National Quality Forum Updates Endorsement of Safe Practices for Better Healthcare

WASHINGTON, Oct. 16 /PRNewswire/ -- 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. In 2003, the National Quality Forum (NQF) endorsed 30 "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.

To ensure the practices reflected new evidence and innovation, NQF undertook an effort to update the list of practices, and today announces endorsement of 3 new practices and 23 practices from the initial list that have materially changed; 4 practices remain unchanged.

  The 26 materially changed or new practices, in brief, are:

  *Create and sustain a healthcare culture of safety.

  *Ask each patient or legal surrogate to "teach back" key information about
   proposed treatments or procedures for which he or she is asked to
   provide informed consent.

  *Following serious, unanticipated outcomes, the patient and, as
   appropriate, family should receive communication about the event.

  *Implement critical components of a well designed nursing workforce.

  *Ensure that non-nursing direct care staffing levels are adequate, staff
   is competent and have had orientation, training, and education to perform
   assigned direct care duties.

  *Ensure that care information is transmitted and documented in a timely
   and clearly understandable form to patients and patient's healthcare
   providers within and between care settings.

  *For verbal or telephone orders or for telephonic reporting of critical
   test results, verify complete order or test result by having the person
   receiving the information record and "read-back" the complete order or
   test result.

  *Implement standardized policies, processes, and systems to ensure
   accurate labeling of radiographs, laboratory specimens or other
   diagnostic studies.

  *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 caregivers with confirmation of receipt.

  *Implement a computerized prescriber order entry system built upon
   foundation of re-engineered evidence-based care, practitioner readiness
   and integrated information technology infrastructure.

  *Standardize a list of "Do Not Use" abbreviations, acronyms, symbols, and
   dose designations that cannot be used throughout the organization.

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

  *Pharmacists should actively participate in medication management systems.

  *Standardize methods for labeling and packaging of medications.

  *Identify all "high alert" drugs and establish policies and processes to
   minimize risks associated with the use of these drugs.

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

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

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

  *Prevent surgical site infections by implementing four components of care.

  *Comply with current Centers for Disease Control and Prevention Hand
   Hygiene Guidelines.

  *Immunize healthcare workers and patients who should be immunized against
   influenza annually.

  *For high-risk elective cardiac procedures or other specified care,
   patients should be clearly informed of likely reduced risk of adverse
   outcome at treatment facilities that participate in clinical outcomes
   registries and minimize the number of surgeons performing procedures with
   strongest volume-outcomes relationship.

  *Implement the Universal Protocol for Preventing Wrong Site, Wrong
   Procedure, Wrong Person Surgery(TM) for all invasive procedures.

  *Evaluate each patient undergoing elective surgery for risk of an acute
   ischemic perioperative cardiac event and consider prophylactic treatment
   with beta-blockers.

  *Evaluate each patient upon admission, and regularly thereafter, for the
   risk of developing pressure ulcers.

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

Also endorsed were recommendations related to disseminating, implementing, and updating the list of practices, as well as several areas where additional research should be undertaken.

Detailed specifications and information on the recommendations may be found at http://www.qualityforum.org/.

  The four practices unchanged and not subject to appeal are:

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

  *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").

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

  *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.

NQF is a voluntary consensus standard-setting organization. Any party may request reconsideration of the recommendations, in whole or part, by notifying NQF in writing no later than 6:00 p.m. EST, November 14, 2006 (601 13th Street, NW, Suite 500 North, Washington, DC, 20005; fax 202.783.3434). For an appeal to be considered, the notification letter must include information clearly demonstrating that the appellant has interests that are directly and materially affected by the NQF-endorsed(TM) recommendations and that the NQF decision has had (or will have) an adverse effect on those interests.

The mission of the National Quality Forum is to improve the quality of American healthcare by setting national priorities and goals for performance improvement, endorsing national consensus standards for measuring and publicly reporting on performance, and promoting the attainment of national goals through education and outreach programs. NQF, a non-profit organization (http://qualityforum.org/) with diverse stakeholders across the public and private health sectors, was established in 1999 and is based in Washington, DC.