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:
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:
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.
What do providers have to record and report?
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:
What data do providers have to collect?
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.
The Medication Management QI covers two issues:
Both have complex requirements so we will deal with them separately.
What do providers have to record and report?
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:
Different dosages of the same medicine must not be counted as different medications.” (Program Manual, p. 32).
What data do providers have to collect?
When and how to review data about polypharmacy
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.
What do providers have to record and report?
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?
When and how to review data about antipsychotic medication
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.
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 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.