hqsc powerpoint blank slides · dhb aim statements . region district health board specific aim (as...

National picture

Prem Kumar Quality improvement advisor, Health Quality & Safety Commission

Safe use of opioids national collaborative learning session two

Breakout session – theory of change

• Must have at least one type of alcohol, garnish, fruit, juice, Ice and glass

• Cocktail must have at least 10 ingredients • 7 min to form the cocktail • Name your cocktail • Teams to feedback their ingredient • Judges will award the most healthy cocktail

Aim: To form a cocktail that is as healthy as possible

DHB harm areas Region District health board Primary harm Secondary harm Tertiary harmCentral MidCentral ConstipationCentral Hawke's Bay ConstipationCentral Capital & Coast ConstipationMidland Waikato ConstipationMidland Bay of Plenty ConstipationMidland Lakes ConstipationMidland Taranaki Constipation Discharge Oxycodone use

Northern Counties Manukau ConstipationSouth Island West Coast ConstipationSouth Island Nelson Marlborough ConstipationCentral Whanganui ConstipationSouth Island Southern Nausea & vomitingMidland Tairawhiti Reduce opioid related harmNorthern Auckland Reduce opioid related harm Discharge

Northern Northland Respiratory depression Constipation Discharge

South Island South Canterbury Respiratory depressionNorthern Mercy Ascot Respiratory depressionNorthern Waitemata Uncontrolled pain Patient experience

South Island Canterbury Uncontrolled painCentral Wairarapa To be confirmedCentral Hutt Valley To be confirmed

DHB aim statements

Region District health board Specific aim (as per project charter)Central MidCentral MidCentral DHB will reduce opioid related constipation by 50% from baseline in Star 2 by December 2015

Central Whanganui Whanganui DHB will reduce opioid related constipation by 50% from baseline in the Surgical ward and Critical Care Unit by December 2015

Central Hawke's Bay To improve the experience of patients admitted to the orthopaedic ward (B3) and who are prescribed an opioid analgesic by reducing constipation by 50% by 29th January 2016 (nine months)

Central Capital & Coast We aim to reduce constipation (harm) associated with opioid use by 25% by June 2016

Central Wairarapa &Hutt Valley

Pending

Midland Waikato To reduce opioid induced constipation by 25% on the pilot wards by June 2016

Midland Bay of Plenty By December 2015 we aim to reduce the occurrence of constipation in patient’s receiving opiate medication within the two pilot wards at Tauranga and Whakatane Hospitals by 25%

Midland Lakes To reduce the incidence of constipation related to opioid use in orthopaedic inpatients by 50% by June 2016

Midland Tairawhiti Reduce preventable opioid related harm by 50%

Midland Taranaki 1. Reduction in constipation (> than or = to 3 days , or enema required) related adverse events caused by opiates, for TDHB orthopaedic patients (Ward 3b) by 25% by June 20162. Restrict the use of oxycodone for TDHB inpatients (excluding hospice and community use) to anaesthetist and pain team only and reduce use by 50% by June 20163. Reduction in patient distress from opioids on discharge by 30% by June 2016

Northern Mercy Ascot (private hospital)

Mercy Ascot aims to reduce the harm related to opioid use by 25% in the participating areas of the hospital by June 2016, specifically: Respiratory depression and over sedation

Northern Counties Manukau We aim to reduce the rate of opioid-induced constipation in adult elective surgical inpatients at MSC 1 & MSC 2 by 30% (from x to y) by June 2016

Northern Northland

1. Reduce respiratory depression events occurring in Whangarei hospital. Increasing the time between respiratory depression events from occurring on an average of every 7 days to greater than 60 days by 1st of May 20162. To reduce constipation related to opioids requiring admission or readmission by 50% by May 2016.3. To reduce the number of surgical patients discharged from hospital requiring long term (> 6 weeks) strong opioids

Northern Waitemata 1. To reduce harm of uncontrolled pain by 25% by June 20162.To improve patient experience of pain management by 25% by June 2016

