Quality: improving patient safety

SIG (prescription instructions), and RxNorm (standard name, dose, and form availability) were not considered ready for implementation because of numerous approaches used in these three areas across health information technology. Electronic prescribing is not required under MMA, but plans are to have it available should providers choose to use it. As standards are developed, the adoption of e-prescribing is expected to improve patient safety by reducing prescribing and dispensing errors (Agency for Healthcare Research Quality, 2007). 

Obtaining critical pro duct quality information while the product is still being manufactured can lead to improved patient safety as well as increased product quality. PAT can also help establish causal links between process variables and product performance. The key is to develop suitable methodologies specific to the manufacturing process and product. It is also important to develop validation strategies that allow for the incorporation of PAT. 

Quality me a.t are merit and improvement requires developing and testing quality measures and investigating the best ways to collect, compare, and communicate these data so they are useful to decision makers. AHRQ s research emphasizes studies of the most effective ways to implement these measures and strategies in order to improve patient safety and healthcare quality. 

Figure 5.2 Framework for Safety Action and Information Feedback from Incident Reporting (SAIFIR) (Reproduced from Quality Safety in Health Care, J Benn, M Kontantji, L Wallace et al. "Feedback from incident reporting information and action to improve patient safety". 18, no. 1, [11-21], 2009, with permission from BMJ Publishing Group Ltd.).

Nieva, V.F. and Sorra, J. (2003) Safety culture assessment a tool for improving patient safety in healthcare organizations. Quality and Safety in Health Care, 12(Suppl. II), iiI7-ii23. 

Speroff.T., James, B.C., Nelson, B.C.rta/. (2004) Guidelines for appraisal and publication of PDSA quality improvement. Quality Management in Health Care, 13(1), 33-39. Wachter, R.M. and Pronovost, P.J. (2006) The 100 000 lives campaign a scientific and policy review. Joint Commission Journal on Quality and Patient Safety, 32(11), 621-627. Waldrop, M.M. (1992) Complexity The Emerging Science at the Edge of Order and Chaos, Cardinal, London. 

Frankel, A., Gandhi, T.K. and Bates, D.W. 2003. Improving patient safety across a large integrated health care dehveiy system. International Journal for Quality in Health Care, 15(suppl 1), 131-140. doi 10.1093/intqhc/mzg075. 

Berni, J., Koutantji, M., Wallace, L., Spurgeon, R, Rejman, M., Healey, A. and dncent, C. 2009. Feedback from incident reporting Information and action to improve patient safety. Quality and Safety in Healthcare, 18,11-20. 

Slovenia Yes Hospital Centre for Quality and Patient Safety improvement in Health Care Andrej Robida (Rohida2013)... 

In the newest report, patient safety culture was included as one of the safe practices that were reviewed for its evidence, both as a practice and in terms of the context sensitivity of the practice and its adoption. In reviewing the evidence on patient safety culture as a practice. Weaver et al. (2013) suggest that developing a culture of safety is a core element of many efforts to improve patient safety and healthcare quality. Their systematic review identified and assessed interventions used to promote safety culture or climate in acute care settings. Based on this review the authors indicate that there is evidence suggesting that interventions can improve perceptions of safety culture and potentially reduce patient harm. 

Morelia, R.T., Lowthian, J. A., Barker, A.L., McGinees, R., Dunt, D. and Brand, C. 2012. Strategies for improving patient safety culture in hospitals A systematic review. BMJ Quality and Safety, doi 10.1136/bmjqs-2011-000582. Online 31 July 2012 (last accessed on 30 January 2013). 

Tupper, J., Cobrnn, A., Loux, S., Moscovice, I., Klingner, J. and Wakefield, M. 2008. Strategies for improving patient safety in small rural hospitals. Advances in Patient Safety New Directions and Alternative Approaches, 1-4, AHRQ Publication Nos. 08-0034 (1-4). Agency for Healthcare Research and Quality, Rockville, MD. Available at http //www.ahrq.gov/qual/advances2/ (last accessed on 14 May 2014). 

