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					                                                                                               Premier Safety Share


Each issue of Safety Share Newsletter contains four to five
popular and frequently used safety tools and resources on
patient, worker and environmental safety. This safety tool
archive is a compiliation of all the safety tools and resources
from Premiers Safety Share issue January 2002 to the
                                                                                                                                                                      IHI
  Month       Year                 Topic by Tab                           Tool                                          Description                                  Tool                Location


                                                                                       Changes in four key elements of the service delivery system are
                                                                                       described in the IHI white paper. The changes include the care team,
                                                                                       patient activation, clinical information system, and leadership. IHI
                                                                                       identifies the challenges faced in the current system, introduces a new              http://www.premierinc.com/quality-
                                                                  IHI white paper –    design for the delivery of primary care, and encourages office practices             safety/tools-services/safety/safety-
                                                                  Planning a primary   and clinics to move ahead with their own efforts to strive for better                share/06-06-downloads/14-planned-
IHI                  Patient Safety                               care delivery system patient outcomes.                                                              √     care-white-paper-2006.pdf
                                                                                      A tool for conducting brief, ad hoc staff meetings focused on sharing                 Word;Patient Safety/Medication
                                                                  Device Use – Safety observations and concerns about safety hazards related to the use of                  Systems/Tools; Under: Culture of
IHI                  Patient Safety                               Briefing Model      medical devices and equipment                                                   √     Safety

                                                                  Executive Review of     A guide for executives on how to channel senior management attention              Word;Improvement Methods/Tools;
IHI                  Patient Safety                               Projects (IHI Tool)     to quality projects                                                         √     Under: Information Gathering Tools

                                                                                          Sampling is used to simplify the gathering of data for improvement and            Excel;Improvement Methods/Tools;
IHI                  Patient Safety                               Sampling (IHI Tool)     to prevent unnecessary data collection.                                     √     Under: Information Gathering Tools
                                                                  Checklist for
                                                                  Assessing                                                                                                 Word;Patient Safety/Medication
                                                                  Institutional           A short self-assessment survey for use by any health care organization            Systems/Tools; Under: Culture of
IHI                  Patient Safety                               Resilience              wishing to gauge its patient safety climate                                 √     Safety
                                                                  Decision Tree for                                                                                         Patient Safety/Medication
                                                                  Unsafe Acts             A decision tree that can be followed when analyzing an error or adverse           Systems/Tools; Under: Culture of
IHI                  Patient Safety                               Culpability             event; developed by Partners HealthSystem                                   √     Safety
                                                                                                                                                                            Patient Safety/Medication
                                                                  Patient Safety                                                                                            Systems/Tools; Under: Culture of
IHI                  Patient Safety                               Tracking Database       Example of a database for tracking patient safety issues                    √     Safety

                                                                                      The tool was developed by safety administrators at Iowa Health System
                                                                                      (IHS) to help front-line staff initiate Device Use – Safety Briefings, which          Word;Patient Safety/Medication
                                                                  Device Use – Safety provide a forum for shared observations and concerns related to the use               Systems/Tools; Under: Culture of
IHI                  Patient Safety                               Briefing Model      of medical devices, equipment, and complex software in the institution.         √     Safety

                                                                                          A simple, easy-to-use tool that front-line staff can use to share                 Adobe;Patient Safety/Medication
                                                                  Safety Briefings (IHI   information about potential safety problems and concerns on a daily               Systems/Tools; Under: Culture of
IHI                  Patient Safety                               Tool)                   basis, to promote safety consciousness and learning                         √     Safety




      Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety Share
                                                                                         Premier Safety Share



                                                                                                                                                                   IHI
  Month       Year                Topic by Tab                      Tool                                           Description                                    Tool                Location


                                                            Safety Huddle           The tool enumerates data elements to collect during a test of Safety                 Word;Patient Safety/Medication
                                                            Results Collection      Briefings, including medication safety issues and "near miss" medication             Systems/Tools; Under: Culture of
IHI                  Patient Safety                         Tool                    errors that are identified before they cause harm.                             √     Safety


                                                                                    The RFID Resource Center includes an implementation guide
                                                                                    describing the use of HIBC (Health Industry Bar Code) Standards with
                                                            RFID – Web-based        RFID, an overview of RFID technology (including its potential
                                                            resource center         applications and costs), a white paper, "RFID In Healthcare: Benefits,               http://www.hibcc.org/AUTOIDUPN/
May           2007 Bar Coding                               available               Limitations & Recommendations," and other related articles.                          RFID.htm


                                                                                    Catheter-related blood stream infections (BSI) are a significant source of
                                                                                    morbidity and mortality associated with a variety of devices used to
                                                                                    access the vascular system. Meticulous aseptic technique is both
                                                                                    required and effective to prevent BSI. Faculty share their observations,
                                                            Webcast – Best          best practices, and outcome data as they discuss this important topic.
                                                            practices to reduce     This free webcast is a replay from the original August 17, 2007, webcast
                                                            catheter-related        provided by Cardinal Health's Center for Safety and Clinical Excellence
                                                            blood stream            and will remain available for one full year. Continuing education credit is          http://www.cardinal.com/clinicalcent
September 2007       Bundling - evidence based practice     infections              also provided.                                                                       er/materials/webcasts/index.asp