Northern Auckland To reduce opioid related adverse events experienced by patients discharged on opioids from the Orthopaedic wards by 50% by December 2015

South Island West Coast The aim of this project is to reduce the harm associated with opioid induced constipation for all inpatient surgical patients by ≥ 25% by the end of March 2016. Constipation being defined as having no bowel motion for 3- consecutive days

South Island Southern We aim to reduce the harm (nausea, vomiting) in orthopaedic patients by 25% by June 2016

South Island South Canterbury We aim to reduce respiratory depression / over sedation / narcosis from the administration of strong opioids (Morphine, OxyContin, Fentanyl and Methadone) by 25% in the surgical ward by June 2016

South Island Canterbury CDHB aim to reduce the incidence of uncontrolled acute pain (pain score > 3/5) by 25% in the setting of general surgery inpatients by March 2016

South Island Nelson Marlborough That 80% of patients undergoing surgical interventions who are prescribed an opioid as part of this episode and are in-patients for 72 hours or more will have a bowel motion every 48 hours by March 2016 whilst an inpatient

DHB pilot areas

DHB Pilot area Ward Patient typeMidCentral Rehab Star 2 ward Patients taking opioid medications during admission

Whanganui Surgical Surgical ward and Critical Care Unit ERAS orthopaedic patients (possible change in focus)

Hawke's Bay Surgical Orthopaedic ward (B3) 25 bed Orthopaedic patients undergoing any orthopaedic procedure with a length of stay (LOS) greater than 24 hours, elective and acute

Wairarapa PendingHutt Valley PendingCapital & Coast Surgical 6 North Ward Orthopaedic surgical patients

Waikato SurgicalGeneral surgery-M2Orthopaedics M6 and 16 General surgical patients

Bay of Plenty SurgicalWhakatane Surgical ward (22 beds)Tauranga Orthopaedic ward (39 beds) Inpatient admission of >36 hours

Lakes Surgical Orthopaedic Unit Acute and elective

Tairawhiti Surgical Surgical Ward Surgical patients

Taranaki Surgical Ward 3b-Orthopaedics Orthopaedic patients

Counties Manuaku Surgical MSC 1 & MSC 2 Adult patients having elective orthopaedic, general surgical and gynaecological procedures

Northland Surgical Surgical Ward General surgical

Waitemata Surgical Ward 4 General surgical, gynaecology and urology patients

Auckland Surgical Orthopaedic Ward (75 and 77) Patients discharged on opioids from pilot area

Mercy Ascot Surgical Cardiothoracic, Orthopaedics ward Surgical inpatients

West Coast Surgical/OT Barclay ward All surgical patients admitted to Barclay ward

Southern Surgical Orthopaedic admission to 3b or 3c Orthopaedic patients

South Canterbury Surgical Surgical Ward All surgical inpatients (possible change in focus)

Canterbury Surgical General Surgical Wards Adult general surgery patients first 24 hours of stay

Nelson Marlborough Surgical Surgical WardsPatients who have undergone a surgical intervention and are an in-patient for >72 hours (possible change in focus)

We aim to reduce

the harm related to opioid use nationally by 25% in

all the participating areas of District

Health Board

hospitals by April 2016

Constipation

Respiratory Depression

& Over Sedation

Primary Drivers Secondary Driver Tertiary Driver Change Ideas

Safe use of opioids collaborative national driver Diagram

Uncontrolled pain

Nausea & Vomiting

Prescribing

Monitoring

Opioid usage

Knowledge & Awareness

Patient management

Co-prescribing & co-administration of laxatives

Daily bowel monitoring

Documentation

• Patient information leaflet

• Laxative sticker

• Algorithms for constipation management

• ‘Bowel’ champions in ward

• Use of stool charts for all patients M6/16

• Use observation charts

• Prunes on breakfast tray Mobility

• Patient information poster

• SMO grand round talks

• HO/RMO training on opioid

• Monthly reports to management

• Constipation flow chart

• Daily patient assessment

• Poster in toilet

Staff education

Patients/ Whanau

Administration

Other medicines

Diet

Other practice

Knowledge & Awareness

• Central pain management resource

Communication

Variation in IV dosing

• Patient pain management plan

• Patient pain management plan

Prescribing

Administration

• Update to Medchart to automatically co-prescribe

• assessment of patients in preop

• Education to prescribers

• Education in annual competency processes

• Patient stories

Prescribing

Monitoring / Evaluation

Escalation of patient care

Anaesthetist “buy in”

