Report Details Steps to Boost Patient Safety03/05/13
TUESDAY, March 5 (HealthDay News) -- Experts estimate that many
tens of thousands of people in the United States die each year from
medical errors, unproven treatments, bad diagnoses and preventable
problems such as bedsores. Now, a federal health care agency is
urging the medical world to follow 10 strategies to improve safety
The strategies range from the straightforward -- keep hands
clean -- to the complicated, including a series of measures to
prevent pneumonia in people on ventilators. The agency also
supports the use of checklists to prevent a variety of
At first glance, the strategies seem fairly simple to implement
because they mainly require changes in the protocol of treating
patients. But it's not an easy task, said Dr. Rainu Kaushal,
director of the Center for Healthcare Informatics and Policy at
Weill Cornell Medical College, in New York City.
"Practicing medicine is complex and growing increasingly complex every day. This includes even simple patient safety measures such as hand washing. Understanding when hand hygiene needs to be performed and in what manner is more complicated than remembering to wash one's hands prior to eating," said Kaushal, who's familiar with the strategies listed in a report released Monday.
The report, from the U.S. Agency for Healthcare Research and
Quality, was written by an international team of physicians and
others who study medicine. The top 10 list of "Strongly Encouraged"
strategies focuses on ways to prevent complications such as
infections and blood clots.
A secondary list of "Encouraged" strategies addresses issues
such as patient falls, bad drug interactions, radiation exposure
and informed consent.
Here are some of the strategies from both lists:
- Better use of safety checklists around surgery and anesthesia
- For patients on ventilators: "sedation vacations," better mouth
care, and suctioning to prevent pneumonia
- Bedsore-prevention measures
- Checklists to prevent bloodstream infections from central
intravenous (IV) catheters in the large neck or heart veins
- Real-time ultrasounds when inserting central lines
- Reduced use of urinary catheters
- A "do not use" list of hazardous abbreviations
- Barrier precautions such as face masks, gloves, gowns used by
health care providers to prevent spread of infection
- Measures to prevent patient falls
- Use of advance directives/living wills
- Lower-dose radiation from CT scans and other imaging tests
- Use of electronic medical orders
This isn't the first time there's been a major focus on errors
that kill or sicken patients. In 1999, a landmark Institute of
Medicine report estimated that as many as 98,000 patients in the
United States die each year in hospitals and other facilities
because of medical errors.
So what's changed since then? Are fewer people dying?
"If you look at the global numbers, we haven't made a lot of progress," said report lead author Dr. Paul Shekelle, chief of internal medicine at VA West Los Angeles Medical Center and director of RAND's Southern California Evidence-based Practice Center.
Indeed, a 2010
New England Journal of Medicinestudy that analyzed North
Carolina hospitals from 2002 to 2007 found little change in patient
safety, with many patients harmed or even killed by their
But, Shekelle said, there's been progress in specific areas,
such as preventing bloodstream infections from catheters. "We
always want things to go faster than they do," he said. "It was
only 1999 when the very concept of patient safety was recognized as
being of importance, and we've come a long way in 13 to 14
Now, Shekelle said, it's clear how to prevent many medical
mishaps. And it's not a matter of just applying common sense, he
said: Strong leadership is needed, and in some cases, like injuries
from falls, "you've got to change the attitude that everybody
falls, and there's nothing you can do about it."
Will it be costly to embrace these strategies? Kaushal said
they're cheaper than adopting other ways of improving safety, like
new technology. And better patient safety saves money over time by
decreasing time in the hospital, among other things, she added.
"Technology is a powerful way to systematically change practices, but those included in this list are generally behavioral and/or staffing practices, which are more prone to variation and require leadership to implement change," Kaushal explained.
The report appears in the March 5 issue of
Annals of Internal Medicine.
For more about
patient safety, visit the U.S. National Library of Medicine.
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