Quality & Safety Markers

The latest quality and safety marker (QSM) results are available on the left-hand menu. Click the quarter you would like to view and use the anchors at the top of the page to navigate to the programme of interest.

The Health Quality & Safety Commission is driving improvement in the safety and quality of New Zealand’s health care through its quality improvement programmes.

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

• eMedicine reconciliation (eMedRec)
• falls
• healthcare associated infections:
  • central line associated bacteraemia (marker retired in December 2014)
  • hand hygiene
  • surgical site infection (cardiac and orthopaedic (hip and knee arthroplasty) surgeries
• safe surgery
• medication safety
• opioids
• patient deterioration
• pressure injury

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 measures at the district health board (DHB) 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 measures chosen are processes that should be undertaken nearly all the time, so the threshold is set at 90 percent in most cases. Outcome measures are shown at a national level, to estimate the size of the problem that the programme is addressing. The measures 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 via direct observational audit (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 cardiac patients receiving prophylactic antibiotics 0–60 minutes before incision
• 95 percent of cardiac patients receiving 1.5g or more of cefazolin or 1.5g or more cefuroxime
• 100 percent of hip and knee replacement patients having appropriate skin antisepsis in surgery using alcohol/chlorhexidine or alcohol/povidone iodine.

In the January–March 2015 quarter we reported the baseline of a new set of QSMs relating to eMedRec). These relate to the implementation of eMedRec in DHB hospitals. The markers are:

• percentage of relevant patients aged 65 and over (55 and over for Māori and Pacific patients) where eMedRec was undertaken within 72 hours of admission
• percentage of relevant patients aged 65 and over (55 and over for Māori and Pacific patients) where eMedRec was undertaken within 24 hours of admission
• percentage of patients aged 65 and over (55 and over for Māori and Pacific patients) discharged where medicine reconciliation was included as part of the discharge summary.

In the April–June 2018 quarter, we began reporting a new set of QSMs relating to patient deterioration. These relate to reducing harm from failures to recognise or respond to acute physical deterioration for all adult inpatients. The measures are:

• percentage of eligible wards using the New Zealand early warning score
• percentage of early warning score calculated correctly
• percentage of patients who triggered an escalation of care and received the appropriate response
• rate of in-hospital cardiopulmonary arrests in adult inpatient wards, units or departments per 1,000 admissions
• rate of rapid response escalations per 1,000 admissions.

In the January–March 2019 quarter, we began reporting a new set of QSMs relating to pressure injuries. These relate to measurement of pressure injury prevalence and reduction of harm. The measures are:

• percentage of patients with a documented and current pressure injury risk assessment
• percentage of at-risk patients with a documented and current individualised care plan
• percentage of patients with hospital-acquired pressure injury
• percentage of patients with a non-hospital-acquired pressure injury.

In the July–September 2019 quarter, we started reporting a new set of QSMs relating to the safe use of opioids. These relate to reducing opioid-related harm in adult surgical inpatients. The measures are:

• percentage of patients whose sedation levels are monitored and documented following local guidelines
• percentage of patients who have had bowel function activity recorded in relevant documentation
• (balance measure) percentage of patients prescribed an opioid who have uncontrolled pain
• opioid-related harm for surgical episode of care.

The QSMs were developed in partnership with DHBs, all of which commented on early designs for the measures, resulting in an improved set of measures.

References

1. de Raad J–P. 2012. Towards a value proposition: scoping the cost of falls. Wellington: NZIER.
2. Ibid.
3. In quarter 1, 2015, 1.5 g or more of cefuroxime was accepted as an alternative agent to 2 g or more of cefazolin for routine antibiotic prophylaxis for hip and knee replacements. This improved the results of this process measure for MidCentral DHB significantly, from 10 percent before the change to 96 percent immediately after the change. It also increased the national result from 90 percent to 95 percent in quarter 1, 2015.