1. Moving-ON Audits and Indicator Database IRT Community Services Professional Development Day - 2009

2. Let’s Refresh… What Is Moving ON Audits? Is an aged care auditing and indicator program; Can be customised to suit aged care organisations; It enables comparative trending data for each service Across an organisation Across the aged care industry A decision making tool that assists IRT to identify areas of deficit Assists in identifying items for continuous quality improvement Allows easy demonstration of continuous quality improvement

3. Let’s Refresh… What Is Moving ON Audits? Community – based on the Quality Reporting Outcomes Quality Indicators - key industry quality indicators to assist clinical and management staff identify trends and act on identified needs As at June 2009, MOA provided audit services to over 640 aged care services in Australia. Whilst these are predominately residential services, community services are growing at a rapid rate particularly from the larger providers.

4. IRT Prior to MOA No internal reporting except for critical incidents. No internal or external benchmarking between like services for quality indicators An ad hoc system for analysing results Lack of integration between various auditing and indicator collection processes An opinion without data is just another opinion. Where is the evidence?

5. IRT Since Commencement of MOA Standardised collection and definitions of indicators Compares performance to other “like” services Encourages analysis and review Requirement of only a basic level of IT experience to use the MOA program. We now have the data to base our opinions on. We have evidence.

6. Difference between MOA Audits and MOA Indicators Audits work on a percentage of returns The number of MOA “Part B’s” is based on the total number of packaged clients approved for the project. Part B audits are done as a random selection of reviews – e.g. combination of CACP/EACH/EACHD. Different clients randomly selected each month (10% of packaged clients or minimum of 5). Audits are undertaken as per a pre-determined calendar with each outcome audited annually.

7. Difference between MOA Audits and MOA Indicators Indicators work on a 100% return. Monthly indicators are identical each month and are predominately clinically based. These are: Incident/Accident (incl falls), Aggression, Skin Integrity (incl wounds), Infection Control, Medication, Service Hours & Support, Weight Loss, Depression. Quarterly indicators are identical and are predominately management based. These are: Case conferences, assessments, complaints, compliments, comments, suggestions, staff appraisals

8. MOA 2009 Program Community

9. April 2009 - Wollongong Community Services commences pilot of audits. July 2009 - All Community Services undertaking the audit component. September 2009 – Shoalhaven South Community Services commenced pilot of indicators. October 2009 – All Community Services now fully operational in both MOA and IRT Indicators.

10. Collecting Information

11. Why do MOA Audits? Without measurement how do we determine if the systems, policies or procedures that IRT and each service has are effective? ….We don ’ t know. 2 types of quality Perception – This is a guess. We think our systems are all working correctly. Reality – This is factual. We have measured our systems and have data as evidence.

12. Why collect indicators? An indicator is a sign or a signal. They provide us with warning about: Changes with individual clients Patterns that may be emerging in new or repeated incidents for individual and groups of clients Impact of new processes, or changes in the environment (both positive and negative). Indicators do not tell us what to do. Their job is to send us a signal (trigger us) as to where and when to look further. “ Something is not right ”

13. Why collect indicators? We collect indicators so that we can: Monitor that our processes are effective Address problems before they become critical issues Demonstrate that improvements we have made are making a difference Quality Indicators with IRT At IRT, we collect clinical (care) and management indicators on a monthly and quarterly basis. A group, or set of these indicators are then benchmarked to other like services within and outside IRT.

14. Life of an Indicator The Paper & e-Process So how does MOA and the IRT Indicator Database link together? Let ’ s follow an indicator

15. Resident/Client A has a fall - Following the appropriate assistance and care, Form 200 (Incident/Accident) is completed.

16. The data is entered onto IRT Indicator Database

17. Resident/Client Details Entered

18. A Report is Produced each month for entry into MOA for Clinical Indicators – This report provides raw figures only. No client details are provided. The information so far is INTERNALLY gathered and produced… IRT provides MOA with data.

19. MOA now provides IRT with data – this is where EXTERNAL benchmarking starts MOA Clinical Indicator Report that is provided to the site monthly. This shows external benchmarking. Managers / Coordinators can then get the specifics from the Indicator Database.

20. Specifics of Incidents – raw data When the MOA data is reviewed, you then can “ drill back down ” to IRT ’ s data to find the “ who, what, when, where, how ”

21. Differences? MOA is raw number – the program does not know if you are correct when entering in your data (attention to detail in data entry is important!). It will provide graphical data back to you on whatever you enter. It ’ s aim it to alert or trigger analysis. IRT Database gives you the specifics of the incidents when you have been “ triggered ” so you can drill down to find the specifics, analyse the information and work towards improvement.