Communication / Education

• Develop escalation process • Involvement of MDT • Pain team involvement

• Automated naloxone prescribing

DHBMeasure

Type of measure

Operational definition Data Source(s) What Where How When Who

DHBName of measure

(Outcome, Process, Balancing)

Formula, definition of words used in measure

What is the source of data?

(GTT, Audit)What are we going to collect?

Area of data collection?

How will the data be collected?

When will the data be collected,

frequency?Who will collect the data?

LakesThe % of patients who receive prophylactic Kiwicrush or medicated laxatives who suffer from diarrhoea.

Balancing

Numerator : Number of patients who experience diarrhoea and received laxatives/kiwicrushDenominator : Patients who received laxatives/kiwicrush

Audit/patient interview

5 patients (LOS ≥3 days) reviewed per week (may be collated into fortnightly subgroups)

Orthopaedic Unit Manual audit/ interview Weekly

Weekly roster. Data collection to be shared by Charlotte, Ulrike, Maria & Kharen

LakesThe % of patients who receive appropriate pain relief with pain scores on movement <5. Balancing

Detail to be confirmedUsing 1-10 pain scale Patient interview


Orthopaedic Unit Patient interview Weekly


Lakes

The % of patients who experience drowsiness (balance measure due to potential additive sedating effect of cyclizine if w e promote it over ondansetron) Balancing

Drowsiness = Patient reports being sleepier than usual for them. Patient interview


Orthopaedic Unit Patient interview Weekly


West coast

% of patients that are given 2 or more antiemetics Balancing Audit

Numerator: Number of patients who have received 2 or more antiemetics within 30 minutes of each other. Demoniator: Number of patients in subgroup

Barlcay ward Audit of medication chart

5 patients every weeek

Members of the opioid collaborative team namely Steph, Rosalie, David or Paul

West coast

% of patients who are administered prophylactic laxsol who suffer from diarrhoea Balancing

Numerator: Number of patients who experience diarrhoea and received laxsol and opioids in the last 24 hours. Demoniator: Number of patients who received laxsol and opioids. Acceptable words in clinical notes: diarrhoea, overflow, type 6-7 on Bristol Stool chart

Any mention of the following words in clinical notes: diarrhoea, overflow, type 6-7 on Bristol Stool chart

Barlcay ward Audit of clinical notes



West coast % of patients who receive appropriate pain

relief with pain scores <3 on movement Balancing Pain score of 1-5 will be used

Interview or take higest pain score from last 24 hours off obs form? ??

Barlcay ward

Audit of obs chart or interview of patient



Mid central Median pain score patients who are

prescribed regular opioids . Balancing Most recent pain score over 5 on movement Audit - observation charMost recent pain score on observation chart. Star 2 Manual Audit Fortnightly

Members of opioid collaborative group and Palliative care team members on the Bowel Interest Group

Mid central

% of patients who are prescribed regular opioids that have diarrhoea Balancing

Numerator - count of patients with diarrhoea who are co-prescribed regular opioids and regular laxatives. Denominator - count of patients prescribed regular opioids. Note: Crude measure, words accepted; diarrhoea, overflow, type 6-7 Bristol Stool Scale

Audit - medication charts and clinical notes

Mention of diarrhoea, overflow, type 6-7 bristol stool scale in clinical notes section of patient file. Star 2 Manual Audit Fortnightly


