January 10, 2002

Improving Patient Safety:
New Guidelines from The Agency for Healthcare Research and Quality (AHRQ)

Commentary by Richard Prielipp, M.D., FCCM

AHRQ:
The Agency for Healthcare Research and Quality (AHRQ), of the U.S. Department of Health and Human Services, recently published an important evidence-based report Number 43 entitled, "MAKING HEALTH CARE SAFER: A CRITICAL ANALYSIS OF PATIENT SAFETY PRACTICES." This report is AHRQ publication 01-E058, and is available via their WEB site: http://www.ahrq.gov/clinic/ptsafety/. Be aware, however, that this PDF file is 2.1 megabytes, and represents a document of about 650 pages!

Rationale:
Medical and public attention has increasingly focused on patient safety since the publication of the IOM (Institute of Medicine) report citing widespread (some say epidemic proportions) of patient injury and death while receiving medical care [Kohn LT, Corrigan JM, Donaldson MS, eds. To Err is Human: Building a Safer Health System. Washington, DC: National Academy Press; 1999]. Widely cited statistics suggest that medical errors kill 40,000 to 98,000 patients per year in US hospitals. The AHRQ aimed to review and collect existing evidence which could guide institutions and clinicians right now on practices to improve patient safety. A patient safety practice is defined as a type of process or structure whose application reduces the probability of adverse events resulting from exposure to the health care system across a range of diseases and procedures. Thus, these procedures most often promote systems changes to reduce medical error, rather than the identification and punishment of individual practitioners.

The Report: 11 Safety Practices to Start Now
The exhaustive AHRQ search identified 79 practices focused primarily on hospitalized patients, especially those in the ICU or undergoing surgery. The following 11 practices were rated most highly because of corroborating clinical evidence, and therefore the AHRQ advocates for their widespread implementation:

• Regular venous thromboembolism prophylaxis for patients at risk
• Use of perioperative beta-blockers whenever possible
• Routine use of maximal sterile barriers while placing central venous catheters
• Appropriate use of antibiotic prophylaxis in surgical patients
• Greater attention to the informed consent process, such as asking patients to recall and restate their understanding of the discussion
• Continuous aspiration of subglottic secretions (CASS) to decrease the incidence of ventilator-associated pneumonia (VAP).
• Optimal use of pressure-relieving bedding materials to reduce pressure ulcers
• Real-time ultrasound guidance during insertion of central venous catheters
• Patient self-management for warfarin
• Appropriate provision of early enteral nutrition for critically ill and surgical patients
• Use of antibiotic-impregnated central venous catheters.