22. Other Reports from MOA Area Managers receive “ Group ” reports to allow them to preview their entire area of operations. Chief Operating Officer receives “ Organisational ” report allow for review of all IRT clinical operations.

23. Quarterly Raw Data – IRT Wide

24. Quarterly Raw Data – Breakdown

25. Analysis of Information Form 620B Use the MOA Audit and Indicator Analysis Report to summarise issues and improvements with indicators, as well as audit results. This report goes to the Manager Area Operations on a monthly basis. This report can also be used by the service for its management team meetings, and as a tool to demonstrate to staff what happens with the information they assist us to collect. This report asks the service to comment on whether the indicator data has improved, is stable, or if issues have been identified. This demonstrates that the service is monitoring results on an ongoing basis, and not just acting on what has happened that month. Any issues identified requiring a quality activity to be commenced should be cross referenced to your QI Plan and the detail placed there, not in this report.

26. The PDCA cycle, Clinical Indicators and MOA Plan Do Act Feedback Check / Study

27. Plan Check the calendar and the Quality Plan for audits and indicators due each month

28. Do Complete the audits. Collect and collate the Indicators

29. Check results using the reports Determine where action may be required

30. Act and Analyse An action sheet in addition to the analysis form is in use to identify any issues arising from audits and indicator results. These issues may be identified from completion of the audits and collation of indicators. This is a tool for all staff completing audits to identify issues. It can also be used as a “brain-dump” during team meetings for any issues, not just those identified in the MOA program.

31. Post Reporting MOA and Clinical Indicators need to be a standing agenda item on all Agendas. Discussion is held by Area Managers with their respective Village Managers / Senior Coordinators on the previous months reports. Area Managers discuss with the Chief Operating Officer any areas of concern or exception items.

32. Resident/Client B has a fall… The process continues …

33. Scenario – How Else Can A Trigger Occur? A care facility was “ triggered ” or “ alerted ” when the monthly report from the database and the MOA indicator report showed a significant spike or increase in reported incidents of Residents ’ aggression for a particular month. On investigation (by analysing the information on the detailed monthly report) the site identified that one (1) resident had 14 out of the 18 incidents of aggression reported. Analysis was made by notation of the increase in aggressive incidents by the one resident in the monthly analysis. A clinical assessment by a RN was undertaken which identified pain as an issue, LMO contacted and requested to review resident. The resident did not communicate that they had pain to staff so pain as a trigger to aggression was not evident at first. Resident was diagnosed to have pain and pain management was implemented, the care plan updated. Outcome / Result of pain management for the resident significantly reduced aggressive incidents over the next and ensuing months.

34. IRT Community Statistics October 2009 Reporting

35. October 2009 Community Services Statistics 90 indicators recorded in total 29 – Incident / Accidents 23 – Skin Integrity 18 – Medication 9 – Infections 9 – Aggression 1 – Depression 1 – Weight Management

37. October 2009 Community Services Statistics ACT – 6 aggression incidents (50% associated with 1 client) Eurobodalla North – recorded 2 falls – both the same client. South East Sydney – 75% of medication incidents were related to a single client (although varying reasons) Illawarra South – 2/3 of recorded falls were linked to 1 client Illawarra South – 75% of medication errors were linked to client administration error (50% being the same client). Illawarra North – 6 medication incidents recorded (4 linked to staff administration error).

38. Incident/Accident

39. Skin Integrity

40. Medication Errors

41. IRT’s Indicator Database An Update

42. Welcome to the Indicator Database

43. It has a help section

44. Enter in New Clients View Existing Clients Enter New Indicators

45. It produces reports a variety of reports Monthly, Quarterly, Annual Project Specific MOA report Plus “ regional ” or “ area ”

46. Not to mention graphical reports

47. It now also allows you to track… Unresolved incidents Aggression Incidents And let ’ s you see at a glance which client has what indicator associated with them.

48. It’s not just for clinical information… there is another side to the database

49. Environmental Database This is where you enter your NON-clinical information such as: Environmental Audits Handwashing Audits Performance Appraisals Staff / Admin Hours Suggestions / comments / complaints Case conferences A number of these indicators will be asked when you undertake the quarterly indicators (December, March, June & September)

50. Problems? Questions? With MOA or the Indicator Database? Contact Kim Hancock on: Email: khancock@irt.org.aukhancock@irt.org.au Phone: 4475 3361