Data sources considered for this report were peer-reviewed publications including randomised clinical trials, observational studies, and surveys of stated practice. We selected key articles on patients' safety to highlight five steps towards individual and system-wide approaches that facilitate the application of effective preventive strategies in the acute care setting. Since the authors practice in internal and intensive care medicine, we have used examples from the acute care
SeriesImproving patients' safety locally: changing clinician behaviour
Section snippets
Preventive health care interventions as a safety priority
The number of effective preventive interventions proven in rigorous randomised trials is increasing. Although application of randomised trial evidence has the potential to significantly decrease both morbidity and mortality, it is clear that, when compared with treatment approaches, preventive strategies are often poorly applied in acute care settings. Well-documented examples of underused interventions that prevent morbidity or fatality include aspirin, β blockers and statins after myocardial
Changing behaviour to focus on safety
Future patients' safety efforts are needed for both individual and system-wide approaches that facilitate the application of effective preventive strategies in practice.17 Herein, we suggest a five-step strategy to achieve this goal by a behavioural change programme specifically adapted to the acute care setting. This model has not been formally assessed for effectiveness, and we recognise that other potentially useful models for behaviour change to improve patient safety exist.
Economic context
Some of the disincentives for patients' safety initiatives are economic. Although professional, legal, and ethical factors often determine which errors are targeted for patient safety initiatives, financial factors determine which initiatives, if any, are undertaken to address the errors. For example, local health care resources will determine the patients' safety response to decrease the chance of recurrence of a life threatening allergic antibiotic reaction. One pharmacy department might
The future
We believe that patients' safety initiatives in the acute care setting should concentrate on not only prevention of high profile errors of commission, but also take a systems approach to prevent those pervasive errors of omission that greatly affect population health. We have suggested a five-step process towards successful implementation of patients' safety initiatives. Although we are humbled by the enormity of the task, we are also encouraged by increasing awareness, public and professional
Search strategy
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Cited by (75)
A survey of acute care clinicians' views on factors influencing hand hygiene practice and actions to improve hand hygiene compliance
2016, Infection, Disease and HealthCitation Excerpt :This contradiction demonstrates that clinicians do not necessarily link hand hygiene practice to patient safety and that this is a problem that could be overcome by treating lapses in hand hygiene as a breach of patient safety. Whether there is mileage in labelling lapses in hand hygiene as a form of health care error has been questioned on the basis that errors of omission may be difficult to identify [43]. Furthermore, the importance of multi-modal strategies has been emphasised, most recently in a quasi-experimental study conducted to examine the effectiveness of an educational intervention on hand hygiene compliance and knowledge in 43 hospitals in 6 countries [1].
Prospective audit for antimicrobial stewardship in intensive care: Impact on resistance and clinical outcomes
2012, American Journal of Infection ControlSecond wave of the French drug harmonisation programme to prevent medication errors: Overall appreciation of healthcare professionals
2012, Annales Francaises d'Anesthesie et de ReanimationPreventing infection in general surgery: Improvements through education of surgeons by surgeons
2011, Journal of Hospital Infection