Adopting National Quality Forum medication safe practices: Progress and barriers to hospital implementation.
BACKGROUND
To reduce medical errors, the National Quality Forum (NQF) developed consensus-based guidelines of 30 safe practices recommended for all hospitals


OBJECTIVE
To determine the hospital characteristics and barriers that influence the rates of adoption of these practices.


METHODS
Retrospective review of annual self-assessment surveys from 2003 to 2004. Medication and culture of safety questions from the survey were mapped to the relevant NQF safe practices.


METHODS
One hundred and forty-eight acute care hospitals.


METHODS
Bivariate analysis was used to examine variation in adoption rates by hospital demographic characteristics.


RESULTS
Most hospitals had adopted 7 of the 9 medication-related practices. Lower adoption rates were seen for resource-intensive safe practices such as consultant pharmacists (52.0%) or CPOE (2.7%). The safety culture questions showed broad diffusion of nonpunitive error reporting (83.7%) but more limited adoption of proactive processes to detect and prevent errors (44.9%). There were no differences by urban versus rural setting and few differences by hospital size. Safe practices that affected hospital-based physicians such as ensuring that new prescribers had access to all currently prescribed medications and minimizing distractions during order writing were difficult for many hospitals. Lower adoption rates were also seen for processes requiring direct physician participation such as eliminating verbal orders and using standardized abbreviations.


CONCLUSIONS
Adoption of NQF-recommended safe practices appeared related to resource constraints and hospital culture. Promoting physician involvement as clinical leaders and team builders, moving from reactive reporting systems to proactive processes that prevent errors, and developing more robust monitoring systems will facilitate further adoption of safe practices.
Emory Center on Health Outcomes and Quality, Rollins School of Public Health, Atlanta, Georgia 30322, USA. krask@emory.edu
Kimberly
K
Rask
Steven
S
Culler
Tracy
T
Scott
Susan
S
Kohler
Jonathan
J
Hawley
Esther
E
Friedman
Dorothy Vi
DV
Naylor
D004059:Diffusion of Innovation; D004282:Documentation; D005845:Georgia; D019983:Guideline Adherence; D006761:Hospitals / Q000592:standards*; D006801:Humans; D008508:Medication Errors / Q000517:prevention & control*; D015279:Organizational Culture; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D017751:Safety Management / Q000592:standards*; D014481:United States