QI Program resources

Good afternoon and welcome to the QI Program webinar. Thank you for joining us.

For many of you this won't be your first QI Program webinar, you would have tuned in when the QI Program became mandatory. So welcome back.

Today's webinar represents yet another milestone in the QI Program journey which will be expanded from 1 July 2021.

The QI Program provides an ongoing focus on continuous quality improvement and improved care outcomes for senior Australians in residential care.

Today's webinar has been delivered by KPMG, who are assisting the Department of Health in developing QI Program guidance materials for the sector.

Before we get started, I would like to acknowledge the traditional owners of the lands on which we are all meeting today, and I pay my respects to Elders past, present, and emerging. I would also like to extend that acknowledgement and respect to any Aboriginal and Torres Strait Islander people here today.

We have a pretty tight agenda today and lots to cover. The session will start by providing you with an overview of the QI Program, including a little bit of background information, a review of the QI Program objectives, and a snapshot of the changes from 1 July.

You will then take a closer look at each of the five quality indicators. Then, we'll look at what you need to be prepared by 1 July. Finally, there will be a Q&A session where you will have the opportunity to ask questions. We encourage everyone to post questions via the blue "Ask a Question" button – a blue hand icon – as we progress through the webinar. You can submit your questions at any time during the session, and only the facilitator will be able to see your questions.

If we don't get to answering your question during today's session, we will be collating all questions into a Q&A document, which will be distributed within a post-event email. The post-webinar email will also include a link to the recording of this session for you to re-watch and share with your colleagues.

Okay, so let's make a start and dive in. Today's session is about the next phase in the QI Program journey, which will see the QI Program expand to include new quality indicators from 1 July 2021. This webinar will help you understand the new QI Program definitions and requirements as set out in the QI Program Manual 2.0 Part A, build your knowledge and confidence to collect the new quality indicators from 1 July 2021, and help us understand what information and support would help you prepare for the change.

The QI Program became mandatory for all Commonwealth-subsidised residential aged care providers in July 2019. The quality indicators measure important aspects of health and wellbeing, many of which can be prevented, improved, or monitored more closely to reduce adverse health events.

Consistent data collected according to the QI Program requirements shows providers what is working well and areas of care that may need improvement, and can support providers and aged care teams to engage in continuous quality improvement and achieve better care outcomes together.

Over time, the QI Program data will give consumers and their families information to make more informed decisions about the care they receive. The data will provide insights and empower consumers with transparent information.

The QI Program works on 3 levels: (1) providing system-level data to government and policymakers, (2) giving providers comparable data to support quality improvement, and (3) empowering consumers in the community to make more informed decisions.

From 1 July 2021, the QI Program will expand to include five quality indicators. The changes mean all quality indicators will have new definitions, collection, and reporting requirements. There are eight categories across the five quality indicators, which specify how each of the quality indicators are reported. For example, the quality indicator "medication management" has two categories: one for polypharmacy and one for antipsychotics.

Providers and teams will need to revise and understand all new quality indicator definitions and requirements, and report accurately against the definitions and reporting requirements outlined within the QI Program Manual 2.0 Part A. The new requirements are shifting to enhance the quality and type of data and to make collection and reporting easier.

The five quality indicators from 1 July 2021 will be: pressure injuries, physical restraint, unplanned weight loss, falls and major injury, and medication management.

From 1 July, the QI Program quality indicators will be reported as a percentage of care recipients. There have also been a range of enhancements to make the QI Program easier for providers to collect and report data. The quality indicators have been updated based on best practice to provide more simple measures that are easier to report.

Some key elements of the QI Program remain the same, including reporting cycles, which will still occur at the end of the quarter via the My Aged Care provider portal.

So, the QI Program from 1 July 2021 will include the following quality indicators:

• The pressure injuries quality indicator will report the percentage of care recipients with pressure injuries, reported against six pressure injury stages.
• The physical restraint quality indicator will report the percentage of care recipients who are physically restrained.
• The unplanned weight loss quality indicator will report across two categories, including the percentage of care recipients who experience significant unplanned weight loss (that is, 5% or more) and the percentage of care recipients who experience consecutive unplanned weight loss.
• The falls and major injury quality indicator will report across two categories, including the percentage of care recipients who experience one or more falls and the percentage of care recipients who experience one or more falls resulting in major injury.
• Finally, the medication management quality indicator will report across two categories, including the percentage of care recipients who are prescribed nine or more medications and the percentage of care recipients who received antipsychotic medications.

