 per cent or above, two of them at 80 percent or above. Four DHBs failed to observe the required number of “moments” the report requires for robust data.
  • After a lower five months, the Staphyloccus aureus bacteraemia rate rose again, and is at around 0.12 per 1000 bed days for the last 12 months.

View the latest QSM results here.

Last updated 30/09/2014