CLINICAL INDICATOR USERS' MANUAL
VERSION 10 FOR USE IN 2007
VERSION 10 FOR USE IN 2007
The data collected with this Users’ Manual are to be reported using the
ACHS Performance Indicator Reporting Tool (PIRT)
ACHS Performance Indicator Reporting Tool (PIRT)
The Royal Australasian College
of Medical Administrators
Outcomes Service
CONTENTS
INDICATOR AREA 1: MEDICATION ERRORS
INDICATOR AREA 2: HOSPITAL RE-ADMISSIONS
INDICATOR AREA 3: RETURN TO OPERATING ROOM
INDICATOR AREA 4: PRESSURE ULCERS
INDICATOR AREA 5: PATIENT FALLS
INDICATOR AREA 6: PATIENT DEATHS
INDICATOR AREA 7: BLOOD TRANSFUSION
INDICATOR AREA 8: DAY OF SURGERY ADMISSIONS
INDICATOR AREA 9: THROMBOPROPHYLAXIS
INDICATOR AREA 1: MEDICATION ERRORS
Indicator Topic
Medication incidents.
Rationale
The use of medication remains the most common intervention in health care. Medicine misuse, underuse or over use and adverse reactions annually result in an estimated 140 000 annual hospital admissions in Australia; most of these adverse drug events are preventable1.
Type of Indicator
This is a comparative rate based indicator addressing the outcome of patient care.
Definitions of Terms
For the purpose of this indicator:
• Medication Incidents include (this list is not exhaustive):
• prescription errors, for example, when the inappropriate medicine is prescribed, or prescriptions are transcribed incorrectly from one chart to another.
INDICATOR
Definitions of Terms (Continued)
errors in admission, for example, where a dose of medicine is given to the wrong patient, where there is unintended omission
errors in dispensing by the hospital pharmacy, for example, when the wrong medicine is dispensed and sent to the ward
errors in documentation, for example, where previously known adverse drug reactions or allergies are not recorded on the patient’s chart.
An adverse event is an incident in which harm resulted to a person receiving health care unrelated to the accepted progression of the persons illness/es.
Occupied bed days are the total number of days for all patients who were admitted for an episode of care.
CI. 1.1 Dimension of Quality Safety EQuIP 4 Criterion 1.1.4, 1.5.1
Stowasser DA, Allison YM and O'Leary KM. Understanding the medicines management pathway, Journal of the Pharmacy Practice and Research, 2004: 34 (4), 293-296.
ACHS Clinical Indicator Users’ Manual 2007
INDICATOR AREA 2: HOSPITAL RE-ADMISSIONS
Indicator Topic
Unplanned and unexpected hospital readmissions.
Rationale
Unplanned and unexpected re-admissions to a hospital may reflect less than optimal patient management.
Type of Indicator
These are comparative rate based indicators addressing the outcome of patient care.
Definitions of Terms
For the purpose of these indicators:
• These indicators address only patients re-admitted to the same organisation.
INDICATOR
Definitions of Terms (Continued)
• Unplanned hospital re-admission refers to an:
unexpected admission for further treatment of the same condition for which the patient was previously hospitalised
unexpected admission for treatment of a condition related to one for which the patient was previously hospitalised
unexpected admission for a complication of the condition for which the patient was previously hospitalised
Day stay patients are included in both the numerator and denominator figures. Day stay patients are those whose admission data equals the discharge date.
Hospital in the Home patients and emergency department patients re-admitted to the emergency department only, are not included in this indicator.
CI. 2.1 | Numerator | Total number of unplanned and unexpected re-admissions within 28 days of separation, during the 6 month time period. |
CI. 2.2 | Numerator | Total number of unplanned and unexpected re-admissions within 14 days of separation, during the 6 month time period. |
* Please note the denominator is the same for 2.1 – 2.2.
Points to consider in addressing Indicator 2.1
• This indicator is designed to flag those re-admissions which are both unplanned and unexpected.
