Quality Report 2010-2011. Te Hanga Whaioranga Mō Te Iwi 1 Building Healthy Communities

Annual Quality Report 2010-2011 Te Hanga Whaioranga Mō Te Iwi 1 Building Healthy Communities

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leadership team statement We are delighted to present our first ever quality report*, which records the steps we took to improve our services and outcomes. Quality is important to all of us, and in 2009 we launched our patient safety initiative, highlighting six priority areas for the provider arm services to focus on, and drive improvement. They were: Reduce medication errors Reduce patient falls Ensure clinical audit is carried out in every clinical unit Set up the Health Waikato mortality committee Improve our hand hygiene practices Implement a safe patient care programme Since then, we have seen steady improvement against each of the priorities, and a growing focus on improving the quality and safety of care we deliver. This is an excellent achievement as we faced the challenge of refurbishing and/or commissioning new areas of both Waikato and Thames hospitals as part of our major campus redevelopment programme during this time. At Waikato Hospital, we opened the refurbished delivery suite, a new newborn intensive care unit, opened the new emergency department and the Acute Services Building. Meanwhile at Thames we opened the Clinical Centre, the inpatient unit and more recently a new primary birthing unit. Part of our journey to success in these areas has been a focus on a strong project methodology, plus introducing the productive series across inpatient wards, our emergency department and some community service areas. We also focused on improving our performance management reporting frameworks, which reports on patient safety, finance and performance targets against key priorities such as elective surgery, six-hour acute targets and smoking cessation. Looking back, we made significant progress since 2009 and our staff can be proud of what they achieved. Looking forward, our focus will continue on improving patient safety, clinical effectiveness and patient outcomes. We look forward to working with all staff as we strive to reach these goals together. During 2011/2012 we will standardise the reporting data into a consistent format, refine the quality strategy and focus on process improvement. Jan Adams Tom Watson Sue Hayward Chief Operating Officer Chief Medical Advisor Director of Nursing and Midwifery *July 1, 2010 - June 30, 2011 3

our priorities for improvement Within the domains of patient safety, clinical effectiveness and patient experience, we set ourselves a number of improvement activities: Priority Domain number Priority Status Patient safety 1 Medication errors Achieved 2 Falls reduction Achieved 3 Clinical audit Achieved 4 Mortality committee Achieved 5 Hand hygiene Achieved 6 Safe patient care Achieved Clinical effectiveness 7 Meeting the health targets Partially achieved 8 Productive series Achieved Patient experience 9 Acute theatre time Partially achieved 10 Average length of stay Partially achieved To illustrate the progress we made, included are three case studies: Child Development Centre Electronic whiteboard Improve transfusion practices 4

priority 1: reduce medication errors STATUS: Achieved Aim To improve the standards and clarity of prescribing so that prescribers intentions about treatment are clear thereby reducing medication errors and thus improving patient safety. Achievement to date Prescribing practices at Waikato DHB hospitals have been recognised as inconsistent and often below the standard required under the Waikato DHB Medicines Management Policy. In order to try and address prescribing standards, medical, nursing, pharmacy and Medicine Safety Forum representatives discussed the fundamental issues and developed a programme strategy. A pharmacy team led the campaign and was responsible for developing all resources, co-ordinating consultation, communication, audits, reporting and implementation of the programme. Following a baseline audit at Waikato Hospital in 2007, a high profile campaign was undertaken. As well as using a range of themed educational and promotional materials, the Prescribing Improvement Programme included an incentives initiative: prescribers who charted medicines to the required standard were given a chocolate fish card which they could exchange for a real chocolate fish. Everyone receiving a chocolate fish card had their names put into a weekly draw for a coffee voucher and at the end of the programme, a dinner voucher. Implementation took place in a co-ordinated approach at Waikato, Thames, Te Kuiti, Tokoroa and Taumarunui hospitals. Ward pharmacists were responsible for implementing the campaign at Waikato and Thames hospitals, nurses led the campaigns for the other hospitals in the absence of a clinical pharmacy service. The programme was highly successful in highlighting an area of improvement for medicine safety and overall did so in a positive and engaging way. An audit following the Prescribing Improvement Programme showed actual improvements in a number of areas.! 5

Withdrawal of the activities focussing prescribers on prescribing practice in the co-ordinated approach of the Prescribing Improvement Programme resulted in a dilution of effect over time. In early 2009 it was apparent that an extension to the programme was necessary in order to embed a culture change. A repeat of the Prescribing Improvement Programme was conducted and then followed by a Zero Tolerance campaign. The Zero Tolerance to prescribing errors involved a new set of resources and required a high level of input from both pharmacy and nursing staff. Although an audit showed success in changing some prescribing behaviours, the programme was not sustainable. Discussion at the Medicine Safety Forum led to the decision for Pharmacy to lead annual repeats of the successful Prescribing Improvement Programme and the latest of these was undertaken earlier this year. Graph 1: Medicine Charting 100% 90% 80% 70% 60% 50% 40% 30% 20% Date Full name Generic names Legibility Dose clear 10% 0% 2007 2008 Pre ZT 09 Post ZT 09 Graph 2: Documentation of allergic reactions!! 100% 90% 80% 70% 60% 50% 40% 30% Allergy or NKDA noted Reaction or allergy described 20% 10% 0% 2007 2008 Pre ZT 09 Post ZT 09 Note: Documentation of allergic reaction and a description of reaction significantly improved over the three year period. 6

Medicine Reconciliation Medicine reconciliation is an evidence based process that has been shown to reduce medication errors at transition points of care (admission, transfer and discharge). By following standard processes, any discrepancies between a patient s medicines prior to admission and those prescribed in hospital can be identified. The aim is to reduce discrepancies that have the potential to become medication errors or result in medication related harm to the patient. Although the standardised processes can be followed by any trained health professional, to date it is Pharmacy Services that have undertaken medicine reconciliation at Waikato Hospital. The two key means of doing this have been the chronic care management pharmacists and ward based pharmacy technicians. The chronic care pharmacists undertake medicine reconciliation at admission and discharge as well as review a patient s medicines and spend time educating the patient and assessing any medicine management issues they may have. The ward based pharmacy technicians also undertake medicine reconciliation at admission and discharge and help in the provision of medication cards. The project continues to operate on wards 5 and 14 of Waikato Hospital. The two ward based pharmacy technicians are providing medicine reconciliation, discharge checks, medication cards, warfarin and patient medication education to these wards. The Safe Medication Management Programme project started on 6 October 2010 to run parallel with the medication reconciliation project for three months with ward 14 used for the pilot study. Following the success of this pilot, the programme continued on ward 14 and has recently been initiated on ward A4. Results of ward based technician work (on two wards) Number of Number of Number of medications Number of discrepancies Dates charts reconciled reconciled discrepancies at discharge To Jan 2011 607 4746 618 137 To July 2011 622 5028 369 72 Note: results are typical of the work that is being achieved by both ward based technicians and the Chronic Care Management team of pharmacists. 7

