Mary Wakefield

Prioritizing Patient Safety Interventions in Small and Rural Hospitals

BACKGROUND A study was conducted in 2004 to determine if 26 interventions--distributed among nine patient safety areas and as recommended by an expert panel as relevant to rural hospitals--would be validated in terms of relevance and implementability for small and rural facilities. METHODS The chief executive officers (CEOs) and/or key managers responsible for patient safety activities in a diverse group of 29 small and rural hospitals assessed the potential effectiveness and feasibility of the 26 interventions. Representatives of 25 hospitals participated in structured, follow-up phone discussions. RESULTS Adverse drug events were the highest-priority area for 14 hospitals, followed by patient falls (selected by 5 hospitals). Some hospitals had already implemented intervention 1 (use at least two patient identifiers) and intervention 6 (read back of verbal orders) and thus ranked them highly, especially for implementability. Intervention 3 (24-hour pharmacist coverage) was ranked low, especially on implementability. Interventions involving health information technology were ranked lower by the hospitals than by the expert panel. DISCUSSION Safety interventions should reflect the general state of the science of safe practices while incorporating relevant contextual issues unique to rural hospitals. The results have important implications for survey and accreditation activity, and the focus of technical assistance and research efforts.

Implementing Patient Safety Initiatives in Rural Hospitals

Implementation of patient safety initiatives can be costly in time and energy. Because of small volumes and limited resources, rural hospitals often are not included in nationally driven patient safety initiatives. This article describes the Tennessee Rural Hospital Patient Safety Demonstration project, whose goal was to strengthen capacity for patient safety initiatives in 8 small Tennessee rural hospitals using a multi-organizational collaborative model. The demonstration identified and facilitated implementation of 3 patient safety interventions: the Agency for Healthcare Research and Quality (AHRQ) patient safety culture survey, use of personal digital assistants (PDAs), and sharing of emergency room protocols. The experience suggested that a collaborative model between rural hospitals, a payer, a hospital association, a quality improvement organization, and academic institutions can effectively support patient safety activities in rural hospitals. Successful implementation of the 3 patient safety interventions depended on leadership provided by nursing and patient safety/quality managers and open, trusting communications within the hospitals.

The Next Era of Regulation: Partnerships for Change

To achieve meaningful impact in the coming years, health care regulators must redouble their efforts to develop robust partnerships. New relationships in the regulatory arena are increasingly central to improving and sustaining high-quality health care broadly and patient safety specifically. The contributions of boards of nursing, with the support of the National Council of State Boards of Nursing, are substantive. Many of them drive an agenda that supports the delivery of safe, competent nursing care, not only in the United States but also in collaboration with counterparts around the world. This article will identify and discuss eight important factors nurse regulators must consider as they work to build strong partnerships in a changing health care environment.