• Patients with progressive conditions (for example, advanced cancer and renal disease), through the nature of their disease, may be expected to return to hospital at some stage, even though the admission date is not planned. These groups of patients should not routinely be excluded as their re-admission may relate to complications arising from treatment during the previous admission. This emphasises the need for clinician input in determining those re-admissions that are both unplanned and unexpected.
• To facilitate data collection:
commence by defining the dates of the study period
the numerator will be all the re-admissions within 28 days (indicator 2.1) or 14 days (indicator 2.2) of previous discharge
the denominator will be the number of separations (excluding deaths) during the time period under study.
Case example for indicator 2.1
Data collection period: January – June
Mrs Y was admitted to hospital for a hysterectomy on February 2nd, and subsequently discharged on February 6th (of same year). Mrs Y was re-admitted for complications relating to the hysterectomy on March 1st (of same year).
Mrs Y is included in the numerator as a ’28 day re-admission’, and is also included in the denominator as a ‘separation’.
Data collection period: July – December
Mr X was admitted to hospital for a hernia operation on June 10th, and subsequently discharged on June 12th (of same year). Mr X was re-admitted for complications relating to the hernia operation on July 2nd (of same year), and subsequently discharged on July 30th.
Mr X is included in the July to December – numerator as a ’28 day re-admission’, and is also included in the July – December – denominator as a ‘separation’.
(Please note: Mr X would not be included in the January to June numerator, but is a separation, and therefore is included in the denominator for both the January to June period and the July to December period.)
CI. 2.1 | Dimension of Quality EQuIP 4 Criterion | Effectiveness, Safety 1.1.4, 1.4.1 |
CI. 2.2 | Dimension of Quality EQuIP 4 Criterion | Effectiveness, Safety 1.1.4, 1.4.1 |
INDICATOR AREA 3: RETURN TO OPERATING ROOM
Indicator Topic
Unplanned return to the operating room during the same admission.
Rationale
Unplanned return of a patient to the operating room during the same admission may reflect less than optimal management.
Type of Indicator
This is a comparative rate based indicator addressing the outcome of patient care.
INDICATOR
Definitions of Terms
For the purpose of this indicator:
Unplanned refers to the necessity for a further operation for complication(s) related to a previous operation / procedure in the operating room.
Return refers to re-admissions to the operating room for a further operation / procedure.
An operating room is defined as a room, within a complex, specifically equipped for the performance of surgery and other therapeutic procedures.
Day stay patients are included in both the numerator and the denominator.
Patients returning to the operating room from the recovery room are included in the numerator figure.
When there are multiple returns to the operating room for the one patient, that patient is counted only once.
CI. 3.1 Dimension of Quality Effectiveness, Safety EQuIP 4 Criterion 1.1.4, 1.4.1
INDICATOR AREA 4: PRESSURE ULCERS
Indicator Topic
Identification of pressure ulcers.
Rationale
Pressure ulcers are largely preventable hospital acquired lesions caused by unrelieved pressure resulting in damage of the skin and underlying tissue2.
Pressure ulcers are largely preventable hospital acquired injuries. In the majority of cases they can be regarded as an adverse outcome of a health care admission. Many national and international health care agencies acknowledge that pressure ulcers not only affect the health of the individual but also place a significant drain on already stretched health resources.
Type of Indicator
These are comparative rate based indicators addressing the outcome of patient care.
INDICATOR
Hospital-Wide Clinical Indicators Version 10
Definitions of Terms
For the purpose of these indicators:
• Overnight Occupied bed days relate to overnight bed days and exclude same day admissions.
For the purpose of indicator 4.1:
• This indicator measures the incidence of patients who develop one or more hospital acquired pressure ulcers.
For the purpose of indicator 4.2:
• This indicator measures the incidence of patients who have a pressure ulcer on admission.
CI. 4.1 | Numerator | Total number of inpatients who develop one or more |
pressure ulcers, during their admission, during the 6 month time period. | ||
CI. 4.2 | Numerator | Total number of inpatients who are admitted with one or |
more pressure ulcers, during the 6 month time period |
* Please note that the denominator is the same for numerator 4.1 – 4.2.