improving patient safety priority 2: reduce patient falls STATUS: Achieved Aim The key aim of the Waikato DHB multi-factorial fall prevention programme is to reduce patient harm related to falling by 10 percent. The DHB falls committee, which has a multi-disciplinary membership, continues to demonstrate the organisational commitment to minimise patient falls. The collaborative partnership between Waikato DHB and Upright enabled the implementation of the research based validated fall risk assessment model (Hendrich II Fall Risk Model), in all appropriate inpatient and several out-patient/clinic areas of the provider arm. Greater staff awareness promotes an everybody s business approach to fall prevention; nursing and allied health colleagues are now better engaged in critical thinking and matching specific falls risk factors with individually assessed interventions. At the present time education and training focuses on nurses, health care assistants and allied health groups as these staff spend the largest proportion of time providing direct care. Resources are more focused on patients identified at high risk of falling. Interventions to reduce risk of harm are becoming better embedded into the usual care planning process, so fall risk management is part of daily language and clinical practice. A data management system provides the ability to record and report on falls events facilitating systematic improvements are available for service use, in conjunction with the established incident management process. However, the upright falls prevention programme is only one part of the systems approach detailed in the fall risk assessment, minimisation and management (inpatient) procedure. The approach aligns and enables a better connect between local fall prevention initiatives such as falls focus groups, identified fall champions at site, product trials (non-slip socks, sensor mats, personal alarms, invisabeam and ultra low beds), regular newsletters and an informed falls website one stop shop staff resource of fall prevention information and minimisation strategies. The fall risk assessment, minimisation and management (inpatient) procedure is presently under review, increasing status to a policy and encompassing fall prevention across all Waikato DHB areas. The initial stage of the programme supports the nursing and midwifery directorate s fall minimisation key performance indicator as fall prevention becomes business as usual and service quality committees monitor success measurements. Achievement to date There is an increase in the number of fall risk assessments and interventions included in patient clinical records and an improved staff knowledge, as more than 1600 staff accessed the on line falls education, 900 staff completed the falls education and competency test (auditable on line). Most areas are reporting between 50 percent to 100 percent education compliance. Interrogating the Quality and Risk incident data base, shows some successes for the fall prevention programme, but also indicates further work is required to meet the required 10 percent reduction in patient falls. There has been a slight increase in the number of falls reported, which could be due to the increased staff education and awareness of fall prevention. 8

Reporting per 1000 bed days, details: The average fall rate for 2010/11 year to date is above the rate for the same time last year but the injury rate has decreased. The average fall rate has been reduced by 0.26 from 2008/09 to 2009/10, equating to approximately 70 less falls across the DHB based on 2009/10 bed days. The average injury rate has fallen from 47 to 43 from 2008/09 to 2009/10, indicating that number of falls resulting in injury has decreased by 4 percent. The injury rate for 2010/11 YTD is below previous years at 42. The number of falls resulting in a SAC score of 1 increased from 2009/10 to 2010/11. The total number of bed days increased from 2009/10 to 2010/11 while the number of patients has increased. No of falls/injury rate 160 140 120 100 80 80 60 60 40 40 20 20-0 Jul 08 Aug 08 WAIKATO Waikato DHB Falls FALLS Sep 08 Oct 08 Nov 08 Dec 08 Jan 09 Feb 09 Mar 09 Apr 09 May 09 Jun 09 Jul 09 Aug 09 Sep 09 Oct 09 Nov 09 Dec 09 Jan 10 Feb 10 Mar 10 Apr 10 May 10 Jun 10 Jul 10 Aug 10 Sep 10 Oct 10 Nov 10 Dec 10 Jan 11 Feb 11 Mar 11 Apr 11 May 11 Jun 11 Incident month Total falls falls Injury Injuries rate Fall rate rate Linear (Total (Total falls) falls) Linear (Injury (Injury rate) rate) Linear (Fall (Fall rate) rate) 7.0 6.0 5.0 4.0 3.0 2.0 1.0 0- Fall rate The incident data base also indicates: The frequency of multiple falls per patient decreased from 2008/09 to 2009/10. The fall rate has decreased across all age groups for females but has generally increased for males from 2008/09 to 2009/10. The injury rate has fallen across all age groups and genders from 2009/10 to 2010/11 except for males aged 40-64. Most hospitals have shown a decrease in their fall rate from 2008/09 to 2009/10, with Te Kuiti showing the greatest decrease. Some hospitals have experienced an increase in falls from 2008/09 to 2009/10 with Rhoda Read having the greatest increase. Taumarunui and Matariki s injury rate decreased significantly from 2008/09 to 2009/10, while Te Kuiti experienced an increase. The Patient Safety Board accepted and signed off on the end of programme report which included further measures of the success of the falls minimisation processes evaluations including staff feedback, audit as well as incident trends, education compliance and procedure compliance. 9

improving patient safety priority 3: ensure clinical audit is carried out in every clinical unit STATUS: Achieved Aim Clinical audit is identified as an essential and integral part of good clinical practice and is defined as a clinically led systematic critical review of the quality of clinical care comparing the actual practice with the standard practice, which is done with an aim of improving clinical care. Clinical audit activity carried out within the Waikato DHB is monitored and supported by the Clinical Audit Support Unit (CASU) with the set goal of ensuring that the clinical audit is carried out in every clinical unit within Waikato DHB. CASU SUPPORT To fulfil this goal, CASU facilitates preparation of audit programmes, audit registrations, developing audit tools, finding support patient information, data entry support, data analysis including statistical data analysis and preparation of audit reports for the auditors. CASU also undertakes work shops regarding the clinical audit process. Sample clinical audits are regularly uploaded into the intranet. The auditors work is recognised by the certificates issued for Completion of a clinical audit and the Audit lead certificates. CASU maintains a central repository of all clinical audit activity happening within the Waikato DHB. Data stored within the central repository is used to generate reports regarding clinical audit activity per clinical unit and to follow up on clinical audits to make sure that auditors are supported to complete a clinical audit if required. CASU also promote the development of achievable recommendations and implementation of them to improve current clinical practice and re-audits to see if change of practice is actually happening. CASU is a support unit. Being part of the patient safety initiative helped to raise awareness among the clinicians regarding the importance of participating in clinical audits and the support available to accomplish clinical auditing. Achievement to date Since 2009 more than 600 clinical audits have been registered with CASU. However, there may still be clinical audits happening in Waikato DHB which are not registered with CASU. The number of clinical audits that are registered with CASU shows a gradual upward trend indicating more clinicians are actively engaging in clinical audit activity. Total number of clinical audits registered per month January 2009-JUNe 2011 Total number of clinical audits 42 40 38 36 34 32 30 28 26 24 22 20 18 16 14 12 10 8 6 4 2 0 Jan 09 Feb 09 Mar 09 Apr 09 May 09 Jun 09 Jul 09 Aug 09 Sep 09 Oct 09 Nov 09 Dec 09 Jan 10 Feb 10 Mar 10 Apr 10 May 10 Jun 10 Jul 10 Aug 10 Sep 10 Oct 10 Nov 10 Dec 10 Jan 11 Feb 11 Mar 11 Apr 11 May 11 Jun 11 Month Audits Re-audits Linear audits 10

