Search results for "United States of America"

The comprehensive unit-based safety program (CUSP) approach emphasizes improving safety culture through a continuous process of reporting and learning from errors, improving teamwork, and engaging staff at all levels in safety efforts. This conference will cover how to utilize CUSP, including understanding and addressing challenges to implementation.

Patient safety challenges and successes have emerged since the publication of To Err Is Human. This commentary discusses examples of progress such as the wide-scale use of the Comprehensive Unit-based Safety Program and the decrease of hospital-acquired conditions. The authors suggest that future efforts focus on improving measures of adverse events and diagnostic error research.

The landmark Keystone ICU study, which achieved remarkable sustained reductions in central line–associated bloodstream infections in intensive care unit (ICU) patients, stands as one of the most prominent successes of the patient safety field. Although the use of a checklist gathered the most publicity, the study's key insight was that preventing health care–associated infections (HAIs) required extensive attention to improving safety culture by addressing the socioadaptive factors within hospitals that contributed to HAIs. In this new AHRQ funded national study, the Comprehensive Unit-based Safety Program was implemented at 603 hospitals in 32 states, with the goal of preventing catheter-associated urinary tract infections in ICU and ward patients. The effort involved socioadaptive interventions (various approaches shown to improve safety culture) and technical interventions (targeted training to reduce usage of indwelling urinary catheters and providing regular data feedback to participating units). Catheter usage and infection rates significantly decreased in ward patients, although no change was found in ICU patients. This study thus represents one of the few safety interventions that has achieved a sustainable improvement in a clinical outcome. An earlier article described the implementation of the program, which involved collaboration between state and national agencies and academic centers. In a 2008 PSNet interview, the study's lead author discussed his work on preventing HAIs.

This evaluation of the Transforming Care at the Bedside initiative—a collaborative intended to drive engagement of bedside nurses in enhancing safety through unit-based quality improvement projects—found highly positive perceptions of the program and evidence of widespread implementation of new innovations.

Operating room briefings or time-outs are mandated by The Joint Commission as a strategy to prevent wrong-site surgery. This commentary explores the use of briefings both before and after surgery, evidence regarding their impact, and how a comprehensive unit-based safety program (CUSP) initiative designed and implemented a briefing and debriefing process.

Central line–associated bloodstream infections (CLABSIs) cause substantial morbidity and mortality. Efforts to combat these complications include implementation of checklists and—perhaps more importantly—the enhancement of safety culture. Despite the widespread success of these interventions, some institutions continue to experience CLABSI rates that are above national benchmarks. This study describes the introduction of a unit-based quality nurse dedicated to preventing CLABSIs within a surgical intensive care unit (ICU) at an academic medical center. The quality nurse helped to educate staff about health care–associated infections and prevention strategies. The nurse also provided immediate, direct feedback to staff regarding their compliance with best practices. The average CLABSI rate decreased significantly, even after adjusting for multiple factors including reduction in CLABSI rates in other adult ICUs. A unit-based quality nurse may prove to be a powerful adjunct to the current available tools for reducing these costly infections.

This Web site summarizes patient safety improvement efforts in Tennessee and provides access to an annual report of their efforts and a calendar of training opportunities.

Leadership WalkRounds—derived from the business management approach of "management by walking around"—are being more widely used as a means of error detection and improving safety culture. This report from a children's hospital, in which structured walkrounds by nursing and physician leaders were implemented on six units, found that this approach increased staff engagement in safety efforts, identified hidden system flaws, and resulted in the successful implementation of multiple quality improvement projects. Although this study did not specifically measure the effect of walkrounds on safety climate, prior studies have found conflicting results, which might imply that different methods of performing walkrounds may influence their success.

This report provides preliminary outcome data from a six-cohort collaborative that used the comprehensive unit-based safety program and associated tools to prevent catheter-associated urinary tract infections (CAUTI). The early data show a decrease in the overall rate of CAUTI, with a more striking decrease in non-intensive care unit settings than in ICU settings.

This commentary describes the design, implementation, and results of a team dedicated to improving quality and safety in an anesthesia department and highlights outcomes of their performance improvement projects.

A nurse-led comprehensive unit-based safety program identified numerous important safety issues in an intensive care unit. Executive walkrounds helped overcome barriers to address these problems.

A unit-based nurse patient safety officer was implemented on a surgical unit at an academic medical center that had a persistently high rate of falls. The fall rate among inpatients decreased markedly after the patient safety officer position was begun.

Implementation of a comprehensive unit-based safety program was associated with a reduction in surgical site infection rates at a tertiary care hospital.

This publication reports the impact hospital participation in CUSP had on patients. This AHRQ-funded program was designed to reduce central line infections using concepts tested in the successful Keystone program.

Through a case scenario, this commentary describes a safety huddle program and illustrates how to apply the strategy in nursing care.

This study found that use of a comprehensive patient safety program was associated with significant improvements in safety climate among 71 diverse units participating in the Keystone ICU project.

Strategies that foster a positive safety culture are increasingly supported by emerging relationships between hospital safety culture and adverse events, such as readmissions. Teamwork training, executive walk rounds, and establishing unit-based safety teams are all initiatives associated with improvements in safety culture measurement. This study describes a hospital-wide initiative that significantly improved nearly all safety culture domains in 144 clinical units over a 3-year period. The initiatives implemented included a comprehensive unit-based safety program (CUSP), specific teamwork and communication tools, a series of educational venues, and investments in infrastructure and leadership positions. A past AHRQ WebM&M conversation and perspective discussed important facets of safety culture in health care.

This commentary discusses the Comprehensive Unit-Based Safety (CUSP) and Translating Evidence Into Practice (TRIP) models and how they prevent error through culture of safety and teamwork improvements.

The importance of active and engaged hospital leadership in improving safety was highlighted by a Joint Commission Sentinel Event Alert, which challenged hospital executives and boards to establish a culture of safety and systematically analyze and address safety issues. This article details a checklist that hospital leadership can use to organize efforts to eliminate central line–associated bloodstream infections. This AHRQ-funded effort is centered around principles of the comprehensive unit-based safety program and includes specific interventions successfully used in the Keystone ICU project. Prior studies have shown that hospital boards are sometimes surprisingly disengaged from safety efforts, and this article provides a blueprint for executives to direct focused and institution-wide safety projects.

Detailing a recent lethal overdose of heparin, this piece describes common risks and offers suggestions to improve the safety of heparin administration.