                                                                                A recent AHRQ audio newscast series featured an interview with Peter
                                                                                Pronovost, M.D., Ph.D., of The Johns Hopkins University School of
                                                                                Medicine. Dr. Pronovost discussed his research about interventions to
                                                                                reduce bloodstream infections in hospital ICUs caused by central
                                                                                venous catheters. Patients in the United States spend about 18 million
                                                                                days in the intensive care unit per year and in more than 50 percent of
                                                                                the cases, an ICU patient will have a central venous catheter inserted.
                                                            AHRQ tools –        Unfortunately, approximately 80,000 patients each year develop                           AHRQ podcast:
                                                            Podcast on reducing catheter-related bloodstream infections, and about 28,000 of them will                   http://www.healthcare411.org/podc
May           2007 Bundling - evidence based practice       BSI                 die from the infection.                                                                  ast.aspx?id=197
                                                                                    The recommendations include the assessment of the electromagnetic
                                                            Recommendations         environment of the facility, identification of areas where critical medical          http://my.premierinc.com/all/safety/
                                                            for Electromagnetic     devices are used, coordination of the purchase and management of all                 publications/01-
                                                            Compatibility in        electronic equipment, and the reporting of problems to FDA MedWatch                  02_downloads/CDRH-%20EMC-12-
January       2002 Cell Phones and EMC                      Healthcare Facilities   program.                                                                             01.doc




      Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety Share
                                                                                          Premier Safety Share



                                                                                                                                                                      IHI
  Month        Year               Topic by Tab                        Tool                                           Description                                     Tool                 Location


                                                                                    A free interactive video module that will help identify and treat C. difficile
                                                                                    is available from the British Medical Journal (BMJ) and the Department
                                                                                    of Health. Titled "How you can reduce C. difficile infections," the video
                                                                                    demonstrates how a major UK hospital successfully managed an
                                                                                    outbreak and introduced measures that can be applied to prevent
                                                                                    infections. The module discusses how to diagnose and treat patients
                                                                                    with C. diffcile infections, the importance of hand hygiene in preventing
                                                                                    infection, the cautious use of prescribing antibiotics, and understanding
                                                               Online learning      the patient experience. To begin the module, go to
September      2007 C. difficile associated disease           module – C. difficile http://bmjlearning.com/cdifficile.                                                      http://bmjlearning.com/cdifficile

                                                                                Community hospitals implementing computerized physician order entry                         http://my.premierinc.com/all/safety/
                                                                                are succeeding in gaining physician participation and addressing the                        publications/07-
                                                                                gaps in safety and quality they were targeting, according to a new report                   03_downloads/10_CPOE_comm_h
July           2003 Computerized physician order entry       CPOE Report & Tips by the California HealthCare Foundation and First Consulting Group.                         osp.pdf

                                                                                                                                                                            http://www.hospitalconnect.com/ah
                                                             CPOE evaluation and The report explores CPOE implementation, costs, challenges, benefits,                      a/key_issues/patient_safety/resour
March          2003 Computerized physician order entry       case studies        and lessons learned.                                                                       ces/index.html#patientsafety


                                                                                  Advances in technology are making it easier to improve patient safety.
                                                                                  The September/October issue of Patient Safety and Quality Healthcare
                                                                                  focuses on recent technology designed to reduce the risk of medical
                                                             On-line resources – errors. Among the topics featured in this issue are bar coding to reduce
                    Computers and electronics in             bar coding, RFID and medication errors, electronic medical records (EMR) and radio                             http://www.psqh.com/sepoct05/tocc
November       2005 healthcare                               patient safety       frequency identification (RFID) systems.                                                  .html


                                                                                     Premier, the first GPO to win Hospitals for a Healthy Environment's
                                                             Web-based resource      (H2E) Champions of Change Award (in 2003) and again in 2004, has
                                                             to assist healthcare    launched a new Web-based resource to assist healthcare organizations
                                                             organizations with      with environmentally friendly selection, recycling and disposal of
                                                             environmentally         computers and electronics. These resources are also being used to
                                                             friendly selection,     guide the selection of electronic device manufacturers for Premier
                                                             recycling and           members and for recycling of electronics in Premier's corporate offices.
                                                             disposal of             The Web-based resource was produced by Premier's Safety Institute
                    Computers and electronics in             computers and           with assistance and support from Health Care Without Harm and the                      http://www.premierinc.com/all/safet
March          2005 healthcare                               electronics.            Computer Take Back Campaign.                                                           y/resources/computers/index.jsp




       Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety Share
                                                                                        Premier Safety Share



                                                                                                                                                                 IHI
  Month        Year               Topic by Tab                       Tool                                        Description                                    Tool                Location


                                                                                   This manual was written to assist hospitals in developing strategies for
                                                                                   temporary negative pressure isolation and provides instruction on the
                                                                                   use of equipment used for airborne infectious disease management. In                Download the manual from the
                                                                                   addition to graphic "how to" portrayals, the guide includes tools such as           Safety Institute's Construction,
                                                             Minnesota manual –    preventative maintenance schedules and a sample log for measuring                   ICRA, risk assessment web site, or
                                                             Methods for           particle counts for performance improvement planning. Additional                    go to:
                                                             temporary negative    information, including education/training slides, are located at the Web            http://www.health.state.mn.us/oep/t
Mar            2007 Construction - ICRA                      pressure isolation    site below.                                                                         raining/bhpp/isolation.html


                                                                                   Created by the University of Minnesota, InformeDesign®
                                                                                   www.informedesign.umn.edu brings research and practice aspects of
                                                                                   the design professions together. Designers face a multitude of complex
                                                                                   challenges that are environmental, behavioral, and design in nature.
                                                                                   This Web site focuses on providing the design community with
                                                                                   reputable research sources that address those challenges. A monthly
                                                                                   publication, Implications, addresses the issues facing practitioners and
                                                                                   researchers who focus on design and human behavior. Under the links,
                                                             Inform eDesign –      "SPACE," then "Healthcare," there is a wide variety of healthcare related
                                                             Healthcare design     articles and research summaries on topics from ambulatory care to                   http://www.informedesign.umn.edu/
Feb            2007 Construction - ICRA                      implications          wellness centers.                                                                   Rs.aspx?s=space&tId=664
                                                                                   The construction and ICRA concept and matrix as described and                       For more information on and
                                                                                   promoted by the Association for Professionals in Infection Control and              resources about construction on
                                                                                   Epidemiology (APIC) and the American Society for Healthcare                         Premiers Web site:
                                                                                   Engineering (ASHE) are available in two training videos. One is directed            www.premierinc.com/quality-
                                                                                   to healthcare professionals (20 minutes) and one to construction                    safety/tools-
                                                             Construction; ICRA    personnel (eight minutes), with availability in English and Spanish. Go to          services/safety//resources/construc
Sept           2006 Construction - ICRA                      training              www.EnvisionInc.net.                                                                tion/.