We identified 106 areas (45 departments, 55 nursing and six allied health) as meeting the criterion to carry out a minimum of two clinical audits per year. By the end of 2010, 89.6% (95/106) of the identified 106 areas had registered clinical audit activity with CASU (41 (91%) departments, 49 (89%) nursing areas and five (83%) of the allied health areas). Of the 95, 42% (44) completed the minimum two clinical audits. The number of clinical audits shows an increase in audit activity per unit / department from 2009 to 2010 (2011 is not a complete year as the number of audits is calculated from completed and ongoing clinical audits registered by nursing and medical staff over a calendar year). The audits carried out by multidisciplinary teams were allocated to the lead auditor s clinical unit. CASU has also set other targets to support a robust clinical audit process and improve the quality of the clinical audits -see table below. CASU patient safety targets 2010 Achieved 2010 70 % of the 106 identified areas to develop an annual clinical audit 69 % by June programme by June 2010 70% by August > 30 area to complete the minimum 2 clinical audits 42% > 80% of completed audits have achievable and measurable 88% recommendations developed for criteria/ standards where non compliance has been identified by Dec 10. > 25% of clinical audits complete the audit cycle by carrying out Departments 73% (11/15) re-audits by Dec 10 Nursing 54% (33/61) Allied health 67% (2/3) > 80% of clinical audits to achieve a score of 16 or more when 93% assessed using the clinical audit assessment tool by Dec 10 Research indicates lack of time is the biggest barrier for clinicians unless dedicated time is allocated within their busy work schedules to conduct clinical audits. CASU s role is to support the clinicians as much as possible with all areas of the auditing process; this support, together with the enthusiasm of clinicians, has brought about the clinical audit activity that is happening. Unfortunately, some of the clinical audits registered with CASU are not completed, usually because the auditor has left and not told CASU the state of their audit. Consequently, these audits end up being recorded as abandoned, even though they have utilised available resources, and thus do not contribute towards improving the quality of clinical care. Since 2009, CASU has recorded 7.5% (46 /613) of the registered clinical audits as abandoned. Almost all clinical units are engaged in clinical audit activity but the number of clinical audits carried out within a clinical unit fluctuates over time. The reasons are multifactorial and include work commitments, other quality improvement activities, and staff changes within the clinical units. 11

improving patient safety priority 4: set up the health waikato mortality committee to reduce avoidable mortality STATUS: Achieved Background The objective of the mortality project is to reduce the number of preventable deaths. Davis et.al, (2003) summarised that a substantial amount of preventable adverse events within New Zealand are system related and therefore susceptible to quality improvements. In addition there is ample international evidence that a hospital mortality reduction programme lowers mortality rates. Waikato DHB also receives retrospective reports on its mortality rate from Health Roundtable (Australasia) and can access Ministry of Health (NZ) reports. On average there are 60 70 deaths per month at Waikato Hospital. The establishment of the Mortality Committee started in February 2010 and was completed in two stages. Waikato DHB is leading the way nationally around the mortality review process. Stage one included the development of the screening process of all patient deaths in Waikato Hospital using a draft screening tool. Stage two saw the establishment of a Waikato Hospital mortality committee. This committee reports to the Board of Clinical Governance and also to the relevant services. Clinicians report back to this committee on aspects of patient management, where it was identified that more clarity was needed about the care provided. The aim of this being to reduce/remove the recurrence of identified sequence of events. Objectives of the mortality project Reduce avoidable mortality and ensure shared learnings across services/disciplines To ensure understanding gained around mortality throughout Health Waikato Improve standards of care as and when required Achievement to date A total of 99.1% of deceased patients have had a mortality screen between June 2010 and June 2011. Of those 2.7% were identified as needing serious event reviews and 10.1% required service level reports back to the mortality committee. The serious event reviews and mortality reports are used to facilitate shared learning with the aim of improving standards of care and reducing mortality. June 2011 report to Waikato Hospital Mortality Committee No of No / % Number / % patients of serious Number / % requiring no Month deceased No screened events of deaths action June 66 65 8 (12%) 12 (18%) 45/69% July 71 69 1 (1%) 8 (12%) 60/87% August 83 83 7 (8%) 10 (12%) 68/82% September 70 70 2 (2.8%) 6 (8.6%) 62/89% October 65 65 0 9 (14%) 56/86% November 67 67 1 (1.5%) 12 (18%) 54/81% December 59 59 1 (1.7%) 2 (3.45%) 56/95% January 66 66 2 (3%) 3 (4.5% 61/92% February 56 56 0 3 (4.8%) 53/95% March 65 64 1 (1.6%) 9 (14.5%) 52/84% April 58 58 0 3 (5%) 53/91% May 66 64 0 7 (11%) 57/89% June 70 68 0 2 (3%) 66/97% Totals 862 854 23 86 12

NUMBER OF DEATHS AT WAIKATO HOSPITAL 90 80 70 60 50 40 Series 1 30 20 10 0 Jun 10 Jul 10 Aug 10 Sep 10 Oct 10 Nov 10 Dec 10 Jan 11 Feb 11 Mar 11 Apr 11 May 11 Jun 11! 13

