Best Practices in HealthCare - Known Solutions Save Lives !

There are few national or state requirements that effectively regulate a health care organization's adoption and adherance to a standard set of best practices. Best practices and quality methodologies have been in existance for several decades in industry. Recently many of these same procedures been applied in health care organizations with outstanding results. Most medical errors can be traced to environments, policies and practices that are known to be deficient.

National organizations like the National Quality Forum (NQF), the Joint Commission on Accreditation of Health Care Organizations (JCAHO), The Institute for Health Care Improvement (IHI) and others have a long history of authorship and dissemination of health care best practices. Still, most health care organizations have not instituted systems that guarantee compliance and effective use of these voluntary standards.

The list below is a sampling of best practices for preventing unnecessary healthcare errors. Many of these are simple common sense, but still need to be implemented. They are taken primarily from the National Quality Forum's 2006 Practices for Better Health Care.

Grassroots HealthCare and local community action groups can communicate with hospitals to verify which voluntary standards they have chosen to adopt and monitor their progress implementing them.

Select Category to Filter the List Below:

Create a health care culture of safety

Create a health care culture of safety. There is a need to promote a culture that overtly encourages and supports the reporting of any situation or circumstance that threatens, or potentially threatens, the safety of patients or caregivers and that views the occurrence of errors and adverse events as opportunities to make the health care system better.

Inform Patients of Opportunities for Better Outcomes

For designated high-risk, elective surgical procedures or other specified care, patients should be clearly informed of the likely reduced risk of an adverse outcome at treatment facilities that have demonstrated superior outcomes and should be referred to such facilities in accordance with the patient's stated preference.

Adequate Nursing

Implement critical components of a well-designed nursing workforce that mutually reinforce patient
safeguards, including the following:

  • a nurse staffing plan with evidence that it is adequately resourced and actively managed and that its effectiveness is regularly evaluated with respect to patient safety
  • senior administrative nursing leaders, such as a chief nursing officer, as part of the hospital senior management team
  • governance boards and senior administrative leaders that take accountability for reducing patient safety risks related to nurse staffing decisions and the provision of financial resources for nursing services
  • the provision of budget resources to support nursing staff in the ongoing acquisition and maintenance of professional knowledge and skills.

Competent Critical Care Providers

All patients in general intensive care units (both adult and pediatric) should be managed by physicians having specific training and certification in critical care medicine ("critical care certified").

Pharmacists participate in medication process

Pharmacists should actively participate in medication management systems by, at a minimum,working with other health professionals to select and maintain a formulary of medications chosen for safety    read more...  »

Clear Verbal Orders

Verbal orders should be recorded whenever possible and immediately read back to the prescriber; that is, a health care provider receiving a verbal order should read or repeat back the information that the prescriber conveys in order to verify the accuracy of what was heard.

Standardize Medication Abbreviations and Dose Descriptions

Use only standardized abbreviations and dose designations. Standardize a list of “do not use” abbreviations, acronyms, symbols, and dose designations that
cannot be used throughout the organization.

Accurate Care Records

Patient care summaries or other similar records should not be prepared from memory.

Accurate and Timely Care Information Transfer

Ensure that care information, especially changes in orders and new diagnostic information, is transmitted in a timely and clearly understandable form to all of the patient's current health care providers who need that information to provide care.

Review and Confirm Care and Consent Discussions

Ask each patient or legal surrogate to recount what he or she has been told during the informed consent discussion.

Visibility of Critical Patient Life Support Info

Ensure that written documentation of the patient's preference for life-sustaining treatments is prominently displayed in his or her chart.

Computerized Order Entry

Implement a computerized prescriber order entry (CPOE)system built upon the requisite foundation of re-engineered evidence-based care, an assurance of healthcare organization staff and independent practitioner readiness, and an integrated information technology infrastructure.

Correct Labeling of Radiographs, Lab Specimens, and Diagnostic Studies

Implement standardized policies, processes, and systems to ensure the accurate labeling of radiographs, laboratory specimens, or other diagnostic studies so that the right study is labeled for the right patient at the right time.

Systems In Place To Assure Awareness of Safety Gaps And Accountability

Practice Element 1: Leadership structures and systems must be established to ensure that there is organization-wide awareness of patient safety performance gaps, that there is direct accountability of leaders for those gaps, that an adequate investment is made in performance improvement abilities,
and that actions are taken to assure the safe care of every patient served.

Organizational Safety Culture Measurement, Feedback and Intervention

Practice Element 2: Healthcare organizations must measure their culture, provide feedback to the
leadership and staff, and undertake interventions that will reduce patient safety risk.

