Implementing patient safety practices in small ambulatory care settings

Improving patient safety in the outpatient setting poses unique challenges for patient safety leaders in clinics and hospitals. Even though ambulatory care may be less technologically complex than inpatient care, it is often more complex logistically.

From October 2002 to May 2003, Gundersen Lutheran Medical Center developed a tool kit of best practices and conducted a collaborative to institute these best practices within a regional health care network. All clinics evaluated patient safety standards and enhanced medication-related practices.

Improvements were demonstrated in medication list accuracy. A number of policies were instituted, and medical and nursing staffs were educated in patient safety issues. Improvements were sustained after one year.

The collaborative model of improvement efforts was an effective model for improving patient safety in small group practices. Structural and process changes often do not require major changes in workflow or large technology installations. Many of the projects allowed for, or required, local assessment and management. However, within a large system of clinics, some of the improvements in this study--verbal order policy, methodology and/or technology for assessment of medication and allergy list accuracy, warfarin care--required systemwide efforts. The degree of difficulty of achieving improvements was surprisingly low and barriers were minimal.