                                                                                  This model program engages nurses and leaders at all levels of the
                                                                                  organization to improve the quality and safety of patient care on medical
                                                                                  and surgical units. Ten hospitals graduated from the third phase of the
                                                                                  five-year program in May. TCAB is not a traditional quality improvement
                                                                                  program; one primary characteristic that sets it apart is its focus on
                                                                                  engaging frontline staff and unit managers. Ideas for transforming the
                                                                                  way care is delivered on medical/surgical units come from the nurses
                                                             Transforming Care at and other care team members who spend the most time with patients                    http://www.rwjf.org/pr/product.jsp?i
September      2008 Culture - Safety - Tool                  the Bedside          and their families.                                                                  d=30051&c=EMC-CA137




       Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety Share
                                                                                        Premier Safety Share



                                                                                                                                                                IHI
  Month        Year               Topic by Tab                       Tool                                        Description                                   Tool                Location


                                                                                   To assist institutions in making the business case for quality programs,
                                                                                   the Institute for Healthcare Improvement (IHI) is unveiling the Adverse
                                                                                   Events Prevented Calculator. This tool helps model the financial
                                                                                   implications of reductions in adverse event rates in an organization and
                                                                                   assists in translating actual and potential improvement results into
                                                                                   projected lives and dollars saved. The tool allows one to track the
                                                                                   change in rate of any one type of adverse event over time and, when
                                                                                   appropriate additional data are added, the consequent change in
                                                                                   unnecessary deaths ("lives saved"), real and additional potential cost
                                                             IHI tool – Adverse    savings ("dark green dollar" savings and "light green dollar" savings,             http://www.ihi.org/IHI/Topics/Patien
                                                             Events Prevented      respectively), and the return on investment of quality improvement work            tSafety/SafetyGeneral/Tools/advers
September      2008 Culture - Safety - Tool                  Calculator            targeting those adverse events.                                              √     eeventspreventedcalculator.htm


                                                                                   The Joint Commission offers an Internet-based collaborative forum to
                                                                                   help frontline workers; healthcare administrators, researchers and other
                                                                                   healthcare professionals collaborate on developing performance
                                                                                   improvement solutions. One feature currently being test piloted allows
                                                                                   registered users to discuss solutions, edit existing solutions and create
                                                                                   new solutions that will then be available to the entire healthcare                 The site, titled WikiHealthCareTM,
                                                                                   community. The first quality improvement topics posted to the site                 can be accessed through a link on
                                                                                   address smoking cessation counseling programs and smoke-free                       The Joint Commission's home
                                                                                   hospital campuses. Development of the site was funded, in part, through            page, or directly at
                                                                                   a research grant from the Smoking Cessation Leadership Center at the               http://wikihealthcare.jointcommissio
October        2007 Culture - Safety - Tool                  WikiHealthCareTM      University of California, San Francisco.                                           n.org.


                                                                                   Now AHRQ is providing a new tool developed for small and critical
                                                                                   access hospitals to benchmark and compare their results from the
                                                                                   AHRQ Hospital Survey on Patient Safety Culture. However, the tool can
                                                                                   be used by any size hospital because it allows the addition of any
                                                                                   benchmarking data. The tool is from Statis Health and the Oklahoma
                                                             Small hospital        Foundation for Medical Quality and the Hospital Interventions Quality              http://www.premierinc.com/quality-
                                                             benchmarking tool     Improvement Organization Support Center (HIQIOSC) and is adapted                   safety/tools-
                                                             for AHRQ hospital     with permission for a benchmarking tool developed by the Nebraska                  services/safety/topics/culture/benc
July           2007 Culture - Safety - Tool                  survey                Center for Rural Health Research.                                                  hmarking-data.jsp#cah-tool




       Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety Share
                                                                                       Premier Safety Share



                                                                                                                                                                  IHI
  Month       Year               Topic by Tab                        Tool                                        Description                                     Tool                Location


                                                                               The Premier Performance Suite is a comprehensive offering of hospital                    For more information on the
                                                                               performance tools to integrate quality and safety, labor management,                     Premier Performance Suite, visit
                                                                               and supply chain channels for a global approach to improving overall                     the home page at:
                                                                               quality and cost. The Performance Suite provides Web-based                               http://www.premierinc.com/quality-
                                                            Premier – New      performance measurement and benchmarking, real time surveillance,                        safety/tools-services/performance-
Mar           2007 Culture - Safety - Tool                  Performance Suite™ and best practices to allow hospitals to make better decisions.                          suite/.


                                                                                  The first monograph, "Are You Rolling the Dice on CEO Succession?" is
                                                                                  designed to help trustees navigate the CEO selection process. The
                                                                                  monograph contains a Leadership Continuity Risk Management Model                      To order any of the monographs,
                                                                                  to help trustees understand how to effectively define the requirements                contact the Center at 888.540.6111
                                                                                  for a new CEO, assess candidates and approach the final selection                     or e-mail at:
                                                                                  process. The second, "The Board's Fiduciary Role: Legal                               info@americangovernance.com.
                                                                                  Responsibilities of Health Care Governing Boards," describes the basic                Access the tool at:
                                                                                  legal duties and obligations of the boards of not-for-profit hospitals. This          http://www.americangovernance.co
                                                            CEO assessment        guidance can be used to support trustee recruitment and orientation,                  m/americangovernance/ctool/welco
Feb           2007 Culture - Safety - Tool                  tool for leadership   and as a reference tool for existing board members.                                   me.html.




