Checklists, hand hygiene cited as top strategies

Of the hundreds, if not thousands, of patient safety strategies employed at hospitals across the country, the Agency for Healthcare Research and Quality (AHRQ) has released a report identifying the top 10 patient safety strategies that can be implemented immediately by healthcare providers.

Based on an assessment of evidence about patient safety interventions, the report finds that these 10 strategies, if widely implemented, have the potential to vastly improve patient safety and save lives in U.S. healthcare institutions. Making Health Care Safer II: An Updated Critical Analysis of the Evidence for Patient Safety Practices assesses the evidence for 41 patient safety strategies and most strongly encourages adoption of the top 10. The strategies can help prevent medication errors, bedsores, healthcare-associated infections, and other patient safety events.

“We have the evidence to show what really works to make care safer,” AHRQ Director Carolyn M. Clancy, MD, said in announcing the report. “Armed with this knowledge about what works and how to apply it, we can continue to advance our efforts to ensure patient safety.”

The new report emphasizes evidence about implementation, adoption, and the context in which safety strategies have been used. This evidence helps clinicians understand what works, how to apply the strategies, and under what circumstances they work best so they can be adapted to local needs. Many of the strategies already are widely in use, and some are based on CDC guidelines. Others have shown great promise, but remain uncommon in practice. The report also identifies gaps where more research can further advance patient safety.

The entire report, including evidence reviews for all 41 patient safety strategies, can be found at

The new report was prepared by AHRQ Evidence-based Practice Centers at the RAND Corp., the University of California, San Francisco/Stanford University, Johns Hopkins University, and ECRI Institute, with input and recommendations from a team of patient safety experts.

These are the recommended patient safety strategies:

• preoperative checklists and anesthesia checklists to prevent operative and postoperative events;

• bundles that include checklists to prevent central line-associated bloodstream infections;

• interventions to reduce urinary catheter use, including catheter reminders, stop orders, or nurse-initiated removal protocols;

• bundles that include head-of-bed elevation, sedation vacations, oral care with chlorhexidine, and subglottic-suctioning endotracheal tubes to prevent ventilator-associated pneumonia;

• hand hygiene;

• the do-not-use list for hazardous abbreviations;

• multicomponent interventions to reduce pressure ulcers;

• barrier precautions to prevent healthcare-associated infections;

• use of real-time ultrasonography for central line placement;

• interventions to improve prophylaxis for venous thromboembolisms.