Develop and Improve Teamwork and Team Based Care

Practice Element 3: Healthcare organizations must establish a proactive, systematic, and organization-wide approach to developing team-based care through teamwork training, skill building, and team led performance improvement interventions that reduce preventable harm to patients.

Continual Systematic Identification and Mitigation of Patient Safety Risks

Practice Element 4: Healthcare organizations must systematically identify and mitigate patient safety risks and hazards with an integrated approach in order to continuously drive down preventable patient harm.

Continuous, Accurate Record of Medication

The healthcare organization must develop, reconcile, and communicate an accurate medication list throughout the continuum of care.

Standardize Medication Labeling, Packaging, and Storage

Standardize the methods for labeling, packaging, and storing medications.

Identify High Alert Drugs and Minimize Usage Risk

Identify all high alert drugs, and establish policies and processes to minimize the risks associated with the use of these drugs. At a minimum, such drugs should include intravenous
adrenergic agonists and antagonists, chemotherapy agents, anticoagulants and anti-thrombotics, concentrated parenteral electrolytes, general anesthetics, neuromuscular blockers, insulin and oral    read more...  »

Unit Dose Medication

Healthcare organizations should dispense medications, including parenterals, in unit-dose, or, when appropriate, in unit-of-use form, whenever possible.

Prevent Ventilator Associated Pneumonia

Action should be taken to prevent ventilator-associated pneumonia by implementing ventilator bundle intervention practices.

Prevent Catheter Associated Infection

Adhere to effective methods of preventing central venous catheter-associated bloodstream infections, and specify the requirements in explicit policies and procedures.

Prevent Surgical Site Infections

Prevent surgical site infections (SSIs) by implementing four components of care:

  • appropriate use of antibiotics
  • appropriate hair removal
  • maintenance of postoperative glucose control for patients undergoing major cardiac surgery
  • establishment of postoperative normothermia for patients undergoing colorectal surgery.

Prevent Hand Transmission of Infectious Disease

Comply with current Centers for Disease Control and Prevention (CDC) Hand Hygiene guidelines.

Prevent Influenza Transmission

Annually, immunize healthcare workers and patients who should be immunized against influenza.

Provide Correct Care

Implement the Universal Protocol for Preventing Wrong Site,Wrong Procedure,Wrong Person SurgeryTM for all invasive procedures.

Prevent Perioperative Ischemic Cardiac Event

Evaluate each patient undergoing elective surgery for his or her risk of an acute ischemic perioperative cardiac event, and consider prophylactic treatment with beta blockers for patients who either:

1. have required beta blockers to control symptoms of angina or have symptomatic arrhythmias or hypertension,

or    read more...  »

Prevent Pressure Ulcers

Evaluate each patient upon admission, and regularly thereafter, for the risk of developing pressure ulcers. This evaluation should be repeated at regular intervals during care. Clinically appropriate preventive methods should be implemented consequent to this evaluation.

Prevent Deep Vein Thrombosis

Evaluate each patient upon admission, and regularly thereafter, for the risk of developing venous thromboembolism/deep vein thrombosis (VTE/DVT). Utilize clinically appropriate, evidence-based methods of thromboprophylaxis.

Prevent Innapropriate Anticoagulation

Every patient on long-term oral anticoagulants should be monitored by a qualified health professional using a careful strategy to ensure the appropriate intensity of supervision.

Prevent Contrast Media Induced Renal Failure

Utilize validated protocols to evaluate patients who are at risk for contrast media-induced renal
failure, and utilize a clinically appropriate method for reducing the risk of renal injury based on
the patient’s kidney function evaluation.

Ensure Continuity of Care After Discharge

A “discharge plan” must be prepared for each patient at the time of hospital discharge, and a concise discharge summary must be prepared for and relayed to the clinical caregiver accepting responsibility for postdischarge care in a timely manner.    read more...  »

Prevent All Wrong Body Part Errors

Prevent surgery performed on the wrong body part defined as any surgery performed on a body part that is not consistent with the correctly documented informed consent for that patient. Surgery includes endoscopies and other invasive procedures. Excludes emergent situations that occur in the course of surgery and/or whose exigency precludes obtaining informed consent.

Prevent All Wrong Patient Errors

Prevent surgery performed on the wrong patient defined as any surgery on a patient that is not consistent with the correctly documented informed consent for that patient.

Surgery includes endoscopies and other invasive procedures.

Prevent All Wrong Procedure Errors

Prevent wrong surgical procedure performed on a patient defined as any surgical procedure performed on a patient that is not consistent with the correctly documented informed consent for that patient.

Surgery includes endoscopies and other invasive procedures.

Excludes emergent situations that occur in the course of surgery and/or whose exigency precludes obtaining informed consent.