Before we dive in, it's important to emphasize that it is critical to read the QI Program Manual 2.0 Part A and engage with the guidance material provided by the department.

The first of the quality indicators is pressure injuries.

A pressure injury is a localized injury to the skin and/or underlying tissue, usually over a bony prominence, resulting from pressure, shear, or a combination of both. Potentially life-threatening, pressure injuries decrease quality of life, are expensive to manage, and are often preventable.

From 1 July, providers will report the percentage of care recipients with pressure injuries against six pressure injury stages. Data collection for the pressure injuries quality indicator will involve one observation assessment for each care recipient around the same time every quarter. Reporting for the pressure injuries quality indicator will include the number of care recipients with one or more pressure injuries, and the number of care recipients with one or more pressure injuries reported against each of the pressure injury stages.

A number of details will be reported additionally, including the total number of care recipients assessed for pressure injuries, the number of care recipients with one or more pressure injuries acquired outside of the service during the quarter, and the number of care recipients with one or more pressure injuries acquired outside of the service during the quarter reported against each of the six pressure injury stages.

Exclusions for the pressure injuries quality indicator include care recipients who withheld consent to undergo an observation assessment for pressure injuries for the entire quarter, and care recipients who were absent from the service for the entire quarter.

From 1 July 2021, the pressure injuries quality indicator will report pressure injury stages against the ICD-10 Australian Modified Pressure Injury Classification System, outlined in the Prevention and Treatment of Pressure Ulcers/Injuries Clinical Practice Guideline 2019.

The second quality indicator is physical restraint.

From 1 July, providers will report the percentage of care recipients who are physically restrained. Data collection for the physical restraint quality indicator will involve a single three-day record review for each care recipient every quarter. Reporting for the physical restraint quality indicator will include the number of care recipients who are physically restrained.

A number of details will be reported additionally, including the total number of care recipients assessed for physical restraint, the number of care recipients who were physically restrained exclusively through the use of a secure area, and the collection date. Care recipients absent from the service for the entire three-day assessment period are excluded from the physical restraint quality indicator.

The Quality of Care Principles 2014 define restrictive practices as any practice or intervention that has the effect of restricting the rights or freedom of movement of a care recipient. The QI Program physical restraint quality indicator measures and reports data relating to all restrictive practices, excluding chemical restraint. This includes physical restraint, mechanical restraint, environmental restraint, and seclusion, as defined in the Quality of Care Principles.

For the purposes of the QI Program, these forms of restrictive practice can be understood as follows: 

• Mechanical restraint is a practice or intervention that involves the use of a device to prevent, restrict, or subdue a care recipient's movement for the primary purpose of influencing the care recipient's behaviour, but does not include the use of a device for therapeutic or non-behavioural purposes in relation to the care recipient.
• Physical restraint is a practice or intervention that involves the use of physical force to prevent, restrict, or subdue movement of a care recipient's body or part of a care recipient's body for the primary purpose of influencing the care recipient's behaviour, but does not include the use of a hands-on technique in a reflective way to guide or redirect the care recipient away from potential harm or injury if it is consistent with what could reasonably be considered to be the exercise of care towards the care recipient.
• Environmental restraint is a practice or intervention that restricts, or involves restricting, a care recipient's free access to all parts of the care recipient's environment, including items and activities, for the primary purpose of influencing the care recipient's behaviour.
• Seclusion is a practice or intervention that involves the solitary confinement of a care recipient in a room or physical space at any hour of the day or night where voluntary exit is prevented or not facilitated, or it is implied that voluntary exit is not permitted, for the primary purpose of influencing the care recipient's behaviour.

For the purposes of the QI Program, restraint through the use of a secure area includes only environmental restraint as defined. All forms of restrictive practice, including instances where the care recipient or their representative instigates or requests the restrictive practice, are considered physical restraint for the purposes of the QI Program.

The third quality indicator is unplanned weight loss.

