22 Proven Patient Safety Strategies

Poor quality of care and preventable medical errors are a major cause of high costs and patient suffering.  The opportunities for improvement are considerable.

In addition, as states and health plans gear up for Health Insurance Exchanges (HIX), they will count quality and patient safety among their key considerations.  For example, Qualified Health Plans (QHP) on the exchanges in many states will be required to implement quality improvement strategies that describe how plans intend to reduce medical errors, prevent hospital readmissions, encourage prescription drug safety, and generally improve patient safety.

AHRQ Recommends 22 Patient Safety Practices:

The Agency for Healthcare Research and Quality (AHRQ) recently published a report that analyzes evidence for more than 40 specific patient safety practices.  AHRQ targets 22 strategies that hospitals, physicians, pharmacies, and other providers can adopt with confidence. Health plans hoping to become QHPs might also find the report helpful as they prepare to enter the Health Insurance Exchanges.

AHRQ’s list of recommended safety practices is broken into two categories: 10 practices that are “strongly encouraged” and 12 others that are simply “encouraged.”  All 22 patient safety practices are amply supported by the evidence.

Strongly Encouraged Safety Practices in Medical Care:

1. Preoperative checklists and anesthesia checklists to prevent operative and postoperative events.
2. Bundles that include checklists to prevent central line-associated bloodstream infections. Resources include Tools for Reducing Central Line-Associated Bloodstream Infections, and the CUSP Toolkit.
3. Interventions to reduce urinary catheter use, including catheter reminders, stop orders, or nurse-initiated removal protocols. See On the CUSP: Stop CAUTI.
4. Bundles that include head-of-bed elevation, sedation vacations, oral care with chlorhexidine, and subglottic-suctioning endotracheal tubes to prevent ventilator-associated pneumonia.
5. Hand hygiene. Resources include the Centers for Disease Control and Prevention (CDC) hand hygiene resources, and the Department of Veterans Affairs (VA) hand hygiene resources
6. “Do Not Use” list for hazardous abbreviations. See the Joint Commission, Facts About the Official “Do Not Use” List.
7. Multi-component interventions to reduce pressure ulcers. Resources include the AHRQ’s On-Time Quality Improvement for Long-Term Care (LTC).
8. Barrier precautions to prevent healthcare-associated infections. See Tools for Reducing Central Line-Associated Bloodstream Infections.
9. Use of real-time ultrasound for central line placement. Tools for Reducing Central Line-Associated Bloodstream Infections.
10. Interventions to improve prophylaxis for venous thromboembolisms. Resources include Preventing Hospital-Acquired Venous Thromboembolism: A Guide for Effective Quality Improvement, Blood Thinner Pills: Your Guide to Using them Safely, and Your Guide to Preventing and Treating Blood Clots.

Encouraged Safety Practices:

1. Multicomponent interventions to reduce falls. See Preventing Falls in Hospitals, and TeamSTEPPS Long-Term Care Version.
2. Use of clinical pharmacists to reduce adverse drug events. Resources include Medications at Transitions and Clinical Handoffs (MATCH) Toolkit for Medication Reconciliation, the Pharmacy Health Literacy Center, Blood Thinner Pills: Your Guide to Using them Safely, and Pharmacy Safety Culture Survey.
3. Documentation of patient preferences for life-sustaining treatment.
4. Use of informed consent to improve patients’ understanding of the potential risks of procedures.
5. Team training, such as TeamSTEPPS®.
6. Medication reconciliation. See Medications at Transitions and Clinical Handoffs (MATCH) Toolkit for Medication Reconciliation, RED (Re-Engineered Discharge) Toolkit for hospitals, and the Safety Culture Survey for pharmacies.
7. Practices to reduce radiation exposure from fluoroscopy and computed tomography scans.
8. Use of surgical outcome measurements and report cards, such as the American College of Surgeons National Surgical Quality Improvement Program.
9. Rapid response systems. TeamSTEPPS Rapid Response Module.
10. Utilization of complementary methods for detecting adverse events/medical errors to monitor for patient safety problems. AHRQ Common Formats, AHRQ Quality Indicators™ Toolkit for hospitals.
11. Computerized provider order entry.
12. Use of simulation exercises in patient safety efforts. Training Guide: Using Simulation in TeamSTEPPS Training.