Much of the initial First, Do No Harm activity has involved developing and building the capacity and capability for undertaking sustainable patient safety improvement processes. Our early work has focused on building the will, ideas and ability to execute changes that will result in reducing harm. The adoption and use of a formal improvement methodology based on improvement science is a cornerstone of this work. We have introduced formal tools such as the Model of Improvement and adopted measurements for improvement. During June Learning Session 1, jointly-hosted by the Health of Older People (HOP) Clinical Network, attracted around 60 participants from the wider sector to focus on initiatives with the potential to reduce falls and pressure injuries.

We recognise there is no single ‘magic bullet’ for things such as falls prevention but a range of interventions can have an impact over time. Robust measurement processes, recently in place or currently being introduced, will allow the results to be analysed over time. The Northern Region DHBs have committed to undertake monthly audits for pressure injuries as one of the key measures to reduce harm and track the effectiveness of interventions. Discussions around measurement suitable for the age-related residential setting are progressing well. Providing staff with results in highly visible ward settings increases the visibility and keeps the whole team on track in reducing these types of injuries.

Several new initiatives to improve patient safety are currently being evaluated or have been implemented. Many of these are simple, low cost measures that can make a big difference to improving patient safety.

Initiatives introduced in the 2011/12 year include:

• All four district health boards and many age-related residential care providers have been involved in a formal cross-sector collaborative on falls and pressure injuries. This has included regional agreement on definitions, measurement and data collection processes.
• The Global Trigger Tool has been implemented in all Northern Region district health boards.
• An Auckland DHB-led cluster model approach that is uniting age-related residential care with acute care areas and helping to foster a joint approach to improve patient safety across the sector.
• The Region-wide roll out of SafeRx, a reference tool for the safe use of high-risk medicines for the primary care community is another approach to work on wider aspects of patient safety.
• Numerous activities/changes are being tried and tested across the Region to improve care and reduce harm. This activity, combined with the collaboration and sharing of learning, is helping us provide ‘safer care together’.  Some examples are:
  • Transfer of care yellow envelope. This yellow envelope has a checklist of vital patient information printed on it and has helped minimize errors and delays during transfer of care from age-related residential care facilities to hospital and back.
  • Intentional rounding. A systematic approach to rounding can improve patients’ experiences of care and build their trust, and improve safety and reliability of care.

We have been sharing these stories with you via the First, Do No Harm website along with resources and other useful information and will continue to do so as we continue to work together to improve patient safety in our Region. Join us on the journey.