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New health data will help improve patient safety


New health data will help drive improvements in patient safety


The publication of new health data will encourage district health boards (DHBs) to consistently put in place steps to improve patient safety, says Professor Alan Merry, Chair of the Health Quality & Safety Commission.

The quality and safety markers show the extent to which DHBs take simple actions to reduce the risk of harm to patients from falls, healthcare associated infections and perioperative harm (harm during or after surgery). No DHBs performed at the highest level in all areas, or performed badly in all areas.

“The markers show some really great work and commitment by DHBs to quality of services and patient safety, but there is also room for improvement,” says Professor Merry.

The Commission evaluated DHBs’ progress in reducing patient harm in the following ways.

Preventing harm from falls is evaluated by the percentage of older hospital patients assessed for their risk of having a fall.
The desired level is having at least 90 percent of older hospital patients assessed for their risk of having a fall.
Reducing harm from healthcare associated infections is evaluated by the number of staff following good hand hygiene practices, and by compliance with agreed protocols for preventing a bloodstream infection called central line associated bacteraemia (CLAB).
For hand hygiene, the desired level is 70 percent compliance with best practice hand hygiene measures.
For CLAB, the desired level is 90 percent compliance with the procedures for inserting catheters into blood vessels near the heart to prevent CLAB.
Perioperative harm is evaluated by the number of operations performed using the World Health Organization’s surgical safety checklist. A simple tool for avoiding mistakes, the checklist promotes better communication and planning for things that might go wrong.
The desired level is using all three parts of the surgical safety checklist in 90 percent of operations.

With the exception of CLAB, which has been the subject of a successful national project to reduce the number of these infections, about one quarter to one third of DHBs reached the agreed level in all areas.

Professor Merry says DHBs’ varying performance shows why Open for better care, New Zealand’s national patient safety campaign, is focusing on these areas.

“The campaign begins with a focus on reducing harm from falls, and then moves on to reducing harm in the areas of healthcare associated infection, surgery and medication.

“The CLAB project reduced the average number of hospital patients developing CLAB in New Zealand intensive care units from between four and six patients per month in January to March 2012 to almost zero. Its success shows the effectiveness of national campaigns to improve patient safety.”

Professor Merry says the Commission will report against the measures in December 2013 and quarterly after that.

“Open for better care seeks to drive improvement in the safety and quality of New Zealand’s health system. The quality and safety markers will help us to track whether DHBs are doing the right things to make health services safer for everyone.”

In addition to ‘process’ measures that track what DHBs have done to make health services safer, the QSMs have a series of ‘outcome’ measures that show the harm and cost caused nationally when things go wrong.

For example, the outcome measures for preventing harm from falls show that on average, in every week in 2012 two patients fell and broke their hip in a New Zealand hospital. This usually added a month to each patient’s hospital stay, at a total cost to the New Zealand health system of least $2.6 million.

To see the Quality and Safety Markers baseline data for each DHB, go to http://www.hqsc.govt.nz/our-programmes/health-quality-evaluation/projects/quality-and-safety-markers/.

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