                                                                                  The Center for Healthcare Governance has provided the first tool in a
                                                                                  series of Collaborative Leadership Tools. "Collaborative Leadership: A
                                                                                  New Model for Developing Truly Effective Relationships Between CEOs
                                                                                  and Trustees" explores the board/CEO relationship in the context of
                                                                                  governance reform, which calls for boards in all sectors to raise the bar
                                                                                  on their performance and accountability. This CEO resource discusses
                                                                                  what governance reform means in terms of how boards and CEOs work
                                                                                  together to lead their healthcare organizations. It also provides an
                                                                                  assessment tool and process that CEOs can use to take the lead in
                                                                                  diagnosing their current relationship with their board, and to work                   Access the tool at:
                                                                                  together with board leaders to re-energize and strengthen the                         http://www.americangovernance.co
                                                            CEO assessment        relationship to achieve maximum effectiveness and value. If completed                 m/americangovernance/ctool/welco
Jan           2007 Culture - Safety - Tool                  tool for leadership   online, all responses are confidential.                                               me.html




      Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety Share
                                                                                          Premier Safety Share



                                                                                                                                                                  IHI
   Month        Year                Topic by Tab                      Tool                                          Description                                  Tool                Location


                                                                                  The tool is for physician practices to use to enhance awareness of
                                                                                  patient safety issues, heighten awareness of characteristics that make a
                                                                                  practice safer, and create a new reference point and baseline for                     There is a $200 per practice fee to
                                                                                  practices to enhance and support patient safety. The tool can be                      complete the assessment online
                                                                                  completed electronically so users can receive a feedback report                       and access the comparative report
                                                                                  comparing themselves to other practices (percentile rankings on each                  site. Download the file or use online
                                                              Assessing physician question). Users also can receive a workbook with information and                     at
Nov             2006   Culture - Safety - Tool                practices           resources on how the practice can improve their performance.                          http://www.physiciansafetytool.org.


                                                                                     The tool is designed to help hospital CEOs and their boards forge a
                                                              Collaborative          stronger relationship. This CEO resource discusses what governance
                                                              Leadership: A New      reform means in terms of how boards and CEOs work together to lead
                                                              Model for Developing   their healthcare organizations. It also provides an assessment tool and
                                                              Truly Effective        process that CEOs can use to take the lead in diagnosing their current
                                                              Relationships          relationship with their board, and to work together with board leaders to          Access the tool at:
                                                              Between CEOs and       re-energize and strengthen the relationship to achieve maximum                     http://www.americangovernance.co
Nov             2006   Culture - Safety - Tool                Trustees               effectiveness and value.                                                           m/americangovernance/




                                                                                     The consensus statement is intended to provide a deeper understanding
                                                                                     of preventable adverse events, their impact on patients, families, and
                                                                                     providers, and how to manage such events. The report provides detailed
                                                                                     guidelines based on the premise that all care should be safe and patient-
                                                                                     centered and proposes a full disclosure when adverse events or medical
                                                                                     errors occur, including an apology to the patient. The report is divided
                                                                                     into three major sections: the patient and family experience, the
                                                                                     caregiver experience, and the management of the event. Each section
                                                                                     contains a summary of the expert consensus of the issue, including the
                                                                                     reasoning and evidence behind the consensus, and recommendations.
                                                                                     The report also offers appendices that include recommendations, a case             Go to:
                                                              When Things Go         study on communicating with patients and families, elements of                     http://www.premierinc.com/all/safet
                                                              Wrong: Responding      emotional support of caregivers, and a bibliography on medical                     y/publications/04-06-downloads/07-
April           2006   Culture - Safety - Tool                to Adverse Events      disclosure.                                                                        responding-adverse-events.pdf




        Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety Share
                                                                                     Premier Safety Share



                                                                                                                                                               IHI
  Month     Year                Topic by Tab                      Tool                                         Description                                    Tool                Location


                                                                                A recent directive from the U.S. Veterans Health Administration provides
                                                                                background information on the disclosure of adverse events related to
                                                                                clinical care to patients or their representatives. VA Directive 2005-049
                                                                                (.pdf) (163 KB), "Disclosure of Adverse Events to Patients," is
                                                                                consistent with the Joint Commission on Accreditation of Healthcare
                                                          Directive on          Organizations requirements, and includes key definitions and a policy                http://www.premierinc.com/all/safet
                                                          disclosure of adverse statement on disclosure for all VA hospitals.                                        y/publications/12-05-downloads/09-
December    2005   PSS News                               events                                                                                                     va-adverse-events.pdf



                                                                                A leadership guide offering eight steps for senior health care leaders to
                                                                                help their organizations achieve patient safety and high reliability is
                                                                                available from the Institute for Healthcare Improvement (IHI). "The
                                                          The Leadership        Leadership Guide to Patient Safety: Resources and Tools for
                                                          Guide to Patient      Establishing and Maintaining Patient Safety" introduces the concept of
                                                          Safety: Resources     "reliability," defined as patients getting the intended tests, medications,
                                                          and Tools for         information, and procedures at the appropriate time and in accordance
                                                          Establishing and      with their values and preferences. Strategies for redesign of healthcare             http://www.premierinc.com/all/safet
                                                          Maintaining Patient   systems are presented using examples that IHI has gleaned from its                   y/publications/11-05-full-
November    2005   PSS News                               Safety                experience in guiding organizations in improving patient safety.               √     txt.jsp#story-06-downloads
                                                                                Premier's Safety Institute has developed a Spanish version of the
                                                                                Agency for Healthcare Research and Quality's (AHRQ) Hospital Survey
                                                          Hospital Survey on    on Patient Safety Culture survey tool, as well as a customized                       The survey tool can be accessed at
                                                          Patient Safety        Microsoft® Excel data tool for easy entry and rapid display of survey                http://www.premierinc.com/all/safet
August      2005   Culture - Safety - Tool                Culture               results.                                                                             y/culture/