improving patient safety priority 5: improve our hand hygiene practices STATUS: Achieved Aim The principal objective of the Hand Hygiene Campaign is to promote, implement and support a Waikato DHB-wide culture change programme to increase staff compliance with hand hygiene. Raising awareness of essential hand hygiene practice among hospital staff, patients and visitors, is one of the most important ways to stop the spread of micro-organisms and infections. The campaign is part of the Patient Safety Programme, based on staff cleaning their hands or using alcohol based hand rub at key moments in patient care. If the hands of those caring for a patient, as well as the hands of the patient and their family and visitors are kept clean, then the risk of the patient getting an infection will be far less. The campaign utilises recommendations of the World Health Organisation (WHO) World Alliance for Patient Safety High Five Programme, an evidenced-based best practice guidance programme, and the structure of the Hand Hygiene Australia programme, all of which provided key guidance to implementation at Waikato DHB. Components include promotion and awareness raising, a programme of staff education in the WHO best practice five moments for hand hygiene, targeted to all staff groups who have contact with patients (including informal staff e.g: volunteers); increased provision of alcohol- based hand product at point of patient care, and a programme of hand hygiene baseline and compliance audits, conducted in selected clinical areas. Achievements to date Improved standards of hand hygiene achieved in all areas Standards of hand hygiene behaviour improved in all clinical areas since the campaign began, with many areas showing a strong and consistent commitment to continue to improve hand hygiene behaviour in their teams. Practice is assessed regularly by staff trained to observe specific points of practice to assess whether the staff are cleaning their hands at key times and thereby reducing infection risks. The consistent improvements in practice seen over the last two years is a real credit to all staff. waikato dhb staff compliance with moments for hand hygiene 2009-june 2011 100 90 Dec 09 Dec 10 Jun 11 16% 15% 10% 13% 15% 80 70 60 50 40 30 20 10 0 Before touching patient Before procedure After procedure/body fluid exposure After touching patient After touching patient surroundings! 14

Improved practice achieved by all clinical staff groups Hand hygiene practice improvement has been achieved by all clinical staff groups, from an overall rating of 31% compliance, to an overall 60% compliance an increase of 29% on baseline. This is a significant improvement in practice (see graph below) 100 90 80 70 60 50 40 30 20 10 0 Waikato DHB overall hand hygiene compliance per staff group 2009-June 2011 Dec 09 Dec 10 Jun 11 20% 15.5% 32% 14% 34% 25% 27% Nurse/Midwife Doctor HCA Allied Health Blood Students (all) Other staff (eg collection cleaner, attendant, non clinical Increased patient satisfaction Feedback from patients has been positive, they say it gives them reassurance and confidence in the staff as they can see them performing hand hygiene. Patient perception of, and satisfaction with staff cleaning hands when caring for them has shown considerable improvements over the period of implementation. Satisfaction ratings of 10-20% show that staff cleaned their hands during early implementation in 2009 improved to 60% during 2011. Reduced incidence of infection outbreaks in 2010 and 2011 A reduction in the incidence of outbreaks or clusters of detrimental organisms spreading between patients and staff in the clinical areas since the campaign began means fewer patients (and staff) impacted by an outbreak of infection, no ward closures at Waikato Hospital and a reduction at rural hospitals means safer care for patients and a safer environment for staff to work.! Restricted No. patients No. staff Ward admission affected affected Year Outbreaks closure periods per episode per episode 2011 cluster MRSA (Feb) 0 One room 3 0 7 days outbreak Norovirus Four rooms 10 13 Rhoda Read Continuing Care 7 days (March: pre campaign roll out) 2010 x 2 clusters of gastroenteritis 0 One room 4 1 4 days +1 parent 0 One room 4 1 7 days 2009 x 7 outbreaks / clusters 0-7 days 2-63 days 3-21 0-7 2008 x 6 outbreaks / clusters 0-67 days 0-77 days 5-8 0-19 15

! waikato dhb staff compliance with moments for hand hygiene dec 2009-june 2011 100 Dec 09 Dec 10 Jun 11 90 80 70 60 50 40 30 20 10 0 Before touching patient Before procedure After procedure/body fluid exposure After touching patient After touching patient surroundings! waikato dhb staff compliance with moments for hand hygiene dec 2009-june 2011 100 Dec 09 Dec 10 Jun 11 90 80 70 60 50 40 30 20 10 0 Nurse/Midwife Doctor HCA Allied Health Blood colllection Students (all) Other staff (eg cleaner, attendant, non clinical 16

priority 6: implement a safe patient care programme STATUS: Achieved Aim Introduce the safe patient care programme developed by the Health Roundtable during 2009. Achievement to date Rapid Response System (RRS) The purpose of the project is to improve early recognition and management of the deteriorating patient. The main aim is a reduction in the incidence of in-hospital cardiopulmonary arrest, unexpected death, and unplanned intensive care unit admission. A secondary aim is to improve documentation of vital signs, together with appropriate action, effective communication and response (i.e. teamwork) by staff. Stage one of the project is over. This has seen the design and trial of a new standard adult vital sign chart that incorporates an early warning scoring tool, called Adult Deterioration Detection System (ADDS), with an associated escalation/response criteria based on the ADDS score. Included in this response are the clinical resource nurses, as well as appropriate escalation to junior, then senior, medical staff. Trial areas at Waikato Hospital included: Cardiac Care Unit (CC2 / CC 3), Wards 2 and 12 (General Surgery), Ward 22 (Respiratory Medicine), Ward 23 (General Medicine), Ward 14 (Cardiothoracic/Vascular Surgery), and the High Dependency Unit (HDU). ADDS rollout Stage two of the RRS project is well underway. Following the successful trial of ADDS at Waikato Hospital, a general introduction of ADDS is now occurring which saw the new chart and process used in the majority of adult in-patient wards by 1 April 2011. Also included in this stage will be the design and trial of a Neuro ADDS chart that incorporates Glasgow Coma Scale monitoring and escalation. This will be done in conjunction with neurosurgery, Comprehensive Stroke Unit, and HDU. Confirmation of a rural ADDS chart and process for Thames, Te Kuiti, Tokoroa and Taumarunui hospitals is also well underway. The system includes a visual representation of a patient s progress captured by the new adult vital signs chart. Staff can see at a glance if there has been any deterioration in a patient s condition, and if there has been, what steps they need to take. An evaluation of the ADDS system at the end of the trial showed that the new chart and process supports improved identification of deterioration and early escalation for medical review. ADDS scores prompt nursing staff to increase the frequency of observations and escalate to medical staff once a review is indicated by the score and staff assessment of patient condition. An ADDS activation sticker is then placed in the continuing medical record (patient notes) at the time nursing staff request a medical review related to an increasing ADDS score. We are aiming for 100 per cent of: improving patient safety patients with observations completed and documented as planned patients with their ADDS score accurately calculated and documented staff having documented ADDS escalation utilising the ADDS activation sticker patients who trigger with an appropriate response (i.e. medical review) 17