WaikatoDiarrhoea secondary to laxatives

Balancing

bowel activity that is more frequent than once a day and abnormal for that patient and has followed administration of one or more doses of laxative

clinical records evidence that bowel activity has been recorded as being diarrhoea following administration of laxatives

ward 2 not sure - to be decided to be decided allocated staff on ward 2

Waikato

Serious events relating to opioid use and constipation

Balancing

Serious event where patient harm has resulted following opioid related constipation either during inpatient stay or following dishcarge home (time frame)

Serious events logged on incident data base

evidence of patient harm that is directly attributable to constipation following surgery and the administration of opioids

ward 2 and 12

from QPS database quarterly QPS

BOPPatients receive inappropriate laxative administration resulting in diarrhoea Balancing

Numerator = no. of patients with documented loose bowel motions; Denominator = the no. of patients on opioids who have received a laxative for BNO>3 days EWS Chart or Bowel cha

Number of patients with diarrhoea or loose bowel motions

Whk surgical ward &Tga Orthopaedic ward

Retrospective audit of patient health records

weekly,5 records each site Lois,Adele, Sandra,Vicky, Karen

BOPPatient is aware of risk of constipation with use of opioid medications. Balancing

Patient mentions constipation as being a risk while receiving opioid medications Patient survey

Numbers of patients with knowledge of Opioid side effects

Whk surgical ward &Tga Orthopaedic ward Patient survey Lois,Adele, Sandra,Vicky, Karen

Counties

% of patients co-prescribed laxatives who develop diarrhoea

Balancing

Numerator: Number of patients co-prescribed laxatives who develop diarrhoeaDenominator: Total number of patients co-prescribed laxatives Diarrhoea = frequent, loose bowel motions identified as Type 5 - 7 on Bristol Stool Chart

Audit 8 patients reviewed per week MSC 1 & MSC 2

Manual audit Weekly MSC 1 & MSC 2 staff

Waikato

Readmission rates due to constipation for whole organisation and for wards 2/12

Balancing

patients readmitted due to constipation following surgery within 7 days of discharge from hospital

iPM data electronic data demonstrating evidence of admission with the diagnosis of constipation following surgical intervention

Business Analysis

electronic data requested 10.4.2015 to be repeated in 12 months time

Allocated BA

Waikato

Constipation rate Outcome

Constipation is defined as no bowel activity >3 days clinical records evidence of bowel activity documented according to definition of constipation

ward 2 and wards 6/16

from Charge Nurse KPI process

5 sets of clinical records on a weekly basis

Charge Nurse Manager or designate

Mid central

% of patients identified with constipation who are prescribed regular opioids. Outcome

Numerator - count of patients who are prescribed regular opioids who have constipation identified. Denominator - count of patients prescribed regular opioids. Constipation ≥ 3 days since bowels last opened

Audit - medication charts and clinical notes

Days since bowels last opened, in the clinical notes section of patient file. Star 2 Manual Audit Fortnightly


Hawke's Bay

% of patients receiving opioids who experience constipation during their admiss ion

Constipation = BNO ≥ 3 days Outcome

Numerator: Number of patient who experience constipation

Demoninator: Number of the patient in the audit cohort

Audit of hea l th records Basel ine: 15 pateients per week x 4 (n=60) 24 hours o r le s s

>24 to 48 hours

>48 to 72 hours

> 72 hours

No t re co rde d

Orthopaedics ; B3

Manual data capture Weekly16/04/15 to 14/04/15

LauraSal ly

BOPNumber of constipated patients numerator/denominator Outcome

Numerator = no. of patients with BNO>3 days; Denominator = no. of patients who are receiving opioid medications Audit health records

% patients with evidence of constipation



weekly,5 records each site Lois,Adele, Sandra,Vicky,Karen

BOPPatient identifies they have received advice on constipation avoidance Outcome

Patient describes at least one action that they can take to avoid constipation. E.g. increase fluid intake, add frui t or fibre to diet Patient survey

Numbers of patients educated on prevention of constipation.

