AHRQ releases 10 best bets for safety

Proven strategies can save lives

A new report by the Agency for Healthcare Research and Quality (AHRQ) ticks off the top 10 patient safety strategies that providers and organizations can implement right now to positively impact patient care.

Completed by a project team from the RAND Corporation; Stanford University; the University of California, San Francisco; Johns Hopkins University; and ECRI Institute, as well as an international panel of 21 stakeholders and evaluation methods experts, the report is based on an evidence-based assessment of patient safety strategies.

If implemented widely, they have the potential to “vastly improve patient safety and save lives in US health care institutions,” the authors believe.

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, which the authors believe can reduce medication errors, hospital-acquired conditions, adverse events, and even bedsores. That list of 41 was culled from an initial list of 158 items that the authors of the report developed from a variety of sources, including The Joint Commission, the National Quality Forum, and the Leapfrog Group.

The list was culled through voting, and 18 were chosen for more in-depth reviews. In the end, the group came up with 41 good ideas, 10 that are slam dunks, and another dozen that are a fine idea. (See lists, below.)

The report emphasizes evidence about implementation, how the strategies are adopted, and the influence of the context in which they are implemented.

The idea is to help organizations know what works and whether a strategy needs adaptation to meet local needs.

The entire report, including evidence reviews for all 41 patient safety strategies, can be found at http://www.ahrq.gov/research/findings/evidence-based-reports/ptsafetyuptp.html.

Patient safety strategies — strongly encouraged

• 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 health care-associated infections

• Use of real-time ultrasonography for central line placement

• Interventions to improve prophylaxis for venous thromboembolisms


Patient safety strategies — encouraged

• Multicomponent interventions to reduce falls

• Use of clinical pharmacists to reduce adverse drug events

• Documentation of patient preferences for life-sustaining treatment

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

• Team training

• Medication reconciliation

• Practices to reduce radiation exposure from fluoros-copy and CT

• The use of surgical outcome measurements and report cards, such as those from ACS NSQIP

• Rapid-response systems

• Use of complementary methods for detecting adverse events or medical errors to monitor for patient safety problems

• Computerized provider order entry

• Use of simulation exercises in patient safety efforts