Audit results so far would indicate that we still have a way to go. Overall compliance with the ADDS process across the areas audited, improved markedly since the trial in April to July 2010. We have gone from overall average compliance of 36 percent, to 65 percent by the end of January 2011; in some instances an almost 100 percent improvement. ADDS process compliance by Ward Ward CC3 Total CC2 Total Ward 2 Total Ward 12 Total HDU Total Ward 14 Total Ward 23 Total Ward 22 Total Grand Total Full Set of Observations ADDS Calculated Correctly Audit period April to July 2010 (ADDS Trial) Frequency reflects ADDS ADDS sticker Missing Medical review actioned Ward averages 32% 24% 47% 0% 50% 30.60% 56% 31% 39% 50% 100% 55.20% 47% 26% 41% 14% 40% 33.60% 41% 15% 24% 38% 78% 39.20% 50% 38% 76% 13% 59% 47.20% 29% 6% 34% 13% 43% 25.00% 29% 14% 43% 20% 50% 31.20% 26% 17% 14% 15% 63% 27.00% 39% 21% 40% 20% 60% (Averages) ADDS process compliance by Ward Ward CCU Total Ward 2 Total Ward 12 Total HDU Total Ward 14 Total Ward 23 Total Ward 22 Total Grand Total Full Set of Observation s ADDS Calculated Correctly Frequenc y reflects ADDS Audit period Oct 2010 to Jan 2011 N.B. CCU CC2 & 3 results combined ADDS sticker Missing Medical review actioned Ward averages 79% 56% 67% 2% 100% 60.8% 72% 55% 96% 0% 100% 64.6% 82% 75% 96% 2% 100% 71.0% 90% 30% 100% 50% 90% 72.0% 65% 15% 83% 2% 100% 53.0% 60% 58% 79% 5% 100% 60.4% 67% 93% 86% 2% 100% 69.6% 73.6% 55.0 % 86.7% 9% 98.6% (Average s) 18