Whk surgical ward &Tga Orthopaedic ward Patient survey Lois,Adele, Sandra,Vicky, Karen

Lakes % of patients receiving opioids who experience constipation during their admission Outcome

Numerator: Number of patients who experience constipationDenominator: Number of patients in subgroupConstipation = BNO ≥3 days





Counties

Rate of opioid-induced constipation in adult elective surgical patients (LOS >24 hrs) at MSC 1 and MSC 2 Outcome

Numerator: Number of patients who develop opioid-induced constipationDenominator: Total number of audited / interviewed patients prescribed opioids Constipation = BNO ≥3 days

1) ADE TT 2) Patient interview 48 hours post-discharge

1) 20 patients reviewed per month using ADE TT methodology 2) Interview data post-discharge

MSC 1 & MSC 2

1) ADE TT methodology used to evaluate 20 patients 2) Telephonic interview

1) Monthly ADE TT 2) Phone call to patients 48 hours post-discharge

1) Anne B to randomly select NHIs for Ashika to process using ADE TT methodology 2) Jo and Shamim - post-discharge telephonic interview

West coast

% of patients receiving opioids who experience constipation during or immeditely post discharge Outcome

Numerator: Number of patients who experience constipation. Denominator: Number of patients on opioids. Immediately post discharge refers to discharge from Barclay ward during the last 4 days.Constipation = BNO ≥3 days

Audit or interview of patients

Whether on interviewing the patient if they have had a bowel movement in the last 3 days.

Barlcay ward

Interview or auditof patient notes/obs chart



NelsonRate of opioid-induced constipation in adult elective surgical patients (LOS >72 hrs) Outcome

Numerator: Number of patients who develop opioid-induced constipationDenominator: Total number of audited / interviewed patients prescribed opioids Constipation = BNO ≥3 days

1) Patient interview 48 hours post-discharge

1) Interview data post-discharge Nn WD9 WR IPU

1) Telephone interview 1) Phone call to patients 48 hours post-discharge

1) Lynne B/ Lisa L to randomly select NHIs for Peter and Wendy - post-discharge telephone interview

Lakes Rate of patient reported opioid related harms per 100 patients in the target group. Outcome

Numerator: Total opioid related harms in subgroupDenominator: Number patients in subgroupAll harms included in this measure





Waikato

Knowledge survey PGY1

Process

Written survey to measure the level of knowledge relating to opioid prescribing for junior doctors in the first year following graduation

questionnaire / audit responses to a set of questions that will inform targeted education

PGY1 staff at a teaching session 1: at the start of the PGY1 run. 2: pre teaching session. 3: immediately post teaching session. 4: End of PGY1 year

Medical Education officer

Waikato

Teaching sessions PGY1 - 75% PGY1 doctors will attend planned opioid teaching sessions

Process

teaching sessions targeted at opioid use and prescribing Medical training officer evidence of practitioner attendance at education sessions

Medical training records

from records at times defined by medical training dept

Medical Education officer

Waikato

Nurses and Doctor knowledge survey - understanding constipation and management of bowel activity

Process

questions designed to measure current knowledge and understanding level of the condition and staff responsibilities in initiating action

paper based questionnaire

information to meausre level of current understanding to then enable targeted education

wards 2, 6 and 16

papre based questionnaire to be completed and analysed

date not decided but as soon as possible

Charge Nurse Manager or designate

Mid central Number of patients who are prescribed

regular opioids. Process

List of agreed regular opioids. Morphine, oxycodone, fentanyl, pethidine, methadone, tramadol, dihydrocodeine, codeine. Audit - medication chart

Number of patients who are prescribed regular opioids as per operational definition. Star 2 Manual Audit Fortnightly


Mid central

% of patients who are co-prescribed regular opioids and regular laxatives Process

Numerator - count of patients on regular opioids co prescribed regular. Denominator - count of patients prescribed regular opioids. List of agreed regular opioids as above and list of agreed regular laxatives. Laxsol, lactulose, movicol, coloxyl, senna, sennosides, biscaodyl. Audit - medication chart

