10 Patient Safety Tips for Hospitals Medical errors may occur in different health care settings, and those that happen in hospitals can have serious consequences. The Agency for Healthcare Research and Quality (AHRQ), which has sponsored hundreds of patient safety research and implementation projects, offers these 10 evidence-based tips to prevent adverse events from occurring in your hospital. Ordering information and links to free AHRQ tools are also provided. 1. Prevent central line- evidence and identify best practices, analyze care associated blood stream delivery, track performance with metrics, layer infections. Be vigilant interventions, and continue to improve. Ordering preventing central line- information for Preventing Hospital-Acquired Venous associated blood stream Thromboembolism: A Guide for Effective Quality infections by taking five steps Improvement (AHRQ Publication No. 08-0075) is every time a central venous available at http://www.ahrq.gov/qual/vtguide/. catheter is inserted: wash 4. Educate patients about your hands, use full-barrier using blood thinners safely. precautions, clean the skin Patients who have had surgery with chlorhexidine, avoid often leave the hospital with a femoral lines, and remove unnecessary lines. Taking new prescription for a blood these steps consistently reduced this type of deadly health thinner, such as warfarin care-associated infection to zero in a study at more than (brand name: Coumadin ®), to 100 large and small hospitals. i Additional AHRQ keep them from developing resources on preventing health care-associated infections dangerous blood clots. are available at http://www.ahrq.gov/qual/hais.htm. However, if used incorrectly, 2. Re-engineer hospital discharges. Reduce potentially blood thinners can cause preventable readmissions by assigning a staff member to uncontrollable bleeding and are among the top causes of work closely with patients and other staff to reconcile adverse drug events. A free 10-minute patient education medications and schedule necessary followup medical video and companion 24-page booklet, both in English appointments. Create a simple, easy-to-understand and Spanish, help patients understand what to expect discharge plan for each patient that contains a medication when taking these medicines. Ordering information for schedule, a record of all upcoming medical Staying Active and Healthy with Blood Thinners (AHRQ appointments, and names and phone numbers of whom Publication No. 09-0086-DVD) and Blood Thinner Pills: to call if a problem arises. AHRQ-funded research shows Your Guide to Using Them Safely (AHRQ Publication that taking these steps can help reduce potentially No. 09-0086-C) is available at http://www.ahrq.gov/ preventable readmissions by 30 percent. ii An online consumer/btpills.htm. toolkit is available at http://www.bu.edu/ 5. Limit shift durations for fammed/projectred/. medical residents and other 3. Prevent venous hospital staff if possible. thromboembolism. Eliminate Evidence shows that acute and hospital-acquired venous chronically fatigued medical thromboembolism (VTE), the residents are more likely to most common cause of make mistakes. Ensure that preventable hospital deaths, by residents get ample sleep and using an evidence-based guide adhere to 80-hour workweek to create a VTE protocol. This limits. Residents who work 30- free guide explains how to take hour shifts should only treat essential first steps, lay out the patients for up to 16 hours and Agency for Healthcare Research and Quality PATIENT Advancing Excellence in Health Care • www.ahrq.gov SAFETY should have a 5-hour protected sleep period between 10 (AHRQ Publication No. 08(09)-0059) are available at p.m. and 8 a.m. iii Resident Duty Hours: Enhancing Sleep, http://www.ahrq.gov/qual/patientsafetyculture/. Supervision, and Safety is available at http:// 9. Build better teams and rapid response books.nap.edu/openbook.php?record_id=12508&page=R1. systems. Train hospital staff to communicate 6. Consider working with a Patient effectively as a team. A free, customizable Safety Organization. Report and share toolkit called TeamSTEPPS™, patient safety information with Patient which stands for Team Strategies Safety Organizations (PSOs) to help others and Tools to Enhance Performance avoid preventable errors. By providing both and Patient Safety, provides privilege and confidentiality, PSOs create a secure evidence-based techniques for environment where clinicians and health care promoting effective communication organizations can use common formats to collect, and other teamwork skills among aggregate, and analyze data that can improve quality by staff in various units or as part of identifying and reducing the risks and hazards associated rapid response teams. Materials can be tailored to any with patient care. Information on PSOs and Common health care setting, from emergency departments to 1 Formats is available at http://www.pso.ahrq.gov/. ambulatory clinics. A free 2 ⁄2-day train-the-trainer course is currently being offered in five locations nationwide. 