Unplanned weight loss results from a deficiency in a person's dietary intake relative to their needs and may be a symptom or consequence of disease. For the purposes of the QI Program, unplanned weight loss is weight loss where there is no written strategy or ongoing record relating to planned weight loss for the care recipient.

The two categories within this quality indicator are significant unplanned weight loss and consecutive unplanned weight loss.

The first category of unplanned weight loss is significant unplanned weight loss.

Significant unplanned weight loss is weight loss equal to or greater than five percent over a three-month period. This represents a very large amount of body weight loss over a three-month period and aligns to the malnutrition diagnostic criteria.

From 1 July, providers will report the percentage of care recipients who experience significant unplanned weight loss (5% or more). Data collection for significant unplanned weight loss will involve collecting the weight of each care recipient in the last month of the quarter and comparing it to the weight at the last month of the previous quarter to determine the percentage of weight loss. Weight loss taken at the end of the quarter is known as the finishing weight.

Additional details to be reported include the total number of care recipients assessed for significant unplanned weight loss, while exclusions for the significant unplanned weight loss category include care recipients who withheld consent to be weighed, care recipients who are receiving end-of-life care, and care recipients who do not have the required weight records available. Comments should be provided explaining why weight records were absent.

For the purposes of the QI Program, unplanned weight loss is where there is no written strategy or ongoing record relating to planned weight loss for the care recipient.

The second category of unplanned weight loss is consecutive unplanned weight loss.

Consecutive unplanned weight loss is weight loss of any amount every month over three consecutive months of the quarter. Consecutive unplanned weight loss should not be dismissed as a natural age-related change. The detection of consecutive unplanned weight loss provides an early opportunity to investigate and improve health outcomes before they become more significant.

From 1 July, providers will report the percentage of care recipients who experience consecutive unplanned weight loss. Data collection for consecutive unplanned weight loss will involve collecting three monthly weights for each care recipient every quarter and comparing against each other as well as the finishing weight from the previous quarter to determine consecutive unplanned weight loss. Starting, middle, and finishing weights are required for this quality indicator.

Details for reporting include the total number of care recipients assessed for consecutive unplanned weight loss, while exclusions for the significant unplanned weight loss category include care recipients who withheld consent to be weighed at the starting, middle, and/or finishing weight collection dates, care recipients who are receiving end-of-life care, and care recipients who did not have the required weight records of previous starting, middle, and/or finishing weights. Comments should be provided explaining why the weight records are absent.

For the purposes of the QI Program, unplanned weight loss is where there is no written strategy or ongoing record relating to planned weight loss for the care recipient.

The falls and major injury quality indicator is a new quality indicator to the QI Program from 1 July 2021.

A fall is an event that results in a person coming to rest inadvertently on the ground, floor, or other lower level. A fall resulting in major injury is a fall that meets this definition and results in one or more of the following: bone fractures, joint dislocations, closed head injuries with altered consciousness, and/or subdural hematoma.

From 1 July, providers will report the percentage of care recipients who experienced one or more falls, and the percentage of care recipients who experienced one or more falls resulting in major injury. Data collection for the falls and major injury quality indicator will involve a single review of the care records for each care recipient for the entire quarter.

Reporting for the falls and major injury quality indicator will include the number of care recipients who experienced a fall (one or more) at the service during the quarter, and the number of care recipients who experienced a fall (one or more) at the service resulting in major injury or injuries during the quarter.

Additional details for reporting include the total number of care recipients assessed for falls and major injury, while exclusions for the falls and major injury quality indicator include care recipients who are absent from the service for the entire quarter.

Medication management is the second new QI Program quality indicator from 1 July 2021.

Medication management plays a critical role in achieving quality of care for older people in aged care. The two categories within the medication management quality indicator are polypharmacy and antipsychotics.

The first category of medication management is polypharmacy.

Polypharmacy is defined as the prescription of nine or more medications to a care recipient. Regular monitoring of polypharmacy is important because polypharmacy has been associated with harms such as adverse drug events, cognitive decline, and hospitalization.

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 purposes of the QI Program, it includes prescription and non-prescription medicines, including complementary health care products, irrespective of the administrative route.