                                                                              The long awaited Patient Safety and Quality Improvement Act (P.L.109-
                                                                              41) was signed into law on July 29, 2005, to encourage a culture of
                                                                              safety in healthcare organizations by providing legal protection of
                                                          Patient Safety and  information on medical errors and adverse events voluntarily reported to               http://thomas.loc.gov/cgi-
                                                          Quality Improvement patient safety organizations (PSOs). Lawmakers intend the information                  bin/bdquery/z?d109:SN00544:|TO
August      2005 PSS News                                 Act (P.L.109-41)    to be used to improve patient safety and reduce medical errors.                        M:/bss/d109query.html




    Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety Share
                                                                                         Premier Safety Share



                                                                                                                                                                  IHI
  Month        Year                Topic by Tab                      Tool                                          Description                                   Tool                Location


                                                                                    Reconciling medications across the continuum of care is a new 2005
                                                                                    JCAHO safety goal. Experience has shown that poor communication of
                                                                                    medical information at transition points is responsible for as many as 50
                                                                                    percent of all medication errors in the hospital and up to 20 percent of
                                                                                    adverse drug events. A Massachusetts Coalition Web site describes                   Go to http://www.macoalition.org
                                                                                    how a group of hospitals in Massachusetts implemented a medication                  and look under ―Coalition
                                                             Medication strategy    reconciliation strategy and provides various tools and forms for others to          Initiatives,‖ then ―Reconciling
July           2005 Culture - Safety - Tool                  tools                  adopt or adapt.                                                                     Medications.‖


                                                                                                                                                                        Copies of "5 Steps to Safer Health
                                                                                    A campaign designed to help distribute valuable information about                   Care" and the public service
                                                                                    improving patient safety to healthcare providers and patients across the            announcement are available on the
                                                                                    country has been initiated by the Agency for Healthcare Research and                AHRQ's Web site: English version:
                                                                                    Quality (AHRQ), the American Hospital Association (AHA). The                        http://www.ahrq.gov/consumer/5ste
                                                                                    campaign, called "5 Steps to Safer Health Care," includes posters and               ps.htm
                                                                                    fact sheets that offer evidence-based, practical tips on the role patients          Spanish version:
                                                             5 Steps to Safer       can play to help avoid errors related to prescription medicines,                    http://www.ahrq.gov/consumer/cinc
June           2005   Culture - Safety - Tool                Health Care            laboratory tests, procedures, and surgery.                                          orec.htm


                                                                                    The Agency for Healthcare Research and Quality (AHRQ) has published                 View entire document at
                                                                                    a new fact sheet entitled "30 Safe Practices for Better Health Care"                http://www.premierinc.com/all/safet
                                                                                    (.doc) (42 KB). These are AHRQ-supported, evidence-based practices                  y/publications/05-05-downloads/07-
                                                                                    from the National Quality Forum (NQF) that demonstrate they can work                fact-sheet-30-practices.doc; An
                                                                                    to reduce or prevent adverse events and medical errors. The safe                    executive summary (.pdf) (495 KB)
                                                                                    practices were endorsed by the NQF member organizations, which                      of the report is available from
                                                             30 safe practices in   strongly urge that these 30 safe practices be universally adopted in all            AHRQ and contains information on
May            2005   Culture - Safety - Tool                healthcare             applicable healthcare settings to reduce the risk of harm to patients.              how to obtain copies of the com


                                                                                    Most hospital leaders are concerned that mandatory, non-confidential
                                                                                    public reporting would discourage internal reporting of patient incidents           http://www.premierinc.com/all/safet
                                                                                    and encourage lawsuits while failing to provide substantial benefits to             y/publications/05-05-downloads/04-
                                                             Error Reporting and    patient safety, according to a recent survey of hospital executives in the          abst-error-report-disclosure-
May            2005 PSS News                                 Disclosure Systems     Journal of the American Medical Association.                                        systems.doc




       Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety Share
                                                                                        Premier Safety Share



                                                                                                                                                                   IHI
  Month        Year                Topic by Tab                       Tool                                        Description                                     Tool                Location


                                                                                  Premier has developed a customized data collection and analysis tool
                                                                                  that provides immediate feedback on the results of the hospital culture
                                                                                  survey tool released by the Agency for Healthcare Research and Quality
                                                             Premier - customized (AHRQ). The customized Excel™ data tool was developed for easy                         http://www.premierinc.com/all/safet
                                                             data collection and  entry and rapid display of the results from the surveys to provide                     y/publications/03-05-full-
March          2005   PSS News                               analysis tool        immediate internal review and feedback.                                                txt.jsp#story-08-downloads


                                                                                   A new tool to assess the safety culture of a hospital as a whole, or in
                                                                                   specific units within hospitals, as well as to track changes in patient
                                                                                   safety over time and evaluate the impact of patient safety interventions.
                                                                                   Premier's Safety Institute is providing the complete tool kit, which                  All components may be
                                                             Hospital Survey on    includes the survey, detailed user's guide for administration of paper or             downloaded at
                                                             Patient Safety        web-based methods, data collection and analysis, customizable                         www.premierinc.com/all/safety/cult
November       2004   Culture - Safety - Tool                Culture               templates for reporting results, references, and results of the pilot study.          ure.
                                                                                   The video discusses how best to inform patients and their families in the
                                                             Discussing            event of a medical error that causes harm. The video includes clinical
                                                             Unanticipated         scenarios and comments from a medical ethicist, a hospital risk                       For information on how to obtain
                                                             Outcomes and          manager, and two healthcare attorneys. The comments offer                             the videotape, go to:
                                                             Disclosing Medical    suggestions on how to effectively disclose adverse events to patients                 http://www.gha.org/pha/video/index
October        2004   Culture - Safety - Tool                Errors                and their families.                                                                   .asp.
                                                                                                                                                                         http://www.ihi.org/IHI/Topics/Patien
                                                             Patient Safety                                                                                              tSafety/MedicationSystems/Tools/P
                                                             Leadership            Collects data and then keeps track of how the information is used, what               atientSafetyLeadershipWalkRound
July            2004 Culture - Safety - Tool                 WalkRounds            actions are taken, and generate feedback and reports.                           √     sDatabase.htm



