Update on anti-staphylococcal bundle using a collaborative approach

Source: Health Quality and Safety Commission

Over the past year the Health Quality & Safety Commission’s infection prevention and control programme team has facilitated the implementation of a preoperative anti-staphylococcal bundle within the Surgical Site Infection Improvement (SSII) Programme.

This bundle aims to reduce the Staphylococcus aureus SSI rate by implementing a bundle of well-established interventions to reduce the SSI risk for cardiac and orthopaedic surgery. The Commission worked with interested hospital teams to roll out the bundle using a collaborative and quality improvement methodology. A total of eight hospital teams (five district health boards [DHBs] and three private hospitals) implemented a bundle.

Participating organisations
Hospital Specialty scope
Acurity Health – Bowen Hospital  Orthopaedic
Acurity Health – Wakefield Hospital  Both
Auckland DHB  Cardiac (adult patients)
Lakes DHB Orthopaedic
Southern Cross – Hamilton Hospital  Both
Southern DHB Cardiac
Waikato DHB Cardiac
Waitemata DHB  Orthopaedic

During the 10-month-long collaborative, small groups (2–4 people per hospital team) attended 3 face-to-face learning sessions with additional members working on improvements in each organisation. Monthly webinars and individual team teleconferences were held. The Commission’s infection prevention and control senior advisor provided additional training related to quality improvement methodology, information sharing and clinical discussion. The multidisciplinary teams involved in the collaborative were highly engaged and well supported by the Commission and their local management throughout the implementation process.

All hospitals achieved 95–100 percent compliance for their bundle interventions. We will maintain contact with the project leads from each team to verify bundle compliance is sustained.

To date the bundle has been applied to nearly 3,000 procedures. Six months of preliminary data, post-implementation of the bundle, indicates there has been an aggregated 56 percent reduction in S. aureus SSI rates (p-value = 0.010) among the 8 participating hospitals for all operations (orthopaedic and cardiac).

For orthopaedic surgery, the 2 DHBs and 3 private hospitals that implemented a bundle have seen a combined 69 percent reduction which has almost reached statistical significance (p-value = 0.066). For cardiac surgery, the 3 DHBs and 2 private hospitals that implemented a bundle have seen a combined 48 percent reduction which is approaching statistical significance (p-value = 0.095).

The graph below represents the combined S. aureus SSI rate pre- and post-bundle implementation for orthopaedic and cardiac surgery.

An educational video specific for surgical patients was developed. This video provides reminders for patients of things they can do to reduce their risk of an SSI before and after surgery. It was also translated into te reo Māori and Samoan. It is available for all hospitals to use for any surgical specialty as it is not targeted for just cardiac or orthopaedic surgical patients. The videos are located at: www.hqsc.govt.nz/staysafe.

The Commission will continue to collect and analyse outcome data to determine the impact of the bundle on S. aureus SSI rates. We will provide further updates as we continue to assess the impact of the bundle. If the bundle is shown to have a significant and sustained impact, we will explore opportunities to implement the bundle in other hospitals and for other appropriate procedures.

Questions related to this update can be sent to SSIIP@hqsc.govt.nz.

Last updated 19/02/2019


Applications of interest sought for new Wellington Free Ambulance consumer council

Source: Health Quality and Safety Commission

Applications of interest sought for new Wellington Free Ambulance consumer council

8 Feb 2019 | Partners in Care

Wellington Free Ambulance (WFA) provides ambulance services for all communities in the greater Wellington region and Wairarapa.

They are looking for ways to improve their services and health outcomes for their communities. With this in mind, WFA is creating a consumer council – a group of consumers and their carers who can provide insight into the patient experience and work with them to improve services and eliminate inequities. 

Applications of interest to join the consumer council close on 8 March 2019.

The consumer council needs to reflect the diverse communities Wellington Free Ambulance works with. If you are over 18, live in the greater Wellington region or the Wairarapa, have used one of Wellington Free Ambulance’s services in the past two years, as a patient or carer, and are keen to improve the health outcomes for our communities please visit: www.wfa.org.nz/consumercouncil for more information. 

Through partnership and collaboration, the thoughts, feelings and ideas of the consumer will be heard in an honest and open forum. This partnership will help create meaningful, sustainable changes to improve the service and experience of their patients. 

