A team of patient safety experts, commissioned by the Agency for Healthcare Research and Quality (AHRQ), has identified 22 patient safety strategies that are deemed to have sufficient evidence base to warrant widespread adoption.
The evidence reviews underlying 10 of the 41 patient safety strategies studied are discussed in an AHRQ report, Making Health Care Safer II: An Updated Critical Analysis of the Evidence for Patient Safety Practices [PDF – 9.6 MB], published as a special supplement to the March 4, 2013 issue of the Annals of Internal Medicine. These strategies include interventions to reduce diagnostic errors, in-facility falls, pressure ulcers, and delirium; efforts initiated in hospitals to improve care transitions and medication reconciliation; interventions in inpatient settings to promote a patient safety culture or climate; implementation of rapid-response systems; examination of the effect of nurse–patient staffing on patient outcomes; and use of simulation exercises to improve patient safety.
The 10 strategies “strongly encouraged” for adoption, based on the strength and quality of evidence, are:
- 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;
- “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; and
- Interventions to improve prophylaxis for venous thromboembolisms.
In addition, Making Health Care Safer II identifies 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 scans;
- Use of surgical outcome measurements and report cards, such as the American College of Surgeons National Surgical Quality Improvement Program;
- Rapid response systems;
- Utilization of complementary methods for detecting adverse events/medical errors to monitor for patient safety problems;
- Computerized provider order entry; and
- Use of simulation exercises in patient safety efforts.