Standardization in patient safety: the WHO High 5s project

Leotsakos, Agnès; Zheng, Hao; Croteau, Richard J.; Loeb, Jerod M.; Sherman, Heather; Hoffman, Carolyn; Morganstein, Louise; O’Leary, Dennis S.; Bruneau, Charles; Lee, Peter; Duguid, Margaret; Thomeczek, Christian; Loos, Erica van der Schrieck-de; Munier, Bill

doi:10.1093/intqhc/mzu010

Cited by 157 publications

(114 citation statements)

References 13 publications

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“…Standardised care is particularly important in critically ill patients, such as those in the NICU, whose outcomes depend on the provision of high-quality care that consistently meets their needs. However, the WHO recognises that one of the biggest challenges in improving patient safety, is the uniform implementation of best practices across hospital settings nationally or internationally 21. Leotsakos et.al.…”

Section: Discussionmentioning

confidence: 99%

“…Leotsakos et.al. report that fluctuating patterns of healthcare services may result in varying patient outcomes and highlight that the standardisation of care practices can reduce costs, inefficiencies and risk 21. The WHO acknowledges that one of the most effective means of promoting practice uniformity is through the development of standardised practice tools that can be adapted and implemented in all hospital settings, both on a national and global scale, such as the WHO High 5’s Project 21.…”

Section: Discussionmentioning

confidence: 99%

“…report that fluctuating patterns of healthcare services may result in varying patient outcomes and highlight that the standardisation of care practices can reduce costs, inefficiencies and risk 21. The WHO acknowledges that one of the most effective means of promoting practice uniformity is through the development of standardised practice tools that can be adapted and implemented in all hospital settings, both on a national and global scale, such as the WHO High 5’s Project 21. A reported benefit to standardisation, is the ability to benchmark services between settings, which allows policy-makers as well as healthcare professionals to compare patient outcomes and to interpret the significance and value of an intervention 21.…”

Section: Discussionmentioning

confidence: 99%

“…The WHO acknowledges that one of the most effective means of promoting practice uniformity is through the development of standardised practice tools that can be adapted and implemented in all hospital settings, both on a national and global scale, such as the WHO High 5’s Project 21. A reported benefit to standardisation, is the ability to benchmark services between settings, which allows policy-makers as well as healthcare professionals to compare patient outcomes and to interpret the significance and value of an intervention 21. Ryan states that benchmarking of pharmacist services is best achieved using a three-tiered approach, comparing against best practice standards, against peers and against yourself, and over time 22.…”

Section: Discussionmentioning

confidence: 99%

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The role of the clinical pharmacist in the NICU: a cross-sectional survey of Australian and Polish pharmacy practice

2018

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ObjectivesTo describe and compare the pharmaceutical services and clinical pharmacy roles performed in neonatal intensive care units (NICUs) in Australian versus Polish hospitals.MethodsA 26-item survey was distributed electronically to directors of pharmacy as well as neonatal pharmacists in hospitals in Poland and Australia. Most questions were fixed ‘agree/disagree’ answers, supplemented by open-ended questions. The survey was distributed between January and May 2017.ResultsOverall, 30 Australian pharmacists and 22 Polish pharmacists completed the survey. Significant differences were observed in the types of pharmaceutical care services provided to NICUs between Australia and Poland. A higher proportion of Australians than Poles performed clinical roles: for example, providing medication recommendations (Aus=96.6%, Pol=9.1%, P<0.001); pharmaceutical interventions to resolve drug therapy problems (Aus=93.1%, Pol=18.2%, P<0.001); and general patient medication chart review (Aus=96.6%, Pol=13.6%, P<0.001). All (100%) Polish pharmacists did not consider themselves members of the NICU team and the majority (59.1%) felt that pharmaceutical care on the NICU was practically non-existent.ConclusionFuture research should focus on bringing practice in countries such as Poland closer in line with practice in countries such as Australia.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The role of the clinical pharmacist in the NICU: a cross-sectional survey of Australian and Polish pharmacy practice

2018

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“…36,37 The PostIntubation Time Out employs multiple tactics to reduce variation in ABG collection. The process is standardized and establishes a guideline for expected ABG timing.…”

Section: Post-intubation Checklist and Time Out To Expedite Mechanicamentioning

confidence: 99%

Using a Post-Intubation Checklist and Time Out to Expedite Mechanical Ventilation Monitoring: Observational Study of a Quality Improvement Intervention

et al. 2016

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BACKGROUND: Delayed mechanical ventilation monitoring may impede recognition of lifethreatening acidemia. Coordination of multidisciplinary processes can be improved by using a checklist and time-out procedure. The study objective was to evaluate process-related outcomes after implementation of a post-intubation checklist and time out. METHODS: An observational study of a 24-bed medical ICU in Philadelphia, Pennsylvania, was conducted from January to December 2011. A random sample of mechanically ventilated adults was selected from the preintervention (n ‫؍‬ 80) and post-intervention (n ‫؍‬ 144) periods. The primary outcome was the proportion of subjects with an arterial blood gas (ABG) result within 60 min of mechanical ventilation initiation. Secondary outcomes included rates of respiratory acidosis, moderate-severe acidemia (pH <7.25), checklist initiation, and project sustainability. Chi-square analysis was used to evaluate differences in outcomes between time periods. RESULTS: After the intervention, the proportion of subjects with an ABG result within 60 min increased (56% vs 37%, P ‫؍‬ .01), and time to ABG result improved (58 min vs 79 min, P ‫؍‬ .004). Adjusting for illness severity, the proportion with an ABG result within 60 min remained significantly higher in the post-intervention period (odds ratio 2.42, 95% CI 1.25-4.68, P ‫؍‬ .009). Checklist adherence was higher with ICU intubations than for intubations performed outside the ICU (71% vs 27% checklist initiation rate, P < .001). Transfer from referring institutions (23% checklist initiation rate, P ‫؍‬ .006) negatively impacted checklist use. Implementation challenges included frequent stakeholder turnover, undefined process ownership, and lack of real-time performance feedback. CONCLUSIONS: A post-intubation checklist and time out improved the timeliness of mechanical ventilation monitoring through more rapid assessment of arterial blood gases. Implementing this peri-intubation procedure may reduce the risks associated with transitioning to full mechanical ventilatory support. Optimal implementation necessitates strategies to surmount organizational and behavioral barriers to change.

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Effect of an Electronic Medication Reconciliation Intervention on Adverse Drug Events

et al. 2019

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Key PointsQuestionDoes an electronic medication reconciliation tool reduce the occurrence of adverse drug events and other adverse outcomes in the 30 days after discharge?FindingsIn this cluster randomized trial that included 3491 patients discharged from 2 medical units and 2 surgical units of 1 academic hospital, electronic medication reconciliation reduced medication discrepancies but had no effect on adverse drug events (primary outcome), emergency department visits, or readmission in the 30 days after discharge.MeaningHospital accreditation requirements for medication reconciliation should be revised to focus on interventions that will reduce the risk of adverse events for patients with multiple changes to their community medication.

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Standardization in patient safety: the WHO High 5s project

Cited by 157 publications

References 13 publications

The role of the clinical pharmacist in the NICU: a cross-sectional survey of Australian and Polish pharmacy practice

The role of the clinical pharmacist in the NICU: a cross-sectional survey of Australian and Polish pharmacy practice

Using a Post-Intubation Checklist and Time Out to Expedite Mechanical Ventilation Monitoring: Observational Study of a Quality Improvement Intervention

Effect of an Electronic Medication Reconciliation Intervention on Adverse Drug Events

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