                                                                                                                                                                         http://www.premierinc.com/safety/r
                                                                                   The majority of hospitals responding to a Premier survey have formal,                 esources/disclosure/downloads/Pre
                                                                                   board approved policies to disclose medical errors to patients, according             mier-disclosure-survey-results.pdf;
                                                                                   to a survey conducted by Premier, Inc. The survey uncovered some                      survey discussion:
                                                             Premier Patient       promising trends in medical error disclosure practices. A full discussion             http://www.premierinc.com/all/safet
                                                             Safety Culture        of the survey may be downloaded.                                                      y/publications/08-04-downloads/02-
June           2004 PSS News                                 Survey results                                                                                              disclosure-release.doc

                                                                                   Michigan Hospital Association toolkit is a series of recommendations
                                                                                   based on current research and best practices. It was developed by a                   http://my.premierinc.com/all/safety/
                                                                                   nine-member volunteer workgroup of health professionals experienced                   publications/06-04-downloads/09-
June            2004 Culture - Safety - Tool                 ICU toolkit           in leading ICUs and improving patient safety and quality of care.                     icu-toolkit.pdf




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                                                                                         Premier Safety Share



                                                                                                                                                                  IHI
   Month        Year               Topic by Tab                       Tool                                        Description                                    Tool                Location
                                                                                    An institution-wide policy regarding non-punitive reporting, this brochure
                                                                                    reinforces the non-punitive reporting policy and encourages all co-                 http://www.premierinc.com/all/safet
                                                              Living a Culture of   workers to report errors, it was signed by the hospital president and               y/publications/02-04-downloads/10-
 February       2004 Culture - Safety - Tool                  Patient Safety        mailed to all co-worker homes.                                                √     st-john-nonpunitive-brochure.pdf
                                                                                    Improvements in medication list accuracy, allergy list accuracy, and safe
                                                                                    prescription writing practices that were observed by Gundersen
                                                              Ambulatory Patient    Lutheran Medical Center.
December        2003 Culture - Safety - Tool                  Safety - Toolkit                                                                                          http://www.gundluth.org/SCOPE
                                                                                    ―Disclosure of unanticipated events: Creating an effective patient
                                                                                    communication policy," the monograph covers considerations for
                                                                                    developing policies and procedures in specific settings such as acute               http://my.premierinc.com/all/safety/
                                                              Disclosure policy     care, long-term care and pediatric care. It also examines the effect of             publications/12-03-downloads/09-
December        2003 Culture - Safety - Tool                  guide                 disclosure policies on litigation.                                                  disclosure-part2-1-policy.pdf
                                                                                    In a report released by the Institute of Medicine, a panel recommends
                                                                                    work hour limits and other changes to the work environment for nurses
                                                              Keeping Patients      to strengthen patient safety. The panel also noted that regulators and
                                                              Safe: Transforming    healthcare leaders should work to reduce workplace inefficiencies, such
                                                              the Work              as excessive paperwork and documentation, which reduce the time                     Purchase the report online at
                                                              Environment of        nurses have to spend with patients.                                                 http://books.nap.edu/catalog/10851
November        2003 PSS News                                 Nurses                                                                                                    .html?onpi_newsdoc110403
                                                                                                                                                                        http://www.qualityhealthcare.org/Q
                                                                                                                                                                        HC/Topics/PatientSafety/Medicatio
                                                              Safety Climate        Organizations working to develop or improve a culture of safety need a              nSystems/Tools/Safety+Climate+S
July            2003 Culture - Safety - Tool                  Survey Tool           reliable measure to monitor the success of their initiatives.                 √     urvey+(IHI+Tool).htm
                                                              Disclosure of
                                                              Unanticipated         Focus on three aspects of the disclosure process: 1.The initial impact of
                                                              Events: The Next      the Joint Commission for Accreditation of Healthcare Organizations                  http://my.premierinc.com/all/safety/
                                                              Step in Better        (JCAHO) Patient Safety Standards 2.Psychological and legal barriers                 publications/06-
                                                              Communication with    that can impede disclosure, and 3.Successful models used by                         03_downloads/07_disclosure_ASH
June            2003 Culture - Safety - Tool                  Patients              organizations to manage the disclosure process.                                     RM_part1of3.pdf


                                                                                  The Agency for Healthcare Research and Quality (AHRQ) PSIs are a
                                                                                  tool to help health system leaders identify potential adverse events
                                                                                  occurring during hospitalization. They are a set of indicators providing
                                                              AHRQ Patient Safety information on potential in-hospital complications and adverse events                 http://www.qualityindicators.ahrq.go
April           2003 PSS News                                 Indicators          following surgeries, procedures, and childbirth.                                      v/psi_download.htm




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                                                                                           Premier Safety Share



                                                                                                                                                                     IHI
  Month     Year                Topic by Tab                          Tool                                           Description                                    Tool                Location
                                                                                      Senior leaders conduct weekly WalkRounds™ in different areas of the
                                                              Creating a Culture of   hospital, to have informal conversations with front-line staff about safety
                                                              Safety Through          issues and to demonstrate their support of an organizational culture that            http://www.premierinc.com/safety/p
                                                              Executive               promotes nonpunitive reporting of errors, adverse events, near misses,               ublications/03-
March       2003 Culture - Safety - Tool                      WalkRoundsTM            and unsafe conditions                                                                03_downloads/01_b.pdf
                                                                                                                                                                           http://www.premierinc.com/all/safet
                                                              Medication System       A sample medication error reporting form designed to collect and                     y/publications/03-
March       2003 Culture - Safety - Tool                      Analyze-ERRTM           analyze actual and potential medication errors.                                      03_downloads/01_d.pdf

