In June 2021, the Department of Health issued new National Aged Care Mandatory Quality Indicator Program FAQs. Here’s a quick, condensed summary of the FAQs for aged care providers.
General
What are the Mandatory Quality Indicator (QI) Program quality indicators?
Residential aged care providers must collect and report data across the five quality indicators:
- Pressure injuries
- Physical restraint
- Unplanned weight loss
- Falls and major injury
- Medication management.
Are care recipients receiving residential respite included in the QI Program?
Yes.
Are care recipients receiving end-of-life care included in the QI Program?
Yes, for every QI except unplanned weight loss. See below for more information on unplanned weight loss.
Is consent required from care recipients to collect QI Program data?
Yes and No. Yes, consent is required before assessing pressure injuries and unplanned weight loss (and you must record and report the number of people who refuse consent). No, consent is not required before assessing physical restraint, falls and major injury, and medication management.
Is there a template to support recording data for each quality indicator?
Yes. Data recording templates are available on the department’s website.
Are residential aged care services able to use their own templates to record QI Program data?
Yes, providing you follow the definitions and instructions in the QI Manual.
When and where do I submit the QI Program data?
Submit through the My Aged Care provider portal every quarter based on the financial year calendar. You must submit data no later than the 21st of the month after the end of each quarter. For this quarter, you must report between 1 and 21 October 2021. If you need help, contact the My Aged Care Provider and Assessor Helpline on 1800 836 799.
Pressure injuries
Which classification system is used to report pressure injuries?
The ICD-10-Australian Modified (AM) pressure injury classification system outlined in the Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline 2019.
Are pressure injuries acquired outside the service counted?
Yes. Record these under the sub-category of “injuries acquired outside the service”, and as part of the total number of care recipients with one or more pressure injuries.
What if a care recipient has more than one pressure injury?
For the purposes of the QI, you don’t have to report the number of pressure injuries a care recipient has overall or against each stage. You only have to report whether one (or more) has been observed.
Note from ACE: As highlighted the above information is for the basis of Quality Indicator (external) reporting. Consider what information is required internally for decision making and ongoing consumer care. The collecting of further pressure injury information could be part of the process to meet both of these needs.
Who should undertake observation assessments for pressure injuries?
Someone who understands the ICD-10-AM and has knowledge to do so accurately and safely. Consult with a suitably qualified health practitioner if uncertain about the presence or stage of a pressure injury.
Physical restraint
Note from ACE: For the purposes of the QI Program, “physical restraint” is a broad term that includes mechanical restraint, physical restraint (in the narrower sense of using hands-on physical force), environmental restraint and seclusion. In other contexts, such as restrictive practices legislation and the SIRS, “physical restraint” is used exclusively in the narrower sense and only includes the use of hands-on physical force. It can be confusing, so take care.
Do we need to record each care recipient in a memory support unit, secure or locked area?
Yes. For the purposes of the QI Program, restraint through the use of a secure area is a form of physical restraint known as “environmental restraint”. This means you must record any use of secure-area restraint under the sub-category of “environmental restraint” and in the overall count of care recipients who were physically restrained.
If equipment is used to protect a care recipient from harm is this considered physical restraint?
Yes. For the purposes of the QI program “physical restraint” includes all “mechanical restraints”, such as the use of equipment to restrain.
If a care recipient has requested bed rails, are these still included in the physical restraint count?
Yes. For the purposes of the QI Program, any use of physical restraint must be reported, even if the restraint was requested by the care recipient or their representative.
Note from ACE: Consider the collecting of information about the type and category of the restraint for internal reporting and decision-making processes. Make the collecting of QI data purposeful for your own quality processes.
Unplanned weight loss
If a care recipient loses weight but has been prescribed a weight loss strategy, should their weight loss be counted?
No. Planned weight loss does not count. But you should ensure you have written evidence of the strategy, including in the consumer’s care plan.
