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30 Safe Practices for

Better Health Care
The mission of AHRQ is to improve the quality, The goal in the United States is to adopted by all applicable health care
safety, efficiency, and effectiveness of health deliver safe, high-quality health care to settings to reduce the risk of harm to
care by: patients in all clinical settings. Despite patients.
• Using evidence to improve health care. the best intentions, however, a high rate
• Improving health care outcomes through
of largely preventable adverse events 30 Safe Practices for Improving
and medical errors occur that cause Patient Safety
harm to patients. Adverse events and
• Transforming research into practice. medical errors can occur in any health Creating a Culture of Safety
AHRQ’s research is designed to address the care setting in any community in this 1. Create a health care culture of
most critical aspects of patient safety country. safety.
improvement: One reason adverse events and medical There is a need to promote a
• How to identify errors and their causes. errors occur is that evidence-based culture that overtly encourages
information on what works to prevent and supports the reporting of any
• Collect and report information on patient them, or reduce the harm they cause, is
safety problems. situation or circumstance that
not available. The National Quality threatens, or potentially threatens,
• Improve safety through the use of Forum, with support from the Agency the safety of patients or caregivers
evidence-based interventions, tools, and for Healthcare Research and Quality and that views the occurrence of
practices, including health information (AHRQ), has identified 30 safe errors and adverse events as
technology. practices that evidence shows can work opportunities to make the health
to reduce or prevent adverse events and care system better.
medical errors.
Matching Health Care Needs with
The 30 safe practices that follow have Service Delivery Capability
been endorsed by the membership of
the National Quality Forum, which 2. For designated high-risk, elective
includes representatives of 215 of the surgical procedures or other
Nation’s leading health care provider, specified care, patients should be
purchaser, and consumer organizations. clearly informed of the likely
These organizations strongly urge that reduced risk of an adverse
these 30 safe practices be universally outcome at treatment facilities

Agency for Healthcare Research and Quality

Advancing Excellence in Health Care • www.ahrq.gov
that have demonstrated superior understandable form to all of the
outcomes and should be referred patient’s current health care
to such facilities in accordance providers who need that
with the patient’s stated preference. information to provide care.
3. Specify an explicit protocol to be 10. Ask each patient or legal surrogate
used to ensure an adequate level of to recount what he or she has been
nursing based on the institution’s told during the informed consent
usual patient mix and the discussion.
experience and training of its 11. Ensure that written
nursing staff. documentation of the patient’s
4. All patients in general intensive preference for life-sustaining
care units (both adult and treatments is prominently
pediatric) should be managed by displayed in his or her chart.
physicians having specific training 12. Implement a computerized
and certification in critical care prescriber-order entry system.
medicine (“critical care certified”).
13. Implement a standardized protocol
5. Pharmacists should actively to prevent the mislabeling of
participate in the medication-use radiographs.
process, including, at a minimum,
being available for consultation 14. Implement standardized protocols
with prescribers on medication to prevent the occurrence of
ordering, interpretation and review wrong-site or wrong-patient
of medication orders, preparation procedures.
of medications, dispensing of In Specific Settings or Processes of
medications, and administration Care
and monitoring of medications.
15. Evaluate each patient undergoing
Facilitating Information Transfer and elective surgery for risk of an acute
Clear Communication ischemic cardiac event during
6. Verbal orders should be recorded surgery, and provide prophylactic
whenever possible and treatment for high-risk patients
immediately read back to the with beta blockers.
prescriber; that is, a health care 16. Evaluate each patient upon
provider receiving a verbal order admission, and regularly thereafter,
should read or repeat back the for the risk of developing pressure
information that the prescriber ulcers. This evaluation should be
conveys in order to verify the repeated at regular intervals during
accuracy of what was heard. care. Clinically appropriate
7. Use only standardized preventive methods should be
abbreviations and dose implemented consequent to the
designations. evaluation.
8. Patient care summaries or other 17. Evaluate each patient upon
similar records should not be admission, and regularly thereafter,
prepared from memory. for the risk of developing deep
vein thrombosis/venous
9. Ensure that care information, thromboembolism. Utilize
especially changes in orders and clinically appropriate methods to
new diagnostic information, is prevent both.
transmitted in a timely and clearly
18. Utilize dedicated anti-thrombotic Increasing Safe Medication Use
(anti-coagulation) services that 27. Keep workspaces where
facilitate coordinated care medications are prepared clean,
management. orderly, well lit, and free of clutter,
19. Upon admission, and regularly distraction, and noise.
thereafter, evaluate each patient for 28. Standardize the methods for
the risk of aspiration. labeling, packaging, and storing
20. Adhere to effective methods of medications.
preventing central venous 29. Identify all “high alert” drugs (for
catheter-associated bloodstream example, intravenous adrenergic
infections. agonists and antagonists,
21. Evaluate each pre-operative patient chemotherapy agents, anti-
in light of his or her planned coagulants and anti-thrombotics,
surgical procedure for the risk of concentrated parenteral
surgical site infection, and electrolytes, general anesthetics,
implement appropriate antibiotic neuromuscular blockers, insulin
prophylaxis and other preventive and oral hypoglycemics, narcotics,
measures based on that evaluation. and opiates).
22. Utilize validated protocols to 30. Dispense medications in unit-dose
evaluate patients who are at risk or, when appropriate, unit-of-use
for contrast media-induced renal form, whenever possible.
failure, and utilize a clinically
appropriate method for reducing The National Quality Forum
risk of renal injury based on the
patient’s kidney function The National Quality Forum is a
evaluation. private, non-profit public benefit
corporation, created in 1999 in
23. Evaluate each patient upon response to the need to develop and
admission, and regularly implement a national strategy for
thereafter, for risk of malnutrition. health care quality measurement and
Employ clinically appropriate reporting. Established as a unique
strategies to prevent malnutrition. public-private partnership, the National
24. Whenever a pneumatic tourniquet Quality Forum has broad participation
is used, evaluate the patient for the from more than 170 organizations that
risk of an ischemic and/or represent all sectors of the health care
thrombotic complication, and industry, including health care
utilize appropriate prophylactic providers, consumers, employers,
measures. insurers, and other stakeholders.
Among its members are the AARP,
25. Decontaminate hands with either
AFL-CIO, the American Hospital
a hygienic hand rub or by washing
Association, the American Medical
with a disinfectant soap prior to,
Association, the American Nurses
and after, direct contact with the
Association, the American Society of
patient or objects immediately
Health-System Pharmacists, the Ford
around the patient.
Motor Company, and General Motors.
26. Vaccinate health care workers
against influenza to protect both
them and patients.

For More Information Copies of the complete report, Safe
Practices for Better Healthcare: A
Detailed information on the 30 safe Consensus Report, are available for
practices listed below is available in the purchase from the National Quality
National Quality Forum report, Safe Forum at www.qualityforum.org. The
Practices for Better Healthcare: A Web site also contains additional
Consensus Report. The National Quality information about the National Quality
Forum consensus report is based, in Forum and its projects. A
part, on work by a team of researchers downloadable copy of the Executive
at the AHRQ Evidence-based Practice Summary is also available from the
Center at Stanford University/ National Quality Forum. You can access
University of California at San the Executive Summary through the
Francisco. Their work is available in an AHRQ Web site at www.ahrq.gov/qual/
AHRQ report entitled Making Health nqfpract.htm.
Care Safer: A Critical Analysis of Patient
Safety Practices.

AHRQ Pub No. 05-P007
March 2005