Number of patients who are co-prescribed regular opioids and regular laxatives as per operational definition Star 2 Manual Audit Fortnightly


Mid central

% of patients who are prescribed regular opioids who have bowel function documented in clinical notes Process

Numerator - count of patients who are prescribed regular opioids who have their bowel function documented in the clinical notes. Denominator -count of patients prescribed regular opioids. Audit - clinical notes Last 24 hours of written clinical notes Star 2 Manual Audit Fortnightly


Mid central

% of patients who are prescribed regular opioids who have language 'days since bowels last opened' used in the clinical notes Process

Numerator - count of patients who are prescribed regular opioids the language 'days since bowels last opened' used in clinical notes. Denominator -count of patients prescribed regular opioids. Audit - clinical notes Last 24 hours of written clinical notes Star 2 Manual Audit Fortnightly


Mid central Number of patients who are prescribed PRN

opioids Process

List of agreed regular opioids. Morphine, oxycodone, fentanyl, pethidine, methadone, tramadol, dihydrocodeine, codeine.

Audit - medication chart

Number of patients who are prescribed regular opioids as per operational definition. Star 2 Manual Audit Fortnightly


Hawke's Bay

Which opioids are prescribed?PRN and regular prescription

Process

Morph ine

Fe n ta nyl

Pe th id ine

Oxycodone

Me tha done

Tra ma do l

Dihydrocode ine

Code ine

Audit of heal th records Basel ine: 15 pateients per week x 4 (n=60) Orthopaedics ; B3


LauraSal ly

Hawke's Bay

Which laxatives are prescribed?PRN and regular prescription

Process

La xs o l (docus a te +s e nnos ide )

Bis a codyl

La ctu los e

Movico l

Glyce rine s up

Othe r

__________________ None

Audit of heal th records Basel ine: 15 pateients per week x 4 (n=60) Orthopaedics ; B3


LauraSal ly

Hawke's Bay

When laxative prescribed relative to opioid

Process

Sa me da y / time

De la ye d by ------ da y(s )

from admiss ion NA – la xa tive no t

prescribed

Audit of hea l th records Basel ine: 15 pateients per week x 4 (n=60)

Orthopaedics ; B3


LauraSal ly

Hawke's Bay

Laxative(s) administered

Process

Ye s

No

Re fus e d

Audit of heal th records Basel ine: 15 pateients per week x 4 (n=60)

Orthopaedics ; B3


LauraSal ly

Hawke's Bay

Bowel monitoring - documenatiion of bowel activity

Process

On me d ica l a s s e s s me n t fo rm

On nurs ing a s s e s s me n t fo rm

On obs e rva tion cha rt

On EWS cha rt

On ca re p la n

In clin ica l no te s

No t docume n te d


Orthopaedics ; B3


LauraSal ly

Hawke's Bay

Diarrhoea. Have we over cooked things with the use of laxatives?

Process

Numerator: Number of patient who experience diarrhoea

Demoninator: Number of the patient in the audit cohort

Audit of hea l th records Basel ine: 15 pateients per week x 4 (n=60) Ye s

No

Orthopaedics ; B3


LauraSal ly

Hawke's Bay

Surgery entry

Process

Acu te (th rough ED)

Ele ctive (th rough p re -a d )


Orthopaedics ; B3


LauraSal ly

Hawke's Bay

Recording of bowel activi ty in patients ' hea l th records(To enable the establ i shment of a basel ine constipation rate)

Process

Recorded, every shi ft, us ing the prescribed s tamp, in the margin of the Asessment & Progress , in the pi lot care centre B3

Audit of hea l th records 5 Patients over a week Orthopaedics ; B3

Manual data capture Over one weekInterim auditWed 19/4, Fri 1/5; Mon 4/5Fina l audit Tue 5/5

Sal ly

Hawke's Bay

When prescribed, are laxatives being adminis tered? Process

Future measure Audit of hea l th records Orthopaedics ; B3

Waikato

100% patients on ward 2 will have bowel activity recorded daily

Process

Bowel activity is a bowel action normal for that particular patient

From patient observation chart

evidence that bowel activity has been recorded at least once every day

ward 2 10 observation charts will be randomly selected each day. Audit of bowel activity. Patient audit / interview.

