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 (Program Manual).

In last week’s article we looked at what the Department of Health’s updated guidance tells us about the new QIs (falls, medication management). Today we look at how the existing three QIs (pressure injuries, use of physical restraint and unplanned weight loss) will function under the new system.

Major Changes Will Be Made to the Three Existing QIs

It is vital to recognise that even though the updated QIs use the same terminology, (pressure injuries, use of physical restraint and unplanned weight loss), from 1 July 2021 the definitions and requirements will be different. You cannot rely on the same old reporting systems and processes to meet these new requirements.

Overview

• Residential aged care providers must gather data on all five QIs, starting in the period 1 July 2021 to 30 September 2021.
• The definition of “physical restraint” has been broadened to include any restrictive practice except chemical restraint. This means that the QI for physical restraint now includes physical restraint, mechanical restraint, environmental restraint and seclusion. These forms of restraint are defined in the upcoming new version of the Quality of Care Principles which is due to commence 1 July 2021.
• Providers must submit data for the July-September quarter via the My Aged Care portal in October 2021.
• As at 28 June 2021, the Department of Health is yet to release Part B of its Program Manual guidance.
• Further guidance and data reporting templates are available on the Department of Health website.

Pressure Injuries

What do providers have to record and report?

• Percentage of care recipients with one or more pressure injuries
• Percentage of care recipients with one or more pressure injuries reported against each of the six pressure injury stages:
  • Stage 1 Pressure Injury
  • Stage 2 Pressure Injury
  • Stage 3 Pressure Injury
  • Stage 4 Pressure Injury
  • Unstageable Pressure Injury
  • Suspected Deep Tissue Injury

What is a pressure injury?

“A pressure injury is a localised injury to the skin and/or underlying tissue, usually over a bony prominence,

as a result of pressure, shear, or a combination of these factors.” (Program Manual, p. 11).

See the Program Manual page 11 for definitions of each of the six stages of pressure injury.

When and how to collect and review data about pressure injuries

The Program Manual advises that you should follow these nine steps:

• 1. Identify a date once every quarter to assess each care recipient residing at the service for pressure injuries, this assessment should be on or around the same time each quarter.
• 2. Inform care recipients about the proposed observation assessment and ensure consent is sought from each care recipient before the assessment can take place.
• 3. Record the care recipients excluded because they withheld consent.
• 4. Record the care recipients excluded because they were absent from the service for the entire quarter.
• 5. Conduct a full-body observation assessment of each care recipient residing at the service during the quarter.
• 6. Record each care recipient with one or more pressure injuries. (Note: The care recipient may have more than one pressure injury. In this case all pressure injuries must be assessed. All instances of pressure injuries must be recorded at this Step, irrespective of where they were acquired).
• 7. Record each care recipient with one or more pressure injuries against each of the six stages under the ICD-10-AM (2019) pressure injury classification system.
• 8. Record each care recipient with one or more pressure injuries acquired outside of the service during the quarter.
• 9. Record each care recipient with one or more pressure injuries that were acquired outside of the service during the quarter against each of the six stages under the ICD-10-AM (2019) pressure injury classification system.

Use of Physical Restraint

What do providers have to record and report?

• Percentage of care recipients who were physically restrained.
  
  

What is physical restraint?

“For the purposes of the QI Program, physical restraint includes all forms of restrictive practice, excluding chemical restraint.” (Program Manual, p. 16).

This means that the QI for physical restraint now includes physical restraint, mechanical restraint, environmental restraint and seclusion.

These forms of restraint are defined in the upcoming new version of the Quality of Care Principles (due 1 July 2021) as follows:

Mechanical restraint is a practice or intervention that is, or that involves, the use of a device to prevent, restrict or subdue a care recipient’s movement for the primary purpose of influencing the care recipient’s behaviour, but does not include the use of a device for therapeutic or nonbehavioural purposes in relation to the care recipient.

Physical restraint is a practice or intervention that:

1. is or involves the use of physical force to prevent, restrict or subdue movement of a care recipient’s body, or part of a care recipient’s body, for the primary purpose of influencing the care recipient’s behaviour; but
2. does not include the use of a hands-on technique in a reflexive way to guide or redirect the care recipient away from potential harm or injury if it is consistent with what could reasonably be considered to be the exercise of care towards the care recipient.
   
