Patient Safety Needs Improvement

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Report: Patient Safety Needs Improvement

Many Hospitals Still Don't Use Proven Safety Techniques

By  Jeff Levine WebMD Medical News

July 17, 2001 (Washington) -- A new federal report gives healthcare

officials a list of proven safety techniques that can stop errors before

they start. But the authors say too often these techniques are ignored.

The massive 640 page document, titled " Making Health Care Safer: A

Critical Analysis of Patient Safety Practices, " is aimed at the

healthcare professionals making patient care decisions.

The impetus for this analysis came from the highly publicized 1999

Institute of Medicine report indicating that between 44,000 and 98,000

Americans annually die from medical errors. While efforts at improving

patient safety are nothing new, this effort, prepared by AHRQ, the

Agency for Healthcare Research and Quality, is different.

" 'Why aren't we doing this?' is the kind of question that a healthcare

leader [reading this report] ought to be asking, " says Eisenberg,

MD, director of AHRQ.

" The nation's healthcare leaders need to know what the science says

about where the opportunities exist to make patient care safer right

now, " said Health and Human Services Secretary Tommy in a

statement accompanying the report.

For this report, researchers at the University of California and

Stanford University evaluated 79 patient safety practices. Of those, 73

are considered likely to improve patient safety.

Eleven techniques were singled out that are generally proven but not

performed routinely. Among them:

•Giving surgery patients antibiotics prior to their operation to prevent

infections. While up to 90% of surgical patients receive antibiotics,

they are improperly administered up to 50% of the time, according to the

report.

•Using ultrasound to guide intravenous lines to help prevent punctured

arteries.

•Treating surgery patients with drugs called beta-blockers, which are

known to reduce the chance of heart attacks.

In addition to these patient-focused recommendations, the report

suggested specific organizational changes. For instance:

•Encouraging a " culture of safety " in institutions

•Changing nurse staffing ratios

•Using computerized systems to order drugs to reduce errors

•Improving hand-washing techniques

Though it's too early to generalize, Eisenberg says that using computers

to manage medications in hospitals could save billions of dollars and

many lives.

One of the big questions yet to be answered is whether an increase in

nurse staffing will improve patient safety.

" Changes in nurse staffing was considered to be a patient safety

practice with high strength of evidence ... but not the greatest

strength of evidence, " said Eisenberg.

The goal is not to create cookbook medicine but rather to suggest

options that will improve patient safety generally. From there, each

healthcare institution will need to individualize its patient safety

strategy.

" Preventing blood clots in patients that undergo surgery may be of major

importance to a hospital with a large number of major orthopaedic

surgeons. ... But methods for reducing ... infections [acquired while in

the hospital] may be of greater interest to a small community hospital, "

says Gregg Meyer, MD, director of AHRQ's Center for Quality Improvement

and Patient Safety.

So what can patients do to insure a safer medical experience?

One recommendation is to read back the consent form to the doctor before

an operation. " Part of what gets missed is having a full comprehension

of that informed consent. So some practices have been evaluated to

improve full comprehension, " says Mc, MM, the project

coordinator.

Medically Reviewed

By Dr. Dominique Walton

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