Monday to Friday and where staffing allows, on weekends. Random day selection

Allocated staff member/s and Pain nurses

BOP

Nurses record patient's bowel activity ProcessNumerator = no.of records which include daily bowel status record; Denominator = no. of records audited EWS Chart or Bowel cha

Numbers of patients with Bowel activity recorded minimin 24hrs




BOPNurses identify patient is constipated and initiate treatment Process

Numerator = no. of patients with recorded constipation who have received a laxative; Denominator = total no. of patients with documented constipation EWS Chart or Bowel cha

Number of patients given laxatives at ≥3days BNO




BOP Patients pain is managed using a range of pain relief medications in addition to opioids, e.g. paracetamol, NSAIDS Process

Evidence of more than 1 type of analgesia prescribed and administered Medication chart

Numbers of patients who have alternative pain relief medications (to opioids) prescribed




BOPAll patients who have an opioid prescribed have a prescription for laxative written at the same time to manage potential risk of constipation Process Opioids and laxatives prescribed on the same day Medication chart

Number of patients with concurrent prescribed opioids and laxatives




BOPPatients prescribed opioids at discharge or who have not opened their bowels during admission (LOS<3days) have laxatives prescribed on discharge Process Discharge prescription includes laxative Discharge documents

Numbers of patients with concurrent prescribing of Opioids and laxatives at discharge




Lakes The % patients with bowel monitoring documented once a shift on the EWS

Process

Numerator : Number of patients for whom bowel motions are recordedDenominator : Number of patients in subgroup





LakesThe % of patients for whom there was insufficient information in the notes to determine constipation

Process

Numerator : Number of patients for whom there was insufficient information in the notes to determine constipationDenominator : Number of patients in subgroup





Lakes The % of patients treated with opioids who receive Kiwicrush

ProcessNumerator : Number of patients who receive KiwicrushDenominator : Number of patients in subgroup





Lakes The % of patients receiving prophylactic laxatives Process

Numerator : Number of patients who receive prophylactic medicated laxativesDenominator : Number of patients in subgroup





Counties

% of patients co-prescribed laxatives with opioids 1) In hospital 2) At discharge

Process

Numerator: Number of patients co-prescribed laxativesDenominator: Total number of audited patients prescribed opioids



Counties

% of patients administered =/> 1 dose of co-prescribed laxatives

Process

Numerator: Number of audited patients administered =/>1 dose of co-prescribed laxativeDenominator: Total number of audited patients co-prescribed laxatives



Counties

% of patients receiving printed low literacy education about opioid-induced constipation

Process

Numerator: Number of patients prescribed opioids receiving educationDenominator: Total number of audited patients prescribed opioids



West coast

% of patients treated with opioids who are administered laxsol regularly Process

Numerator: Number of patients who are administered laxsol reguarly. Denominator: Number of patients on opioids. Regularly refers to Laxsol being prescribed on the regular page of the medication chart and being administered at all times Audit




West coast

% of patients treated with opioids who are prescribed laxsol regularly Process

Numerator: Number of patients who are presribed laxsol reguarly. Denominator: Number of patients on opioids. Regularly means prescribed on the regular page of the medication chart in line with WCDHB guidelines Audit




West coast # of patients who are prescribed regular

opioids Process

Can include patients who have been prescribed regular AND PRN opioids. Opioids to include all forms of morphine, oxycodone, pethidine, codeine tramadol, dihydrocodeine Audit

Number of patients who are prescribed regular opioids as per operational definition.




West coast

# of patients who are prescribed ONLY PRN opioids and have had PRN opiods administered in the last 24 hours. Process

Patient to not have been prescribed any regular opioid. Opioids to include all forms of morphine, oxycodone, pethidine, codeine tramadol, dihydrocodeine Audit

Number of patients who are prescribed ONLY PRN opioids and have had at least one PRN opiod administered in the last 24 hours.




