whether they would take an intermittent or continuous approach to data collection. Discussions regarding audit frequency, whether frequent feedback to clinicians was required, how analysis would be undertaken and how the future activity would be guided by the results were undertaken prior to data collection. Sample type Whether you are collecting a sample for intermittent or continuous data collection, a key decision is whether to collect a random (probability) or judgement (non-probability) sample. Both types of sampling are appropriate in different circumstances and each has strengths and limitations to consider. Definitions and factors to consider are outlined in Table 2. Table 2: Sample type considerations What is it? Why use it? Considerations Random sampling 18,31,35,36 A process of taking a sample so that each member of the population has an equal chance of selection. This removes bias and allows inferences to be made from the sample to the whole population. Random sampling should be considered if: you need to infer from the sample to the whole population you need assurance the results are representative of the population it is a requirement of key stakeholders. It may be hard to define a population from which to take a random sample given the dynamic nature of health care. A but important patient group could be missed if sampling is left to chance as part of random sampling especially if small samples are chosen. There are different types of random sampling*. Consider seeking statistical advice regarding specific sampling needs. See examples in Box 2. Judgement sampling (also A Consider judgement sampling when is a risk of bias when using
descriptive data it can sometimes be difficult to determine if observed changes are truly due to performance change or are due to chance. Key considerations are described in Table 4 below. 4: Considerations for analysing data What is it? Why use it? Considerations Statistical analysis 16, 36, Intermittent indicator data collection When data have been collected randomly according to a calculated sample size and a valid biostatistical calculation performed, the results can be generalised from the sample to the whole population. Consider statistical analysis if: you need to from the sample to the whole population you need assurance the results are representative of the population it is a requirement of key stakeholders. Statistical advice may be required to determine the correct statistical tests. This is a useful method to consider for overall program evaluation.26 See examples in Box 4. Continuous indicator data collection Statistical process control (SPC) is used to determine if a process is stable or if an intervention has led to improvement or meaningful change. Data are displayed graphically using run or control charts and this is assessed using defined rules. A control chart template has a centre-line (the mean), as well as upper and lower control limits. Figure 4 is an example of a control chart. Considerations as per intermittent indicator data collection. Benefits include: identification of type of variation present – common cause or special cause variation determination if improvements are statistically significant. Effective use of SPC requires training and a commitment to ongoing and repeated data collection and feedback. To be most helpful in assessing processes of care, SPC requires collection of at least 10 data points before the results can be analysed. Subject matter expertise is required to determine if improvements are clinically significant. A resource that may be helpful is the Institute of Healthcare Improvement Improvement Tracker: See examples in Box 4. Table 4 continued overleaf Table 4: Considerations for analysing data (continued) Descriptive analysis Intermittent and continuous indicator data collection Data plotted as a bar or as a line graph provides a descriptive display of results. These methods are widely Consider descriptive analysis if are resource and practical difficulties in statistical analysis This approach can be useful for providing feedback to stakeholders during cycle quality improvement activities. It can be difficult to determine if any