This council was established by the Australian govertunent in January 2000 to provide leadership in improving patient safety and quality through advice to all federal, state, and territory health ministers for a five-year term. Its three main specific goals were as follows ... 

McKeon, L., M., Cunningham, R, D., Oswaks, D., Jill, S, Improving Patient Safety Patient-Focused, High-Reliability Team Training, Journal of Nursing Quality, Vol. 25, 2005, pp. 87-92. 

Ortiz, E., Meyer, G., Burstin, H., The Role of Glinical Informatics in the Agency for Healthcare Research and Quality s Efforts to Improve Patient Safety, JAMA, Vol. 

Raab, S. S., Improving Patient Safety through Quality Assurance, Archives (f Pathology Laboratory Medicine, Vol. 130, 2006, pp. 633-637. 

Tuttle, D., Holloway, R., Baird, T., Sheehan, B., Skelton, W. K., Electronic Reporting to Improve Patient Safety, Quality and Safety in Health Care, Vol. 13, 2004, pp. 281-286. 

To improve patient safety and increase efficiency and quality, Froedtert Hospital has adapted the highly disciplined improvement methodology of Six Sigma. Developed and trademarked by Motorola, and traditionally used in manufacturing and engineering, Six Sigma is data-driven. It relies on rigorous statistical analysis and follows a defined process to choose, define, measure, and maintain improvement projects. 

The AHA Quality and Patient Safety initiative features several avenues for education and information for hospital leaders with interest in improving safety and their organizations. 

NASHP examines how states monitor and respond to quality and patient safety issues. Recent areas of focus include the state government s role in safety and what steps states have taken to improve patient safety. 

The Agency for Healthcare Research and Quality (AHRQ) offers the following tools for healthcare organizations, providers, policymakers, and patients to improve patient safety in healthcare settings. 

A Toolkit for Hospitals Improving Performance on the AHRQ Quality Indicators helps hospitals understand AHRQ s Qnality Indicators that use hospital administrative data to assess the quality of care provided, identify areas of concern in need of further investigation, and monitor progress over time. The toolkit is a general guide to using improvement methods and focuses on the 17 Patient Safety Indicators and the 28 Inpatient Quality Indicators to improve quality and patient safety. 

Simulation-based education (SBE) has been introduced as an efFective method for training healthcare workers [1]. SBE can improve patient safety in healthcare facilities in different ways, particularly if used in individual skills [2]. As a result of the proven efficacy of SBE, there has been an increased number of simulation centers worldwide. These centers have various visions, purposes, and functionahties. Most of them are tailored to deliver education to particular healthcare giver categories or undergraduate trainees, with the end result being better training, reduced medical errors, and thus improved patient safety and quality of care in many medical domains. 

Woods, D.D. 2000a. Behind human error human factors research to improve patient safety. National Summit on Medical Errors and Patient Safety Research, Quality Interagency Coordination Task Force and Agency for Healthcare Research and Quality, September 11, 2000. www.apa.org/ppo/issues/shumfactors2.html. 

Firth-Cozens, J., (2001), Cultures for improving patient safety through learning The role of teamwork. Quality and Safety in Health Care, 10, 70-75. [PubMed 11389314] [DOI 10.1136/qhc. 10.2.70]... 

Salas, E., Wilson, K.A., Burke, C.S. and Priest, H.A. (2005), Using Simulation-Based Training to Improve Patient Safety What does it take Journal on Quality and Patient Safety, 31, 363-371. 

After submission of a paper, the editors of a journal will start the review process in order to critically investigate the paper and to improve its quality. For publication about hemodialysis vascular access, one can publish in different papers depending on the research question of the paper and the methodological quality. Table 2 summarizes the impact factor of journals in which peer-reviewed papers can be found dealing with dialysis accesses [15]. The table further shows clearly a lack in RCTs in the domain of vascular access and that more well-designed studies are mandatory to improve patient safety in regard of treatment strategies. 

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