22 strategies called most effective for patient safety

After analyzing 41 patient safety practices, an international panel of patient safety experts has identified 22 strategies that should be adopted right away. Enough evidence exists that health systems and institutions can move forward in implementing these strategies to improve the safety and quality of health care, the panel says.

A report from the Agency for Healthcare Quality and Research (AHRQ) summarizes the research and findings of the panel. “Making health care safer II: an updated critical analysis of the evidence for patient safety practices” (AHRQ Evidence Report No. 211) updates the agency’s 2001 report on the same topic. The 2001 report analyzed the strength of evidence for patient safety practices in use at that time. The 2013 report analyzed a growing body of patient safety research to determine the level of evidence regarding the outcomes, as well as implementation, adoption, and the context in which safety strategies have been used.

Of the 22 strategies identified in “Making Health Care Safer II,” these 10 are “strongly encouraged” for adoption based on the strength and quality of evidence:

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

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

• 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;

• “do-not-use” list for hazardous abbreviations;

• multicomponent interventions to reduce pressure ulcers;

• barrier precautions to prevent healthcare-associated infections;

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

• interventions to improve prophylaxis for venous thromboembolisms.

“Making Health Care Safer II” also identifies these 12 patient safety strategies that are “encouraged” for adoption based on the strength and quality of evidence:

• multicomponent interventions to reduce falls;

• use of clinical pharmacists to reduce adverse drug events;

• documentation of patient preferences for life-sustaining treatment;

• use of informed consent to improve patients’ understanding of the potential risks of procedures.

• team training;

• medication reconciliation;

• practices to reduce radiation exposure from fluoroscopy and computed tomography (CT) scans;

• use of surgical outcome measurements and report cards, such as the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP);

• rapid response systems;

• utilization of complementary methods for detecting adverse events/medical errors to monitor for patient safety problems;

• computerized provider order entry (CPOE);

• use of simulation exercises in patient safety efforts.

To access “Making Health Care Safer II” (AHRQ Evidence Report No. 211), go to http://tinyurl.com/safetystrategies.