For further information about the consumer council visit www.wfa.org.nz/consumercouncil or download a copy of the consumer council poster. (2MB, PDF)

Last updated 08/02/2019


International Forum on Quality & Safety in Healthcare

Source: Health Quality and Safety Commission

International Forum on Quality & Safety in Healthcare

  • Event start: 18 Sep 2019 9:00am
  • Event end: 20 Sep 2018 5:00pm
  • Location: Taipei

The International Forum on Quality & Safety in Healthcare showcases internationally-recognised keynotes and addresses regional needs, bringing together the best international learning. The conference programme is developed in close partnership with regional strategic partners.

The event aims to bring together health care professionals who share a concern and a passion for improving quality and safety in health care, to provide the opportunity for health care professionals to publish their work as a poster or to be a speaker, to share and learn best practices, meet peers and build international connections.

Call for posters

The deadline for poster submissions is 1 May 2019. More information is available on the conference website: https://internationalforum.bmj.com/taipei/call-for-posters/.

Conference website

More information about the conference is available on the conference website: https://internationalforum.bmj.com/taipei/.

Last updated 07/02/2019


Call for nominations for the Neonatal Encephalopathy Working Group

Source: Health Quality and Safety Commission

The Perinatal and Maternal Mortality Review Committee (PMMRC) is seeking a new member to join its Neonatal Encephalopathy Working Group (NEWG).

Applications close at 5pm on Friday 1 March 2019

PMMRC is appointed under section 59e of the New Zealand Public Health and Disability Act 2000 by the Health Quality & Safety Commission. The NEWG is a working group established in 2007 under PMMRC. The purpose of the NEWG is to review data with the aim of improving outcomes and services for babies with neonatal encephalopathy (NE).

We are requesting nominations and applications for a midwife to join the NEWG. The applicant will have expertise in the areas of maternal and perinatal care, and primary care, and knowledge and experience in health service provision to Māori.

All applicants are required to have:

  • experience in working with Māori and Pacific peoples
  • wide professional and cultural networks
  • credibility in relevant communities and respect of peers
  • strong personal integrity and ethical behaviour
  • commitment to the issues at the heart of the working group’s business
  • critical appraisal skills, well developed written and oral skills, strategic thinking
  • appropriate clinical or professional experience
  • ability to engage with the other members of the committee and contribute constructively
  • Māori health expertise and critical understanding of impact of inequity.

Collectively, the working group should have combined knowledge and expertise in:

  • obstetrics and gynaecology
  • paediatrics
  • clinical epidemiology
  • midwifery
  • neonatal nursing
  • neonatology
  • health quality and risk management
  • consumer engagement
  • understanding of Māori and Pacific health.

If you would like to nominate any suitable candidates, please complete the nomination form (available to download below) and email it to MRCsecretariat@hqsc.govt.nz.

If you would like to apply directly, without nomination, please complete the application form (available to download below) and provide a current curriculum vitae to the same email address.

For background on the NEWG please visit the Perinatal and Maternal Mortality Review Committee section of the website.

If you would like to know more about the functions and activities of the NEWG please view the terms of reference (156KB, PDF).

Related downloads:

Last updated 01/02/2019


Choosing Wisely 2019 forum puts spotlight on unnecessary medical intervention

Source: Health Quality and Safety Commission

The Choosing Wisely forum Continuing the Conversation will be held at Te Wharewaka o Pōneke in Wellington on Friday 10 May 2019.

The Choosing Wisely campaign encourages health professionals to talk with patients about unnecessary tests, treatments and procedures; and patients to discuss with their health professional whether they really need a particular intervention.

Choosing Wisely clinical lead Dr Derek Sherwood says the campaign puts the spotlight on unnecessary medical intervention, and the unintended harm that can be caused.

‘A recent survey of around 800 clinicians, carried out with (NZMA), the Association of Salaried Medical Specialists (ASMS) and the New Zealand Nurses Organisation (NZNO) found that nearly 70 percent consider the provision of unnecessary tests, procedures or treatments an issue for New Zealand health care.

‘Unnecessary interventions are stressful, and potentially expose patients to harm, leading to more testing to investigate false positives.’

Forum speakers include:

  • Prof Tammy Hoffman from the Centre for Research in Evidence-Based Practice, Bond University, Queensland who will be talking about shared decision making
  • Associate Prof Sue Crengle from Otago University’s Department of Preventive and Social Medicine, who will discuss Choosing Wisely and equity
  • Dr Robyn Lindner from Choosing Wisely in Australia, who will discuss successfully implementing the campaign, and evaluation.

