Patient Safety

Contents and Outline

PART I. Overview
  1. An Introduction to the Compendium
    • General Overview
    • How to Use this Compendium
    • Acknowledgments
  2. Drawing on Safety Practices from Outside Healthcare
  3. Evidence-Based Review Methodology
PART II. Reporting and Responding to Patient Safety Problems
  1. Incident Reporting
  2. Root Cause Analysis
PART III. Patient Safety Practices & Targets

Section A. Adverse Drug Events (ADEs)

  1. Computerized Physician Order Entry (CPOE) with Clinical Decision Support Systems (CDSSs)
  2. The Clinical Pharmacist’s Role in Preventing Adverse Drug Events
  3. Computer Adverse Drug Event (ADE) Detection and Alerts
  4. Protocols for High-Risk Drugs: Reducing Adverse Drug Events Related to Anticoagulants
  5. Unit-Dose Drug Distribution Systems
  6. Automated Medication Dispensing Devices

Section B. Infection Control

  1. Practices to Improve Handwashing Compliance
  2. Impact of Barrier Precautions in Reducing the Transmission of Serious Nosocomial Infections
  3. Impact of Changes in Antibiotic Use Practices on Nosocomial Infections and Antimicrobial Resistance—Clostridium Difficile and Vancomycin-resistant Enterococcus (VRE)
  4. Prevention of Nosocomial Urinary Tract Infections
    • Use of Silver Alloy Urinary Catheters
    • Use of Suprapubic Catheters
  5. Prevention of Intravascular Catheter-Associated Infections
    • Use of Maximum Barrier Precautions during Central Venous Catheter Insertion
    • Use of Central Venous Catheters Coated with Antibacterial or Antiseptic Agents
    • Use of Chlorhexidine Gluconate at the Central Venous Catheter Insertion Site
    • Other Practices
  6. Prevention of Ventilator-Associated Pneumonia (VAP)
    • Patient Positioning: Semi-recumbent Positioning and Continuous Oscillation
    • Continuous Aspiration of Subglottic Secretions
    • Selective Digestive Tract Decontamination
    • Sucralfate and Prevention of VAP

Section C. Surgery, Anesthesia, and Perioperative Medicine

  1. Localizing Care to High-Volume Centers
  2. Learning Curves for New Procedures—the Case of Laparoscopic Cholecystectomy
  3. Prevention of Surgical Site Infections
    • Prophylactic Antibiotics
    • Perioperative Normothermia
    • Supplemental Perioperative Oxygen
    • Perioperative Glucose Control
  4. Ultrasound Guidance of Central Vein Catheterization
  5. The Retained Surgical Sponge
  6. Pre-Anesthesia Checklists To Improve Patient Safety
  7. The Impact Of Intraoperative Monitoring On Patient Safety
  8. Beta-blockers and Reduction of Perioperative Cardiac Events

Section D. Safety Practices for Hospitalized or Institutionalized Elders

  1. Prevention of Falls in Hospitalized and Institutionalized Older People
    • Identification Bracelets for High-Risk Patients
    • Interventions that Decrease the Use of Physical Restraints
    • Bed Alarms
    • Special Hospital Flooring Materials to Reduce Injuries from Patient Falls
    • Hip Protectors to Prevent Hip Fracture
  2. Prevention of Pressure Ulcers in Older Patients
  3. Prevention of Delirium in Older Hospitalized Patients
  4. Multidisciplinary Geriatric Consultation Services
  5. Geriatric Evaluation and Management Units for Hospitalized Patients

Section E. General Clinical Topics

  1. Prevention of Venous Thromboembolism
  2. Prevention of Contrast-Induced Nephropathy
  3. Nutritional Support
  4. Prevention of Clinically Significant Gastrointestinal Bleeding in Intensive Care Unit Patients
  5. Reducing Errors in the Interpretation of Plain Radiographs and Computed Tomography Scans
  6. Pneumococcal Vaccination Prior to Hospital Discharge
  7. Pain Management
    • Use of Analgesics in the Acute Abdomen
    • Acute Pain Services
    • Prophylactic Antiemetics During Patient-controlled Analgesia Therapy
    • Non-pharmacologic Interventions for Postoperative Plan

Section F. Organization, Structure, and Culture

  1. “Closed” Intensive Care Units and Other Models of Care for Critically Ill Patients
  2. Nurse Staffing, Models of Care Delivery, and Interventions
  3. Promoting a Culture of Safety

Section G. Systems Issues and Human Factors

  1. Human Factors and Medical Devices
    • The Use of Human Factors in Reducing Device-related Medical Errors
    • Refining the Performance of Medical Device Alarms
    • Equipment Checklists in Anesthesia
  2. Information Transfer
    • Information Transfer Between Inpatient and Outpatient Pharmacies
    • Sign-Out Systems for Cross-Coverage
    • Discharge Summaries and Follow-up
    • Notifying Patients of Abnormal Results
  3. Prevention of Misidentifications
    • Bar Coding
    • Strategies to Avoid Wrong-Site Surgery
  4. Crew Resource Management and its Applications in Medicine
  5. Simulator-Based Training and Patient Safety
  6. Fatigue, Sleepiness, and Medical Errors
  7. Safety During Transportation of Critically Ill Patients
    • Interhospital Transport
    • Intrahospital Transport

Section H. Role of the Patient

  1. Procedures For Obtaining Informed Consent
  2. Advance Planning For End-of-Life Care
  3. Other Practices Related to Patient Participation
PART IV. Promoting And Implementing Safety Practices
  1. Practice Guidelines
  2. Critical Pathways
  3. Clinical Decision Support Systems
  4. Educational Techniques Used in Changing Provider Behavior
  5. Legislation, Accreditation, and Market-Driven and Other Approaches to Improving Patient Safety
PART V. Analyzing The Practices
  1. Methodology for Summarizing the Evidence for the Practices
  2. Practices Rated by Strength of Evidence
  3. Practices Rated by Research Priority
  4. Listing of All Practices, Categorical Ratings, and Comments

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