40. Thor J, Lundberg J, Ask J, et al. Application of statistical process control in healthcare improvement: systematic review. Qual Saf Health Care 2007; 16(5): 387-399. 41. Ganley H. Demonstration of analysis and reporting for the NSW Therapeutic Advisory Group. Bounty Brokers Pty Ltd, 2012. 42. Lane S, Weeks A, Scholefield H, et al. Monitoring obstetricians’ performance with statistical process control charts. BJOG 2007; 114(5): 614-618. 43. R. The Science of Improvement on a Whiteboard!. Institute of Healthcare Improvement – Open School, 2014. Indicator summary Indicator summary No. Indicator QUM domain addressed by indicator Page Antithrombotic therapy 1.1 Percentage of hospitalised patients that are assessed for risk of venous thromboembolism Judicious selection 24 1.2 Percentage of hospitalised adult patients that receive venous thromboembolism prophylaxis appropriate to their level of risk Judicious selection Appropriate choice 26 1.3 Percentage of patients prescribed enoxaparin whose dosing schedule is appropriate Safe and effective use 30 1.4 Percentage of patients prescribed hospital initiated warfarin whose loading doses are consistent with a drug and therapeutics committee approved protocol Safe and effective use 32 1.5 Percentage of patients with an INR above 4 whose dosage has been adjusted or reviewed prior to the next warfarin dose Safe and effective use 34 1.6 Percentage of patients with atrial fibrillation that are discharged on oral anticoagulants Judicious selection 36 Antibiotic therapy 2.1 Percentage of patients undergoing specified surgical procedures that receive an appropriate prophylactic antibiotic regimen Appropriate choice Safe and effective use 40 2.2 Percentage of prescriptions for restricted antibiotics that are concordant with drug and therapeutics committee approved criteria Appropriate choice Safe and effective use 44 2.3 Percentage of patients in whom doses of empirical aminoglycoside therapy are continued beyond 48 hours Safe and effective use 48 2.4 Percentage of patients with community acquired pneumonia that are assessed using an appropriate validated objective measure Judicious selection 52
transplantation Insertion of a permanent pacemaker Head, neck and thoracic surgery Procedures involving an incision through oral, pharyngeal or oesophageal mucosa, stapedectomy or similar operations, or the insertion of prosthetic material Neurosurgery Prolonged craniotomy or re-explorations and microsurgery Insertion of prosthetic material Obstetrics and gynaecology Hysterectomy and termination of pregnancy Caesarean section Orthopaedic surgery Prosthetic large joint replacement, other orthopaedic procedures involving insertion of prosthetic or transplant material, and
the history with prescribed medicines medication history with their prescribed inpatient treatment. Check that these match, or that any changes are clinically appropriate. Where there are discrepancies, discuss these with the prescriber and ensure that the reasons for changes to therapy are documented e.g. atenolol ceased prior to surgery. 4. Supply accurate medicines information When patients are transferred between wards, hospitals or to their home or residential care facility, ensure that the person taking over their care is supplied with an accurate and complete list of the patient’s medicines. Ensure that the care provider, patient and/or their carer are also provided with information about any changes that have been made to medicines. Data collection for local use
Denominator = Number of medication orders in sample Limitations and interpretation This indicator does not measure the use of error-prone abbreviations other than those specified. Other error-prone abbreviations should also be avoided. Hospitals may to audit the use of other error-prone abbreviations, symbols or terminology according to locally agreed priorities, for example the use of abbreviated names of medicines. Key definitions abbreviations relevant to this indicator and their acceptable alternatives are outlined below: Error-prone abbreviation Intended meaning Why? What should be used? μg, mcg or ug microgram Mistaken as ‘mg’ microgram, microg U or u unit Mistaken as the numbers ‘0’ or ‘4’, causing a overdose or greater (eg 4U seen as ‘40’ or 4u seen as ‘44’). Mistaken as ‘cc’ so dose as a volume instead of units (eg 4u seen as 4 cc) unit No leading zero before a decimal point (eg .5mg) 0.5mg Mistaken as 5mg if the decimal point is not seen Use zero before a decimal point when the dose is less than a whole unit Trailing zero decimal point (eg 1.0mg) 1mg Mistaken as 10mg if the decimal is not seen Do not use trailing for doses expressed in whole
being a medicine commonly requested by abusers seeking opioids and abused by health professionals. Key definitions Parenteral opioid dosage means ampoules, vials or infusion bags of any opioid medicine for parenteral administration. Data collection for local use Please refer to the section Using the National Quality Use of Medicines Indicators for Australian Hospitals for guidance on sample selection, sample size, measurement frequency and other considerations. Inclusion criteria: Orders or requisitions for parenteral opioids presented to the pharmacy. Exclusion criteria: Supplies of parenteral opioids to hospitals. Recommended data sources: Opioid orders or requisitions and relevant pharmacy records. The data collection tool for QUM Indicator 6.3 assists data collection and indicator calculation. Data collection for comparison This indicator may be suitable for comparison. In this case, definitions, sampling methods and guidelines for audit and reporting need to be agreed in advance in consultation with the coordinating agency. Indicator calculation Numerator = Number of parenteral opioid dosage units that are pethidine Denominator = Total number of parenteral opioid dosage units requisitioned from pharmacy (including pethidine) in sample Limitations and interpretation This indicator does not examine the reason for pethidine utilisation or use of oral pethidine. If there is concern about the results of this indicator, further investigation may be appropriate. It is acknowledged that pethidine may be an appropriate therapy in some specific indications. Nevertheless, the of pethidine to all parenteral opioids should be close to zero. Further information A safety bulletin issued by the Institute for Safe Medication Practices Canada, includes recommendations for improving safety with pethidine (meperidine), is available at This indicator can be used to assist hospitals in meeting the National Safety and Quality Health Service Standard 1 [items 1.2.1, 1.2.2, 1.5.2, 1.6.1, 1.6.2] and Standard 4 [items 4.1.2, 4.2.2, 4.5.1, 4.5.2, 4.11.1].4 References
7 7.4, 7.5 7.4, 7.5 7.4, 7.5 7.4, 7.5 7.4, 7.5 National QUM Indicators National Safety and Quality Health Service Standard items 1.7.2 1.8.1 1.8.2 1.18.1 1.18.2 1.18.3 National QUM Indicators 1 1.1, 1.2, 1.3, 1.4 1.1, 1.5 National QUM Indicators 2 2.1, 2.2, 2.5 2.4 National QUM Indicators 3 3.6 3.2 National QUM Indicators 4 4.2 National QUM Indicators 5 5.1, 5.2 5.4, 5.5, 5.6 5.4, 5.5, 5.6, 5.9 National QUM Indicators 6 6.2 National QUM Indicators 7 7.2, 7.4, 7.5 7.3 7.3 7.3 7.3 Table 2: National QUM Indicators mapped to each action item of the NSQHS Standards (continued) National QUM Indicators National Safety and Quality Health Service Standard items 3.1.1 3.1.2 3.4.1 3.4.2 3.4.3 3.14.1 3.14.3 3.14.4 National QUM Indicators 1 National QUM Indicators 2 2.1, 2.2, 2.3, 2.4, 2.5 2.1, 2.2, 2.5 2.1, 2.2, 2.3, 2.4, 2.5 2.1, 2.2, 2.3, 2.4, 2.5 2.1, 2.2, 2.3, 2.4, 2.5 2.1, 2.2, 2.3, 2.5 2.1, 2.2, 2.3, 2.4, 2.5 2.1, 2.2, 2.3, 2.4, 2.5 National
QUM Indicators 3 National QUM Indicators 4 National QUM Indicators 5 National QUM Indicators 6 National QUM Indicators 7 Table 2: National QUM Indicators mapped to each action item of the NSQHS Standards (continued) National QUM Indicators National Safety and Quality Health Service Standard items 4.1.1 4.1.2 4.2.1 4.2.2 4.3.2 National QUM Indicators 1 1.4 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, National QUM Indicators 2 2.2 2.1, 2.2, 2.3, 2.4, 2.5 2.1, 2.2, 2.3, 2.4, 2.5 2.2 National 3.2, 3.1, 3.1,
QUM Indicators 3 3.3 3.2, 3.3, 3.4, 3.5, 3.6 3.2, 3.3, 3.4, 3.5, 3.6 National QUM Indicators 4 4.1, 4.2 4.1, 4.2 National QUM Indicators 5 5.1, 5.2, 5.3, 5.4, 5.5, 5.7, 5.8, 5.9 5.6 5.1, 5.2, 5.3, 5.4, 5.5, 5.6, 5.7, 5.8, 5.9 National QUM Indicators 6 6.4 6.1, 6.2, 6.3, 6.4 6.1, 6.2, 6.3, 6.4 National QUM Indicators 7 7.1 7.1, 7.2, 7.3, 7.4, 7.5 Table 2: National QUM Indicators mapped to each action item of the NSQHS Standards (continued) National QUM Indicators National Safety and Quality Health Service Standard items 4.3.3 4.4.2 4.5.1 4.5.2 4.6.1 National QUM Indicators 1 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, National QUM Indicators 2.2 2.1, 2.2, 2.3, 2.1, 2.2, 2.3,
Indicators 5 National QUM Indicators 6 6.1 6.1 National QUM Indicators 7 7.2, 7.4, 7.5 Table 2: National QUM Indicators mapped to each action item of the NSQHS Standards (continued) National QUM Indicators National Safety and Quality Health Service Standard items 4.10.6 4.11.1 4.11.2 4.12.1 4.12.2 National QUM Indicators 1 1.1, 1.2, 1.3, 1.5 National QUM Indicators 2 2.3 National QUM Indicators 3 3.5, 3.6 3.1 National QUM Indicators 4 4.1, 4.2 National QUM Indicators 5 5.4 5.3, 5.8, 5.9 5.9 National QUM Indicators 6 6.1 6.1, 6.3 6.1 National QUM Indicators 7 7.2, 7.4 National QUM Indicators National Safety and Quality Health Service Standard items 4.12.3 4.12.4 4.13.1 4.13.2 4.14.1 4.15.1 National QUM Indicators 1
National QUM Indicators 2 National QUM Indicators 3 3.1 3.1 National QUM Indicators 4 4.2 4.2 4.2 National QUM Indicators 5 5.3, 5.8 5.1, 5.2, 5.3, 5.4, 5.5, 5.6, 5.7, 5.8, 5.9 5.4, 5.5, 5.6, 5.9 5.4, 5.6 5.4, 5.6 5.9 National QUM Indicators 6 National QUM Indicators 7 7.3 7.3 7.3 7.3 Table 2: National QUM Indicators mapped to each action item of the NSQHS Standards (continued) National QUM Indicators National Safety and Quality Health Service Standard items 6.1.1 6.2.1 6.3.1 6.4.1 6.4.2 6.5.1 National QUM