The links below will take you to QSM information for the July – September 2015 quarter.

Falls

Nationally, 92 percent of older patients* were given a falls risk assessment in quarter 3, 2015. This is 16 percentage points higher than the baseline level of 76 percent in quarter 1, 2013. Compared with the previous quarter, one more DHB achieved the 90 percent threshold, increasing the total number of DHBs achieving this to 15.

Table 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 92 percent of patients at risk of falling received an individualised care plan. This measure has remained broadly consistent at 90 percent or above since quarter 2, 2014. Lower achievement levels are reducing.

Table showing percentage of older patients given 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. Compared with only four DHBs sitting at the top right corner in quarter 3, 2013, in the current quarter, 11 DHBs are in this ‘ideal’ box.

Scatter plot showing falls assessments compared with care planning

Chart showing harm and cost associated with in-hospital falls.

There were 69 falls resulting in fractured neck of femur in the 12 months ending September 2015. This is significantly lower than the 106 falls we would have expected in this year given the falls rate observed in the period from July 2010–June 2012.
The precise cost of in-hospital falls with a fractured neck of femur is difficult to estimate. Initially a cost of $27,000 per incident was used, which only covers the excess hospital stay and does not consider the additional costs of diagnosis, repair and rehabilitation. Since last quarter we decided to use a more comprehensive estimate of $47,000[1] cost for a fall with a fractured neck of femur. This new method has been carried on in this quarter and it is estimated the reduction in falls noted above would result in $1.8 million savings.

However, this may be too conservative an estimate, as it assumes all patients who fall and break their hip in hospital return home. We know that at least some of these are likely to be admitted to aged residential care on discharge from hospital. This is a far more expensive proposition – estimated at $135,000 a time[1]. If we conservatively estimate that 20 percent of the patients who avoided falls were admitted to a residential care facility, the reduction in falls represents $2.4 million in total avoidable costs.

The run chart continues to show a significant decrease since December 2014. The median of monthly falls reduced from eight to five. It was the second quarter that this quality marker showed a significant improvement.

Run chart showing in-hospital falls with fractured neck of femur by month

Hand hygiene

National compliance with the five moments for hand hygiene continues to increase. DHBs achieved an average of 81 percent compliance in quarter 3, 2015, which is slightly higher than the national target of 80 percent. Almost all DHBs met or came close to the target. All DHBs once again submitted 100 percent or more of the required hand hygiene data in this period.

Table showing percentage of opportunities for hand hygiene 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 a significant shift.

Run chart showing Staphylococcus aureus bacteraemia per 100 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 2, 2015.

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. In quarter 2, 2015, 96 percent of hip and knee arthroplasty procedures were given an antibiotic within 60 minutes before ‘knife to skin’. It has remained broadly consistent at 94 percent or above since quarter 2, 2014. Eight DHBs achieved the national goal, four more than in quarter 1.

Antibiotic given 0–60 minutes before 'knife to skin'

Process measure 2: Right antibiotic in the right dose – cefazolin 2g or more or cefuroxime 1.5g or more

The Surgical Site Infection Improvement Programme decided previously that 1.5g or more of cefuroxime is an acceptable alternative to cefazolin 2g or more for routine antibiotic prophylaxis for hip and knee replacements. This change has been included in the QSM report since quarter 1, 2015.

In some instances, 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.

In quarter 2, 2015, 95 percent of hip and knee arthroplasty procedures were given the right antibiotic in the right dose. This is consistent with previous results. Fourteen DHBs reached the threshold level compared with only three in the baseline quarter.

Chart showing 2grams or more cefazolin or 1.5g or more cefuroxime 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. Appropriate skin antisepsis is clearly normal practice across DHBs as the national compliance rate of 99 percent attests, an increase from 87 percent at baseline.

Chart showing appropriate skin preparation

In quarter 2, 2015, DHBs performed 2588 hip and knee arthroplasty procedures. Within them, there were 32 surgical site infections; an infection rate of 1.2 percent. The run chart below shows that the infection rate has fluctuated around the median rate of 1.2 percent since the baseline quarter (quarter 3, 2013), with no sign yet of a significant change.

Run 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 medicine reconciliation – a process by which health care professionals ensure all medicines a patient is taking and their adverse reaction (including allergy) history are accurately documented and the information is used across health care. An accurate medicine list can be reviewed to ensure medicines are appropriate and safe. Medicines which should be continued, stopped or temporarily stopped can be documented on the list. Doing this reduces the risk of medicines being:

  • omitted
  • prescribed at the wrong dose
  • prescribed to a patient who is allergic, or that has the potential to interact with other prescribed medicines.

The introduction of electronic medicine reconciliation (eMR) will enable medicine reconciliation to be done more routinely and facilitate medicine reconciliation at discharge. There is a national programme to roll-out eMR throughout the country; five DHBs have implemented the system currently.

Structure: Implementation of eMR

Chart showing implementation of eMR

Structure markers

Table showing structure markers for eMR

Within these five DHBs, Northland DHB has 70 percent of relevant wards with eMR implemented. The proportion of medicine reconciliation undertaken in older patients within 72 hours of admission was 59 percent and within 24 hours was 52 percent. The proportion of medication reconciliation included as part of the discharge summary was 72 percent.  Canterbury DHB has recently implemented the system, so there is no data collected for the July–September quarter. The other three DHBs are in the process of system upgrades and were unable to report this quarter.

Process markers

Table showing eMR process markers

References

  1. de Raad J-P. 2012. Towards a value proposition: scoping the cost of falls. Wellington: NZIER.

Last updated 18/12/2015