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Making Safety Systematic: Dana-Farber's Patient Safety Rounds Toolkit

A new toolkit can help hospitals and other health care organizations implement a patient safety program that takes a dual approach: dedicated staff members interview other clinical staff about potential safety issues, while volunteer former patients interview current patients to solicit their views on hospital safety. The toolkit includes an organizational assessment tool, program guidelines, training materials, surveys, and other resources needed to implement a "Patient Safety Rounds" program. By proactively investigating safety issues, health care organizations can solicit information and insights needed to create safer care environments.

Organization: Dana-Farber Cancer Institute, Center for Patient Safety

Target Population: Hospitals, health clinics, and other health care settings

The Issue: The Institute of Medicine's report, To Err Is Human (1999), focused attention on the need for systems and protocols to ensure safety in health care practice. Hospitals, health clinics, and other health care settings will only be able to address the root causes of medical errors by identifying potential problems in a systematic fashion and developing mechanisms to address them.

The Intervention: The Dana-Farber Cancer Institute's Center for Patient Safety wanted an alternative to the traditional incident reporting system for tracking medical and medication errors. The Center developed Patient Safety Rounds, through which staff members and patient volunteers seek to identify potential safety issues through proactive surveillance.

On Patient Safety Rounds, "clinician champions"—nurses or other clinicians whose job it is to promote patient safety—work in multidisciplinary health teams, regularly touring through hospital wards and asking questions of clinical staff. Through observation and interviews, the teams probe for potential safety problems and bring salient issues to light.

Questions asked during Patient Safety Rounds might include:

  • Has anything happened today, yesterday, or recently that you think is an obstacle in providing safe care to your patients?
  • Do you have everything you need when you need it? What keeps you awake at night?

What makes the Patient Safety Rounds approach so innovative is the inclusion of patients and their families—perspectives from "inside" the health system. Dana-Farber solicits and trains former patients or their family members to act as safety "liaisons," interviewing current patients to learn about their experiences and views on the safety of their care. In this way, they hope to discover the underlying causes of safety problems.

The details and insights gathered during the clinical rounds and patient interviews inform efforts to improve safety.

With Fund support, the Center for Patient Safety evaluated the effectiveness of Patient Safety Rounds in two Dana-Farber outpatient chemotherapy clinics. The evaluation found that reporting of events increased after the introduction of clinician champions on the Patient Safety Rounds by 40 percent. In addition, the types of safety concerns that emerged differed from those communicated through the traditional incident reporting system. For example, medical errors not resulting in injury and general concerns about the environment of care were reported. Frontline staff and unit managers addressed most issues as they were identified.

Based on their experience, Dana-Farber developed a Patient Safety Rounds toolkit to help hospitals and other health care settings design and implement similar systems. The resources include an organizational assessment, program guidelines, training materials, surveys, and other materials. A Patient Safety Rounds program can help hospitals comply with the error-reduction requirements issued by the Joint Commission on Accreditation of Healthcare Organizations.

For Further Information: Contact the Center for Patient Safety, Dana-Farber Cancer Institute, 44 Binney St., Boston, MA 02115, (617) 667-4935, [email protected].

To download the free toolkit, visit the Dana-Farber Center for Patient Safety Web site.

November 2006


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