New AHRQ evidence report details top patient safety strategies
In a major effort to help health care systems protect the safety of patients in the United States, AHRQ released a report in March identifying the top 10 patient safety strategies (see box on page 3) that can be implemented immediately by health care 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. health care 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," said AHRQ Director Carolyn M. Clancy, M.D. "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 helps clinicians understand what works, how to apply it, and under what circumstances it works best so it can be adapted to local needs. Many of the strategies are already widely in use and some are based on guidelines from the Centers for Disease Control and Prevention. Others have shown great promise but remain uncommon in practice. The report also identifies gaps where more research can further advance patient safety.
Ten of the 41 strategies were published as papers in a special supplement to the March 5 Annals of Internal Medicine. The entire report, including evidence reviews for all 41 patient safety strategies, can be found at www.ahrq.gov/research/findings/evidence-based-reports/ptsafetyuptp.html. The report is an update to a landmark 2001 AHRQ report, Making Health Care Safer: A Critical Analysis of Patient Safety Practices (Evidence Report/ Technology Assessment No. 43). The 2001 report helped identify early evidence-based safety practices and opportunities for research. That 2001 report was also preceded by two major Institute of Medicine reports, To Err Is Human: Building a Safer Health System and Crossing the Quality Chasm, which together galvanized the modern patient safety and quality improvement movements in the United States.
The Agency’s ongoing work helps implement the Affordable Care Act (ACA) through support of the National Quality Strategy and Partnership for Patients. The National Quality Strategy (www.ahrq.gov/workingforquality) aligns national efforts to improve the quality and safety of care. Partnership for Patients (http://partnershipforpatients.cms.gov) is a national, public-private partnership of hospitals, employers, physicians, nurses, consumers, State and Federal governments, and other key stakeholders. Together with incentives created by the ACA, these efforts represent a coordinated approach to making care safer by drawing on the strengths and expertise of providers, Department of Health and Human Services agencies, and others to demonstrate and implement proven patient safety strategies.
The new report was prepared by AHRQ Evidence-based Practice Centers at the RAND Corporation, 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. For more information, please visit www.ahrq.gov.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.
* Shekelle PG, Wachter RM, Pronovost P., et al. Making Health Care Safer II: An Updated Critical Analysis of the Evidence for Patient Safety Practices. Comparative Effectiveness Review No. 211. (Prepared by the Southern California-RAND Evidence-based Practice Center under Contract No. 290-2007-10062-I.) AHRQ Publication No. 13-E001-EF. Rockville, MD: Agency for Healthcare Research and Quality. March 2013. www.ahrq.gov/research/findings/evidence-based-reports/ptsafetyuptp.html.