10 Patient Safety Tips for Hospitals, (c) US
Department of Health and Human Services, October, 2007
Medical errors (or adverse events) can occur at
many points in the health care system, particularly
in hospitals. These tips for hospitals are from
studies by the Agency for Healthcare Research and
Quality (AHRQ), which has funded more than 100
patient safety projects since 2001. Many findings
from AHRQ research can be put into practice in
hospitals by following 10 practical tips.
- Assess and improve your patient safety
culture. Survey staff in individual units
and throughout the hospital to improve the culture
of patient safety, as noted in the 1999 Institute
of Medicine report, To Err is Human.
Surveys are available, including AHRQ's free
Hospital Survey on Patient Safety Culture and
its accompanying toolkit materials (http://www.ahrq.gov/qual/hospculture/),
designed to provide basic knowledge and tools for
- Build teamwork. Train
hospital staff to communicate effectively as a
team. A free, customizable toolkit (called
TeamSTEPPS), developed by AHRQ and the Department
of Defense, provides evidence-based training
techniques for effective communication and other
teamwork skills. TeamSTEPPS can be tailored to any
health care setting, from emergency departments to
ambulatory clinics (http://www.ahrq.gov/qual/teamstepps/).
- Limit shifts for hospital staff, if
possible. Consider options to minimize
shifts of more than 16 consecutive hours by
residents, interns, and nurses working in
hospitals. The rate of serious medical errors at
two Boston hospital intensive care units (ICUs),
by first-year interns, dropped by 36 percent when
30-hour-in-a-row work shifts were eliminated.
Motor vehicle accidents and needle stick injuries,
by sleep-deprived interns, also decreased with
- Insert chest tubes safely.
Universal Precautions (achieved
by using sterile cap, mask, gown, and gloves);
Wider skin prep; Extensive
draping; and Tray positioning (UWET,
an easy-to-remember mnemonic) should be used when
inserting chest tubes, as per a universal protocol
from the Joint Commission. A free 11-minute DVD
from AHRQ provides video excerpts of 50 actual
chest tube insertion procedures to illustrate
problems that can occur (http://www.ahrq.gov/qual/chesttubes.htm).
- Prevent central line-related
bloodstream infections. Being vigilant
and using five evidence-based procedures—including
hand washing, using full-barrier precautions
during the insertion of central venous catheters,
cleaning the skin with chlorhexidine, avoiding the
femoral site, and removing unnecessary
catheters—reduced deadly infections to zero in a
study at more than 100 large and small hospitals.
- Make good use of senior ICU nurses.
Use Registered Nurses and maintain appropriate
round-the-clock staffing levels in intensive care
units (ICUs) to prevent airway tube complications.
Adults and children had fewer airway events during
daytime hours (7:00 a.m. to 3:00 p.m.), and their
negative impact was limited by skilled assistants,
backup, and cross-coverage in ICUs.
- Use reliable decision-support tools at
the point of care. Ensure that
computerized physician order entry or personal
digital assistant-based drug information is
readily available at the point of prescribing or
ordering. For example, RxPro, ePocrates, Lexi-Drugs,
and mobileMicromedex met AHRQ's quality and safety
criteria by reducing potential errors associated
with insufficient or incomplete drug information.
- Set up a safety reporting system.
Watch a video that explains how to implement a
Web-based reporting system in the ICU to help
eliminate system failures that lead to errors in
health care (http://safetyresearch.jhu.edu/QSR/Research/Projects/project_ICUSRS.asp).
Compare near-misses to adverse events and examine
provider's perceptions of reporting systems.
- Limit urinary catheter use to 3 days.
Assess catheter use early and use computer-based
reminders to alert clinicians to remove catheters
as soon as possible to reduce the risk of urinary
tract infections (UTIs). A computer-based order
entry system prompting catheter removal after 72
hours decreases the duration of urinary
catheterization by about one-third, or 3 days, and
- Minimize unnecessary interruptions.
Reduce distractions faced by the nursing staff,
especially during critical times such as shift
changes. Encourage staff to speak up when
necessary, but create a "zone of silence" near
medication preparation carts and other areas where
concentration is essential.