Clinical Safety and Quality Indicators

When you receive treatment and services by Ramsay Health Care, you can expect a high level of professional expertise and safe and effective care. We want you to feel reassured and understand what you are experiencing during your stay in hospital as well.

We encourage you to ask questions about any aspect of your care, and participate in planning and decisions about your treatment.

Ramsay Health Care aims to improve safety for patients by minimising key risks and optimising the quality of the services we provide. In each of our hospitals, we focus on known risks to our patients which, for example may include: falls, medication safety and pressure injuries.

Open Disclosure

Every effort is made to minimise risk, unfortunately, incidents do occur and Ramsay Health Care supports open disclosure.  This is the process of open communication with patients and families when an incident results in unintended harm.  It involves discussion of the incident, investigation and any actions taken to improve the care delivered and ensure the incident is not repeated. Read more information.

Patient Identification/Information Sharing

Sharing of information about your care while you are in hospital is an important aspect of ensuring your safety and continuity of care between your doctor, nurse and other healthcare workers.  Every day, at the start of a shift, a handover is undertaken by staff. One aspect of the handover is at the bedside, which is an opportunity for you, your family or your carer to be involved - by asking questions, clarifying concerns and participating in your care including your discharge from hospital.

What you can do to reduce your risk

You will be given an identification band when you are admitted to hospital. Staff may refer to it as an 'ID band' or a 'wrist band'. It will include your name and date of birth, and be placed on your wrist or leg.

You should:

• Always wear your ID band
• Make sure the information on the ID band is correct
• Check that you have a red ID band if you have any allergies

Staff will check your ID band before every test or procedure and before giving you any medication. They will also ask you what your name is and other details, to make sure that the right patient is getting the right treatment every time.

All our hospital staff should be wearing an identification badge. If you can't see their badge, or you're not sure who someone is, please ask

Hygiene and Infection indicators

We aim to minimise the risk of infection to patients, staff and visitors that come to our hospitals across Australia. Our infection rates have been consistently below the industry benchmark.

What Ramsay Health Care does to reduce your risk

Ramsay Health Care has a programs in place to detect and prevent infections that are common within health care hospitals. Visitors to Ramsay hospitals are encouraged through appropriate signage to use antiseptic hand rub located throughout our hospitals.

What you can do to reduce your risk

There are several ways you can assist in preventing an infection:

• Always wash your hands after using the toilet, bedpan or a commode
• Wash or clean your hands before eating
• Don’t be afraid to ask your doctor or staff caring for you, if they have washed their hands
• Avoid touching your wound or devices (for example fluid tubes into your arm or drain tubes)
• Let the care staff know if your wound or areas around any of the lines or tubes become red or swollen or painful
• Discourage visitors who may be feeling unwell
• Stop smoking before any surgery, as smoking increases the risk of infection

One of the most effective ways to prevent infection spreading amongst patients is for all health professionals to wash their hands. Hand hygiene is conducted in accordance with the ‘five moments’ that is; before touching a patient; before a procedure; after a procedure; after touching a patient; and after touching a patient’s environment.
Ramsay Health Care participates in the national hand hygiene strategy through Hand Hygiene Australia, and Hand hygiene audits are conducted three times per year.

Hand hygiene compliance is reported as the percentage of correct moments from all observed moments.

The rate of Staphylococcus aureus bacteraemia (SAB) infections is an indicator of the effectiveness of the hospital’s infection prevention and control program. It is a key indicator for acute hospitals, and is reported nationally.

The SAB indicator is reported as a rate of infections per 10,000 patient days. It is calculated by dividing the number of SAB infections that meet the indicator criteria, by the number of patient days then multiplying that figure by 10,000.

Surgical site infections are an indicator for infections that develop as a result of an operation. Ramsay Health Care participates in the Australian Council on Healthcare Standards (ACHS) Clinical Indicator Program and use their definitions for these indicators.

These indicators are reported as a percentage of all procedures during the period. They are calculated by dividing the number of deep or organ/space surgical site infections that meet the indicator criteria by the number of prosthesis procedures performed.

Ramsay Health Care has a low percentage of patients who have an unplanned readmission to hospital following discharge. Monitoring of this information is very important as it provides an indication of the effectiveness of our discharge planning processes or the development of complications after a patient has gone home.

What Ramsay Health Care does to reduce your risk

Ramsay Health Care doctors provide surgery in many specialty areas which range from minor procedures to more complex surgery requiring specialised care. We monitor our patient outcomes by comparing any unplanned returns to theatre to other Australian hospitals nationally. The aim is to reduce returns to theatre where possible; however, there are many factors which influence these returns and sometimes these returns may be essential.

Unplanned returns to the operating theatre are frequently due to complications, for example to treat bleeding or other problems which may occur early after the operation. Some complications following complex surgery are to be expected due to patients’ pre-existing diseases or condition, and the nature of the disease or condition being treated. Our hospitals monitor all returns to theatre and implement any quality measures which may be required so that our patients have the best possible outcomes following surgery.