Prevent All Retained Foreign Objects After Surgery Errors

D. Unintended retention of a foreign object in a patient after surgery or other procedure.    read more...  »

Prevent All Unnecessary Intraoperative or Immediately Postoperative Death Errors

Prevent intraoperative or immediately postoperative death in an ASA Class I patient.

Includes all ASA Class I patient deaths in situations in which anesthesia was administered; the planned surgical procedure may or may not have been carried out.    read more...  »

Prevent All Death and Disability From Contaminated Drugs, Devices, or Biologics

Preven patient death or serious disability associated with the use of contaminated drugs, devices, or biologics provided by the healthcare facility

Includes detectable contaminants in drugs, devices, or biologics regardless of the source of contamination and/or product.

Prevent All Death and Disability From Device Misuse or Malfunction

Patient death or serious disability associated with the use or function of a device in patient care
in which the device is used or functions other than as intended

Includes, but is not limited to, catheters, drains and other specialized tubes, infusion pumps, and ventilators.

Prevent All Death and Disability From Air Embolism

Prevent patient death or serious disability associated with intravascular air embolism that occurs while being cared for in a healthcare facility

Excludes death or serious disability associated with neurosurgical procedures known to present a high risk of intravascular air embolism.

Prevent All Infants From Being Discharged to Wrong Person

Prevent all instances of a infant being discharged to the wrong person

Prevent All Death and Disability from Patient Disappearance

Prevent patient death or serious disability associated with
patient elopement (disappearance)

Excludes events involving competent adults

Prevent All Suicide and Attempted Suicide

Patient suicide, or attempted suicide, resulting in serious disability while being cared for in a healthcare facility

Prevent All Death and Disability From Medication Errors

Patient death or serious disability associated with a medication error (e.g., errors involving
the wrong drug, wrong dose, wrong patient, wrong time, wrong rate, wrong preparation, or wrong route of administration)

Excludes reasonable differences in clinical judgment involving drug selection and dose.    read more...  »

Prevent All Death and Disability From Blood Product Incompatibility

Prevent patient death or serious disability associated with a hemolytic reaction due to the administration of ABO/HLA incompatible blood or blood products

Prevent All Death and Disability From Low Risk Pregnancy Complication

Prevent maternal death or serious disability associated with labor or delivery in a low-risk pregnancy while being cared for in a healthcare facility

Prevent All Death or Disability from Hypoglycemia

Patient death or serious disability associated with hypoglycemia, the onset of which occurs while the patient is being cared for in a healthcare facility

Prevent All Death or Disability from Kernicterus

Death or serious disability (kernicterus) associated with failure to identify and successfully treat hyperbilirubinemia in neonates.

Hyperbilirubinemia is defined as bilirubin levels >30 mg/dl. Neonate refers to the first 28 days
of life.

Prevent All Stage 3 or 4 Pressure Ulcers

Stage 3 or 4 pressure ulcers acquired after admission to a healthcare facility

Excludes progression from Stage 2 to Stage 3, if Stage 2 was recognized upon admission.

Prevent All Death or Disability from Spinal Manipulation

Patient death or serious disability due to spinal manipulative therapy

Prevent All Artificial Insemination With the Wrong Sperm or Egg

Artificial insemination with the wrong donor sperm or wrong egg

Prevent All Death or Disability from Unintended Electrical Shock

Patient death or serious disability associated with an electric shock while being cared for in a healthcare facility

Excludes events involving planned treatments such as electric countershock/elective cardioversion.

This event is intended to capture:    read more...  »

Prevent All Errors Associated With Incorrect or Contaminated Gas Delivery

Any incident in which a line designated for oxygen or other gas to be delivered to a patient contains the wrong gas or is contaminated by toxic substances

Prevent All Death or Disability from Burns Incurred During Care

Patient death or serious disability associated with a burn incurred from any source while being cared for in a healthcare facility

Prevent All Death or Disability from Falls

Patient death or serious disability associated with a fall while being cared for in a healthcare facility. Includes but is not limited to fractures, head injuries, and intracranial hemorrhage.

Prevent All Death or Disability from Restraints

Patient death or serious disability associated with the use of restraints or bedrails while being cared for in a healthcare facility.    read more...  »

Wrong Patient Wrong Site Errors - A Continuing Problem

A recent Los Angeles Times article reporting on two studies documenting continued patient errors despite adoption by Joint Commission of Universal Wrong Patient Wrong Site protocol.    read more...  »

Lessons From Flight Crews Can Help Surgical Teams Work Better

A recent Bloomberg Business Week article reporting on a large study documenting reductions in surgical death rates at hospitals implementing proactive team collaboration and feedback.

Surgical death rates might be reduced if operating room staff borrowed team-building procedures used by the airline industry, a new study suggests.    read more...  »