                                                              Checklist/Action Plan
                                                              for the Management                                                                                           http://www.premierinc.com/all/safet
                                                              of High-Alert                                                                                                y/publications/03-
March       2003 Culture - Safety - Tool                      Medications           A checklist/action plan for the safe use of high-alert medications.                    03_downloads/01_g.pdf
                                                              Policy for Non-
                                                              punitive, System-
                                                              based Adverse Drug                                                                                           http://www.premierinc.com/all/safet
                                                              Event Reporting    A sample policy detailing a blame-free adverse drug event reporting                       y/publications/03-
March       2003 Culture - Safety - Tool                      Program            program.                                                                                  03_downloads/01_h.pdf
                                                                                                                                                                           http://www.premierinc.com/all/safet
                                                              Medication Safety       A patient safety tool helping patients understand their rights and                   y/publications/03-
March       2003 Culture - Safety - Tool                      Pledge for Patients     responsibilities regarding safe medication use.                                      03_downloads/01_j.pdf

                                                                                      The video provides step-by-step instructions on how to disclose medical
                                                                                      errors, why disclosure is important, and how open communication can
February    2003 Culture - Safety - Tool                      Let's Talk              strengthen the patient-provider relationship.                                        http://www.npsf.org/
                                                                                  Participating organizations will work to create a system of safety,
                                                              Breakthrough Series including changing organizational culture and attitudes of leadership and
                                                              Collaborative on    front line staff, improving critical core processes, encouraging                         http://www.ihi.org/collaboratives/bre
                                                              Improving Patient   appropriate use of technology, and establishing an effective system for                  akthroughseries/PatientSafety/inde
August      2002 Culture - Safety - Tool                      Safety              measuring harm.                                                                    √     x.asp

                                                              Patient Safety          A job description for a safety officer, an organization-wide safety plan,
                                                              Program Resource        Power Point slides of program elements and key committees, sample
June        2002 Culture - Safety - Tool                      Guide                   grids for documenting interdisciplinary components, and other tools.                 Download at Safety Store.
                                                                                                                                                                           http://my.premierinc.com/all/safety/
                   Patient Safety Topics - Patient safety -   Patient Safety          The intent of the sample Patient Safety Program is to provide tools to               resources/patient_safety/patient_sa
HSOPSC             downloads (*.doc)                          Program                 assist organizations in implementation of a patient safety program.                  fety_downloads.htm




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                                                                                         Premier Safety Share



                                                                                                                                                              IHI
 Month    Year                Topic by Tab                          Tool                                         Description                                 Tool                Location
                                                                                The ED is part of a larger, complex system. Given the complexity of the
                                                                                system, for the thousands of patients treated each day, there are many
                                                                                opportunities for medical errors, as well as opportunities to reduce such           http://www.premierinc.com/all/safet
                                                                                errors. This document includes the recommendations of the Patient                   y/resources/patient_safety/downloa
                 Patient Safety Topics - Patient safety -   ACEP Patient Safety Safety Task Force and the Principles of Patient Care in the Emergency               ds/24_ACEP_patient_safety_progr
HSOPSC           downloads (*.doc)                          Program             Care Environment.                                                                   am.doc

                                                            ECRI Disclosure of      Reviews the JCAHO's disclosure standard, discusses how to develop a             http://www.premierinc.com/all/safet
                 Patient Safety Topics - Patient safety -   unanticipated           disclosure policy and what the policy should address, and analyzes the          y/resources/patient_safety/downloa
HSOPSC           downloads (*.pdf)                          outcomes                impact of the standard on medical malpractice claims.                           ds/disclosure_ecri.pdf



                                                            ASHRM: Perspective
                                                            on Disclosure of    A perspective paper on the disclosure of information involving                      http://www.premierinc.com/all/safet
                 Patient Safety Topics - Patient safety -   Unanticipated       unanticipated outcomes of diagnostic tests, medical treatments, and                 y/resources/patient_safety/downloa
HSOPSC           downloads (*.pdf)                          Outcome Information surgical interventions.                                                             ds/ASHRM_disclosure_05-01.pdf
                                                                                                                                                                    http://www.premierinc.com/all/safet
                                                                                    Provides guidance for minimizing the chance of the occurance of                 y/resources/patient_safety/downloa
                 Patient Safety Topics - Patient safety -   VA Patient Safety       untoward outcomes consequent to medical care. This handbook                     ds/25_VA_patient_safety_handboo
HSOPSC           downloads (*.pdf)                          Handbook                incorporates Root Cause Analysis.                                               k.pdf


                                                            Disclosure: What
                                                            works now & what
                                                            can work even better
                                                            of unanticipated
                                                            events: the next step   ASHRM Monograh addresses the components of effective
                 Patient Safety Topics - Patient safety -   in better               communication of unanticipated outcome, considerations for each of the          http://www.premierinc.com/all/safet
                 sample policies - disclosure resources     communication with      components and the unique perspectives to be taken in various clinical          y/resources/patient_safety/downloa
HSOPSC           and policies                               patients                settings.                                                                       ds/disclosure-part3-02-04.pdf