7. Use good hospital design Ordering information for the TeamSTEPPS Multimedia principles. Follow evidence- Resource Kit (AHRQ Publication No. 06-0020-3) and based principles for hospital information on the training sessions are available at design to improve patient safety http://teamstepps.ahrq.gov/index.htm. and quality. Prevent patient falls by providing well-designed 10. Insert chest tubes safely. patient rooms and bathrooms and Remember UWET when inserting creating decentralized nurses’ stations that allow easy chest tubes. The easy-to-remember access to patients. Reduce infections by offering single- mnemonic is based on a universal bed rooms, improving air filtration systems, and protocol from the Joint providing multiple convenient locations for hand Commission and stands for: washing. Prevent medication errors by offering Universal Precautions (achieved pharmacists well-lit, quiet, private spaces so they can fill by using sterile cap, mask, gown, and gloves); Wider skin prescriptions without distractions. Ordering information prep; Extensive draping; and Tray positioning. A free 11- for a free 50-minute DVD, Transforming Hospitals: minute DVD provides video excerpts of 50 actual chest Designing for Safety and Quality (AHRQ Publication No. tube insertions to illustrate problems that can occur 07-0076-DVD), is available at http://www.ahrq.gov/ during the procedure. Ordering information for Problems qual/transform.htm. and Prevention: Chest Tube Insertion (AHRQ Publication No. 06-0069-DVD) is available at 8. Measure your hospital’s http://www.ahrq.gov/qual/chesttubes.htm. patient safety culture. Survey hospital staff to assess your For free copies of AHRQ tools, please call the AHRQ facility’s patient safety culture. Publications Clearinghouse at 1-800-358-9295. AHRQ’s free Hospital Survey on Patient Safety Culture and i Pronovost P, Needham D, Berenholtz S, Sinopoli D, Chu H, Cosgrove related materials are designed to S, Sexton B, Hyzy R, Welsh R, Roth G, Bander J, Kepros J, Goeschel provide tools for improving the C. An intervention to decrease catheter-related bloodstream infections patient safety culture, evaluating in the ICU. N Engl J Med 2006 Dec 28;355(26):2725-32. the impact of interventions, and ii Jack BW, Chetty VK, Anthony D, Greenwald JL, Sanchez GM, tracking changes over time. If your health system Johnson AE, Forsythe SR, O’Donnell JK, Paasche-Orlow MK, Manasseh C, Martin S, Culpepper L. A reengineered hospital includes nursing homes or ambulatory care medical discharge program to decrease rehospitalization: a randomized trial. groups, share culture surveys customized for those Ann Intern Med 2009 Feb 3;150(3):178-87. settings. Free patient safety culture surveys for hospitals iii Institute of Medicine, 2009. Resident Duty Hours: Enhancing (AHRQ Publication No. 04-0041), nursing homes Sleep, Supervision, and Safety. Washington, DC: The National (AHRQ Publication No. 08-0060), and medical offices Academies Press. AHRQ Publication No. 10-M008 (Replaces AHRQ Publication No. 08-P003) December 2009 infection control and hospital epidemiology september 2008, vol. 29, no. 9 shea/apic guideline SHEA/APIC Guideline: Infection Prevention and Control in the Long-Term Care Facility July 2008 Philip W. Smith, MD; Gail Bennett, RN, MSN, CIC; Suzanne Bradley, MD, Paul Drinka, MD; Ebbing Lautenbach, MD; James Marx, RN, MS, CIC; Lona Mody, MD; Lindsay Nicolle, MD; and Kurt Stevenson, MD Long-term care facilities (LTCFs) may be defined as institu- fessional (ICP), and many larger hospitals have a consulting tions that provide health care to people who are unable to man- hospital epidemiologist. The Study on the Efficacy of Nosoco- age independently in the community.1 This care may be mial Infection Control (SENIC) documented the effectiveness chronic care management or short-term rehabilitative ser- of a hospital infection control program that applies standard vices. The term nursing home is defined as a facility licensed surveillance and control measures.2 with an organized professional staff and inpatient beds that The major elements leading to a HAI are the infectious provides continuous nursing and other services to patients agent, a susceptible host, and a means of transmission. These who are not in the acute phase of an illness. There is consider- elements are present in LTCFs as well as in hospitals. It is not able overlap between the 2 terms. surprising, therefore, that almost as many HAIs occur annually