Injury prevention report welcomed

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Auckland DHB Chief Executive Ailsa Claire says she welcomes the Accident Compensation Corporation (ACC) report “Supporting Patient Safety”.

Ms Claire says it provides a useful contribution to knowledge of medical treatment injuries occurring in the New Zealand health system.

“Auckland DHB provides excellent health services that people can and do trust. Sometimes harm occurs in the delivery of those services and this includes treatment-related injuries.”

“Any information we have to better understand how and why harm occurs is central to our health care quality and safety improvement programmes and, in turn, managing risk for patients,” Ms Claire says.

Chief Medical Officer Dr Margaret Wilsher says clinicians’ understanding of what causes harm and what is preventable is constantly improving.

“Treatment injuries, a subset of our definition of harm, are not expected in the normal course of an illness or condition. But they can and do occur and include infection, medication errors or pressure injuries.”

“This ACC report, of its accepted treatment injury claims data for public hospitals, provides a real focus on the importance of patient safety and clinicians across the system welcome it. It’s a useful contribution to our understanding of the harm that can occur in hospitals and provides impetus to continually improve the quality of care we provide” said Dr Wilsher.

“Some treatment injuries are more common in patients who have underlying risk factors or who require major treatment interventions which make them especially vulnerable. Patients being cared for in intensive care following major surgery, or trauma, are an example.”

“Many of Auckland DHB’s services provide care for patients with the most complex medical conditions in New Zealand. Starship and Auckland City Hospitals are the hospitals of last resort for many of the patients we care for and we constantly strive to improve the quality of their care, no matter how complex.”

“Our quality initiatives aim to improve patient outcomes, ensure patient safety, lift the patient and family experience as well as focusing on health and equity for the population and value for public health system resources.”

“As part of our patient safety programme we aim for a culture of patient safety where staff feel free to speak up for safety and our values based culture underpins that. Data such as that provided by ACC, together with a transparent and just approach to the investigation of harm, allows us to identify areas for improvement. These are just some of the pillars of a safe health organisation.

Auckland DHB is involved in a range of initiatives to reduce treatment injuries based on international best practice. They include:

• Medication Safety, where 39% of adult patients routinely have medicines reconciliation completed and medicines reconciliation occurs for more than 50% of high risk patients. Our Reduction In Dispensing Errors project has reduced dispensing errors by over 50%. The medication safety programme features the IMPACT (Inpatient Medical Pharmacist Admitting Collaborative Team) project, which places a clinical pharmacist across Auckland City Hospital’s Emergency Department and Admission Planning Unit (APU) to work alongside the specialist clinicians, so reducing medication-related discrepancies from 1.42 to 0.33 per patient.

• Surgical Site Infection Improvement Programme (SSII). At the start of the Surgical Site Infection Improvement programme, about 3/100 patients undergoing a hip or knee joint replacement developed an infection, now it’s 1/100 procedures. Central Line Acquired Bacteraemia rate (CLAB) infections account for about 30% of all healthcare-associated bloodstream infection events within our hospitals. The combined Central Line Acquired Bacteraemia rate for our three Intensive Care Units was 0.46/1000 catheter days to June 2016. The target is 1/1000.

• Pressure Injury Prevention. The prevalence of pressure injuries has fallen from a baseline four years ago of 8.4% of hospitalised patients of all ages to 4.0% in 2014/2015. Almost all these pressure injuries are stage I (reddened skin) and stage II (broken skin) pressure injuries. Initiatives include the introduction of high specification foam mattresses for children’s cots, low air loss mattresses for extremely unwell children, a standardised care plan incorporating a bundle of care for children, revision of the assessment and care planning forms in adult services, and development of a care bundle specific to adults on extracorporeal membrane oxygenation. We have a Concept Ward in development to test other pressure injury prevention initiatives including improved heel lifts, turning schedules, seating solutions, and pressure injury alerts.

• Falls Prevention (not an ACC category of treatment injury). In our 2015/16 reporting year Auckland DHB managed a 26% reduction in the number of falls causing serious harm. Auckland DHB records about four falls per 1,000 bed days each year. It’s a rate that remains stable as the number of patients we see has steadily increased. By way of example, we saw 20% more patients for elective surgery 2015/16 than the 2014/15 year. The Adult Community and Long Term Conditions Directorate has had a 53% reduction in the number of falls per month since January 2016. We have had a 60% reduction in patients falling over bed rails – a decrease from approximately 9 per month to 3.6 per month.

Dr Wilsher said that patients being cared for in Auckland DHB’s services can be confident they are in an environment that values patient safety and quality as well as making patients’ experience of care the very best it can be.

The ACC’s report on treatment injury claims data can be found at http://www.acc.co.nz/.

Ends

For further information, please contact the Auckland DHB Media Line on (09) 375 3499

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