Final Report:Safe Practices for Better Healthcare – 2009 Update
Ad Hoc Review:
An endorsed practice from this project - Safe Practice 22: Surgical-site Infection Prevention - is under review. Learn
more.
List of Practices (PDF)
The Opportunity
Hospital errors cause significant harm to patients in hospital institutions across the country.
Healthcare-associated infections account for an estimated 1.7 million infections and 99,000 associated deaths each year1. At least 1.5 million preventable drug events occur each year due to drug mix-ups and unintentional overdoses. Up to 10% of hospitalized patients suffer from an infection acquired while they are in the hospital.
The harm can also be measured by heavy financial costs. Preventable errors have been estimated to cost the United States $17 - $29 billion per year in healthcare expenses, lost worker productivity, lost income and disability2. Meanwhile, healthcare expenditures are growing at more than seven percent per year and patient safety is improving by only one percent3.
Similarly, it is well-recognized that committed and informed leadership within healthcare systems will not only improve the functioning of a healthcare organization, but also its overall culture and the approaches to patient safety practices. Direct involvement of patients and families in the processes of care with open, transparent communication also improves patient safety. Both the roles of leadership and patient and family engagement are important components in the 2009 Safe Practices.
About the Project
The 2009 update to Safe Practices for Better Healthcare ended in March 2009.
Objectives
In this project, NQF updated Safe Practices for Better Healthcare with new evidence and expanded implementation approaches. Some Practices from the 2006 update were retired, others were harmonized and new practices were added in areas of pediatric imaging, glycemic control, organ donation, catheter-associated urinary tract infection, and multi-drug resistant organisms.
Previously endorsed practices in areas such as the pharmacist’s role in medication management, pressure ulcers, and the entire healthcare-associated infection chapter were updated in 2009 based on new evidence.
Process
Candidate practices were considered for NQF endorsement as national voluntary consensus standards. Agreement was developed through NQF’s Consensus Development Process (CDP, version 1.8). This project involved the active participation of representatives from across the spectrum of healthcare stakeholders and was guided by a steering committee.
Funding
Funding for this project was provided by the Texas Medical Institute of Technology.
Related NQF Work
The 2009 update builds on NQF’s original Safe Practices that were first endorsed in 2003 and updated in 2006. Safe Practices also work in concert with NQF’s work on Serious Reportable Events.
Contact Information
For more information, contact 202-783-1300 or e-mail info@qualityforum.org.
Notes
1. Yokoe DS et al. A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals. ICHE 2008; 28(1) S12-21.
2. IOM, To Err Is Human: Building a Safer Health System. Washington, DC: National Academy Press; 1999.
3. Catlin A, Cowan C, Heffler S, et al., National health spending in 2005: the slowdown continues, Health Affairs, 2007;26(1):142-153.
This project updated NQF’s Safe Practices for Better Healthcare and endorsed 34 Safe Practices. The Safe Practices were updated with current evidence and expanded implementation approaches. New practices were added including pediatric imaging, glycemic control, organ donation, catheter-associated urinary tract infection, and multi-drug resistant organisms.
The project maintenance Steering Committee, representing the full range of stakeholder perspectives, was formed following the process set forth in NQF’s Consensus Development Process.
Steering Committee
For additional information on the Steering Committee formation process, including specific information on conflicts of interest and required time commitment, please refer to the Call for Nominations documents.
Call for Nominations and Nomination Form (MS Word)
Disclosure of Interest Form (Word)
NQF received candidate standards to review for potential endorsement as national voluntary consensus standards.
The Steering Committee met in person and by conference call numerous times from March through December 2008. The Steering Committee reviewed all submissions and met to determine the practices to recommend for endorsement. Following this review period, the recommended practices were made available for public and member comment.
Agenda from March 25, 2008 in-person meeting
For the member voting period 34 practices were presented in the draft report that reflected public and member comments from the open comment period.
View voting draft.
The CSAC endorsed 34 safe practices.
The Board of Directors ratified the CSAC’s decision to endorse 34 safe practices.
The public had 30 days to appeal the decision to endorse a voluntary consensus standard. No appeals were submitted on the endorsement of these measures.
