The links below will take you to QSM information for the January – March 2015 quarter.

Falls

Nationally, 90 percent of older patients* were given falls risk assessment in quarter 1, 2015. This rate has remained broadly consistent at 89 percent or above since the beginning of 2014. Compared with the previous quarter, three more DHBs achieved the 90 percent threshold, increasing the total number of DHBs achieving this to 12. Lower achievement levels are reducing. 

Chart showing percentage of older patients assessed for the risk of falling

*Patients aged 75+ (55+ for Māori and Pacific peoples)
(Note: for this update, baselines and the most recent two quarters are shown for all tables.)

About 90 percent of patients at risk of falling received an individualised care plan. This measure has improved on the baseline level of 80 percent.


Falls-risk patients who received an individualised care plan

When assessments and care plans are plotted against each other, a trend of movement over time from the bottom left corner to the top right corner is shown.

Chart showing falls assessment compared with care planningThere were 88 falls resulting in fractured neck of femur in the 12 months ending March 2015, which is fewer than the 95 recorded in the baseline year (2012). This resulted in a slight drop in the estimated cost based on a fixed cost per fractured of neck of femur and additional bed-days.

Chart showing harm and cost associated with in-hospital falls

The number of falls resulting in fractured neck of femur has dropped since July 2014. But, as the run chart shows, it is still too early to see a significant, sustained shift.

Chart showing in-hospital falls with fractured neck of femur by month.

Perioperative harm

The recorded use of the surgical safety checklist remained above 90 percent in quarter 1, 2015, an increase of more than 20 percentage points from the baseline. Almost all DHBs showed an improvement in this measurement since 2013. For West Coast DHB, the relatively lower use of the ‘check in’ process reduced their rate of using all three parts of checklist.

Auckland DHB is currently moving from using audit forms to a direct observation process. This has the advantage of allowing us to know how well the checklist is being used. From 2016–17 it is likely that a measure based upon direct observation will replace the current process marker, so this represents a step in the right direction. This means, however, that Auckland’s reported result is based upon a very small sample and for this reason the data are reported separately.

Chart showing % of operations where all three parts of the checklist were used

Compared with baseline year of 2012, we estimate there have been 73 fewer postoperative cases of DVT/PE, resulting in 2576 fewer bed-days and a $2.0 million reduction in cost. However, there has been an increase of 202 postoperative sepsis cases than would have been expected using 2012 rates, resulting in 1998 more bed-days and more than $1.5 million in extra cost. Overall, additional bed-days and costs across the two measures have reduced.

Chart showing harm and costs from DVT/PE and sepsis following operations

Hand hygiene

National compliance with the five moments for hand hygiene continues to increase, to 77 percent, two percentage points higher than the 75 percent target. All 20 DHBs were compliant and it is the first time this has happened. Fourteen of them met or exceeded the target and eight achieved a compliance rate of 80 percent or higher.

Chart showing percentage of hand hygiene opportunities taken

The run chart below shows the monthly national average for healthcare associated Staphylococcus aureus bacteraemia per 1000 bed-days. This measure still fluctuates considerably month-by-month, with no signs of significant change.

Chart showing Staphylococcus aureus bacteraemia per 1000 bed-days by month

Surgical site infection

As the Commission uses 90-day outcome measures for surgical site infection, these data run one quarter behind other measures. Information in this section relates to quarter 4, 2014.

Process measure 1: Antibiotic administered in the right time

For primary procedures, an antibiotic should be administered in the hour before the first incision (‘knife to skin’). As this should be happening in all cases, the threshold is set at 100 percent. The national average dropped two percentage points from the last quarter to 94 percent.

Chart showing antibiotic given 0–60 minutes before 'knife to skin'

Process measure 2: Right antibiotic in the right dose – cefazolin 2g or more

Cefazolin 2g is recommended for routine antibiotic prophylaxis for hip and knee replacements unless the patient has a beta-lactam allergy and requires a non-beta-lactam antimicrobial agent, or is colonised with multi-resistant Staphylococcus aureus, in which case they should receive both cefazolin and vancomycin. To allow for these relatively rare instances, the threshold is set at 95 percent.

The use of 2g or more of cefazolin continues to increase. In the most recent quarter, the national average reached 90 percent. Fourteen DHBs reached the threshold level compared with only three in the baseline quarter.

Chart showing 2 grams or more cefazolin given

Process measure 3: Appropriate skin antisepsis in surgery using alcohol/chlorhexidine or alcohol/povidone iodine

Skin preparation involving either chlorhexidine or povidone iodine in alcohol should occur on all occasions, so the threshold is set at 100 percent. Thirteen DHBs achieved the threshold. Appropriate skin antisepsis is clearly normal practice across DHBs as the national compliance rate of 98 percent attests, an increase from 87 percent at baseline.

After showing relatively lower infection rates in the first half of 2014, the most recent months have seen volatile movement around the long-term trend of 1.2–1.3 infections per 100 operations.

Chart showing appropriate skin preparation

Chart showing surgical site infections per 100 hip and knee operations

Medication safety

We introduced a quality and safety marker for medication safety in September 2014. It focuses on the task of medication reconciliation – a process by which health care professionals ensure all medicines a patient is taking are known and reviewed to ensure they are appropriate and safe. Doing this reduces the risk of medicines with potentially dangerous interactions being prescribed.

A key first step to allow medication reconciliation to be done routinely and in a more straightforward manner is the introduction of an electronic system, known as electronic medication reconciliation (eMR). There is a national programme to roll out eMR throughout the country; four DHBs have access to the system currently; five have an expected date for implementation.

Structure: Implementation of eMR

Chart showing the implementation of eMR by district health board

Structure markers

Chart showing eMR structural markers

Northland and Taranaki DHBs also use the eMR system to report on the proportion of medication reconciliation undertaken of older patients, who typically, likely to benefit most from eMR. More DHBs are expected to report on this as their systems are updated over the next few months.

Chart showing medication safety process markers

Last updated 27/10/2015