The National Aged Care Mandatory Quality Indicator Program started on 1 July 2019. The program required every residential aged care home to collect data on these three issues and report that data to the Department of Health every three months:
- pressure injuries
- use of physical restraint
- unplanned weight loss.
From July 2021, the definitions and processes for the existing three indicators will be substantially changed and there will be two additional quality indicators (QIs) that providers will have to report on:
- falls and major injury
- medication management.
The Department of Health has released this guidance ahead of the commencement of the new QIs: National Aged Care Mandatory Quality Indicator Program Manual – 2.0 – Part A – Final draft (Program Manual).
Today we look at what the Department of Health’s updated guidance tells us about the new QIs. Next week we will explore the changes to the existing three QIs.
Overview of Latest Updates on the new Mandatory QIs
- Two new QIs will be added to the existing three. These are: falls and major injury, medication management
- Definitions and processes for the existing three QIs will substantially changed
- Residential aged care providers must gather data on all five QIs, starting in the period 1 July 2021 to 30 September 2021
- Providers must submit data for the July-September quarter via the My Aged Care portal in October 2021
- As at 22 June 2021, the processes for reporting via the My Aged Care portal are unclear – we do not yet know precisely which items of data providers will have to report or in what form (e.g., numbers and/ or percentages)
- As at 22 June 2021, the Department of Health is yet to release Part B of its Program Manual guidance
Falls and major injury
What do providers have to record and report?
- Percentage of care recipients who experienced one or more falls.
- Percentage of care recipients who experienced one or more falls resulting in major injury.
What do providers not have to record or report?
“Falls resulting in major injury that occurred while the care recipient was away from the service and not under direct supervision of service staff are not included.” (Program Manual, p. 29).
What is a fall?
“An event that results in a person coming to rest inadvertently on the ground or floor or other lower level.” (Program Manual, p. 29).
What is a “fall resulting in major injury”?
“A fall resulting in major injury is a fall that meets the definition above and results in one or more of the following:
- Bone fractures
- Joint dislocations
- Closed head injuries with altered consciousness; and/or
- Subdural haematoma.” (Program Manual, p. 29).
What data do providers have to collect?
- Number of care recipients whose records were assessed for falls and major injury (this should be every care recipient who resided at your service for part or all of the quarter)
- Number of care recipients excluded because they were absent from the service for the entire quarter (e.g. because they were hospitalised for the whole period)
- Number of care recipients who experienced a fall (one or more) at the service during the quarter
- Number of care recipients who experienced a fall at the service resulting in major injury (one or more), during the quarter
When and how to collect and review data about falls
Obviously you must record falls whenever they happen. But you should not do your full QI data reporting until the quarter has finished so that you can review the whole quarter.
The Department of Health says you must review your records in the period 21 days after the end of the quarter. For the next reporting period this means you must start reviewing your records from 1 October 2021, and complete this process by 21 October 2021.
Do we record “number of falls” or “number of residents who experienced falls”?
The requirement in the Department’s Program Manual is to record the “number of care recipients who experienced a fall (one or more).” This reduces the issue to a Yes/No question (“Did this resident experience one or more falls: Y/N?”) which implies that the Department is only interested in whether or not there was at least one fall per resident. For the purposes of the QI Program, the Department is not interested in whether a particular resident fell one time or five times.
However, for purposes outside of the QIs, providers should record and review the number of falls per resident.
Medication Management
The Medication Management QI covers two issues:
- Polypharmacy
- Antipsychotic medications
Both have complex requirements so we will deal with them separately.
Medication Management – Polypharmacy
What do providers have to record and report?
- Percentage of care recipients who were prescribed nine or more medications (“polypharmacy”).
What is medication?
“For the purposes of the QI Program, medication is defined as a chemical substance given with the intention of preventing, diagnosing, curing, controlling or alleviating disease or otherwise enhancing the physical and/or mental welfare of people. For the purpose of the QI Program, it includes prescription and non-prescription medicines, including complementary health care products, irrespective of the administered route.” (Program Manual, p. 32).
What is polypharmacy?
“For the purposes of the QI Program, polypharmacy is defined as the prescription of nine or more medications to a care recipient.” (Program Manual, p. 32).
What is not counted in the polypharmacy count?
