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2011 report, Health IT and Patient Safety: Building Safer Systems for Better Care, which called for a shared responsibility between developers and users in ensuring the safety of health based on longstanding aviation industry practices. HIT1001-1 is available for free down- load at aspx?id=HIT10001PS2018.

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AHRQ-funded patient safety research on reducing medication, diagnostic errors Research studies funded by the Agency for Healthcare Research and Quality (AHRQ) and published in Health Affairs highlight challenges and potential strategies for making healthcare safer in the United States.

The articles explore a broad range of safety initiatives, including the use of health infor- mation technologies to reduce medication errors, emerging efforts to improve diagno- ses and how clinical teams might respond more effectively to surgical complications. Articles explore such topics as:


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• Medication errors among children caused by electronic health record usability issues

• Communication failures that increase the risk of death following surgical com- plications

• Policy initiatives aimed at reducing pres- sure sores, falls, infections and medication errors in nursing homes

• Potential changes in electronic prescrib- ing systems to improve medication order safety

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• Better teamwork and use of health infor- mation technology to reduce diagnostic errors

Abstracts of the articles can be found at

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Best practices in providing palliative care supported by growing body of evidence A study commissioned to help guide revi- sions of best practices in providing palliative care fi nds that there is a wide and varied body of evidence to support such clinical practice guidelines.

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The systematic review by researchers from the RAND Corporation found that the re- search base for palliative care was larger than generally appreciated, although there was limited evidence across some areas of clini- cal practice such as how to care for patients during the last days of their lives. Published in the Journal of Pain and Symptom Management, the study was con- ducted to support the fourth edition of the National Consensus Project’s Clinical Practices Guidelines for Quality Palliative Care, which establishes best practices in


end-of-life care. While previous guidelines have been developed through consensus among experts, the systematic review was incorporated into the just-released fourth edition of the guidelines. Palliative care is a rapidly growing fi eld aimed at improving quality of life for patients with serious illness and their care- givers. Inpatient palliative care programs have increased sharply in recent years, with two-thirds of hospitals with 50 or more beds reporting that they have an interdisciplin- ary palliative care team.

Researchers from the Southern California Evidence-based Practice Center at RAND reviewed the research literature to assess the status of evidence across eight domains of palliative care: the structure and process of care; physical aspects of care; psychologi- cal aspects of care; social aspects of care; spiritual, religious and existential aspects of care; cultural aspects of care; care of the patient nearing the end of life; and ethical and legal aspects of care.

The most promising approaches to pal-

liative care structure and process identifi ed by the review include home-based pallia- tive care, interdisciplinary team care and telehealth interventions. The fi ndings sup- port continued growth in these areas, with attention needed on workforce expansion, quality assessment of these services and innovative payment models.

The study also found there is now docu- mented evidence for comprehensive pallia- tive care and music/art therapy addressing physical and psychological aspects of care. However, the existing evidence base for social needs assessments and culturally- sensitive care remains very limited. There is also documented evidence that grief and bereavement support services appear to improve key outcomes for care- givers, but the evidence base for effective approaches for care focused on the last days of life is very limited. Evidence for physician orders and ad- vance directive interventions showed the strongest evidence in the ethical and legal aspects of care domain. Ethics consulta- tions improve consensus in the intensive care unit, which can help reduce use of high-intensity and often life-prolonging treatments at the end of life.

“Our review will help guide best prac- tices going forward and help focus future research efforts to build a high-quality evi- dence base for end-of-life care,” said San- geeta Ahluwalia, the study’s lead author and a senior policy researcher at RAND, a nonprofi t research organization. “While the palliative care evidence base has been rapidly growing, we now better understand where there are gaps.” HPN

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