priority 7: meet the health targets STATUS: Partially achieved Your District Health Board Health Targets Your District Health Health Board Board QUARTER FOUR RESULTS 2010/11 clinical effectiveness Aim To meet the six health targets set by the Ministry of Health for all district health boards in New Zealand. Four of these apply to the provider arm; the other two to the funder arm. Results are published quarterly by the Ministry of Health. Quarter four Quarter four Quarter four performance performance Progress performance Progress Progress How to read the graphs How to read How the graphs to read the graphs Your District 00 District Health Board 00% District 00 Health District Board Health Board 00% 00% Your District Health Board How to read the graphs Ranking GOAL 2010/11 QUARTER FOUR RESULTS DHB current performance Ranking Ranking GOAL GOAL DHB current performance 00 2010/11 2010/11 QUARTER QUARTER FOUR RESULTS FOUR RESULTS DHB current performance District Health Board Quarter Change from Quarter Progress Quarter Change from Shorter four previous Improved four against plan Shorter four previous performance 95% quarter stays in Quarter Quarter access Change to from Change from performance 100% (discharges) waits for Quarter Quarter Progress Ranking performance Progress 100% quarter Shorter 1 West Coast Shorter 100% four four previous previous 1 Northland Improved 119% Improved 2010/11 QUARTER FOUR RESULTS four 1four Northland against plan against 100% plan 2 Wairarapa 98% performance performance 95% quarter 95% quarter 2 Whanganui 116% performance performance 1100% Waitemata (discharges) 100% (discharges) stays in stays in access toaccess to 100% 3 Nelson Marlborough 97% 1 West Coast 1 West Coast 100% 100% 3 Wairarapa 112% 1 Northland 1 Northland119% Quarter 119% 1 Auckland Change 100% from Emergency Shorter four previous Departments 4 South Canterbury 97% Elective Surgery 4 Lakes 111% Cancer Treatment 1 Counties Manukau 100% 2 Wairarapa 2 Wairarapa 98% 98% 2 Whanganui 116% 5 Counties Manukau 97% 5 stays in 2 Whanganui performance 116% 95% quarter Counties Manukau 108% 1 Waikato 100% Shorter stays in Emergency 3 Nelson Marlborough 3 Nelson Marlborough 97% 97% Improved access to elective 3 Wairarapa 1 Shorter 3 West Wairarapa Coast112% 100% 112% waits for cancer 6 Taranaki 96% 6 West Coast 107% 1 Lakes 100% Emergency Emergency Departments Departments 7 Tairawhiti Departments 96% 4 South Canterbury 4 South Canterbury 97% surgery 97% 7 MidCentral Elective 106% Surgery Elective Surgery 4 Lakes treatment 2 4 Wairarapa Lakes 111% 98% 111% 1 Bay of Plenty 100% The target is 95 percent of 8 Canterbury 96% 5 Counties 5Manukau Counties Manukau 97% The target is 97% an increase in the 8 Taranaki 106% 5 Counties The target 3 5Manukau Nelson is Counties everyone Marlborough Manukau 108% needing 97% 108% 1 Tairawhiti 100% patients will be admitted, 9 Auckland 95% volume of elective surgery by 9 Bay of Plenty 104% Emergency radiation treatment will have 1 Hawke s Bay 100% Shorter stays Shorter in Emergency stays in Emergency 6 Taranaki 6 Taranaki 96% 96% Improved Improved access to discharged, or transferred from 10 Hawke s Bay 94% an average of 4000 discharges Departments access elective to elective 6 West Coast 4 6 South West Canterbury Coast 107% 97% 107% 10 Capital & Coast 103% this within four weeks. Six 1 Taranaki 100% an Emergency Departments (ED) Departments 7 Tairawhiti 7 Tairawhiti 96% 11 Waitemata per year. 96% surgery surgery 7 MidCentral regional 5 7oncology Counties MidCentral centres Manukau 106% 97% 106% treatment treatment 94% 11 Hawke s Bay 103% 1 MidCentral 100% within six hours. The target is The is 95 target DHBs planned to deliver 140,063 provide radiation oncology 12percent Whanganui is 95 of percent 91% of 8 Canterbury 8 Canterbury 96% 96% 12 Waitemata The target Shorter The is 103% an target increase stays is an in in Emergency increase the 8in the Taranaki 6 8 Taranaki 106% 96% 106% 1 Whanganui 100% discharges year to date, and have services. These centres patients will patients be 13admitted, Bay will of Plenty be admitted, 90% 9 Auckland9 Auckland 95% 95% 13 Hutt Valley 102% 1 Capital & Coast 100% delivered 5290 more. volume of Departments volume elective of surgery elective by surgery 9 by Bay are of in 7Plenty Auckland, 9 Tairawhiti Bay of Hamilton, Plenty 104% 96% 104% surgery through public hospitals, discharged, and discharged, or 14 transferred Northland or transferred from 90% 14 Waikato 102% Palmerston North, Wellington, 1 Hutt Valley 100% 10from Hawke s 10 Bay Hawke s Bay 94% 94% an average The an of target average 4000 discharges of 954000 percent discharges of 10 Capital 8& 10 Coast Canterbury Capital & Coast 103% 96% 103% home again. 15 Lakes 89% 15 South Canterbury 101% Christchurch and Dunedin. 1 Wairarapa 100% an Emergency an Emergency Department Department (ED) 16 Waikato 11 (ED) Waitemata 11 89% Waitemata per year. 94% patients per year. 94% 16 will be admitted, Southern 101% 11 Hawke s 9 11 BayAuckland Hawke s Bay 103% 95% 103% Canterbury DHB s result is 99.53 1 Nelson Marlborough 100% within six within hours. The six hours. target The is target is 17 Hutt Valley 87% 12 Whanganui 12 Whanganui 91% 91% 17 Tairawhiti DHBs planned discharged, DHBs 101% to planned deliver or transferred 140,063 to deliver 140,063 12 from Waitemata percent. 1012 One Hawke s Waitemata patient Bay waited 103% three 94% 103% 1 West Coast 100% 18 MidCentral 87% 13 Bay of Plenty 13 Bay of Plenty 18 Nelson discharges Marlboroughyear 100% to date, and have 90% an discharges Emergency year Department to date, and 13(ED) have Hutt days Valley longer than target 102% as a result 1 South Canterbury 100% per year. 90% 113 Waitemata Hutt Valley 94% 102% 19 Southern 83% 19 Auckland delivered within 5290 delivered 100% more. six hours. 5290 more. The target is of earthquakes. 1 Southern 100% through public 20hospitals, Capital & Coast and 14 Northland 90% 14 Waikato 12 Whanganui102% 91% through public hospitals, 74% and 14 Northland 90% 14 Waikato 102% Canterbury 97% Canterbury 99.5% home again. home again. 15 Lakes 15 Lakes 89% 89% 15 South 13 Canterbury 15 Bay South of Plenty Canterbury 101% 90% 101% All DHBs 92% All DHBs 104% All DHBs 100% 16 Waikato 95% 16 Waikato 89% 89% through public 100% hospitals, 16 and Southern 1416 Northland Southern 101% 90% 101% 100% Quarter 17 Hutt Valley Change 17 Hutt from Valley 87% 87% home Quarter again. Change from 17 Tairawhiti 1517 Lakes Tairawhiti 101% 89% 101% Quarter Change from Increased four previous Better four previous Better four previous performance 18 MidCentral 90% 18quarter MidCentral 87% 87% performance 90% quarter performance quarter help for 18 Nelson 16 Marlborough 18 Waikato Nelson Marlborough 100% 89% 100% 1 Wairarapa 94% 19 Southern19 Southern 83% 83% 1 Lakes 100% 19 Auckland 1719 Hutt Auckland Valley 100% 87% 100% 1 Taranaki 81% of earthquakes. 