From 1 July, providers will report the percentage of care recipients who are prescribed nine or more medications. Data collection for medication management (polypharmacy) will involve a single review of medication charts and/or administration records for each care recipient on a selected collection date every quarter. Polypharmacy reporting will include the number of care recipients who were prescribed nine or more medications.

A number of details will be reported additionally, including the number of care recipients assessed for polypharmacy and the collection date. Exclusions for the medication management (polypharmacy) category include care recipients admitted to hospital for the collection date.

The second category of medication management is antipsychotics.

Antipsychotics are medications prescribed for the treatment of a diagnosed condition of psychosis. Regular monitoring of the use of antipsychotics is important because the inappropriate use of certain medication classes, such as antipsychotics, has been shown to be associated with poor health outcomes.

From 1 July, providers will report the percentage of care recipients who received antipsychotic medications. Data collection for medication management (antipsychotics) will involve a seven-day medication chart and/or administration record review for each care recipient every quarter. Reporting for medication management (antipsychotics) will include the number of care recipients who received an antipsychotic medication.

A number of details will be reported additionally, including the number of care recipients assessed for antipsychotic medications, the number of care recipients who received an antipsychotic medication for a diagnosed condition of psychosis, and the collection date. Exclusions for the medication management (antipsychotic) category include care recipients who were admitted to hospital for the entire seven-day assessment period.

As we progressed through the webinar, we just want to thank everyone who's posting questions into the chat box. We can see some really great questions coming through, so thank you and please keep posting as we go.

That concludes the deep dive of looking specifically at the QI Program requirements.

Now we're going to take a second to have a look at the data submission requirements.

The QI Program data collection cycles have not changed and remain in line with the financial calendar year. Providers are required to collect and report data as detailed in the QI Program Manual 2.0 Part A, in accordance with legislation. Providers are required to submit data no later than the 21st day of the month after the end of each quarter. It is also worth noting that should third-party providers be used, the provider remains responsible for submitting data accurately and on time.

Now we're going to move on to how to get prepared.

We have outlined and identified a number of key steps to support you in preparing for the 1 July 2021 requirements. Many of these steps are based on the critical areas of being familiar with the QI Program requirements and the QI Program Manual, and communicating these with your teams and organizations as a whole.

Firstly, it's critical to familiarize yourself with the QI Program requirements as detailed in the QI Program Manual. Read and engage with the full range of guidance materials, and understand exactly what the changes are and what your responsibilities are to action change.

The next important step is to identify actions required. Some actions might include updating all processes and policies, allocating QI Program training time, allocating completion dates for the training, adopting and using education and communications materials provided by the department, and having discussions with your team as the next step in preparation.

You'll need to encourage your team to adopt and understand the new requirements. Talk to them about the changes and what it means for your operating environment. Communicate with your teams regularly and check in with those responsible for particular tasks. Establish a collective responsibility – all staff members play an important role in the successful implementation and adherence to QI Program changes.

Finally, make a change plan to be ready on 1 July.

We recommend following a clear and effective change plan for the kind of compliance change the QI Program is looking for. We would recommend following a behavioural change management methodology to provide structure. This means following a path of making a clear goal, identifying owners and responsibility relating to the change, supporting staff to understand and prepare for the change, equipping staff to meet the new requirements, and putting the processes in place that will sustain the change over time to achieve optimal outcomes.

You can see an example of the steps for this change strategy on the screen, which is: make it clear, make it known, make it real, make it happen, and make it stick.

That covers the content component of today's webinar.

We're now going to progress to the question and answer session. Thank you to everyone who's been sending questions over during the webinar – it's great to have such an engaged group. We're now going to be working through as many of the questions as we can in the remaining time we have. Remember, if we don't get to your question today, we will be answering all questions in a Q&A document that will be sent to you post-webinar via email and incorporated into a frequently asked questions document on the department's website.

Q&A section

Question: We've been using our own templates to collect QI data. Can we keep using them?

Answer: That's a great question – thank you for sending it through. Many organizations have developed and introduced their own QI data collection templates, which is fantastic. From 1 July, you can keep using your own templates, but you will need to ensure that they are consistent with the updated definitions and instructions in the QI Program Manual.

Question: If a resident is prescribed antipsychotics, do I need to record this against both medication management categories?

