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Federal Report Documents Top Patient Safety Practices
http://nurses.medscape.com/40541.rht...mp=nurs-072001
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WESTPORT, CT (Reuters Health) Jul 17 - A federal report released today identifies dozens of "evidence-based" practices that could improve patient safety in the nation's hospitals and nursing homes.

Eleven of the practices highlighted in the report are considered "clear opportunities" to improve patient safety but are not being routinely performed throughout the healthcare system, researchers said. They include administering antibiotics before surgery to prevent infections, using ultrasound to help guide the insertion of central intravenous lines and to prevent punctured arteries, and giving surgery patients beta-blockers to prevent heart attacks.

The 640-page report released by the federal Agency for Healthcare Research and Quality (AHRQ) represents an exhaustive review of the scientific literature to identify practices that are proven to be effective and believed to represent a significant opportunity for improvement. Because of the documented risks to patient safety, the report focuses on hospital care, but also considers care delivered in nursing homes, at ambulatory care sites and by patients themselves in managing their care.

"Things that made the list are by definition things that we do have some room for improvement," said Dr. Gregg Meyer, director of AHRQ's Center for Quality Improvement and Patient Safety. Other practices known to improve patient safety, such as counting sponges in the operating room, did not rank highly because they are "pretty much universal," he told Reuters Health.

Compiled by AHRQ's Evidence-based Practice Center at the University of California-San Francisco/Stanford University, the report is the federal government's "first effort" to examine the patient safety "through the lens of evidence-based medicine."

"We are sharing these findings with healthcare administrators, medical directors, health professionals and others who are responsible for patient safety programs in the institutions where they work," Health and Human Services Secretary Tommy G. Thompson said of today's publication. "The nation's healthcare leaders need to know what the science says about where the opportunities exist to make patient care safer right now."

Dr. Meyer stressed that the effort is in its infancy and that "a great deal more research" needs to be done.

"In general, I think today's report...is a welcome resource for healthcare leaders," Carmela Coyle, the American Hospital Association's senior vice president for policy, told Reuters Health. What AHRQ has done "is to really provide very much needed information that really hasn't been out there about what works and what doesn't," she said.

National interest in patient safety issues soared following the Institute of Medicine's release of a sentinel report pegging the number of US deaths related to medical errors at up to 98,000 per year.

The National Forum for Health Care Quality Measurement and Reporting, a public-private partnership of consumers, employers, health plans and other stakeholders, plans to use the AHRQ report to develop a list of measures that patients can use to evaluate the care they receive at hospitals and other healthcare facilities.

Forum President and CEO Dr. Kenneth W. Kizer, told Reuters Health that the partnership is likely to expand the criteria used for reviewing the evidence and anticipates developing a list of recommendations that is broader than the one AHRQ has developed.

In all, AHRQ reviews 79 patient-care practices, including 73 that are likely to improve patient safety and 11 "highly rated" practices considered the best opportunity for making the healthcare system safer.

Each hospital needs to look at the list and determine how the interventions fit in their delivery of care, Dr. Meyer said. A facility with a high volume of major joint surgeries might want to focus on different practices than a children's hospital, for example. "And so there is no right list," he said.

The list is as interesting for what it includes as for what it does not. There is strong evidence to suggest, for example, that patients be asked to recall and restate what they were told during the informed consent process, according to the report.

However, improved hand washing and use of computer order-entry systems — practices long considered important for patient safety — did not make the top 11 list because of a dearth of published studies.

"Even though many of these practices are clearly valuable in improving patient safety, the report shows that there needs to be more research in these areas so that we know more about which practices are most effective and how complex or costly they would be to put into place," said Dr. John M. Eisenberg, director of the AHRQ.

The full report is available at AHRQ's Web site along with supplementary information at http://www.ahrq.gov/clinic/ptsafety/.