2 Hawke s Bay 93% 2 Wairarapa 99% 2 Whanganui 80% Quarter four Quarter four 20 Capital & 20 Coast Capital & Coast 74% 74% Canterbury 18 MidCentral Canterbury97% 87% 97% performance 3 Southern performance93% Progress Progress 3 Whanganui 97% Diabetes and 3 MidCentral 77% How to read Cardiovascular Immunisation the graphs 4 Auckland 92% Smokers to Quit 4 Capital & Coast 97% 19 Southern 83% Services 4 Wairarapa All DHBs All DHBs 92% 92% All DHBs All DHBs 104% 104% 76% 5 Waitemata 92% 5 South Canterbury 94% 5 Hutt Valley 75% 95% 95% 20 Capital & Coast 74% 100% 100% 00 Increased District 00 Immunisation District Health Health Board Board 6 00% MidCentral00% 92% Better help for smokers 6 Northland 93% Better diabetes and 6 Hawke s Bay 75% The national immunisation 7 South Canterbury 92% Quarter to quit Quarter Change from Change 7 Hawke s from Bay 91% cardiovascular All DHBs services Quarter Quarter 92% 7 Counties Change Manukau from Change 74% from Increased Increased four four previous previous Better Better four four previous Better target is for 90 percent by July 8 Hutt Valley 91% The target is that 90 percent of 8 Hutt Valley 91% This graph represents the 8 Southern 95% previous 74% Ranking performance GOAL performance GOAL 90% quarter 90% quarter performance performance 90% quarter 90% quarter 2011; and 95 percent by July 9 Capital & Coast DHB current DHB 91% performance current performance hospitalised smokers will be 9 Nelson Marlborough help 90% forhelp for average progress made by 9 Capital & Coast 73% Progress 2012. 1 Wairarapa 1 Wairarapa Quarter 94% 10 Waikato 91% provided with 94% Change advice and from help 1 10 Counties Manukau 86% a Lakes DHB towards 1 Lakes three target 100% Quarter 100% Change from against plan Shorter four previous Increased four 10 Waikato previous 73% (discharges) Change This quarterly from Change progress from result 11 Tairawhiti to quit by July 2011, and 95 indicators: 90% 2 Hawke s 2Bay Hawke s performance Bay Quarter 93% Quarter 93% 100% Progress quarter Progress 11 Waitemata 86% 2 Wairarapa 2 Wairarapa Quarter 99% performance Quarter 11 99% Northland Change 90% from Change quarter 73% from previous includes children previous who turned two Improved waits for Improved percent four by four July 2012. against The data plan against plan Shorter Shorter 12 Canterbury 90% 3 Southern 93% 12 MidCentral 85% (a) increased percent four of the four previous previous 12 South Canterbury 72% quarter years 95% between quarter 1 Northland 3 Southern April and June 2011 performance 100% covers performance patients 93% 100% presenting (discharges) 100% to (discharges) 3 Whanganui 1 3 Wairarapa Whanganui performance 97% performance 94% 97% 100% quarter 100% quarter Diabetes and access 13 Counties access tomanukauto 90% 13 Tairawhiti waits 85% for waits for eligible adult population 13 Bay of Plenty 72% and who were fully immunised at Immunisation Emergency Departments, day Cardiovascular 4 Auckland 92% will have had their that stage. 14 Whanganui Immunisation 1 Waitemata Northland 14 89% Northland Auckland 100% 119% 119% 92% stay and other hospital based 14 West Coast Smokers to Quit Smokers to 4 Capital & Coast 97% 83% Quit 1 Northland 21 4 Hawke s Northland Capital Bay & Coast 100% 93% 100% 97% 14 Waitemata 72% Services cardiovascular disease risk 15 Lakes 89% 51 2 Waitemata Auckland Whanganui 25 Whanganui Waitemata 92% 100% 116% interventions. 116% 92% 15 Taranaki 83% 51 South Waitemata 3Canterbury 15 Southern Waitemata Canterbury 94% 100% 93% 100% 15 94% West Coast 72% Increased Increased Cancer Immunisation 16Treatment Taranaki Immunisation 88% 61 3 MidCentral Counties Wairarapa 36 Manukau Wairarapa MidCentral 92% 100% 112% 112% 92% 16 Waikato Better help Better for 81% smokers help Immunisation for smokers 61 Northland Auckland 93% 16 Lakes 72% years; 41 6 Auckland Northland 100% 92% 100% 93% Better diabetes and 17 Bay of Plenty 87% 17 Southern 79% 17 Nelson Marlborough 69% The national The immunisation national immunisation 71 South Canterbury 7 South Canterbury 92% 92% to quit to quit 7 (b) Hawke s an 5increased 7Bay Waitemata Hawke s percent Bay 91% 92% of 91% Elective 18 Surgery 4 Waikato Lakes 100% 111% Nelson Elective Marlborough Surgery 4 Lakes 111% 87% 18 Auckland Cancer 79% Treatment Cancer Treatment 1 Counties 1 Manukau Counties Manukau 100% 100% 18 Auckland 69% target Shorter is for waits target 90 percent for is for cancer 90 by percent July by 81 July Hutt Valley 91% The target Increased is that 90 Immunisation percent of 8 Hutt people Valley 6 MidCentral with diabetes 91% will 92% 19 West Coast 84% 5 Lakes Counties 58 Manukau Counties Hutt Valley Manukau 100% 108% 108% 91% 19 The target that 90 percent Bay of Plenty 77% 1 of Waikato 18 Waikato Hutt Valley 100% 100% 91% attend free annual checks; 19 Tairawhiti 68% 2011; treatment Improved and Improved 2011; 95 access percent 20and Northland to 95 access by elective percent July to elective by 83% 9July 1 Capital & Coast 91% Canterbury hospitalised The hospitalised smokers national 71% will immunisation smokers be will 9be Nelson 7Marlborough South Canterbury 90% 92% Canterbury to quit 6 Bay West of Coast Plenty 69 West Capital Coast & Coast 100% 107% 107% 91% Shorter Shorter waits for waits cancer for cancer 1 Lakes 19 Lakes Nelson Marlborough 100% 100% 90% 66% 2012. 2012. provided with advice and help (c) an increased percent of All DHBs 90% 10 Waikato 91% All DHBs target provided 85% is for with 90 percent advice and by 10 July help The surgery target surgery is everyone needing 17 Tairawhiti MidCentral 710 MidCentral Waikato 100% 106% 106% 91% treatment treatment 1 Counties Bay people of 81 Plenty 10 Manukau Hutt Valley 86% 91% with Bay Counties of diabetes Plenty Manukau 100% will 100% 86% All DHBs 72% This quarterly This progress quarterly result progress result 11 Tairawhiti 90% 11 Tairawhiti to quit by July 2011, and 90% 95 have satisfactory or better indicators: 90% 2011; to quit and by 95 July percent 2011, by and July 11 95 Waitemata 9 Capital & Coast 86% 91% indicators: radiation 90% 11 Waitemata 86% The target treatment an increase will have the 18 Hawke s Taranaki Bay 100% The target is an increase in the 8 Taranaki 106% 106% diabetes management. This information includes should be children includes read conjunction who children turned who with two turned percent The target by The July 2012. The data the 12 Canterbury two DHB s 90% performance has not been ranked in four 2012. percent is target everyone by is July everyone needing 2012. The needing 1 Tairawhiti 1 Tairawhiti 100% 100% data this volume within of four elective weeks. surgery Six volume of elective by surgery 19 by Taranaki Bay of 912 Plenty Bay Canterbury of Plenty 100% 104% 104% 90% of the six health targets 12 MidCentral 1012 Waikato MidCentral 85% 91% 85% (a) (a) details on the website years between www.moh.govt.nz/healthtargets years April between and June April 2011 and June 2011 in acknowledgment of the impact of the earthquakes covers radiation on patients radiation the covers treatment DHB s presenting year-end patients treatment will have results. presenting to will have 1 Hawke s to 1 Bay Hawke s Bay100% 100% regional an average oncology of 4000 centres an average discharges of 4000 discharges 13 1 Counties 13 Manukau Counties Manukau 90% 90% This quarterly progress result 13 Tairawhiti 113 Tairawhiti 85% 90% 85% and who were and fully who immunised were fully immunised at 10 MidCentral Capital at 10& Coast Capital & Coast 100% 103% 103% Emergency this within this Emergency Departments, four within weeks. four Departments, Six weeks. day Six 1day Taranaki 1 Taranaki 100% 100% provide per year. radiation oncology that stage. 14 89% includes children who turned stay and other hospital based 14 two per year. West Coast 12 Canterbury 83% 90% that stage. 