   

Environmental restraint is a practice or intervention that restricts, or that involves restricting, a care recipient’s free access to all parts of the care recipient’s environment (including items and activities) for the primary purpose of influencing the care recipient’s behaviour.

Seclusion is a practice or intervention that is, or that involves, the solitary confinement of a care recipient in a room or a physical space at any hour of the day or night where:

1. voluntary exit is prevented or not facilitated; or
2. it is implied that voluntary exit is not permitted;

for the primary purpose of influencing the care recipient’s behaviour.

When and how to review data about physical restraint

The Program Manual advises that you should follow these six steps:

1. Identify and record a collection date, which is to take place during each quarter. The date must be varied and unpredictable to staff directly involved in care. The assessment period will include the selected collection date and the two days before – this must be the same three days for all care recipients at the service.
2. Record the care recipients whose records are assessed for physical restraint.
3. Record the care recipients who were absent from the service for the entire three-day assessment period.
4. Review care recipient records and assess whether each care recipient was physically restrained on any occasion over the three-day assessment period. (Note: Physical restraint must be recorded, even if a care recipient or their representative have provided consent to the use of the restraint.)
5. Record whether each care recipient was physically restrained (once or more and including the use of secure areas) on any occasion during the three-day assessment period.
6. Of the care recipients physically restrained during the three-day assessment period recorded in Step 5 above, record whether the physical restraint was exclusively through the use of a secure area.

Unplanned Weight Loss

Providers must report on two forms of unplanned weight loss:

• Unplanned weight loss – significant
• Unplanned weight loss – consecutive

Unplanned Weight Loss - Significant

What do providers have to record and report?

• Percentage of care recipients who experienced significant unplanned weight loss (5% or more).

What is significant unplanned weight loss?

“Significant unplanned weight loss is weight loss equal to or greater than 5% over a three month period.” (Program Manual, p. 19).

When and how to review data about significant unplanned weight loss

The Program Manual advises that you should follow these six steps:

1. Using your service’s weight records, identify each care recipient’s finishing weight from the previous quarter.
2. In the final month of the current quarter, collect and record the finishing weight for each care recipient residing at the service, using a calibrated scale.
3. Record the care recipients who withheld consent to be weighed on the finishing weight collection date.
4. Record the care recipients who were not weighed because they are receiving end-of-life care.
5. Record the care recipients who were not assessed for significant unplanned weight loss because they did not have the required weight records. Include comments as to why the weight recording/s are absent (e.g. the care recipient was hospitalised).
6. For each care recipient who provided their consent, compare their finishing weight from the current quarter with their finishing weight from the previous quarter and calculate the percentage of weight loss (formula provided at p 21 of the Program Manual).

Unplanned Weight Loss – Consecutive

What do providers have to record and report?

• Percentage of care recipients who experienced consecutive unplanned weight loss.

What is consecutive unplanned weight loss?

“Consecutive unplanned weight loss is weight loss of any amount every month over three consecutive months of the quarter.” (Program Manual, p. 23).

When and how to review data about consecutive unplanned weight loss

The Program Manual advises that you should follow these eight steps:

1. Using your service’s weight records, identify each care recipient’s finishing weight from the previous quarter.
2. In the first month of the quarter, collect and record the starting weight of each care recipient residing at the service, using a calibrated scale.
3. In the second month of the quarter, collect and record the middle weight of each care recipient residing at the service, using a calibrated scale.
4. In the third and final month of the quarter, collect and record the finishing weight for each care recipient residing at the service, using a calibrated scale.
5. Record the care recipients who withheld consent to be weighed at the starting, middle and/or finishing weight collection dates.
6. Record the care recipients who were not weighed because they are receiving end-of-life care.
7. Record the care recipients who were not assessed for consecutive unplanned weight loss because they did not have a previous, starting, middle and/or finishing weight record/s. Include comments as to why the weight recording/s are absent (e.g. the care recipient entered the service during the quarter).
8. For each care recipient compare the starting, middle, and finishing weights to determine if there has been weight loss in every month over three consecutive months of the quarter.

How to submit data

Submit via the My Aged Care provider portal. Further guidance and data reporting templates are available on the Department of Health website.

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.