Strategies for Promoting Patient Safety

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, which has sponsored hundreds of patient safety research and implementation projects, offers these evidence-based tips to prevent adverse events from occurring in your hospital.

Improve hand hygiene compliance

The link between dirty hands and the transmission of health care-associated infections has strong backing in epidemiological literature, and the importance of hand hygiene has been touted by the World Health Organization, the Joint Commission and the Centers for Disease Control and Prevention. Yet rates of hand washing are low, averaging 39%, with many doctors and nurses underestimating the activity's safety value.Research shows that effective hand hygiene initiatives improve knowledge of when to clean and how to clean, require demonstration of the knowledge, ensure that alcohol-based rub and gloves are available at the bedside, and guarantee that compliance is monitored continuously.

Use barrier precautions to stop the spread of infections

Along with hand hygiene, barrier precautions are key to reducing the 1.7 million health care-associated infections that occur in the U.S. each year, which the CDC says kill about 99,000 patients annually.When a patient has a serious nosocomial infection such as vancomycin-resistant Enterococcus, health workers should wear gowns and gloves when providing care. They should use dedicated disposable equipment and follow the encounter with immediate hand hygiene. A care bundle including barrier precautions has been shown to cut the spread of VRE from 21% to 9% in intensive care units.

Avoid hazardous drug abbreviations

About 15,000 medication errors a year have been linked to using abbreviations such as “u” for “unit” and “q.d.” instead of “once daily.” Starting in April 2004, the Joint Commission required hospitals to ban these and other commonly used abbreviations that jeopardize medication safety.Studies done around the time the ban went into effect found that hospitals were able to cut use of hazardous medication abbreviations from about 20% to 3% through education and follow-up with doctors who used the shorthand prescription lingo. Implementation of computerized physician order entry systems also can help eliminate the vestiges of this problem.

Use multi component interventions to prevent pressure ulcers

About 2.5 million Americans develop bedsores each year, and about 60,000 patients will die from complications related to pressure ulcers acquired in U.S. hospitals.One bundle of preventive care measures has reduced pressure ulcers by 90% at a large health system, from a rate of 5.7% of patients to less than 0.5%. The bundle, dubbed SKIN, calls for continual assessment of the skin of at-risk patients, regular turning of these patients, management of incontinence to prevent soiling that can contribute to bedsores, and nutritional assessment for malnourishment that can enable the ulcers.

Educate patients about using blood thinners safely

Patients who have had surgery often leave the hospital with a new prescription for a blood thinner, such as warfarin brand name: Coumadin®), to keep them from developing dangerous blood clots. However, if used incorrectly, blood thinners can cause uncontrollable bleeding and are among the top causes of adverse drug events. A free 10-minute patient education video and companion 24-page booklet, both in English and Spanish, help patients understand what to expect when taking these medicines. 

Patient safety is an essential and vital component of quality nursing care. However, the nation’s health care system is prone to errors, and can be detrimental to safe patient care, as a result of basic systems flaws. A variety of stakeholders are responsible for ensuring that patient care is safely delivered and that no harm occurs to patients.