West coast

% of patients who have had bowel movements recorded on the obs chart at each shift (am, pm and nocte) Process

At each shift the nursing staff must indicate on bowel charts of bowels have opened or have not opened during their shift. You can not check any other areas for mention of bowels opening or not. Audit

Number of patients that on each shift have had recorded whether bowels were open or bowels were not open

Barlcay ward Audit of obs chart



West coast

% of patients that leave theatre with concurrently prescribed opioids and regular laxsol Process

Patient may have both medications prescribed up to anytime before the patient leaves recovery Audit

Numerator: Number of patients leaving Recovery with opioids and regualr Laxsol prescribed. Demoniator: Number of patients leaving Recovery in subgroup

To be undertaken in recovery for patients transfering to Barlcay ward

Audit of medication chart in Recovery

All surgical ward inpatients that meet inclusion criteria for a week each month

Will will have oversight of Recovery staff

Nelson% of patients charts that provide data for safer opiates collobarative data collection 2 and 3 Process

Numerator : Number of patients charts audited. Denominator: Total number of charts with all measures complete.

Audit 3 sets of notes Wd 9 Manual Audit Once Peter T

Nelson

% of patients co-prescribed laxatives with opioids 1) In hospital 2) At discharge

Process

Numerator: Number of patients co-prescribed laxativesDenominator: Total number of audited patients prescribed opioids

Audit 8 patients reviewed per week Nn WD9 WR IPU

Manual audit Weekly NNwd9 and Wr IPU staff

Nelson

% of patients administered =/> 1 dose of co-prescribed laxatives

Process

Numerator: Number of audited patients administered =/>1 dose of co-prescribed laxativeDenominator: Total number of audited patients co-prescribed laxatives

Audit 8 patients reviewed per week Nn WD9 WR IPU

Manual audit Weekly NNwd9 and Wr IPU staff

Constipation Respiratory depression

Uncontrolled pain

Measures compiled

Safe use of opioids national collaborative dashboard structure

L1

L2

L3

L4

National dashboards

Dashboard upload date:15th of every month

Outcome measure Harm graph

Please paste your primary harm graph here Balancing measure Process measure

Process measure Process measure Process measure

Process measure Process measure PDSA level measure

Safe use of opioids national collaborative Monthly dashboard for: July


L1

L2

L3

L4

National dashboards

Safe use of opioids collaborative national dashboard - harm by district health board

Bay of Plenty

Northland

Waikato

South Canterbury

West Coast

Southern

Canterbury

Lakes

Auckland

Nelson Capital & Coast

Hutt & Wairarapa

Taranaki

Waitemata Tairawhiti

Hawke’s Bay

Whanganui

MidCentral

Counties Manukau

Data related to process

measures received. Outcome (harm) data

pending

Mercy Ascot

Data related to process

measures received. Outcome (harm) data

pending

Pending

Pending


L1

L2

L3

L4

National dashboards

Safe use of opioids collaborative national dashboard – Constipation interventions

Bay of Plenty Waikato West Coast Lakes

Nelson Capital & Coast Taranaki Hawke’s Bay

MidCentral

Counties Manukau

Nelson

Bay of Plenty Waikato West Coast Lakes MidCentral

Capital & Coast Taranaki Hawke’s Bay Counties Manukau

Pending

Pending

Data received. Further analysis required



Documentation of bowel activity

Co-prescribing of laxative


L1

L2

L3

L4

National dashboards

Safe use of opioids collaborative national dashboard – constipation

Overall Harm Prescribing

Uncontrolled pain

Safe use of opioids collaborative national dashboard (20 DHBs)

Overall Harm Constipation

Respiratory depression

Nausea & vomiting

Uncontrolled pain

Delirium Patient experience

Other

Falls

Harm compiled

hqsc powerpoint blank slides · dhb aim statements . region district health board specific aim (as...

Documents