Te māwhenga tūroro | patient deterioration programme update

The Health Quality & Safety Commission’s te māwhenga tūroro | patient deterioration programme is focusing on several key projects in 2020. Find out more in this update.

• Newborn observation chart and early warning system
• Insights on co-design as part of a patient and whānau escalation system
• Adult and maternity early warning systems implementation
• Planning for 2020

Newborn observation chart and early warning system

A new initiative from the Accident Compensation Corporation (ACC) is underway, to develop and test a newborn observation chart and newborn early warning score. The aim is to identify early deterioration in newborns and reduce the incidence of neonatal encephalopathy. Find out more on the ACC website: www.acc.co.nz/for-providers/treatment-safety.

Insights on co-design as part of a patient and whānau escalation system

We recently released a report on insights from a group of hospital sites co-designing patient and whānau escalation systems. Read the report: Evaluation of the patient deterioration programme | Formative feedback summary report on Kōrero mai cohort two.

Co-design is at the heart of the Kōrero mai | Talk to me workstream. The formative report shows how a group of hospital sites sought to ensure responsiveness to Māori and provides ideas to strengthen the cultural appropriateness of the co-design capability building approach.

Dr Alex Psirides, clinical lead for the patient deterioration programme, says involving patients in the design of the escalation process is important because they have unique experiences and insights to share alongside the staff delivering care.

The report also provides key considerations to support implementation and improvement of Kōrero mai, including advice from district health boards (DHBs).

Six DHBs are co-designing their Kōrero mai projects. Southern Cross Christchurch and Waitematā, MidCentral and Capital & Coast DHBs have implemented Kōrero mai into their main hospitals. Read more about Kōrero mai.

Adult and maternity early warning systems

Nationally consistent vital signs chart and local escalation processes have been implemented in all DHB hospitals and many private facilities. DHBs are now reporting on their patient deterioration quality and safety marker measures. See the  July–September 2019 quality and safety marker results.

We are continuing to work with providers to make sure robust governance and other supports are in place for this work to be effective and sustainable.

Implementation of a maternity early warning system (MEWS) is also well underway.

Over the last two years we have developed a recognition and response system to help clinicians identify when a pregnant or recently pregnant woman’s condition starts to deteriorate, so they can respond quickly.

• Wairarapa, Taranaki, South Canterbury, MidCentral, Hauora Tairāwhiti and West Coast DHBs have recently implemented the system hospital-wide.
• Canterbury, Bay of Plenty, Capital & Coast, Hauora Tairāwhiti, Counties Manukau Health, Hawkes Bay, Southern (Dunedin) and Waikato DHBs have implemented MEWS in their maternity services and are planning hospital-wide release in early 2020.
• Test site DHBs Nelson Marlborough and Auckland are embedding the system across the whole of their hospitals.
• Northland, also a MEWS test site, has implemented in maternity services with plans to go hospital wide early 2020.
• The remaining DHBs have plans in place to implement in early 2020. 

We are also testing national principles for shared goals of care conversations with Waitematā and MidCentral DHBs.

Planning for 2020

We recently conducted a national patient deterioration survey of clinical staff working in adult and maternity inpatient wards. An independent research company will analyse the results and a final report will be published in the near future.

We are also planning a second patient deterioration conference for 2020/21.