The National Aged Care Mandatory Quality Indicator Program (QI Program) Webinar

From 1 July 2021, the National Aged Care Mandatory Quality Indicator Program (QI Program) requires approved providers of residential aged care to report on new quality indicators across 5 crucial clinical areas.

37:19

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 in which

we are all meeting today

and i'd like to pay my respects to

elders past present and

emerging i would like to extend that

acknowledgement and respect to any

and 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 qpqi 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 one july

finally there'll 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

three levels

two one provides system level data to

government and policy makers

2 give providers comparable data to

support

quality improvement and 3 empower

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 polypharmacy

and two 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

combination of both

potentially life-threatening pressure

injuries decrease

quality of life are expensive to manage

and often preventable

from one 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 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 slash

injuries

clinical practice guideline 2019

the second quality indicator is physical

restraint

from one 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 would 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 is

or that involves the use of a device

to prevent restrict or subdued 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-behavioral

purposes

in relation to the care recipient

physical restraint is a practice or

intervention that

is or involves the use of physical force

to prevent restrict or subdued 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

behavior

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 that 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 is

or 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 recipients 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 the care recipient

or their representative

instigate or request 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 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 here 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 the 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 one 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

here

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 fallen event that results in a person

coming to rest

inadvertently on the ground or 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 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 mage 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 receive

who experienced a full 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 one 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 would 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 one 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 would 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 and as we

progressed through the webinar

we just like to thank everyone who's

popping questions into the chat box

we can see some really great questions

coming through

so thank you and please keep posting as

we go

okay so 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 so

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 the

submitting of data

accurately and on time

excellent now we're going to move on to

the how to get prepared

so we have outlined and identified a

number of key steps to support you in

preparing for the one 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 commuting

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

having discussions with your team is 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 one

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

and 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

so 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 and

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

okay so the first question that we've

got coming through

is we've been using our own templates to

collect

qi data can we keep using them

so that's a really great question thanks

for sending that one 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

all right the next question we've got

coming through is if a resident

is prescribed antipsychotics do i need

to record this against both medication

management categories

another really great question so thanks

for that one

if a care recipient is prescribed an

antipsychotic medication

whether it be 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

so again thanks for that question the

next one we have

is what do we do if a care recipient

refuses an

assessment for example a skin

assessment or a weight assessment to

take place

the answer to that is where 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 a number

assessed or counts for that quality

indicator

again thanks so much for the question

another one that we have coming through

is are respite care recipients

included in qi program

reporting and the answer to that

is 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

okay so the next question we have is

are exclusions counted in the number of

care recipients assessed

and the answer that is 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's 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

so thanks for that question um

that is a good one to clarify okay so

another one we have coming through

is if someone is eligible for multiple

exclusions

how do we record this and uh the answer

that would be

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

uh fabulous so we've got some really

good

questions coming through another one um

are palliative care recipients excluded

so the answer that is palliative care

recipients

must be included in all qi data

collection

care recipients receiving end-of-life

care and not included in the unplanned

weight loss

data collection instead reported against

exclusion criteria so please note that

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

okay so i think we've got time for one

more question that's come through

and that is what are the collection

dates for audits

the answer that is the qi program does

not

specify collection dates for each

quality indicator

each quality indicator has specified

data collection requirements

which providers choose their own

collection dates

so providing that they are the same for

all care recipients at the service

so thanks again for all the questions

that have come through

as we said if your question didn't get

answered today

we are collating them into a q a

document

which will be circulated via a post

webinar email

okay so now we're going to move on to

a bit about the key support documents uh

that are out there for providers so

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 too

updates and the latest material

available will be published

via the department's aged care sector

newsletter

so the key support documents include

the qi program manual 2.0

part a and part b in accordance with

legislation

providers must collect consistently and

according to part a

of the qi program manual which contains

detail about collecting

recording submitting and interpreting

information

part b the qi program manual will

provide a collection

of the best practice tools to support

providers to engage in continuous

quality improvement part a is available

now

and part b of the manual is to be

published in june

2021 okay then we have data reporting

templates

and the data reporting templates that we

used as part of the quality indicator

pilot

are being updated for the qi program

providing a simple tool to guide data

collection and reporting requirements

so these downloadable templates

automatically

calculate and summarize data for

submission

to the provider portal and will be

published for each quality indicator

then we have the qi programs quick

reference guides which provide

concise advice on each of the quality

indicators

including definitions on how provider

staff and clinical teams should assess

and record information there are also

four easy to understand information

sheets with more

general information about the qi program

for consumers and families clinical care

teams

senior staff and boards as well as gps

and allied health

a collection of the qi program

frequently asked questions or the q

a will be published as a faq document

the faqs will include all webinar

questions

the online training and education model

modules

are a highly visual quick and simple

pocket expert

approach to online learning which are a

clear and enjoyable way for provider

staff to learn about the qi

program it's reporting requirements and

using quality indicator data for

continuous quality improvement

for qr program assistance contact the my

age

care provider and assessor helpline on

1-800-836-799

this helpline will be available between

8 a.m

and 8 p.m monday to friday and between

10 a.m

and 2 p.m on saturdays then we also have

the

aged care sector newsletter updates so

for regular updates and information on

the qy program

this will be published on the

department's website and will

often be communicated via the aged care

sector newsletter

and through the department's bulk

information distribution service

which is known as bids

okay excellent now we're going to move

on to

uh two questions where we'd love to hear

back from

you so the two questions that we have

posed to better understand provider

readiness

that we would like you to answer is

one what extra tools or information

would help you prepare for the qi

program expansion from 1 july 2021

and what key tools or information

would help your organization engage in

continuous

quality improvement so just answer these

as you have been shooting your questions

through during the session

via the blue ask a question button or

blue hand

icon so just pop your responses in to

the chat

using the blue hand icon

and we'll leave five minutes for that

thanks very much

okay so thanks very much for popping

your responses to those questions into

the chat that's great

um the we're actually going to move on

to now just

wrapping up and uh just reiterating some

of the support places and where to go

for help

so just remember that the key qrqi

program documents can be accessed on the

department of health's website

and for further assistance on the qi

program this

is available by the my aged care

provider

and assessor helpline and i'll just

repeat that number again it's

1-800-836-7999

uh and as a reminder a post-event

email will be sent uh to those who

registered for the webinar for this

webinar event

and that post event email will include

the questions and

answers from today's session and as well

as a link

to the recording so you can

re-watch and share with your colleagues

thank you very much for joining us in

the qi program webinar

and we look forward to seeing you again

thanks very much bye-bye

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