Quality and Safety Markers

Problem Statement

We aim to continuously improve our safety and quality.

What are we trying to achieve?

The quality and safety markers (QSMs) help us evaluate the success of our patient safety programmes, and determine whether the desired changes in practice and reductions in harm and cost have occurred. 

What have we done?

The QSMs are sets of related indicators concentrating on specific areas of harm:

• falls
• healthcare associated infections:
  • hand hygiene
  • surgical site infection (cardiac and orthopaedic (hip and knee arthroplasty) surgeries)
• safe surgery
• medication safety
• patient deterioration (recently added)
• pressure injury (recently added).

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 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 QSMs chosen are processes that should be undertaken nearly all the time, so the threshold is set at 90 percent in most cases. 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 – and are measured through direct observational audits (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.

What did we find?

CM Health has consistently met the threshold for falls, hand hygiene, safe surgery and patient deterioration.

One marker that has been difficult to meet is the timing of antibiotic administration prior to joint replacement surgery. The surgeons and anaesthetists at CM Health are working hard to reliably record the timing of these important medicines.

How did we make a difference?

There has been a significant reduction in the number of hip fractures sustained during stays at Middlemore Hospital. Serious bacterial blood infections have remained lower than the national average.

Where to from here?

New QSMs are on the way – opioid safety and consumer engagement measures are being developed.