The links below will take you to quality and safety marker (QSM) information for the October–December 2015 quarter.

Falls

Nationally, 92 percent of older patients* were given a falls risk assessment in quarter 4, 2015. This is 15 percentage points higher than the baseline level of 77 percent in quarter 1, 2013. It was the fifth consecutive quarter where the 90 percent target was achieved nationally. At the district health board (DHB) level, 13 out of 20 DHBs achieved the target. Results from Hutt Valley DHB, Bay of Plenty DHB, Northland DHB and Southern DHB are significantly lower than the national average (see Figure 1).

  • Upper group: percentage >=90 percent
  • Middle group: percentage is between 75–89 percent
  • Lower group: percentage <75 percent

* Patients aged 75+ (55+ for Māori and Pacific peoples)

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. Figure 2 shows the number of DHBs performing at a higher level continues to increase.

  • Upper group: percentage >=90 percent
  • Middle group: percentage is between 75–89 percent
  • Lower group: percentage <75 percent

When assessments and care plans are plotted against each other, a trend of movement over time is shown from the bottom left corner to the top right corner. Compared with only five DHBs sitting at the top right corner in quarter 1, 2013, in the current quarter, 10 DHBs are in this ‘ideal’ box (see Figure 3).

There were 64 falls resulting in fractured neck of femur in the 12 months ending December 2015 (see Figure 4). The run chart continues to show a significant decrease since December 2014. The median of monthly falls reduced from eight to six. This is the third quarter this quality marker has shown a significant improvement.

This number of falls is significantly lower than the 108 falls we would have expected in this year, given the falls rate observed in the period from July 2010–June 2012. This reduction is estimated to have saved $2.1 million in the year ending December 2015 based on a comprehensive estimate of $47,000[1] for a fall with a fractured neck of femur.

However, this estimate may be too conservative, as it assumes all patients who fall and break their hip in hospital return home. We know that at least some of these patients 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[2]. 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 $2.8 million in total avoidable costs.

 

Hand hygiene

National compliance with the five moments for hand hygiene continues to improve. Nationally, DHBs achieved an average of 81 percent compliance in quarter 3, 2015. Twelve DHBs met the 80 percent target and the remaining eight DHBs were within 5 percent of the target. All DHBs once again submitted 100 percent or more of the required hand hygiene data in this period.

  • Upper group: percentage >=70 percent before Q3, 2014, and then 75 percent in Q3 and Q4, 2014, and then 80 percent since Q1, 2015 
  • Middle group: percentage is 60 percent to target
  • Lower group: percentage <60 percent
  • Hand hygiene national compliance data is reported on 3 times per annum, therefore no data point is shown specifically for Q4 in any year.

The run chart below shows a minor upward shift since January 2015 for the outcome measure for the hand hygiene programme. The median value of monthly health care associated Staphylococcus aureus bacteraemia per 1000 bed-days increased from 0.12 to the end of 2014 to 0.15 in the period January to October 2015. Further analysis is needed to explore the possible reason/s for the shift. The November 2015 to March 2016 data will be available in June quarter’s report and will show if the shift continues.

Safe surgery (previously perioperative harm)

A new QSM aimed at measuring levels of teamwork and communication will be rolled out during the 2015–16 financial year. The first public reporting will be in November 2016 on data for quarter 3, 2016.

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 3, 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 primary cases, the threshold is set at 100 percent. In quarter 3, 2015, 97 percent of hip and knee arthroplasty procedures were given an antibiotic within 60 minutes before ‘knife to skin’, which is the highest proportion recorded nationally to date. There has been a slow increase for the measure since the start of the programme. Six DHBs achieved the national goal.

  • Upper group: percentage = 100 percent
  • Middle group: percentage is between 80–99 percent
  • Lower group: percentage <80 percent


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

In quarter 1, 2015, 1.5g or more of cefuroxime was accepted as an alternative agent to cefazolin 2g or more for routine antibiotic prophylaxis for hip and knee replacements. It improved the results of this process measure for MidCentral DHB significantly from 10 percent before the change to 96 percent immediately after the change. Nationally, this measurement also increased from 88 percent to 96 percent in quarter 3, 2015. Sixteen DHBs reached the threshold level of 95 percent compared with only three in the baseline quarter. Only Taranaki DHB’s results for this measure remain significantly lower than the target rate.

  • Upper group: percentage >=95 percent
  • Middle group: percentage is between 8094 percent
  • Lower group: percentage <80 percent

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

Skin preparation using either chlorhexidine or povidone iodine in alcohol is recommended for all orthopaedic procedures, 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. This is a four percentage point increase from the baseline.

  • Upper group: percentage = 100 percent
  • Middle group: percentage is between 80–99 percent
  • Lower group: percentage <80 percent

Compared with the baseline surgical site infection rate of 1.5 percent in quarter 3, 2013, when 1747 hip and knee arthroplasty procedures were performed, the current quarter showed some improvement. In quarter 3, 2015, DHBs performed 2713 operations, a 55 percent increase on the number of procedures performed in quarter 3, 2013. Thirty surgical site infections were reported, an infection rate of 1.1 percent, which is a point four percent reduction compared with the baseline. However, the improvement in rate has not been stable enough to indicate a shift on the run chart below. It is still too early to confirm a statistically significant, sustained change.

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 reactions history (including allergy) are accurately documented and the information is used across health care. An accurate medicines 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
  • prescribed which 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 including at discharge. There is a national programme to roll-out eMR throughout the country; five DHBs have implemented the system currently.

Figure 12: Structure marker, implementation of eMR

Table showing implementation of electronic medicine reconciliation

Figure 13: Structure markers

Table showing structure markers for electronic medicine reconciliation

Within these five DHBs, Northland DHB and Taranaki DHB are able to produce the results of these process measures. Canterbury DHB has implemented the system recently, so no data was collected for the OctoberDecember quarter. The other two DHBs are in the process of system upgrades and were unable to report this quarter.

Figure 14: Process markers

Table showing process markers for electronic medicine reconciliation

Local DHB report

Using the interactive charts (below) to read individual QSM results for each DHB.

  • Use the drop-down box on the homepage below to access a list of DHBs.
  • Select your DHB.
  • Use the tabs along the top to look at reports on falls and SSI over time.
  • Return to the homepage to select a different DHB.
  • Results can be downloaded as a PDF by using the 'download' button on the bottom right of each page.


References

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

Last updated 31/03/2016