Carolyn Hoffman

Standardization in patient safety: the WHO High 5s project

QUALITY PROBLEM Despite its success in other industries, process standardization in health care has been slow to gain traction or to demonstrate a positive impact on the safety of care. INTERVENTION The High 5s project is a global patient safety initiative of the World Health Organization (WHO) to facilitate the development, implementation and evaluation of Standard Operating Protocols (SOPs) within a global learning community to achieve measurable, significant and sustainable reductions in challenging patient safety problems. GOALS The project seeks to answer two questions: (i) Is it feasible to implement standardized health care processes in individual hospitals, among multiple hospitals within individual countries and across country boundaries? (ii) If so, what is the impact of standardization on the safety problems that the project is targeting? METHOD The two key areas in which the High 5s project is innovative are its use of process standardization both in hospitals within a country and in multiple participating countries, and its carefully designed multi-pronged approach to evaluation. STATUS Three SOPs-correct surgery, medication reconciliation, concentrated injectable medicines-have been developed and are being implemented and evaluated in multiple hospitals in seven participating countries. Nearly 5 years into the implementation, it is clear that this is just the beginning of what can be seen as an exercise in behavior management, asking whether health care workers can adapt their behaviors and environments to standardize care processes in widely varying hospital settings.

Improved Hand Hygiene to Prevent Health Care-Associated Infections

StAtement of tHe Problem And ImPAC t: It is estimated that at any one time, more than 1.4 million people worldwide are suffering from infections acquired in hospitals (1,2). Health care-associated infections (HAI) occur worldwide and affect both developed and developing countries. In developed countries, between 5% and 10% of patients acquire one or more infections and 15%–40% of patients admitted to critical care are thought to be affected (3). In resource-poor settings, rates of infection can exceed 20% (4), but available data are scanty and more research is urgently needed to assess the burden of disease in developing and transitional countries.

Assuring Medication Accuracy at Transitions in Care: Patient Safety Solutions, Volume 1, Solution 6, May 2007

STATeMenT of ProbleM And IMPAC T: Errors are common as medications are procured, prescribed, dispensed, administered, and monitored but, they occur most frequently during the prescribing and administering actions (1). The impact is significant, as medication errors harm an estimated 1.5 million people and kill several thousand each year in the United States of America (USA) , costing the nation at least US

Performance of Correct Procedure at Correct Body Site: Patient Safety Solutions, Volume 1, Solution 4, May 2007

3.5 billion annually (1). Other industrialized countries around the world have also found that medication adverse events are a leading cause of injury and death within their health-care systems (2,3).

Communication During Patient Hand-Overs

A Standard Operating Protocol (SOP) is a set of instructions for implementing a defined patient care process by multiple users in a consistent and measurable manner. In the High 5s initiative, each SOP targets a specific patient safety problem, defines a standardized care process for addressing the problem, and prescribes an implementation plan that includes relevant measures and analytic procedures. These High 5s SOPs are to be implemented in a group of selected hospitals within participating countries for the purpose of demonstrating the feasibility of implementation of standardized care process across multiple hospitals and countries, as well as determining the impact of this standardization effort on the targeted patient safety problem.