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Patient Safety and Quality

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Survey suggests that hospitals in Iowa have made the most progress in following longstanding safe practices

The National Quality Forum recently released a list of 30 safe practices to enhance patient safety at all types of hospitals. The survey asked chief executive officers or administrators at 100 Iowa hospitals to rate the priority given to and the progress made at their hospital for each of the 30 safe practices. Marcia M. Ward, Ph.D., of the University of Iowa, and colleagues correlated hospital ratings of the practices with measures of hospital structure, capacity, and resources.

Hospitals generally made the most progress in the following safe practices: handwashing, unit-dose medication dispensing, administering influenza vaccinations, implementing protocols to prevent wrong-site procedures, and using standardized methods for labeling and storing medications. Hospitals made the least progress in staffing intensive care units with intensivists (specialists in intensive care) and implementing a computerized provider order entry system. Overall, hospitals gave higher priority to and made more progress in implementing safe practices that have been recommended for some time. Most safe practices were equally endorsed by large and small hospitals.

Priority and progress ratings on 20 of the 30 safety practices were not correlated with factors such as hospital structure, capacity, and resources. Of the Iowa hospitals responding to the survey, 40 percent were accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and had made greater progress than other hospitals on several safety practices. These included reading back of verbal orders, use of only standardized abbreviations, implementation of protocols to prevent wrong-site and wrong-patient procedures, evaluation of patients for risk of pressure ulcers, and identification of high-alert drugs. Four of these safety practices overlap with JCAHO safety priorities. The study was supported in part by the Agency for Healthcare Research and Quality (HS15009).

More details are in "National Quality Forum 30 safe practices: Priority and progress in Iowa Hospitals," by Dr. Ward, Thomas C. Evans, M.D., Arthur J. Spies, M.M., and others, in the March 2006 American Journal of Medical Quality 21(2), pp. 101-108.

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