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National Quality Forum endorses four new safe practices
Study: More that a quarter of ambulatory patients suffer adverse drug events
Leapfrog relaxes its patient safety standards

Patient Safety Monitor Alert, April 22, 2003

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NATIONAL QUALITY FORUM ENDORSES FOUR NEW SAFE PRACTICES

Looking for some sound ideas to improve patient safety at your organization? Check out four new suggestions that the National Quality Forum (NQF) added last week to the list of 30 practices it currently endorses. Here are the new practices:

1. Clearly inform patients that they will reduce their risk of an adverse outcome if they seek treatment at facilities with a successful record of treating their particular condition, for certain high-risk, elective surgeries. If the patients say they'd like a referral to those facilities, the hospital should give them one.

2. Physicians certified in critical care should manage all patients in both adult and pediatric general intensive care units.

3. Pharmacists should participate in the medication use process. At the very least they should be available to consult with prescribers who order medications about issues including reviewing and interpreting the orders, as well as preparing, dispensing, and administering medications and monitoring those activities.

4. Hospitals should make sure that staff transmit care information-such as order changes or new diagnostic details-quickly and clearly to all of a patient's current health care providers that will need the information in order to care for him or her.

NQF has also completed its set of 39 national voluntary concensus standards for measuring hospital care quality. Go to www.qualityforum.org to read the standards. Subscribers to Briefings on Patient Safety can read upcoming issues of the newsletter for more information.

STUDY: MORE THAN A QUARTER OF AMBULATORY PATIENTS SUFFER ADVERSE DRUG EVENTS

Adverse drug events in ambulatory settings may occur more than four times more often than they do in inpatient settings, according to a recent article in the New England Journal of Medicine (NEJM).

Researchers who surveyed 661 patients at four adult primary care practices in Boston found that 162 of those patients—or about 25%—experienced a total of 181 adverse drug events. That rounds out to about 27 events per 100 patients, compared to inpatient studies that usually report about six events per 100 patients. (However, inpatient researchers did not directly survey patients to find out about adverse events, the NEJM study authors note. They found that patients reported about three times the number of events that trained chart reviewers found.)

Six percent of the events in ambulatory settings were both serious and caused harm that could have been reduced or prevented altogether. Some of these events included a patient who had an allergic reaction to an antibiotic, despite the fact that the allergy to the drug was documented, and a patient who experienced prolonged sexual dysfunction because the provider did not discontinue the drug that caused the problem. The article, "Adverse Drug Events in Ambulatory Care," was published in the April 17 edition of the journal.

LEAPFROG RELAXES ITS PATIENT SAFETY STANDARDS

Hospitals won't have to jump quite as high to meet the Leapfrog Group's three patient safety standards. The organization has eased up on some of its recommended practices, which call for hospitals to implement computerized physician order entry (CPOE) systems, staff their intensive care units with intensivists, and refer patients to organizations that have a successful record of treating particular conditions.

Some of the changes include
- giving hospitals partial credit for implementing CPOE in at least one area of the facility
- giving partial credit for hospitals that take "intermediate-level" outcome-based risk reduction strategies
- expanding the definition of a physician "certified in Critical Care Medicine" to include physicians with a long history of experience in intensive care medicine
- giving partial credit for hospitals where intensivists lead multidisciplinary team rounds each day or makes admissions and discharge decisions during the weekday

However, some of Leapfrog's standards will become more stringent in other ways. For instance, in addition to the adult intensive care units (ICUs), hospitals must now staff pediatric ICUs with intensivists. Go to https://leapfrog.medstat.com/new to read more about the changes.

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