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 hospitalsOBJECTIVE: To determine the hospital characteristics and barriers that influence the rates of adoption of these practices.DESIGN: 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.SETTING: One hundred and forty-eight acute care hospitalsMEASUREMENTS: 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.