Many patients are treated in the Intensive Care Unit (ICU) as their risk is recognised and specialised monitoring and management is required.  An unplanned admission to the ICU may indicate that a patient requires a higher level of care due to a complication or deterioration in their condition which was not anticipated. Our hospitals monitor all unplanned admissions to the ICU and implement any quality measures which may be required so that our patients have the best possible outcomes during their treatment.

The unplanned readmissions within 28 days indicator is reported as a percentage of patients having an admission during the period. It is calculated by dividing the events that meet the indicator criteria by the number of patients having an admission during the period.

The unplanned return to theatre indicator is reported as a percentage of patients having a procedure during the period. It is calculated by dividing the events that meet the indicator criteria by the number of patients having a procedure during the period.

The unplanned admission to ICU indicator is reported as a percentage of patients receiving anaesthesia care during the period. It is calculated by dividing the events that meet the indicator criteria by the number of patients receiving anaesthesia care during the period.

Skin Care

Pressure injuries are wounds which form as a result of prolonged pressure to an area of skin. Pressure injuries are recognised worldwide as a common cause of harm to patients and could cause significant pain and discomfort which may result in a slower recovery for a patient.

What Ramsay Health Care does to reduce your risk

Ramsay hospitals are well equipped with the latest equipment to assist staff to prevent these injuries from occurring. Patients are risk-assessed on admission using an evidenced based tool. Staff follow a care plan which is targeted to minimise a patient’s risk of developing a pressure injury for those patients assessed as high risk. This includes inspecting the patient’s skin frequently, managing moisture, keeping the skin dry, optimising nutrition and hydration, moving the patient frequently, or using special pressure relieving mattresses when needed.

What you can do to reduce your risk

Pressure injuries also called bed sores or pressure ulcers can happen very quickly if you are unwell or not able to move easily. Any form of pressure or rubbing can cause skin damage, particularly if your skin is moist or if you suffer from poor circulation or poor sensation.
You can assist by telling your nurse if you have:

• Any skin pain or burning feeling
• Keep active – when in bed change positions, turn from side to side to relieve the pressure on you bottom and heels, move as much as possible
• Eat a variety of foods each day and drink plenty of fluids
• Avoid wrinkled, damp clothes and bedding – alert the staff
• Sliding down the bed can put pressure on heels, bottom and elbows. To avoid this ask the staff to raise the foot of the bed or sit out of bed to eat, if allowed
• Avoid smoking as this reduces blood flow to the skin

The pressure injury indicator is reported as a percentage of all patient days during the period. Ramsay Health Care participates in the Australian Council on Healthcare Standards (ACHS) Clinical Indicator Program and use their definitions for this indicator. It is calculated by dividing the number of patients who develop a pressure injury that meets the indicator criteria by number of days for all patients who were admitted.

Medications

Medicines are commonly used to treat a variety of conditions in the healthcare setting, and therefore, it is important to measure the risk of errors. Ramsay Health Care has a very low rate of medication errors due to its implementation of a range of medication safety strategies.

What Ramsay Health Care does to reduce your risk

Ramsay Health Care takes all medication errors very seriously. We encourage staff to report all medication errors as incidents, no matter how minor they may seem. All medication incidents are investigated and actioned and any serious medication incidents are investigated thoroughly and monitored by Ramsay’s National Clinical Governance Unit.
In addition, Ramsay Health Care has medication administration policies and processes in place which have been developed using best practice principles.
The Australian Commission on Safety and Quality in Health Care has introduced safety initiatives for medication administration and reconciliation and Ramsay Health Care has adopted these strategies. This includes the National Inpatient Medication Chart which standardises the documentation on how medicines are prescribed and ordered. Adoption by Ramsay Health Care of the User-Applied Labelling of Injectable Medicines recommendations has assisted in preventing medication errors related to the wrong route, dose or medication being administered.

What you can do to reduce your risk

We encourage you to be involved in the management of your medicines, if you have any concerns please discuss this with your doctor, pharmacist or nurse.

It is important during your stay with us that we know what medicines you are taking. Our doctors, pharmacists and nurses will ask you about the medications you take at home, including any complementary or alternative therapy medicines, for example vitamins, nutritional supplements, homeopathic medicines, Chinese or Ayurvedic medicines and Australian indigenous medicines. 

It is important you advise the staff of any allergies you have experienced or any reactions you have had to medicines taken in the past.

The serious medication error indicator is reported as a percentage of all patient days during the period. Ramsay Health Care participates in the Australian Council on Healthcare Standards (ACHS) Clinical Indicator Program and use their definitions for this indicator. It is calculated by dividing the number of patients who require medical intervention as a result of a medication safety incident by number of days for all patients who were admitted.