CI. 4.1 | Dimension of Quality EQuIP 4 Criterion | Effectiveness, Safety 1.1.4, 1.4.1, 1.5.3 |
CI. 4.2 | Dimension of Quality EQuIP 4 Criterion | Effectiveness, Safety 1.1.4, 1.4.1, 1.5.3 |
Agency for Health Care Policy and Research. Treatment of pressure ulcers: clinical practice guideline No 15. U.S. Department of Health and Human Services. 1994.
ACHS Clinical Indicator Users’ Manual 2007
INDICATOR AREA 5: PATIENT FALLS
Indicator Topic
Identification of falls during an admission.
Rationale Fall-related injury is one of the leading causes of morbidity and mortality in older Australians and the single biggest reason for hospital admissions and emergency department presentations in people over 65 years of age3.
Adverse events associated with falls may include bone fractures, soft tissue injury, and fear of falling again. Interventions based on a proactive assessment, anticipation of patient needs, and participation of the multidisciplinary teams in prevention efforts are critical4.
Type of Indicator
These are comparative rate based indicators addressing the outcome of patient care.
Definitions of Terms
For the purpose of these indicators:
• A patient fall is defined as an event which results in a person coming to rest inadvertently on the ground or floor or other lower level.
INDICATOR
Hospital-Wide Clinical Indicators Version 10
Definitions of Terms (Continued)
• The numerator includes:
falls from cardiovascular causes such as hypotension and transient ischaemic attacks
falls where a person who is found on the ground or floor or other lower level and could not explain why they were there
falls resulting from epileptic seizures
The numerator excludes:
• falls resulting from sustaining a violent blow
For the purpose of indicator 5.2:
• Intervention is defined as any of the following:
therapeutic treatment
diagnostic procedures
increase nursing care and/or
monitoring
monitoring
Occupied bed days are the total number of days for all patients who were admitted for an episode of care.
CI. 5.1 | Numerator | Total number of patient falls, during the 6 month time period. |
CI. 5.2 | Numerator | Total number of patient falls that require intervention, during the 6 month time period. |
CI. 5.3 | Numerator | Total number of fractures of closed head injuries that result because of a patient fall, during the 6 month time period. |
* Please note that the denominator is the same for numerator 5.1 – 5.3.
Pointer S, Harrison J and Bradley C. National injury prevention plan priorities for 2004 and beyond: discussion paper. Injury research and statistics series number 18. Canberra: Australian Institute of Health and Welfare, 20034 Szumlas, S, Groszek, J, Kitt, S, Payson, C, Stack K Take a Second Glance: A Novel Approach to Inpatient Fall Prevention Joint Commission Journal Quality and Safety June 2004 Vol 30 No 6 pp 295 – 301.
CI. 5.1 | Dimension of Quality EQuIP 4 Criterion | Effectiveness, Safety 1.1.4, 1.5.4, 1.4.1 |
CI. 5.2 | Dimension of Quality EQuIP 4 Criterion | Effectiveness, Safety 1.1.4, 1.5.4, 1.4.1 |
CI. 5.3 | Dimension of Quality EQuIP 4 Criterion | Effectiveness, Safety 1.1.4, 1.5.4, 1.4.1 |
CI. 5.4 | Dimension of Quality EQuIP 4 Criterion | Effectiveness, Safety 1.1.4, 1.5.4, 1.4.1 |
INDICATOR 6: PATIENT DEATHS
Indicator Topic
Deaths addressed within a clinical audit process.
Rationale
Although death can be the expected outcome from progression of all illness or disease, it can also be the ultimate adverse event associated with or resulting from health care delivery.
It is appropriate for patient deaths occurring within a health care organisation to be analysed through clinical audit and review processes to facilitate identification and introduction of any necessary improvements in safety.
INDICATOR
Hospital-Wide Clinical Indicators Version 10
Type of Indicator
This is a comparative rate based in indicator addressing the outcome of patient care.
Definition of Terms
For the purpose of this indicator:
A clinical audit process may include peer review and clinical audit.
Clinical audit is defined as the process of reviewing the delivery of care against know or best practice standards to identify and remedy deficiencies through a process of continuous quality improvement5
Tidak ada komentar:
Posting Komentar