The Health Quality & Safety Commission is driving improvement in the safety and quality of New Zealand’s health care through the national patient safety campaign Open for better care.
The quality and safety markers (QSMs) will help us evaluate the success of the campaign 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 the four areas of harm covered by the campaign:
- healthcare associated infections:
- central line associated bacteraemia (marker retired in December 2014)
- hand hygiene
- surgical site infection
- perioperative harm
- medication safety.
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 a care plan for them). The outcome measures focus on harm and cost that can be avoided. Process markers at the district health board (DHB) level show the actual level of performance, compared with a threshold for expected performance.
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 campaign 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
- all three parts of the WHO surgical safety checklist used in 90 percent of operations
- 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.
For the first time in the January – March 2015 quarter we report 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.