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Medication Safety, v3 Timely and appropriate monitoring of aminoglycoside antibiotics CI 6.1: Aminoglycoside toxicity – dosage adjustment prior to next dose (H) Rationale Aminoglycosides are useful but toxic medicines with a narrow therapeutic index. In patients treated with aminoglycosides for more than 48 hours, dosage should be adjusted according to plasma drug concentrations and renal function. Failure to act on a toxic concentration result could lead to renal impairment and ototoxicity. Numerator Denominator Total number of patients with a toxic aminoglycoside concentration whose dosage has been adjusted prior to the next aminoglycoside dose Total number of patients with a toxic aminoglycoside concentration in the sample Dimensions of care: Accessibility Appropriateness Continuity Effectiveness Quality Improvement and Risk Safety Desirable level: Low High Not specified Type of Indicator: Process Outcome Structure Year No. HCOs Total numerator Total denominator Rate # Rate# (20) Rate # (80) 2011 3 45 46 97.8 97.8 97.8 #per 100 patients Centile Gains Stratum Gains Outlier Gains In 2011 there were three submissions from three HCOs. The annual rate was 97.8 per 100 patients. Variation between strata There were no significant stratum differences in 2011. Variation between HCOs There were no potential gains in 2011. Outliers There were no outlier HCOs in 2011. Australasian Clinical Indicator Report 2004–2011 Page 19 © ACHS. This work is copyright. Requests and inquiries concerning reproduction and rights should be addressed to pos@achs.org.au
Medication Safety, v3 Clinical Significance of these results Of the six indicators that were suitable for trending, two improved and two deteriorated. There was a significant contribution from private HCOs to these indicators, in excess of 50% of patients covered in several indicators. Reporting of adverse drug reactions to the TGA CI 1.1: Adverse drug reactions reported to OPC, TGA (N) In 2011, there were 893,193 separations reported to the Therapeutic Goods Administration (TGA) from 97 HCOs. The annual rate was 0.12 per 100 separations. The fitted rate decreased from 0.17 to 0.093, a change of 0.074 per 100 separations. This trend was also significant after allowing for the changing composition of HCOs contributing over the period. Medication errors resulting in an adverse event CI 2.1: Medication errors – adverse event requiring intervention (L) In 2011, there were 7,132,050 bed days reported from 247 HCOs. The annual rate was 0.013 per 100 bed days. The fitted rate improved from 0.051 to 0.030, a change of 0.021 per 100 bed days. This trend was also significant after allowing for the changing composition of HCOs contributing over the period. The rate change was 0.020 per 100 bed days. In 2011, there were 21 outlier submissions from 17 HCOs whose combined excess was 330 more medication errors resulting in an adverse event requiring intervention. Documentation of adverse drug reactions (ADRs) CI 3.1: Known ADRs documented in current medication chart (H) In 2011, there were 15,674 patients reported from 57 HCOs. The annual rate was 93.0 per 100 patients. In 2011, there were 21 outlier submissions from 17 HCOs whose combined excess was 569 fewer patients whose known ADRs are documented on the current medication chart. Error-prone abbreviations CI 4.1: Medication orders with error-prone abbreviations (L) In 2011, 58,827 medication orders were reported from 36 HCOs. The annual rate was 4.7 per 100 medication orders. There were 12 outlier submissions from nine HCOs whose combined excess was 1,072 more medication orders that include error-prone abbreviations. Warfarin management CI 5.1: Warfarin – abnormal bleeding (L) In 2011, there were 35 submissions reported from 24 HCOs. The annual rate was 1.4 per 100 separations. The fitted rate deteriorated from 0.45 to 0.77, a change of 0.32 per 100 separations. In 2011, there were three outlier submissions from two HCOs whose combined excess was nine more separations of inpatients receiving warfarin who experience abnormal bleeding. The outlier HCO rate was 11.8 per 100 separations. CI 5.2: Warfarin – INR * / prothrombin reading >5 (L) In 2011, there were 7,296 separations reported from 26 HCOs. The annual rate was 2.2 per 100 separations. The fitted rate improved from 4.2 to 2.8, a change of 1.3 per 100 separations. This trend was also significant after allowing for the changing composition of HCOs contributing over the period. The rate change was 1.4 per 100 separations. In 2011, there were two outlier submissions from a single HCO whose combined excess was 35 more separations receiving warfarin as an inpatient with an INR* reading greater than 5. * The International Normalised Ratio is a test for blood clotting. Australasian Clinical Indicator Report 2004–2011 Page 20 © ACHS. This work is copyright. Requests and inquiries concerning reproduction and rights should be addressed to pos@achs.org.au
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