‘We will also be assisting consumers to attend the meeting to repeat last year’s commentary from consumers on all sessions. Feedback on last year’s forum noted that “the consumer presence was key to adding value.’

Abstracts for the conference are now invited, and close on Friday 22 February 2019.

There will also be a repeat of last year’s popular special interest groups, including Choosing Wisely 101 for those just learning about this work.

Depending on interest, other workshops will cover:

  • Spreading the message
  • Choosing Wisely and allied health
  • Choosing Wisely working in nursing
  • Choosing Wisely and medical education
  • Choosing Wisely and pharmacy
  • Choosing Wisely in general practice
  • Choosing Wisely and medico-legal issues.

The campaign is gaining momentum in New Zealand. Seventeen district health boards are involved in Choosing Wisely work and it is supported by a number of PHOs and GP practices. Thirty-one medical colleges, specialty societies and health practitioners’ associations are now linked to the campaign. Over 154 lists of tests, treatments and procedures that should be questioned have been developed, along with 45 patient resources.

Last updated 01/02/2019


Health Quality & Safety Commission e-digest – Issue 94 online now

Source: Health Quality and Safety Commission

Ngā ihirangi | In this issue

Whakapai i te kounga me te haumaru | Quality and safety improvement

  • Dave’s story
  • Orders for Kia kōrero | Let’s talk advance care campaign resources

Whakaheke mōrearea | Reducing harm

  • New dosing guidelines for the treatment of paracetamol overdose and toxicity
  • 5 questions to ask about your medications – consumer safety poster available
  • More draft Frailty Care Guides available for testing
  • Blog: Māori health advancement – how can we do it?
  • Mental health and addiction tools and resources
  • Dispensing errors: Learning from the national primary care patient experience survey
  • Presentations and videos from Patient deterioration New Zealand: current state and future developments

Pūrongo me te whakamārama | Reporting and commentary

  • Maternal morbidity review toolkit for maternity services | Te kete arotake mate whakawhānau mō ngā ratonga whakawhānau
  • Evaluation of the early implementation of the national maternity early warning system
  • Guidelines for reporting on and talking about suicide in Aotearoa
  • New portal for quality and safety marker data
  • Survey finds nearly 70 percent of clinicians concerned about unnecessary medical interventions
  • Medical Council statement supports Choosing Wisely

Ngā hui huhua | Events

  • Upcoming events calendar
  • Serious illness conversation guide training
  • Continuing the conversation: A Choosing Wisely forum

Last updated 31/01/2019


Orders for Kia kōrero | Let’s talk advance care campaign resources

Source: Health Quality and Safety Commission

Orders for Kia kōrero | Let’s talk advance care campaign resources

30 Jan 2019 | Advance Care Planning

The first national public-facing advance care planning campaign is being launched on Tuesday 19 February in Wellington. Kia kōrero | Let’s talk features personal stories from six New Zealanders with diverse backgrounds.

The aim of the campaign is to encourage consumers to understand what advance care planning is, talk about their wishes for their future health care with whānau and their doctors and caregivers, and develop an advance care plan.

Following the launch, the Health Quality & Safety Commission would appreciate your help and support to promote the campaign locally.

Resources available as part of the campaign include:

  • six videos of individuals’ advance care planning stories
  • six posters of the above – four will be available in print and all will be available to download (all posters and videos will be available in English, te reo Māori, Samoan and Tongan)
  • promotion and advertising on social media (Facebook and Twitter).

Information about how to order resources has been sent to each region via advance care planning facilitators.

Resources can be ordered from your regional contact. If you are unsure who this is, please contact the Commission’s advance care planning team at communications@hqsc.govt.nz.

Last updated 30/01/2019


New treatment guidelines for the treatment of paracetamol overdose and toxicity

Source: Health Quality and Safety Commission

New treatment guidelines for the treatment of paracetamol overdose and toxicity

30 Jan 2019 | Medication Safety

The National Poisons Centre has issued new dosing guidance for acetylcysteine for the treatment of paracetamol overdose and toxicity.

A 2-bag dosing regimen is now recommended:

  Dose acetylcysteine:
1. First bag 200mg/kg IV over 4 hours
2. Second bag 100mg/kg IV over 16 hours

Current evidence suggests a modified two-bag dosing regimen is associated with a reduction in adverse effects associated with acetylcysteine administration. As the new dosing recommendations are simpler than the traditional ones, there is a reduced risk of administration errors.

