Safer Patients Initiative

The Health Foundation. Safer Patients Initiative. Lessons from the first major improvement programme addressing patient safety in the UK. London The Health Foundation 2011. 

The Safer Patients Initiative (SPI) is one of the most ambitious programmes of safety and quality improvement yet attempted. It was ambitious partly in scale, in that 24 hospitals were involved in total, but more in the speed of implementation and the bravura of the objeaives. Studies in many countries have shown that about 10% of patients are harmed in hospitals and that there is little sign of any change over time. Yet the SPI programme boldly set out to achieve a 50% reduction in adverse events in two years, as well as a range of other changes. No one knew whether this was achievable or simply naive SPI was, in the best sense, a gigantic experiment. 

Berm, J., Burnett, S., Parand, A. et al. (2009a) Perceptions of the impact of a large-scale collaborative improvement programme experience in the UK Safer Patients Initiative. Journal of the Evaluation of Clinical Practice, 15(3), 524-540. 

Benn et al. (2009) Safer Patients Initiative Unclear though the Initiative ran for a total of five years Acute care organisations Compared perceptions of safety climate to 18 performance dimensions Safety climate improvement attributed to Safer Patients Initiative... 

Chloramphenicol was the first orally active, broad-spectrum antibiotic to be used in the clinic, and remains the only antibiotic which is marketed in totally synthetic form. Its initial popularity was dampened, and its utilization plummeted when it was found that some patients developed an irreversible aplastic anemia from use of the drug. Of the hundreds of analogues synthesized, none are significantly more potent or certain to be safer than chloramphenicol itself. Two analogues have been given generic names and fall into this chemical classification. It was found early in the game that activity was retained with p-substituents, and that... 

It has been suggested that low-to-intermediate doses of aldesleukin alone or associated with interferon alfa may be safer under outpatient conditions (5). Patients over 60 years of age and individuals with previously raised serum creatinine concentrations have been thought to be likely to have longer-lasting and more severe renal impairment, but neither previous nephrectomy nor the interval between nephrectomy and initiation of aldesleukin therapy were associated with a higher risk of renal insufficiency (4). 

Although -blockers and calcium chaimel blockers have taken a more prominent role in acutely controlling rate in patients with rapid atrial fibrillation or flutter, a cautionary note must be made. That is, most patients with these tachycardias also have concomitant symptoms of heart failure, and these two forms of drug therapy may worsen the situation initially. Usually, a prompt decline in rate and increase in stroke volume balances the decrease in contractility seen with p blockers or calcium chaimel blockers such that heart failure symptoms remain unchanged. However, occasionally, severe reactions and hypotension may occur one study implies that diltiazem may be safer than verapamil. ... 

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