On a six-monthly basis, WDHS submits a range of data to a national database so that we can compare our performance against other similar organisations. Areas where we have compared favourably in comparison to other similar organistions include:
- Post-operative pulmonary embolism (a blood clot in thelungs)
- Unplanned or unexpected re-admission to hospital
- Injury during gall bladder surgery
Areas requiring further monitoring or evaluation include:
- unplanned return to the operating room
- unplanned return to hospital from the Hospital in the Home program.
The organisation’s aged care facilities participate in a national benchmarking program (QPS) as a means of measuring our quality of care. This program enables us to submit data to a national database and compare our performance with other similar facilities. Data submitted includes resident satisfaction surveys, infection control, falls, skin tears and medications.
Areas where WDHS is performing well compared to other similar facilities include:
- Falls (The Birches & The Grange)
- Skin Tears (Penshurst)
- Infections (Penshurst)
- Staff Competency on Aged Care Issues (The Birches, TheGrange & Penshurst)
The focus for further improvements will be on medication management and clinical record documentation.
Performance Indicators - Aged Care (top)
WDHS has volunteered to assist the Department of Human Services (DHS) in the development of performance indicators for use in residential aged care facilities across the state. The reason for the identification of performance indicators is primarily to enhance the quality of care. Indicators that have been trialled at WDHS are related to weight and medication management, with information being fed back to DHS. The trial will continue over a six-month period with the expectation that the indicators will be introduced in 2006.
From time to time the media reports cases where the care of patients in hospitals has not met expected standards. To minimise the likelihood of this occurring, Western District Health Service continually examines potential risks to safety and implements strategies accordingly. A Clinical Risk Register has been established to document potential risk and to identify the action that has been put in place to minimise incidents from occurring. Strategies that have been implemented include changes to policies and procedures, the introduction of various recruitment strategies, staff education and revised documentation. As new risks are identified, additions are made to the Clinical Risk Register and appropriate action implemented.
Antibiotic Guidelines (top)
Antibiotic guidelines have been developed to promote appropriate prescribing practices and to minimise the emergence of antibiotic resistance. In the past year a surveillance program has been introduced to assess the appropriateness of antibiotic prescribing against recommendations established in the Therapeutic Antibiotic Guidelines. Regular consultation with medical staff and appropriate educational have resulted in a marked improvement in compliance and the effectiveness of prescribing. In the past 12 months we have seen antibiotic prescribing compliance improve from 40% to 88% compliance. These results are very pleasing given that the statewide Victorian Infection Control Nosocomial Surveillance Study (VICNISS) average was 50.7%.
Incidents (top)
The greatest number of incidents fall into the following four main categories:
- Falls
- Medication related errors
- Skin tears and
- Pressure areas
Predominantly, falls and skin tears occur in our aged care facilities and relate to the frailty of the residents, with medication errors and pressure areas occurring in both acute and aged care areas.
These issues are a prime focus of our clinical risk management program. Strategies introduced in an effort to minimise incidents include a falls management program, a skin tear risk assessment tool and purchase of various additional pressure relieving devices. In addition, errors relating to the signing of medication charts have been significantly reduced through the introduction of double checking procedures at change of shift times.
Staff at Western District Health Service are encouraged to report all incidents and, while this can indicate an increase in the number of incidents, improved reporting greatly assists the introduction of appropriate preventative measures.
Falls Risk Assessment (top)
A falls risk assessment screening program has been implemented since 2000. This program aims to assesspatients/residents to determine the likelihood of them having a fall. If that risk is identified then a range of preventative measures are put into place. Continuing staff education, performance monitoring and implementation of interventions have resulted in the following:
A reduction in the total number of falls:
- 2003/04 310 falls
- 2004/05 262 falls
A reduction in serious falls-related injuries:
- 2003/04 3.2%
- 2004/05 2.3%
A reduction in falls-related fractures:
- 2003/04 7 fractures
- 2004/05 5 fractures
Pressure Ulcer Point Prevalence Survey (top)
There has been a growing concern regarding the prevalence and incidence of pressure ulcers in Australian healthcare facilities. In addition to the added cost to healthcare facilities, pressure ulcers can impact significantly on a patient’s length of hospital stay and quality of life. In 2003 the Victorian Quality Council – Department of Human Services- initiated a statewide survey to identify the prevalence of hospital acquired pressure ulcers in Victoria. Western District Health Service was invited to participate in the 2003 audit and again in 2004. In both audits WDHS performed well. In 2004 the state wide average was 20.8%, with WDHS scoring 9.7%. The statewide comparative data showed Hamilton Base Hospital ranking second compared to other similar-sized organisations. These results are reflective of the many initiatives the organisation has introduced to minimise the risk of pressure ulcers, including risk assessment, monitoring of incidents and extensive staff education.
A statewide initiative introduced by DHS in response to audit results was a $2 million mattress replacement and staff training program for acute healthcare facilities in Victoria. We envisage that this initiative, together with ongoing staff training, will yield continued improvement in the current incidence of pressure ulcers at both the state and local levels.To date nine nurses have been trained as Pressure Risk Assessors and an additional 185 have participated in inservice education.
National Medication Chart Trial (top)
Western District Health Service has participated in the pilot of a National Medication Chart, with suggestions for improvement being fed back to the national body. Intended for future distribution to all hospitals in Australia, the new medication chart has been devised to minimise medication errors, by building safety features into its format. A further advantage in the future will be that all of our rotating junior doctors will be familiar with the chart when they first arrive at Hamilton, as it will have been in use at their parent hospital.
As a result of the seven-week pilot study, Western District Health Service was able to show that medication errors were considerably reduced. Consequently Western District Health Service has elected to continue using the National Medication Chart, and is anticipating the release of an updated format foruse from July 2005 onwards. The chart shown below depicts some of the additional data collected pre and post implementation of the National Medication Chart Trial. Many improvements were noted, although the study has identified areas where further improvements to medication chart recording can be made. Despite completion of the National Medication Chart Trial, WDHS will continue with its use in an effort to maintain the focus on medication-related incidents.