111 Whanganui Hawke s 14Bay Whanganui 89% regional years stay oncology between and other centres 103% April hospital and June based 1 MidCentral 14 West Coast 100% 83% services. These centres 11 Hawke s Bay100% regional oncology centres 103% 1 MidCentral 100% 2011 DHBs planned to deliver 140,063 15 Lakes 15 Lakes 89% 89% interventions. provide radiation 15 Taranaki 13 Counties Manukau 83% 90% and interventions. oncology 15 Taranaki 83% are in Auckland, DHBs planned Hamilton, deliver 140,063 112 Capital Waitemata & Coast 100% 103% provide radiation oncology 12 Waitemata 103% who were fully immunised 1 at Whanganui 1 Whanganui 100% 100% discharges year to date, and have 16 Taranaki 16 Taranaki 88% 88% services. These centres 16 Waikato 81% that stage. 1416 Whanganui Waikato 89% Palmerston discharges North, Wellington, year to date, and 113 have Hutt Hutt Valley Valley 100% 102% services. These centres 13 Hutt Valley 102% 1 Capital 1 & Coast Capital & Coast 100% 100% 81% delivered 5290 more. are in Auckland, Hamilton, years; years; delivered 5290 more. are in Auckland, Hamilton, Christchurch and Dunedin. 17 114 Bay Wairarapa Waikato of Plenty 14 17 Waikato Bay of Plenty 87% 100% 102% 102% 87% 17 Southern 1517 Lakes Southern 79% 89% 79% Palmerston Palmerston North, Wellington, North, Wellington, 1 Hutt Valley 1 Hutt Valley 100% 100% (b) (b) 1815 South 18 Canterbury Nelson Marlborough 87% 101% 87% 18 Auckland 1618 Taranaki Auckland 79% 88% 79% Canterbury DHB s result is 99.53 1 Nelson 15 Marlborough South Canterbury 100% 101% Christchurch Christchurch and Dunedin. and Dunedin. 1 Wairarapa 1 Wairarapa 100% 100% percent. One patient waited three 19 116 West Southern Coast 16 19 Southern West Coast84% 100% 101% 101% 84% 19 Bay of 17 Plenty 19 Bay Bay of of Plenty 77% 87% 77% Canterbury DHB s result is 99.53 1 Nelson Marlborough 100% Canterbury DHB s result is 99.53 1 Nelson Marlborough 100% days longer than target as a result 20 117 Northland South Tairawhiti Canterbury 17 20 Tairawhiti Northland 83% 100% 101% 101% 83% Canterbury 18 Nelson Canterbury Marlborough 71% 87% 71% percent. percent. One patient One waited patient three waited 1three West Coast 1 West Coast 100% 100% (c) (c) of earthquakes. 118 Southern 19 West Coast 84% All Nelson DHBs 18Marlborough Nelson All DHBs Marlborough 100% 90% 100% 90% days longer days than longer target than as target a result as a 1result All South DHBs 1Canterbury South All DHBs Canterbury 85% 100% 100% 85% 19 Canterbury Auckland 19 Auckland 99.5% 100% 100% 90% 90% of earthquakes. of earthquakes. 1 Southern 20 1 Northland Southern 100% 83% 100% 90% 90% All Canterbury DHBs Canterbury 97% Canterbury All DHBs 99.5% 90% This information This information should be should read in be conjunction read in conjunction with the 100% 97% with the Canterbury Canterbury 99.5% Canterbury DHB s performance DHB s performance has not been has not ranked been in ranked four of in the four six of health the six targets health targets 90% details on details the website on the website www.moh.govt.nz/healthtargets All DHBs 104% 100% All DHBs 104% in acknowledgment in acknowledgment of the impact of the of impact the earthquakes of the All earthquakes DHBs on All DHBs the DHB s on 100% the year-end DHB s 100% year-end results. results. Change 95% from Quarter 100% Change 100% from This information should be read in conjunction with the 100% 100% previous Better four previous Change quarter from Change from performance Quarter Quarter Change quarter from Change from details on the website www.moh.govt.nz/healthtargets Quarter Quarter Change from Change from previous previous Better Better four four previous previous Better Better four four previous previous quarter 90% quarter 1 Taranaki performance 81% performance 90% quarter 90% quarter performance performance quarter quarter help for help for 21 Whanganui Lakes 1 Lakes 100% 80% 100% 1 Taranaki 1 Taranaki 81% 81% Diabetes and 32 MidCentral Wairarapa 2 Wairarapa 77% 99% 99% 2 Whanganui 2 Whanganui 80% 80% Cardiovascular Services 43 Wairarapa Whanganui 3 Whanganui 76% 97% 97% Diabetes and Diabetes and 3 MidCentral 3 MidCentral 77% 77% Cardiovascular 5 Smokers to Quit 4 Hutt Capital Valley & Coast 75% 97% Cardiovascular Smokers to Quit 4 Capital & Coast 97% Services 4 Wairarapa 76% Services 4 Wairarapa 76% Better diabetes and 65 Hawke s South 5Canterbury BaySouth Canterbury 75% 94% 94% 5 Hutt Valley 5 Hutt Valley 75% 75% cardiovascular Better help Better for services help smokers for smokers 76 Counties Northland 6 Manukau Northland 74% 93% 93% Better diabetes Better diabetes and and 6 Hawke s 6 Bay Hawke s Bay 75% 75% This to quit graph to represents quit the 87 Southern Hawke s 7 Bay Hawke s Bay 74% 91% 91% cardiovascular cardiovascular services services 7 Counties 7 Manukau Counties Manukau 74% 74% average The target progress is that made 90 percent by of 98 Capital Hutt Valley & Coast 73% The target is that 90 percent of 8 Hutt Valley 91% 91% This graph This represents graph represents the the 8 Southern 8 Southern 74% 74% a hospitalised DHB towards hospitalised smokers three target smokers will be will 10 be 9 Waikato Nelson 9 Marlborough Nelson Marlborough 73% 90% 90% average average progress progress made by made by 9 Capital 9 & Coast Capital & Coast 73% 73% indicators: provided provided with advice with and advice help and 11 10 help Northland Counties 10 Manukau Counties Manukau 73% 86% 86% a DHB towards a DHB towards three target three target 10 Waikato 10 Waikato 73% 73% (a) to an quit increased by to July quit 2011, by percent July and 2011, of 95 the and 95 12 11 South Waitemata 11 Canterbury Waitemata 72% indicators: 86% indicators: 86% 11 Northland 11 Northland 73% 73% percent eligible percent by adult July 2012. population by July The 2012. data The 13 data 12 Bay MidCentral of 12 Plenty MidCentral 72% 85% 85% (a) an increased (a) an increased percent percent of the of 12the South 12 Canterbury South Canterbury 72% 72% covers will have patients covers had patients presenting their presenting to to 14 13 Waitemata Tairawhiti 13 Tairawhiti 72% 85% 85% eligible adult eligible population adult population 13 Bay of 13 Plenty Bay of Plenty 72% 72% Emergency cardiovascular Emergency Departments, disease Departments, risk day day 15 will have had their stay and other hospital based 14 West Coast 72% 83% stay and other hospital based 14 West Coast will have had their 83% 14 Waitemata 14 Waitemata 72% 72% cardiovascular disease risk interventions. 16 years; 15 Lakes Taranaki 72% interventions. 83% cardiovascular disease risk 15 Taranaki 83% 15 West Coast 15 West Coast 72% 72% 17 16 Nelson Waikato 16 Marlborough Waikato 69% 81% 81% 16 Lakes 16 Lakes 72% 72% (b) an increased percent of years; years; 18 17 Auckland Southern 69% 79% 17 Nelson Marlborough 69% people with diabetes will 17 Southern 79% 17 Nelson Marlborough 69% (b) an increased percent of attend free annual checks; 19 18 Tairawhiti Auckland 68% 79% (b) an increased percent of 18 Auckland 79% 18 Auckland 18 Auckland 69% 69% people with people diabetes with diabetes will will 19 Canterbury Bay of 19 Plenty Bay of Plenty66% 77% 77% attend free annual checks; 19 Tairawhiti 68% (c) an increased percent of attend free annual checks; 19 Tairawhiti 68% people with diabetes will All Canterbury DHBs Canterbury 72% 71% 71% Canterbury Canterbury 66% 66% (c) an increased (c) an increased percent percent of of 90% have satisfactory or better All DHBs All DHBs 85% 85% people with people diabetes with diabetes will will All DHBs All DHBs 72% 72% 90% 90% diabetes management. 90% 90% have satisfactory have satisfactory better or better diabetes diabetes management. management. Canterbury Canterbury DHB s performance DHB s performance has not has been not ranked been ranked in four of in the four six of health the six targets health targets 19