Are we required to report weight loss for care recipients who are receiving end-of-life care?
No. When reporting unplanned weight loss, exclude any recipients receiving end of life care. Record and report the number of these exclusions.
Can the same measurements that were taken for significant weight loss be used for consecutive unplanned weight loss?
The same “finishing weights” can be used for consecutive unplanned weight loss and do not need to be collected again.
Falls and major injury
How do we choose the collection date for falls and major injury?
The collection date must be after the end of the quarter and before data submission is due on the 21st day of the next month. The current quarter ends on 30 September 2021. So, your collection date must be sometime between 1 and 21 October 2021.
If a care recipient is found on the ground following an unwitnessed fall, should this be counted and recorded for the falls and major injury quality indicator?
Yes.
If a fall takes place outside of a provider’s care or facility should this be recorded?
No. Falls that occurred while the care recipient was away from the service and not under direct supervision of service staff are not included.
ACE note: there is some potential confusion here. What about falls that occurred while the care recipient was away from the service but was under direct service staff supervision? (E.g. a staff-supervised excursion). Should these be counted? The answer is unclear at this stage.
A care recipient fell once with no injury and a second time resulting in major injury, how is this recorded?
For this QI, you must report two separate things: (1) percentage of care recipients who experienced a fall; (2) percentage of care recipients who experienced a fall resulting in major injury. In the case of a care recipient who experiences a fall and then a fall resulting in major injury, you must record both falls separately.
Medication management
Are there certain medications that are excluded from the count of medications for polypharmacy?
Yes. You should not count:
- Lotions, creams or ointments used in skin and wound care (e.g. medicated creams for rashes or thrush)
- Dietary supplements, including those containing vitamins
- Short-term medications, such as antibiotics or temporary eye drops
- PRN medications (unless the PRN medication is an antipsychotic, in which case it must be included).
Note from ACE: Consider carefully who will collect this data and the benefit of understanding the numbers of excluded areas in the count. This will ensure the accuracy of your QI information and could support internal decision-making processes relate to the right knowledge and skills of staff that administer medications.
Are vitamin injections, such as Vitamin B12, included in the count of medications for polypharmacy?
Yes. Dietary supplements, including those containing vitamins are excluded from the count for polypharmacy but injections, such as Vitamin B12, must be included.
Are medications with more than one active ingredient counted as more than one medication for polypharmacy?
No. Data is not collected on the number of active ingredients. A single medication with more than one active ingredient is counted as one medication for polypharmacy.
A care recipient was on leave with family on the collection date – are they excluded from the count for polypharmacy?
No. Only care recipients who were a hospital admitted patient on the collection date are excluded. All other care recipients are included.
Is there a list of antipsychotic medications counted for antipsychotics?
The following non-exhaustive list of antipsychotic medications is available in Part B of the Manual*. The list will be updated periodically as indicated by evolving clinical evidence.
*ACE note: as at 13 July 2021, Part B of the Manual is yet to be released.
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· Amisulpride
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· Droperidol
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· Periciazine
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· Aripiprazole
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· Flupentixol
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· Quetiapine
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· Asenapine
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· Haloperidol
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· Risperidone
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· Brexpiprazole
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· Lurasidone
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· Trifluoperazine
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· Chlorpromazine
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· Olanzapine
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· Ziprasidone
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· Clozapine
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· Paliperidone
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· Zuclopenthixol
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How do I record a care recipient who received antipsychotics on more than one occasion during the seven-day assessment period?
For this QI, a care recipient who received six antipsychotic medications is recorded the same as a care recipient who received one antipsychotic medication. Both are simply recorded as “receiving an antipsychotic medication”.
Should providers aim to have zero care recipients receiving antipsychotic medication?
No. Antipsychotic medications are an appropriate treatment in some situations.
Can care staff select the collection date?
No. The collection date must be kept secret from staff directly involved in care.
More Information
QI Program Manual 2.0 – Part A
See also our previous articles:
