AHRQ (the Agency for Healthcare Research and Quality) has updated its list of strategies to improve patient safety that are supported by research and clinical evidence (AHRQ 2013).
Ten of the strategies identified are "strongly encouraged" for adoption based on the strength and quality of evidence:
1. Preoperative checklists and anesthesia checklists to prevent operative and postoperative events.
2. Bundles that include checklists to prevent central line-associated bloodstream infections.
3. Interventions to reduce urinary catheter use, including catheter reminders, stop orders, or nurse-initiated removal protocols.
4. Bundles that include head-of-bed elevation, sedation vacations, oral care with chlorhexidine, and subglottic-suctioning endotracheal tubes to prevent ventilator-associated pneumonia.
5. Hand hygiene.
6. "Do Not Use" list for hazardous abbreviations.
7. Multicomponent interventions to reduce pressure ulcers.
8. Barrier precautions to prevent healthcare-associated infections.
9. Use of real-time ultrasound for central line placement.
to improve prophylaxis for venous thromboembolisms.
Twelve other strategies are "encouraged" for adoption based on a slightly lesser strength and quality of evidence:
1. Multicomponent interventions to reduce falls.
2. Use of clinical pharmacists to reduce adverse drug events.
3. Documentation of patient preferences for life-sustaining treatment.
4. Use of informed consent to improve patients' understanding of the potential risks of procedures.
5. Team training.
6. Medication reconciliation
7. Practices to reduce radiation exposure from fluoroscopy and computed tomography scans.
8. Use of surgical outcome measurements and report cards, such as the American College of Surgeons National Surgical Quality Improvement Program.
9. Rapid response systems
10. Utilization of complementary methods for detecting adverse events/medical errors to monitor for patient safety problems.
11. Computerized provider order entry.
simulation exercises in patient safety efforts.
Summaries of several of the recommended practices and the evidence behind them are available in a special supplement to the Annals of Internal Medicine. Others will appear in an upcoming issue of BMJ Quality and Safety.
AHRQ. Making Health Care Safer II. An Updated Critical Analysis of the Evidence for Patient Safety Practices. March 2013
Making Health Care Safer: A Critical Review of Evidence Supporting Strategies to Improve Patient Safety. Annals of Internal Medicine 2013; 5 March 2013; 158(5 Part 2): 365-440
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