Comprehensive care indicators

Falls

The risk of falling increases according to age; with data suggesting that one third of people over the age of 65 years have one or more falls a year. Falls can occur at all ages, though the frequency and severity of fall-related injuries increases significantly with age. These injuries can include minor skin abrasions, joint dislocation, fractures and head injuries. These injuries may result in hospitalisation or an increased length of stay in hospital.

The risk of falling can greatly increase when admitted to hospital due to a range of factors including: illness and unsteadiness, adapting to a new environment, the introduction of new medications and walking in unsafe footwear or slippers.

What Ramsay Health Care does to reduce your risk

In 2015, Ramsay Health Care increased the focus on falls prevention in hospitals by appointing a National Falls Prevention Advisory Group. This group has standardised the approach to falls prevention across all Ramsay hospitals by targeting a structured risk assessment, policy and guidelines, equipment for falls prevention and clinical staff education.
Our hospitals use a number of strategies to prevent falls and these include: targeted hourly rounding of patients identified as high risk of falling; ensuring that call bells and personal items are within patient reach; call bells are answered promptly, and patients are assisted to the toilet at regular intervals. In addition, Ramsay Health Care has purchased low beds, falls mats, and patient alarms to minimise the risk of patients falling whilst in our hospitals.

What you can do to reduce your risk

Falls can be a major cause of injury.  We want to protect you from a fall during your hospital stay and you can help by:

• Becoming familiar with your surroundings
• Get to know how the bed controls work and how to use the call bell – if you cannot reach it, ask your nurse to move it within your reach
• If you need help, use the call bell to alert staff
• Wear supportive, flat, non-slip shoes – do not walk around in socks or pressure stockings (TED stockings)
• If you use glasses, hearing aids, a walking stick or walker, keep them in easy reach by the bedside, use the call bell to ask staff to assist you
• Make sure your bed height is appropriate for you to get in and out of – if your bed is too high ask the nurse to adjust it for you

Falls indicators are reported as a percentage of all patient days during the period. Ramsay Health Care participates in the Australian Council on Healthcare Standards (ACHS) Clinical Indicator Program and use their definitions for these indicators. The indicators are calculated by dividing the number of inpatient falls that meet the indicator criteria by number of days for all patients who were admitted.

Blood Safety

Australia has one of the safest blood supplies in the world, however, as with all medical procedures, a blood transfusion is not completely free from risk. A blood transfusion is a procedure where you receive blood through an intravenous cannula (IV) inserted into a vein.

What Ramsay Health Care does to reduce your risk

Before you receive a transfusion, strict checks of your name and date of birth are done by two staff.  If you need to have more than one bag of blood, staff will do these checks every time.  Staff will also monitor your pulse, blood pressure and temperature on a regular basis.  Most people feel no different whilst having a transfusion, but if you feel unwell advise staff immediately.

What you can do to reduce your risk

Any treatment is a choice and before you are given a transfusion, you will be asked for your consent. To help you make this choice, the following questions may be helpful:

• Do you know why a transfusion has been recommended?
• Have you asked about ways to avoid or reduce the need for a transfusion?
• Do you understand the risks?

More common risks of transfusion include:

• Minor reactions including a mild temperature or skin rash
• Fluid overload, causing breathing difficulties especially with older patients and those with heart disease

Other less common risks of transfusion include:

• Receiving blood that is not ‘matched’ to you
• Transmission of infection, for example bacteria or viruses

The serious blood transfusion events indicator is reported as a percentage of all transfusion episodes during the period. Ramsay Health Care participates in the Australian Council on Healthcare Standards (ACHS) Clinical Indicator Program and use their definitions for this indicator. It is calculated by dividing the number of patients who have a serious blood transfusion event that meets the indicator criteria by number of transfusion episodes during the period.

Coming to hospital for obstetric and maternity care

For all babies delivered at our Ramsay Health Care maternity hospitals an APGAR score is completed at one minute, and again at five minutes after birth. The APGAR score is a simple assessment of a baby’s condition at birth, which helps determine whether the baby needs any additional medical assistance. At birth, the Midwife and Doctor assess the baby’s heart rate, breathing effort, muscle tone, reflex irritability and skin colour. Each characteristic is rated from zero to two, and the sum of these five characteristics is the total APGAR score of the baby. The total APGAR rating scale is from 1 to 10, with a score of 7 and above being considered normal, and the baby doesn’t require additional medical intervention. The graph below shows the percentage of healthy babies born with normal APGAR scores. This is very similar to the industry average.

The indicator for surgical repair for fourth degree tear is an indicator of major complication of a vaginal birth. Ramsay Health Care participates in the Australian Council on Healthcare Standards (ACHS) Clinical Indicator Program and use their definitions for these indicators.

The APGAR indicator is reported as a percentage of births. The indicator for surgical repair of a fourth-degree tear is reported as a percentage of women giving birth for the first time. They are calculated by dividing the events that meet the indicator criteria by the number of babies or women giving birth for the first time during the period.