“For the purposes of the QI Program, any medication with an active ingredient is counted in the polypharmacy quality indicator, except for those listed below which must not be included in the count of medications:
- Lotions, creams or ointments used in wound care
- Dietary supplements, including those containing vitamins
- Short-term medications, such as antibiotics or temporary eye drops; and
- PRN medications.
Different dosages of the same medicine must not be counted as different medications.” (Program Manual, p. 32).
What data do providers have to collect?
- Number of care recipients assessed for polypharmacy (this should be every care recipient who was residing at your service on the collection date)
- Number of care recipients who were excluded because they were admitted to hospital on the collection date
- Number of care recipients prescribed nine or more medications
When and how to review data about polypharmacy
- Nominate one day within the quarter as the “collection date”
- Make a list of all care recipients who were admitted to hospital on the collection date and exclude them from your review
- Review the medication charts and/or administration records for all other care recipients as they are on the collection date and list all the care recipients who were prescribed nine or more medications
Do we have to get the whole review done in one day?
No. You can do the review over several days, but all the data must come from the medication charts and/or administration records as they were on the collection date.
What if a care recipient is absent from the service on the collection date?
The Program Manual says that the only residents you can exclude from the review are those who are absent from the service on the collection date because they were admitted to hospital. This implies that if a resident was absent from the service on the collection date for some other reason (e.g. staying with family) you must include them in the review.
Medication Management – Antipsychotics
What do providers have to record and report?
- Percentage of care recipients who received antipsychotic medications.
What is medication?
“For the purposes of the QI Program, medication is defined as a chemical substance given with the intention of preventing, diagnosing, curing, controlling or alleviating disease or otherwise enhancing the physical and/or mental welfare of people. For the purpose of the QI Program, it includes prescription and non-prescription medicines, including complementary health care products, irrespective of the administered route.” (Program Manual, p. 32; 35).
What is psychosis?
“Diagnosed by a medical doctor, psychosis is characterised by symptoms such as delusions, hallucinations, and perceptual disturbances, and by the severe disruption of ordinary behaviours (adapted from the ICD 10 AM, 2017).
Disorders where there may be a diagnosed condition of psychosis include: schizophrenia bipolar disorder, Huntington’s chorea, delusions and hallucinations. End-of-life care recipients may also experience psychosis.” (Program Manual, p. 35).
What is antipsychotic medication?
The Program Manual does not define this term but notes that a “non-exhaustive list of antipsychotic medication is available in Part B of this Manual.” (Program Manual, p. 35). As at 22 June 2021, Part B had not been released.
What data do providers have to collect?
- Number of care recipients assessed for antipsychotic medication (this should be every care recipient who was residing at your service for part or all of the collection period)
- Number of care recipients who were excluded because they were admitted to hospital for the entire seven-day collection period
- Number of care recipients who received antipsychotic medication
- Number of care recipients who received antipsychotic medication for a medically diagnosed condition of psychosis
When and how to review data about antipsychotic medication
- Nominate a collection date during the quarter – between the second week and end of the quarter. The collection date and the six days prior will be the assessment period for which all care recipient medication charts and administration records are reviewed for antipsychotic medications.
- Make a list of all care recipients who were admitted to hospital for the whole seven-day assessment period and exclude them from your review
- Review the medication charts and/or administration records for all other care recipients as they are across the seven-day assessment period. List all care recipients who received an antipsychotic medication. This includes PRN medications.
- Make a list of all care recipients who received an antipsychotic medication and have a medically diagnosed condition of psychosis (based on a review of their medical records)
The collection date must be varied
The Program Manual says: “The collection date must be varied between quarters and must not be identified to, or conducted by, staff directly involved in care.” (Program Manual, p. 35).
What if a care recipient is absent from the service on the collection date?
The Program Manual says that the only residents you can exclude from the review are those who are absent from the service on the collection date because they were admitted to hospital during the whole seven-day assessment period. This implies that if a resident was absent from the service during the collection period for some other reason (e.g. staying with family) you must include them in the review.
How to submit data
Submit via the My Aged Care provider portal. Note: as at 22 June 2021, the processes for reporting via the My Aged Care portal are unclear – we do not yet know precisely which items of data providers will have to report or in what form (e.g., numbers and/ or percentages).
Reporting deadlines
Reporting on the QIs is done quarterly. Residential aged care providers must gather data on all five QIs for the period 1 July 2021 to 30 September 2021. Providers must submit that data via the My Aged Care portal in October 2021.