Download the treatment guidelines below.

Last updated 30/01/2019

Related Resources


Serious Illness Conversation Guide training

Source: Health Quality and Safety Commission

  • When you have difficult conversations with patients, do you sometimes wonder how to start?
  • Are you confident you are discussing patients’ prognosis in a way that allows them to really understand what you are telling them?
  • Do you understand their fears and worries, and what is important to them?

In association with the Choosing Wisely Forum, the Health Quality & Safety Commission is offering three-hour Serious Illness Conversation Guide training on Thursday 9 May (the afternoon before the forum). The training helps clinicians feel more confident to have quality conversations with seriously ill people.

Where: Health Quality & Safety Commission
Level 9, 17-23 Whitmore St, Wellington

When: 2.30 to 5.30pm

Cost: $215

To register: SICGadmin@hqsc.govt.nz

About the Serious Illness Conversation Guide

The Serious Illness Conversation Guide was developed by American non-profit organisation Ariadne Labs with Atul Gawande, following the publication of his book Being Mortal.

The guide is a set of structured questions drawn from best practices in basic palliative care which serves as a framework for clinicians to explore topics that are crucial to gaining a full understanding about what is most important to patients.

It covers:

  • patient’s understanding of their illness
  • their preferences for information
  • sharing a prognosis
  • in light of the prognosis, exploring their personal goals, their fears and worries, the abilities they find most important to their daily life and tradeoffs they are willing to make for the possibility of more time
  • discussing a plan and agreeing a way forward.

The three-hour SICG training workshop will:

  • describe the evidence-based benefits of serious illness conversations for patients and families
  • describe the clinician’s role in improving serious illness conversations
  • list the components of the Serious Illness Conversation Guide
  • allow you to practice using the Serious Illness Conversation Guide.

Last updated 29/01/2019


Think twice about that medical test or treatment this summer

Source: Health Quality and Safety Commission

Summer in New Zealand is about days at the beach, the sound of cicadas and the smell of melting tar.

But for some people it can also be synonymous with having skin rashes and sore knees and backs from gardening or backyard cricket; not to mention tennis elbow.

It can be tempting to ask your doctor to send you for a scan just to make sure there’s nothing really wrong, or to give you antibiotics.

But Choosing Wisely chair Dr Derek Sherwood says just because tests and treatments are available doesn’t mean we should always use them. Choosing Wisely, coordinated by the Council of Medical Colleges, supports reducing unnecessary tests, treatments and procedures in health care.

‘There is mounting evidence that more tests and procedures don’t always equal better care. While modern medicine has given us more ways than ever to diagnose and treat illness, sometimes, the best option may be to do nothing.’

He points to X-rays for people with back pain as among the tests that need to be considered carefully before use.

‘Back pain is one of the most common reasons we visit the doctor. But evidence shows most of us recover without needing scans or other tests.

‘Not only do X-rays and CT scans expose patients to potentially cancer-causing radiation but many studies have shown scans frequently identify things that require further investigation but turn out to be nothing. This means patients can undergo stressful and potentially risky follow-up tests and treatments.’

Tennis elbow causes pain around the outside of the elbow and is often triggered by overuse of the muscles and tendons of the forearm.

‘People sometimes request steroid injections,” Dr Sherwood says, “but resting the arm and avoiding doing things that make the injury worse is the best way to recover. While steroid injections can provide short-term relief, in the longer term, they can hold back recovery.’

He says rashes such as eczema, that are not infected, will not be helped by antibiotics.

‘You can control eczema better with moisturisers. To relieve itching and swelling, ask your doctor about creams or ointments containing a steroid or other medicines.

The Choosing Wisely website has lots of resources about different tests, treatments and procedures that you might want to discuss further with your health professional.

They include information on:

  • allergies and allergic reactions
  • tests before surgery
  • back, knee and ankle x-rays
  • using antibiotics
  • blood tests
  • coughs, colds and sore throats
  • dementia
  • ear infections
  • electrocardiograms (ECGs)
  • end of life care
  • reviewing and using medicines.

Find out more at www.choosewisely.org.nz.

Choosing Wisely sponsors are the Council of Medical Colleges, Southern Cross Health Society, Pacific Radiology and PHARMAC. Consumer NZ and the Health Quality & Safety Commission are Choosing Wisely partners, and there is wide health sector support for the campaign.

Last updated 16/01/2019