PATIENT SAFETY

Six Countries Endorse "High 5s" for Safer Care

Canada, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States agreed to support a new patient safety project that promotes standard operating protocols in five key areas of patient care.

The "Action on Patient Safety: High 5s Project" is an initiative of the World Alliance for Patient Safety - World Health Organization (WHO). Top health officials from the six countries signed an agreement in support of the project during the 2007 International Symposium on Health Care Policy of the Commonwealth Fund, in Washington, D.C., in early November. The project is being coordinated by the PAHO/WHO Collaborating Center for Patient Safety, which is run by the Joint Commission and Joint Commission International.

The "High 5s" refer to five common problem areas in patient care and proposed solutions in the form of standard operating protocols that are cost-effective and evidence-based (see box). PAHO Assistant Director Carissa Etienne told health officials signing on to the project, "We sincerely hope and expect that it will become a vehicle for coordinating the energy and enthusiasm for tackling unsafe care."

"The interest and commitment being shown by the six countries to implement these solutions is inspiring," said Sir Liam Donaldson, chief medical officer of the United Kingdom and chair of the World Alliance for Patient Safety. "Over the years to come, risks to patients will be reduced, lives will be saved, and many lessons will be learned as a result of the High 5s action being initiated in Washington, D.C., today."

WHO's web site has more information on the High 5s initiative.

Top five problems and protocols

Concentrated injectable medicines can be fatal if not handled properly.

Use ready-to-administer or ready-to-use preparations whenever possible.
Remove concentrated injectable medicines from patient care units.
Use multiple safeguards if concentrates are stored on patient care units.
Minimize the number of different concentrations of injectable medicines.

Inaccurate or incomplete patient medication information at transitions in care can lead to harmful medication errors.

Obtain a complete list of patient home medications on patient admission.
Identify discrepancies in medication orders during hospitalization.
Reconcile discrepancies before medicating the patient.
Provide a list of medicines to the patient and caregivers on discharge.

Incomplete or unclear communication of information, responsibility or accountability for a patient's care can lead to harmful errors.

Identify the points in the patient care process at which handover of responsibility and accountability occur.
Standardize the handover process.
Provide an opportunity for the receiving care team to get clarification.
Provide easy access to additional information, if needed.

Procedures done on the wrong patient or at the wrong body site can be physically and psychologically devastating; they are more common than generally appreciated, and are preventable.

Gather and verify standardized preoperative information.
Mark the surgical/procedural site.
Conduct a "time out" just prior to starting the procedure.
Employ these strategies wherever invasive procedures are performed.

The burden of healthcare-associated infections, in terms of human suffering and cost, is huge and can be significantly reduced through improved hand hygiene.

Determine the best systems to support hand hygiene in health care.
Educate caregivers.
Provide the necessary materials and equipment for hand hygiene.
Measure and provide feedback to caregivers about their compliance.
Provide reminders about the need for good hand hygiene.
Facilitate a culture of safety and hygiene.