BOX 5-5

The National Quality Forum’s Safe Practices for Better Health Care

Among the 30 safe practices identified by the NQF consensus report, the following 13 relate to medication use:

1. Create a health care culture of safety.

3. Specify an explicit protocol to be used to ensure an adequate level of nursing based on the institution’s usual patient mix and the experience and training of its nursing staff.

5. Pharmacists should actively participate in the medication-use process, including at a minimum, being available for consultation with prescribers on medication ordering, interpretation and review of medication orders, preparation of medications, dispensing of medications, and administration and monitoring of medications.

6. Verbal orders should be recorded whenever possible and read back to the prescriber—i.e., a health care provider receiving a verbal order should read or repeat back the information that the prescriber conveys in order to verify the accuracy of what was heard.

7. Use only standardized abbreviations and dose designations.

8. Patient care summaries or other similar records should not be prepared from memory.

9. Ensure that care information, especially changes in orders and new diagnostic information, is transmitted in a timely and clearly understandable form to all of the patient’s current health care providers who need that information to provide care.

12. Implement a computerized prescriber order entry system.

25. Decontaminate hands with either a hygienic hand rub or by washing with disinfectant soap prior to and after direct contact with the patient or objects immediately around the patient.

27. Keep workspaces where medications are prepared clean, orderly, well lit, and free of clutter, distraction, and noise.

28. Standardize the methods for labeling, packaging, and storing medications.

29. Identify all “high alert” drugs (e.g., intravenous adrenergic agonists and antagonists, chemotherapy agents, anticoagulants and antithrombotics, concentrated parenteral electrolytes, general anesthetics, neuromuscular blockers, insulin and oral hypoglycemics, narcotics and opiates.

30. Dispense medications in unit-dose or, when appropriate, unit-of-use form, whenever possible.

SOURCE: NQF, 2003.

within the clinical unit—a small group of clinicians and staff working together with a shared clinical purpose to provide care for a defined set of patients (Mohr and Batalden, 2002). Research on highly effective clinical units has indicated that they share a number of characteristics (Mohr and Batalden, 2002). Such units (1) integrate information within the care deliv-



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