The increase in ‘nurse sensitive’ indicators like pressure injuries and hospital acquired infections in the annual adverse events report released today were ‘concerning’, says the New Zealand Nurses Organisation.

Increased reporting of patients suffering delayed diagnosis and pressure injuries were largely behind an increase in public hospital adverse events, shows the 2016-17 Learning from adverse events report released today. But the number of falls leading to injuries continues to decrease.

Jane McGeorge, the NZNO’s nursing and professional services manager said it was pleased to see the small decrease in patient falls. But it was concerned about the number of reports of nurse sensitive indicators like the failure to respond to deteriorating patients and the increase in reports of other indicators like pressure injuries and hospital acquired infections.

Commission chair Professor Alan Merry believed the steep upswing in reported pressure injuries – from about 15 last year to 51 this year – might reflect a “concerted effort across the sector to raise awareness of the impact and devastating harm of those injuries”. He also believed the increase in healthcare associated infections (HAIs) – up from three last year to 16 this year – was due to the Commission highlighting the issue leading to additional reporting. In the separate reporting area of failing to recognise, rescue or manage deteriorating patients there were 26 events reported.

MacGeorge said NZNO believed indicators like pressure injuries, deteriorating patients and HAIs needed to be monitored specifically, “not as part of a homogenous group as they are barometer of quality of care and typically observed in an under-resourced system”. She said NZNO was working to have the safe staffing Care Capacity Demand Management system operating in all DHBs to ensure hospitals were safe for patients and staff.

“The underfunding of the health service has led to understaffed hospitals and lean resources but with a new government promising reinvestment we expect the situation for patients and health staff to improve,” MacGeorge said.

She said NZNO thanked the Commission for their work to produce recent and relevant data and said the changes to the national adverse events reporting policy – which came into effect on July 1 this year – were also progressing well. She also congratulated the Commission on the increased focus on outcomes of serious events for the consumer, increased engagement with whānau and extending coverage to the whole health and disability sector.

“We appreciate the culture of learning that allows us to find meaningful ways to improve patient safety while identifying workforce and, resource and system issues that are a barrier to safe care and safe staffing,” she said.


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