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Patient safety strategies hospitals should implement now

Every time you turn around there’s another study on how you can improve patient care and safety at your hospital. But how do you know which strategies really work, which ones will be good for your facility and which you should implement first?

ECA_043One way is to look at this new report. The Department of Health and Human Services’ (HHS) Agency for Healthcare Research and Quality (AHRQ) recently released a report of the top 10 patient safety strategies healthcare systems and their providers should put in place immediately.

The report is based on Making Health Care Safer II: An Updated Critical Analysis of the Evidence for Patient Safety Practices, which assesses evidence of 41 patient safety strategies in 955 pages. If implemented, these strategies have the potential not only to improve patient care, but to save lives.

They cover everything from preventing medication errors, bedsores, hospital-acquired infections and many other patient safety events.

To help clinicians adapt these practices to meet their facilities’ specific needs, the report gives details on implementation, adoption and the context in which safety strategies have been used.

While many of the 41 recommended strategies are currently used in some healthcare systems, there are many that aren’t — despite the fact they have demonstrated great promise.

Of course trying to incorporate all 41 strategies is overwhelming for any healthcare system. That’s why AHRQ “strongly recommends” that all facilities at least implement its top 10 strategies — a few of which have been listed below — that have been proven to make patient care safer.

Improved hand hygiene

Healthcare-associated infections (HAI) account for approximately 80,000 U.S. deaths per year, and cost hospitals billions. The sad fact is these infections often are preventable with simple, thorough hand hygiene.

If you’re thinking, “My hospital’s got this down,” think again. Among healthcare workers, compliance with hand hygiene practices historically has been low — about 39%.

If you need assistance improving hand hygiene at your facility, the Centers for Disease Control and Prevention (CDC), the Institute for Healthcare Improvement, the Joint Commission and World Health Organization (WHO) all have hand hygiene compliance programs to share.

What AHRQ found was a successful hand hygiene educational program has several key features:

  • reinforcement of hand hygiene messages
  • knowledge of healthcare workers’ perceived importance of hand hygiene and its role in prevention of HAIs
  • monitoring and feedback of hand hygiene practices
  • practical education tools
  • role-modeling by senior staff, and
  • supportive infrastructure and management.

Preoperative and anesthesia checklists

Surgical operations can be directly responsible for substantial morbidity and mortality. That’s why preoperative checklists and anesthesia checklists are essential to prevent operative and postoperative events.

According to Making Health Care Safer II, in industrialized countries, the rate of perioperative death directly due to inpatient surgery ranges from 0.4% to 0.8%, with the rate of major complications being as high as 17%.

In addition, while huge strides have been made in improving the safety of administering anesthesia, it’s believed that increased awareness can lower the risks — particularly morbidity risk — even further.

That why using preoperative checklists is on the top 10 list. They can help prevent errors and complications related to surgery and anesthesia administration.

While checklists are often just one part of a strategy, they’re an important part. WHO has a surgical safety checklist that is widely used as a preoperative checklist intended to ensure safe surgery and minimize complications.

Care bundles for central venous catheters

Central venous catheters (CVCs) are necessary when caring for critically ill patients. They give providers reliable venous access for drawing blood, infusing medications and hemodynamic measurements. But they’re also the leading cause of healthcare associated bloodstream infections (BSIs), which are frequently implicated in life threatening illnesses.

Approximately 249,000 BSIs occur in U.S. hospitals each year and 32.2% occur in the intensive care unit (ICU). And since the presence of a CVC is the strongest predictor of developing a BSI, prevention is often targeted there.

In addition to being life threatening, each central-line associated bloodstream infection (CLABSI)  increases length of hospitalization from seven to 21 days, and adds a cost of about $37,000 (2002 dollars) per patient, noted the report. So reducing them is vital to reducing hospital stays and reducing healthcare costs.

After years of study, it’s been found that implementing care bundles have been successful at some sites in reducing CLABSIs.

In addition to using barrier precautions, such as healthcare professionals wearing caps, masks, sterile gowns and gloves, and using a full body drape on the patient, hospitals should also use proper hand hygiene, clean the patient’s skin with chlorhexidine, and avoid the femoral site for catheter insertion and remove unnecessary catheters.

Intervention for urinary catheter use

A very common healthcare associated infection, urinary tract infections often occur after the catheter has been inserted and, at times, forgotten.

It’s estimated that 1 million catheter-associated urinary tract infections (CAUTIs) occur per year. And the associated cost is $676 per admission.

Knowing that, it’s easy to see why CAUTIs were one of the first hospital-acquired conditions chosen by Medicare for nonpayment, and they’ve been selected as a “never event” with the goal of reducing CAUTI by 25% and reducing urinary catheter use by 50% by 2014.

Aside from reducing the use of urinary catheters, many CAUTI prevention strategies have been bundled together. Known as bladder bundles, they consist of educational interventions for appropriate use and clinical skill in catheter placement, behavioral interventions such as catheter restriction and removal protocols, and use of specific technologies such as the bladder ultrasound.

Part of the educational intervention plan is changing the habits of healthcare providers and patients when it comes to urinary catheters.

To help prioritize the interventions to prevent CAUTI, the report suggests using the conceptual model of the four stages of the lifecycle of the urinary catheter: its initial placement, when the catheter is in day after day, removal of the catheter,  placement of a new catheter. The highest yield interventions will target at least one of the four stages.

Making Health Care Safer II: An Updated Critical Analysis of the Evidence for Patient Safety Practices, includes evidence reviews for all 41 patient safety strategies, and 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 from patient safety experts. 

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