Quality & Safety Challenge 2012:Quality Enhancement in Residential Aged Care

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John Parsons PhD NZRPSenior Lecturer

Applied Ageing Research Group, School of NursingThe University of Auckland

Older people in Waikato DHBOlder people in Waikato DHB

Study objectivesStudy objectives1. Reduction in Emergency Department

presentation from older people living in residential care

2. An increase in staff satisfaction3. Implementation of a Residential Aged

Care Benchmarking programme4. Implementation of a targeted Residential

Aged Care education programme

Intervention Intervention • MDT case review• An advanced nursing support programme • Advanced care planning support• Benchmarking using PASS

– pressure ulcers rate– falls and urinary tract infection (n/total number of

residents multiplied by 1000 occupied bed days)– percentage of residents for whom restraint

minimisation, urinary catherisation and more than nine medications were used (n/total number of residents multiplied by 100%)

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Presentations to ED - 2011Presentations to ED - 2011

Presentations to ED - 2011-2012Presentations to ED - 2011-2012

Presentations to ED - 2012Presentations to ED - 2012

Presentations to ED Presentations to ED • The number of presentations to ED from both

control and intervention facilities was divided by the number of resident beds at each facility (range 27-83) to give a rate of presentations per bed

• The data for 2011 and for 2012 were compared together with the study allocation (intervention or control)

• Repeated measures ANOVA showed that there was no significant difference between the rate of ED presentations between the two groups when 2011 ED rates were used as a covariate (F = 0.76, p=0.08)

Other findingsOther findingsPressure ulcers•Figure 6 shows the average prevalence rates of pressure ulcers for both study groups (per 1000 resident days). •Pressure ulcer rates were low overall and were lower in the intervention group than the control group (0.34 versus 1.06% prevalence rate)•The rates do not appear to have been influenced by the intervention  Falls•The intervention group had a higher falls rate than the intervention group (11.03 versus 9.07/1000 resident days). This needs further analysis•These rates are higher than those found in the PASS study (8.03/1000 resident days)Restraint use•The control group had lower percentage of the residents using restraint than the intervention group (4.49 versus 1.78 %) and this did not change during the study

Other findingsOther findingsUrinary Tract Infections•There was no difference observed between the 2 groups (intervention 1.45 and control 1.51/ 1000 resident days) during the study and the rates were similar to those found in the PASS study of 1.63 /1000 resident days Catheter use•There was no observed difference between the two groups during the studyMedication use•The proportion of residents prescribed more than nine medications•The intervention group had a higher percentage of residents on 9+ medications per day than the control group (46.09 versus 36.67%)•The clinicians found it very difficult to organise the MDT medication reviews due to travel and time availability

ImplicationsImplications• High rurality• Geriatrician time

– A different model required– Use of IT

• Medication review– A different model required

• Upskilling of RNs– Peer review– Shared learning

• Buy-in from GP• Organisational culture

Contact details

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021 532 980

09 373 7599 Ext 83935

09 367 7158