The Health Quality & Safety Commission is driving improvement in the safety and quality of New Zealand’s health care through its quality improvement programmes.
The quality and safety markers (QSMs) will help us evaluate the success of the programmes and determine whether the desired changes in practice and reductions in harm and cost have occurred.
The QSMs are sets of related indicators concentrating on specific areas of harm:
- healthcare associated infections:
- central line associated bacteraemia (marker retired in December 2014)
- hand hygiene
- surgical site infection (cardiac and orthopaedic (hip and knee arthroplasty) surgeries
- safe surgery
- medication safety
- patient deterioration.
The process measures show whether the desired changes in practice have occurred at a local level (eg, giving older patients a falls risk assessment and developing an individualised care plan for them based on the findings of the assessment). Process markers at the district health board (DHB) level show the actual level of performance, compared with a threshold for expected performance. The outcome measures focus on harm and cost that can be avoided.
The markers chosen are processes that should be undertaken nearly all the time, so the threshold is set at 90 percent in most cases. Outcome measures are shown at a national level, to estimate the size of the problem that the programme is addressing. The markers set the following thresholds for DHBs' use of interventions and practices known to reduce patient harm:
- 90 percent of older patients are given a falls risk assessment
- 80 percent compliance with good hand hygiene practice
- safe surgery measures are the levels of teamwork and communication around the use of the three paperless surgical checklist parts: sign in, time out and sign out via direct observational audit (with a minimum of 50 observational audits per quarter per part required before the observation is included in uptake and engagement assessments).
- 100 percent of audits where all components of the checklist were reviewed
- 95 percent of audits with engagement scores of 5 or higher
- 100 percent of primary hip and knee replacement patients receiving prophylactic antibiotics 0-60 minutes before incision
- 95 percent of hip and knee replacement patients receiving 1.5g or more of cefazolin or 1.5g or more cefuroxime
- 100 percent of hip and knee replacement patients having appropriate skin antisepsis in surgery using alcohol/chlorhexidine or alcohol/povidone iodine (marker retired in July 2016).
In the January–March 2015 quarter we reported the baseline of a new set of QSMs relating to medication reconciliation (eMR). These relate to the implementation of eMR in DHB hospitals. The markers are:
- percentage of relevant patients aged 65 and over (55 and over for Māori and Pacific patients) where eMR was undertaken within 72 hours of admission
- percentage of relevant patients aged 65 and over (55 and over for Māori and Pacific patients) where eMR was undertaken within 24 hours of admission
- percentage of patients aged 65 and over (55 and over for Māori and Pacific patients) discharged where medicine reconciliation was included as part of the discharge summary.
By tracking the change in practice over time, we can measure the impact of the campaign.
The QSMs were developed in partnership with DHBs, all of which commented on early designs for the measures, which resulted in an improved set of markers. Quality and safety marker results are available by using the left-hand menu.