National Quality Forum Endorses Healthcare Safety Practices, Achieves Consensus on List of 26 Practices to Reduce Adverse Events

WASHINGTON -- The National Quality Forum (NQF) today announced that it had approved 26 "safe practices" that should be universally utilized in applicable healthcare settings to reduce the risk of harm resulting from processes, systems, or environments of care; 4 additional practices will continue to be evaluated and may be approved in the coming months.

Adverse healthcare events are a leading cause of death and injury in the United States, even though well-documented methods are available that could prevent the occurrence of such events. The report identifies 26 safe practices in five specific categories: promoting a culture of safety; matching healthcare needs with service delivery capabilities; facilitating information transfer and clear communication; adopting safe practices in specific clinical settings or for specific processes of care; and increasing safe medication use.

The report also identifies 27 practices that have great promise for reducing adverse events and should have high priority for further research.

The National Quality Forum's 26 Safe Practices are as follows:

1. Create a healthcare culture of safety.

2. Specify an explicit protocol to be used to ensure an adequate

level of nursing based on the institution's usual patient mix

and the experience and training of its nursing staff.

3. Verbal orders should be recorded whenever possible and

immediately read back to the prescriber -- i.e., a healthcare

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.

4. Use only standardized abbreviations and dose designations.

5. Patient care summaries or other similar records should not be

prepared from memory.

6. Ask each patient or legal surrogate to recount what he or she

has been told during the informed consent discussion.

7. Ensure that written documentation of the patient's preference

for life-sustaining treatments is prominently displayed in his

or her chart.

8. Implement a computerized prescriber order entry system.

9. Implement a standardized protocol to prevent the mislabeling

of radiographs.

10. Implement standardized protocols to prevent the occurrence of

wrong-site procedures or wrong-patient procedures.

11. Evaluate each patient undergoing elective surgery for risk of

an acute ischemic cardiac event during surgery, and provide

prophylactic treatment with beta-blockers to high-risk


12. 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 the evaluation.

13. Evaluate each patient, upon admission, and periodically thereafter,

for the risk of developing deep vein thrombosis (DVT)/venous

thromboembolism (VTE). Utilize clinically appropriate methods to

prevent DVT/VTE.

14. Utilize dedicated anti-thrombotic (anti-coagulation) services that

facilitate coordinated care management.

15. Upon admission, and periodically thereafter, evaluate each patient for

the risk of aspiration.

16. Rigorously adhere to effective methods of preventing central venous

catheter-associated blood stream infections.

17. Evaluate each pre-operative patient in light of his or her planned

surgical procedure for the risk of surgical site infection, and

implement appropriate antibiotic prophylaxis and other preventive

measures based on that evaluation.

18. Utilize validated protocols to evaluate patients who are at risk for

contrast media-induced renal failure, and utilize a clinically

appropriate method for reducing risk of renal injury based on the

patient's kidney function evaluation.

19. Evaluate each patient upon admission, and periodically thereafter, for

risk of malnutrition. Employ clinically appropriate strategies to

prevent malnutrition.

20. Whenever a pneumatic tourniquet is used, evaluate the patient for the

risk of an ischemic and/or thrombotic complication, and utilize

appropriate prophylactic measures.

21. Decontaminate hands with either a hygienic hand rub or by washing with

a disinfectant soap prior to and after direct contact with the patient

or objects immediately around the patient.

22. Vaccinate healthcare workers against influenza to protect both them

and patients from influenza.

23. Keep workspaces where medications are prepared clean, orderly, well

lit, and free of clutter, distraction, and noise.

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


25. Identify all "high alert" drugs (e.g., intravenous adrenergic agonists

and antagonists, chemotherapy, anticoagulants and antithrombotics,

concentrated parenteral electrolytes, general anesthetics,

neuromuscular blockers, insulin and oral hypoglycemics, narcotics and


26. Dispense medications in unit-dose or, when appropriate, unit-of-use

form, whenever possible.

This work was funded, in part, by the Agency for Healthcare Research and Quality, Centers for Medicare and Medicaid Services, Robert Wood Johnson Foundation, California HealthCare Foundation, Horace W. Goldsmith Foundation, Department of Veterans Affairs, United Hospital Fund of New York, and U.S. Office of Personnel Management.

A private, non-profit public benefit corporation, the NQF was created in 1999 in response to the need to develop and implement a national strategy for healthcare quality measurement and reporting. Established as a unique public- private partnership, the NQF has broad participation from nearly 170 organizations who represent all sectors of the healthcare industry, including consumers, employers, insurers, healthcare providers and other critical stakeholders.

Source: National Quality Forum