Positive trend emerging on medication QIs
The Residential Aged Care Quality Indicators January to March 2022 report shows rates of polypharmacy, antipsychotic use and physical restraint are down but unplanned weight loss is up.
Rates of polypharmacy, antipsychotic use and physical restraint among aged care residents have fallen while the proportion of residents experiencing weight loss is up, the latest quality indicators report shows.
The Residential Aged Care Quality Indicators January to March 2022 report also shows rates of falls remain steady but those resulting in major injury are up.
This report includes quality indicator measurements from the third data collection under the expanded QI program for 2,470 residential aged care services. This represents 92 per cent of the 2,685 services receiving government subsidies in the quarter, up from 91 per cent in the previous quarter and 89 per cent in the quarter before.
The expanded program counts the number of care recipients meeting QI criteria and produces prevalence rates. However, not all care recipients are counted in each QI measurement and may be excluded due to not consenting, being absent or receiving end-of-life care.
As can be seen below, polypharmacy, which refers to being prescribed nine or more medications, is the most prevalent quality indicator that residents meet criteria for.
Medication management indicators showing improvement
The report found that 37.4 per cent of residents were prescribed nine or more medications at the collection date in the January-March quarter, which is an improvement on both the October-December 2021 (38.3 per cent) and July-September 2021 (41 per cent) quarters.
Similarly, the proportion of residents using an antipsychotic during the seven-day assessment period in the most recent quarter (20.5 per cent) was lower than the previous two quarters (20.7 per cent and 21.6 per cent). The proportion of antipsychotic users who were diagnosed with psychosis was the same for the most recent two quarters (11.1 per cent) but lower than the July-September quarter (11.6 per cent).
Lower rates of physical restraint
The QI program physical restraint quality indicator measures and reports data relating to restrictive practice, including physical restraint, mechanical restraint, environmental restraint and seclusion, but not chemical restraint.
Based on a three-day recording period during the third quarter, 37,050 residents were restrained, including 28,907 residents restrained exclusively via a secure area.
The proportion of total residents physically restrained in the third quarter (21.4 per cent) was lower than the October-December (21.9 per cent) and July-September (23 per cent) quarters.
Weight loss up
The QI program measures unplanned weight loss, which is where there is no written strategy or ongoing record relating to planned weight loss for the resident, via a monthly check around the same time of the day and with similar clothing.
The rate of significant unplanned weight loss, which is 5 per cent or more compared to current and previous quarters, was 10.9 per cent in the most recent quarter, up from 8.9 per cent and 8.4 in the previous two quarters.
Consecutive unplanned weight loss, which is weight loss every month over three consecutive months of the quarter, was also up in the January-March quarter (11.2 per cent) compared to the October-December (10 per cent) and July-September quarters (9.5 per cent).
Falls steady but major injury up
During the most recent quarter 58,455 residents recorded one or more falls (31.5 per cent) and 4,035 residents (2.2 per cent) had a fall that resulted in one or more major injuries.
Major injuries include bone fractures, joint dislocations, closed head injuries with altered consciousness and subdural haematoma.
The rate of falls is the same as the previous quarter (31.5 per cent) but less than the first quarter of this financial year (31.9 per cent). However, the rate of falls resulting in a major injury (2.2 per cent) is higher than the previous two quarters (2.10 per cent in both).
Mixed trends on rates of pressure injuries
The QI program’s pressure injury measures the incidence of a localised injury to the skin or underlying on or around the same time and day in each quarter.
It also counts pressure injuries acquired outside of the service separately, but these are included in the total number of residents reported as having pressure injuries.
In the most recent quarter, a total of 10,403 residents had one more more pressure injury including 1,420 residents who acquired a pressure injury offsite. The proportion of residents with one or more pressure injury (5.9 percent) was more than the previous quarter (5.7 per cent) but the same as the quarter before that (5.9 per cent).
Comment on the story below. Follow Australian Ageing Agenda on LinkedIn and Facebook, sign up to our twice-weekly newsletter and subscribe to AAA magazine for the complete aged care picture.
Check your date ranges – you have 2022 dates indicating – these dates have not occurred.
Corrected to 2021. Thank you.
Sadly, the QI data is essentially meaningless.
Medication info is only relevant if we’re auditing the same residents every quarter.
P.I. rates are farcical: Pick a day and just do one count each quarter?…and if someone has multiple P.I.s of similar staging, it’s only counted as one.
In the absence of any background information, simply counting falls tells us nothing.
And although the Commission believes everyone should die fat and healthy (and if they don’t, it must be our fault), the weight loss data is crude and irrelevant. Are they fading away because of age-related pathology (Cardiac failure, cachexia in dementia, mitochondrial dysfunction, etc,) or a lack of cold party pies?
The QI Program is a good idea , dumbed-down to create the illusion the Commission is actually doing something proactive. Other than being deceptive, it’s not.