WHO unveils patient strategies to redesign care
Joint Commission bodies coordinate effort
The World Health Organization (WHO) has published nine strategies aimed at assisting member states in the redesign care process to prevent human errors in patient care. The strategies, developed by WHO's Collaborating Centre for Patient Safety Solutions, include:
- Look-alike, sound-alike medication names: The recommendations focus on using protocols to reduce risks and ensuring prescription legibility or the use of preprinted orders or electronic prescribing.
- Patient identification: The recommendations emphasize methods for verifying patient identity, including patient involvement; standardization of identification methods across hospitals in a system; patient participation; and use of protocols for distinguishing the identity of patients with the same name.
- Communication during patient hand-overs: The recommendations include using protocols for communicating critical information; providing opportunities for practitioners to ask and resolve questions during the hand-over; and involving patients and families in the process.
- Performance of correct procedure at correct body site: The recommendations include a preoperative verification process; marking of the operative site by the practitioner who will do the procedure; and having the team involved in the procedure take a "time out" immediately before starting the procedure to confirm patient identity, procedure, and operative site.
- Control of concentrated electrolyte solutions: The recommendations address standardization of the dosing, units of measure, and terminology; and prevention of mix-ups of specific concentrated electrolyte solutions.
- Assuring medication accuracy at transitions in care: The recommendations address creating the most complete and accurate list of all medications the patient is currently taking; comparison of the list against the admission, transfer and/or discharge orders; and communication of the list to the next provider of care whenever the patient is transferred or discharged.
- Avoiding catheter and tubing misconnections: The recommendations address the need for meticulous attention to detail when administering medications and feedings (i.e., the right route of administration), and when connecting devices to patients (i.e., using the right connection/tubing).
- Single use of injection devices: The recommendations address the need for prohibitions on the reuse of needles at health care facilities, periodic training of practitioners and other health care workers regarding infection control principles, education of patients and families regarding transmission of blood borne pathogens, and safe needle disposal practices.
While many of the topics and strategies are familiar to quality managers and patient safety officers in the United States, several of the strategies were influenced by international experts participating in the process, says Peter Angood, MD, vice president and chief patient safety officer for The Joint Commission. It is The Joint Commission and The Joint Commission International that were named as the Collaborating Centre, or, as Angood puts it, a "Center of Excellence."
"We have developed these 'solutions' with the help of a couple of different groups we use as external advisors for vetting — including an international steering committee," he explains. In addition, Angood says, there are three regional advisory groups — Europe, Asia Pacific, the Middle East — and there will eventually be five. "In addition, there are three other expert panels — for communication, medication safety, and patient/family involvement," he notes.
WHO's Alliance for Patient Safety, he adds, has been active for more than two years, and includes a number of different topic areas. "Since the start-up, our recommendations have been based on review data from our own sentinel event database and National Patient Safety Goals program, and other international safety organizations," Angood explains. "We presented a variety of topics to our steering committee and eventually focused on those nine topics."
The draft solutions were vetted through the advisory groups and expert panels, followed by an extensive Internet-based survey (field review). "The recommendations were revised based on all that input, and re-presented to the steering committee for approval, and then released," says Angood.
All of the recommendations are designed with a similar template — that is, the same topic areas are found within each solution — and "are basically meant to highlight and profile issues and general strategies that could be used to address the problems," says Angood. "We have stopped short of specific implementation protocols because it would have been really complex to simultaneously disseminate information and try to evaluate if there had been any impact."
(The complete patient safety solutions can be found at: www.jointcommissioninternational.org/solutions.)
Angood says that while The Joint Commission saw many of its standards validated through the process, there was also new and valuable knowledge gained. "Patient safety problems are fairly uniform around the globe, and we found that our National Patient Safety Goals program and standards are pretty solid overall, but there are differences and other areas within these topics that other countries have addressed differently," he says.
For example, notes Angood, the UK has done a good deal of work focusing on avoiding catheter and medical tubing missed connections. "African countries have taught us a lot about injection safety and the use of single injection devices."
As a result of these new insights, "we've learned from these and they will be incorporated into our solutions," says Angood. "Our attitude, after all, was to learn as much as we could and be as all-encompassing in the development of solutions as we could. We did not promote America-based strategies."
Quality managers, he says, will find The Joint Commission web site on these findings a valuable resource, "not only the preamble but the nine strategies and 'Access to Patient Safety Goals.' It could help improve their own patient safety strategies," Angood offers.
As for the future, Angood says the center is in the process of getting an implementation test pilot project off the ground. "We will take five of these solution topics, with the goal of organizing far more specific protocolized approaches to solutions, and implement those into at least seven different countries through technical lead agencies," he reports. "We will then implement them into at least 10 health care facilities in these countries, and we will evaluate sentinel event activity, do root cause analyses, collect patient safety indicator data, culture of safety information, and economic data. We will learn from all of this what works and what doesn't."
[For more information, contact Peter Angood, MD, Vice President and Chief Patient Safety Officer, The Joint Commission. Phone: (630) 792-5000.]
The World Health Organization (WHO) has published nine strategies aimed at assisting member states in the redesign care process to prevent human errors in patient care.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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