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

1. Quality & Safety Challenge 2012:Quality Enhancement in Residential Aged Care John Parsons PhD NZRP Senior Lecturer Applied Ageing Research Group, School of Nursing The University of Auckland

2. Older people in Waikato DHB Methods Findings Implications

3. Older people in Waikato DHB Methods Findings Implications

4. Older people in Waikato DHB

5. Older people in Waikato DHB Methods Findings Implications

6. Study objectives • Reduction in Emergency Department presentation from older people living in residential care • An increase in staff satisfaction • Implementation of a Residential Aged Care Benchmarking programme • Implementation of a targeted Residential Aged Care education programme

7. 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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12. Older people in Waikato DHB Methods Findings Implications

13. Presentations to ED - 2011

14. Presentations to ED - 2011-2012

15. Presentations to ED - 2012

16. 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)

17. Other findings Pressure 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

18. Other findings Urinary 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 study Medication 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

19. Older people in Waikato DHB Methods Findings Implications

20. Implications • 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

21. Contact details John Parsons PhD NZRP Senior Lecturer, The Applied Ageing Research Group, School of Nursing Faculty of Medical and Health Sciences The University of Auckland 09 367 7158 021 532 980 09 373 7599 Ext 83935 j.parsons@auckland.ac.nz http://www.fmhs.auckland.ac.nz/son/aarg/default.aspx