Answer: Another excellent question. If a care recipient is prescribed an antipsychotic medication – whether it is for the treatment of a diagnosed condition of psychosis or not – then the medication would be included in the count of medications for both polypharmacy as well as the antipsychotics quality indicator categories. A list of antipsychotics will be provided in Part B of the QI Program Manual, which is due for publication in June.

Question: What do we do if a care recipient refuses an assessment, for example, a skin assessment or a weight assessment?

Answer: If a care recipient does not provide consent for an assessment to take place, you will need to record this under the relevant exclusion criteria. You should not include the care recipient in the number assessed or counts for that quality indicator.

Question: Are respite care recipients included in QI Program reporting?

Answer: Yes, respite care recipients should be included in QI data collection if they are residing at the service during the assessment period and do not meet exclusion criteria.

Question: Are exclusions counted in the number of care recipients assessed?

Answer: No. If a care recipient meets exclusion criteria, they should not be counted in the number of care recipients assessed or reported against a quality indicator. However, services should ensure that the care recipient is reported against the relevant exclusion criteria. For example, if a care recipient is hospitalized for the entire quarter, it is logical that they are not assessed or reported against a quality indicator. However, you would report this care recipient in the number excluded due to hospitalization.

Question: If someone is eligible for multiple exclusions, how do we record this?

Answer: Where multiple exclusion reasons apply to any care recipient who is excluded from being assessed for a quality indicator, the care recipient should be recorded only once against the primary reason for exclusion.

Question: Are palliative care recipients excluded?

Answer: Palliative care recipients must be included in all QI data collection. Care recipients receiving end-of-life care are not included in the unplanned weight loss data collection; instead, they are reported against exclusion criteria. The QI Program defines end-of-life care as the terminal phase of life where death is imminent and likely to occur within three months. Sometimes this is referred to as active dying.

Question: What are the collection dates for audits?

Answer: The QI Program does not specify collection dates for each quality indicator. Each quality indicator has specified data collection requirements, but providers choose their own collection dates, provided that they are the same for all care recipients at the service.

If your question did not get answered during the session, all questions are being collated into a Q&A document, which will be circulated via a post-webinar email.

Closing remarks and support information

Now, let's move on to the key support documents available for providers. The Department will publish a range of guidance materials to support you in meeting the requirements of the QI Program. Each document serves a different purpose, and we recommend engaging with them and encouraging staff – and, where possible, care recipients – to do the same.

Updates and the latest material will be published via the Department's Aged Care Sector Newsletter.

Key support documents include:

• QI Program Manual 2.0 Part A and Part B: In accordance with legislation, providers must collect data consistently and according to Part A of the QI Program Manual, which contains detail about collecting, recording, submitting, and interpreting information. Part B will provide a collection of best practice tools to support providers in continuous quality improvement. Part A is available now, and Part B is to be published in June 2021.
• Data reporting templates: The templates used as part of the quality indicator pilot are being updated for the QI Program. These downloadable templates automatically calculate and summarize data for submission to the provider portal and will be published for each quality indicator.
• QI Program quick reference guides: These provide concise advice on each of the quality indicators, including definitions and guidance on how provider staff and clinical teams should assess and record information.
• Information sheets: There are four easy-to-understand information sheets with general information about the QI Program for consumers and families, clinical care teams, senior staff and boards, as well as GPs and allied health.
• Frequently asked questions (FAQs): A collection of the QI Program FAQs will be published as a document, including all webinar questions.
• Online training and education modules: These are highly visual, quick, and simple "pocket expert" approaches to online learning, designed to help provider staff learn about the QI Program, its reporting requirements, and using quality indicator data for continuous quality improvement.

For QI Program assistance, contact the My Aged Care Provider and Assessor Helpline on 1800 836 799. This helpline is available between 8 a.m. and 8 p.m. Monday to Friday, and between 10 a.m. and 2 p.m. on Saturdays.

For regular updates and information on the QI Program, refer to the Department's website and the Aged Care Sector Newsletter, as well as the Department's bulk information distribution service (BIDS).

Final remarks:

A post-event email will be sent to those who registered for the webinar. This email will include the questions and answers from today's session, as well as a link to the recording so you can re-watch and share with your colleagues.