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Approach to Improving Safety
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Tools/Toolkit > Multi-use Website
TeamSTEPPS: Strategies and Tools to Enhance Performance and Patient Safety.
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Washington, DC: Department of Defense. Rockville, MD: Agency for Healthcare Research and Quality; 2016.
Effective teamwork plays an essential role in providing safe patient care. The Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) program was developed in collaboration by the United States Department of Defense and AHRQ in order to support effective communication and teamwork in health care. This updated version of the widely implemented program provides new tools to measure its impact, supports increased emphasis on the role of effective communication in team training, and includes a new course management guide. Teamwork training programs have been shown to improve knowledge and attitudes, but have received mixed reviews on their effectiveness in changing behaviors. An AHRQ WebM&M commentary discussed how improved teamwork and shared decision-making might have prevented the unnecessary placement of a peripherally inserted central catheter that led to significant complications.
Book/Report
Assessment of DoD Wounded Warrior Matters: Managing Risks of Multiple Medications.
Alexandria, VA: Department of Defense, Office of the Inspector General; February 21, 2014. Report No. DODIG-2014-040.
Examining medication safety challenges unique to the United States military patient population, this report advocates for strengthening policy and medication reconciliation to address concerns, including accidental overdose and misuse of prescription drugs.
Journal Article > Commentary
Staffing matters—every shift.
West G, Patrician PA, Loan L. Am J Nurs. 2012;112:22-27.
Highlighting the importance of measuring and ensuring adequate staffing levels in hospitals, this commentary describes scenarios drawn from experiences of military nurses that demonstrate how limited staffing can affect nurses, and consequently, patient safety.
Journal Article > Review
How to develop an effective obstetric checklist.
Fausett MB, Propst A, Van Doren K, Clark BT. Am J Obstet Gynecol. 2011;205:165-170.
This commentary discusses checklists as a tactic for improving patient outcomes and describes how the US Air Force Medical Corps implemented a checklist-based protocol to reduce error.
Journal Article > Study
Influence of unit-level staffing on medication errors and falls in military hospitals.
Breckenridge-Sproat S, Johantgen M, Patrician P. West J Nurs Res. 2012;34:455-474.
This study found that staff category and patient acuity were associated with medication errors and falls, but total nursing hours and census had no effect. The authors advocate for greater study of organizational factors, particularly at the unit level, to better understand clinical microsystems.
Award > Award Recipient
Quality and Patient Safety Awards.
Department of Defense Patient Safety Program.
This award recognizes outstanding patient safety improvement work in the Military Health System. The process for submitting applications for the 2016 awards has yet to be announced.
Tools/Toolkit > Government Resource
Professional Conduct Toolkit.
Washington, DC: US Department of Defense, Patient Safety Program.
This toolkit provides a checklist, a planning guide, and other tools to help address disruptive staff behavior.
Journal Article > Study
Medication error reporting and the work environment in a military setting.
Patrician PA, Brosch LR. J Nurs Care Qual. 2009;24:277-286.
This study describes nurses' reasons for medication errors and the barriers to reporting them and then shares experiences with an anonymous shift-based reporting system. The authors advocate for accurate and timely systems to identify medication errors and discuss the importance of a positive safety culture.
Journal Article > Study
Standardized sign-out reduces intern perception of medical errors on the general internal medicine ward.
Salerno SM, Arnett MV, Domanski JP. Teach Learn Med. 2009;21:121-126.
This study describes the development and implementation of a standardized written sign-out sheet that improved the completeness and effectiveness of handoffs between housestaff.
Newspaper/Magazine Article
Winning the battle for standardization.
Health Manage Technol. October 2007;28:34-36.
This article outlines the challenges and successes the US Army Medical Department has experienced in its approach to implementing medication reconciliation technology.
Web Resource > Government Resource
Department of Defense (DoD) Patient Safety Program.
United States Department of Defense.
This Web site includes information on several initiatives within the US Military Health System to support its culture of safety and reduce medical error through leadership, transparency, teamwork, and communication.
Journal Article > Commentary
TeamSTEPPS: assuring optimal teamwork in clinical settings.
Clancy CM, Tornberg DN. Am J Med Qual. 2007;22:214-217.
The authors discuss the TeamSTEPPS training program—a collaboration of the US Department of Defense and Agency for Healthcare Research and Quality to enhance patient safety through improved teamwork.
Book/Report
Department of Defense Health Care Quality.
Falls Church, VA: TRICARE Management Activity, Office of the Assistant Secretary of Defense; 2006.
This report discusses activities and achievements of the U.S. Department of Defense's health care program in 2005 including culture of safety development, error and near miss report analysis, and medical team coordination.