                                                                                    ASHRM American Society of Healthcare Risk Management: Disclosure
                                                            Disclosure of Medical   of Medical Errors: Demonstrated Strategy to Enhance Communication,
                                                            Errors: Demonstrated    a one-hour video produced by ASHRM, focuses on practical risk                   http://www.ahaonlinestore.com/Pro
                 Patient Safety Topics - Patient safety -   Strategy to Enhance     management strategies to approach disclosure. The video is available            ductDisplay.asp?ProductID=555&c
HSOPSC           Education & training - ASHRM               Communication           for $50 to ASHRM members, $60 to non-members. Catalog #169520.                  artID=163827&PCatID=25
                                                      Strategies for                                                                                                http://www.ihi.org/IHI/Topics/Patien
                                                      Leadership: Hospital                                                                                          tSafety/MedicationSystems/Tools/S
                 Culture - Safety -Tool Adobe;Patient Executives and Their                                                                                          trategiesforLeadershipHospitalExec
                 Safety/Medication Systems/Tools;     Role in Patient                                                                                               utivesandTheirRoleinPatientSafety.
HSOPSC           Under: Culture of Safety             Safety               A compilation of leadership strategies for enhancing patient safety                √     htm




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                                                                                      Premier Safety Share



                                                                                                                                                               IHI
  Month     Year                Topic by Tab                      Tool                                         Description                                    Tool                Location

                                                                                 Walk-throughs enable providers to better understand the experience of               http://www.ihi.org/IHI/Topics/Improv
                                                          Walk-through (IHI      care from the patient’s and family’s points of view — by going through              ement/ImprovementMethods/Tools/
HSOPSC             Patient Safety                         Tool)                  the experience themselves                                                     √     Walk-through.htm


                                                                               The Emergency Preparedness Atlas includes maps showing the
                                                                               location of hospitals and nursing homes in each state, and case studies
                                                                               for six states that show bed capacity and the emergency management
                                                                               and bioterrorism preparedness regions for each facility. The Atlas is
                                                                               intended to help nursing homes plan how they may be used to handle a
                                                                               surge of patients in response to emergency situations; it is not a review
                                                                               of the quality or adequacy of preparedness efforts in any area. The Atlas
                                                                               can help explain the state-specific regulatory environment of nursing
                                                                               homes with respect to surge capacity and illustrate nursing home
                                                                               geographic distribution in the United States. A separate report, "Nursing
                                                          AHRQ – Emergency Homes in Public Health Emergencies – Special Needs and Potential
                                                          prep guide to locate Roles," addresses the role that nursing homes could play in regional
                                                          healthcare sites     preparedness, and is based on focus groups with nursing homes in the                  http://www.ahrq.gov/prep/nursingho
August      2007 Emergency Preparedness                   during disaster      case study states.                                                                    mes/atlas.htm


                                                                                 The Department of Health & Human Services' (HHS) Agency for
                                                                                 Healthcare Research and Quality (AHRQ) has released a DVD titled,
                                                                                 "Cross Training Respiratory Extenders for Medical Emergencies (Project
                                                                                 XTREME)," that trains healthcare professionals who are not respiratory
                                                                                 care specialists to provide basic respiratory care and ventilator
                                                                                 management to adult patients in any mass casualty event. The DVD
                                                                                 includes six training modules with interactive quizzes to test viewers'
                                                                                 knowledge. Meant for physicians, physician assistants, nurses and
                                                                                 others, the modules cover topics such as infection control, respiratory
                                                                                 care terms and definitions, manual ventilation (using hand-held bags),              A free, single copy of the DVD and
                                                          AHRQ DVD –             mechanical ventilation (using the two types of ventilators included in the          a CD-ROM with the report may be
                                                          Training for           federal government's Strategic National Stockpile of medicines and                  ordered by calling 800.358.9295 or
                                                          respiratory care/vents medical supplies for emergencies), airway maintenance, and airway                   by sending an e-mail to
June        2007 Emergency Preparedness                   in disasters           suctioning.                                                                         ahrqpubs@ahrq.hhs.gov.




    Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety Share
                                                                                        Premier Safety Share



                                                                                                                                                              IHI
  Month       Year               Topic by Tab                       Tool                                         Description                                 Tool               Location


                                                                               AHRQ has released a questionnaire that hospitals and other healthcare
                                                                               facilities can use to plan and evaluate their readiness for a public health
                                                                               emergency involving a chemical, biological, radiological, nuclear or
                                                                               explosive event. The 43-question document is divided into eight
                                                                               categories: administration and planning; education and training;
                                                                               communication and notification; patient (surge) capacity; staffing and
                                                            Emergency response support; isolation and decontamination; supplies, pharmaceuticals, and
May           2007 Emergency Preparedness                   planning tool      laboratory support; and surveillance.                                                http://www.ahrq.gov/prep/cbrne/


                                                                                  The CDC has provided advance data from vital and health statistics
                                                                                  demonstrating wide variations in terrorism preparedness training. A               The report and many updates on
                                                            CDC – QuickStats on study by Niska et al., "Training for terrorism-related conditions in                Emergency Preparedness may be
                                                            training ER staff for hospitals: United States, 2003-04; No. 380," used data to determine               downloaded from the Safety
                                                            emergency             which hospital characteristics are associated with providing terrorism            Institute's Emergency
May           2007 Emergency Preparedness                   preparedness          preparedness training to clinical staff.                                          Preparedness Web site.



                                                                              Two courses designed to help hospital personnel implement the
                                                                              National Incident Management System (NIMS) are available from the
                                                                              Federal Emergency Management Agency (FEMA). NIMS was
                                                                              developed so responders from different jurisdictions and disciplines can
                                                                              better collaborate to respond to natural disasters and other
                                                                              emergencies. Course IS-100. HC, "Introduction to the Incident
                                                                              Command System for Healthcare/Hospitals," describes the history,
                                                                              features, principles and organizational structure of ICS. FEMA notes
                                                                              that the course is for hospital personnel who would have a direct role in
                                                                              emergency preparedness, incident management, and/or emergency
                                                                              preparedness. Course IS-200. HC, "Applying ICS to Healthcare                          http://www.training.fema.gov/EMIW
                                                                              Organizations," is designed to enable healthcare personnel to operate                 eb/IS/is100HC.asp;
                                                            FEMA –            efficiently during an incident or event within the ICS and is for personnel           http://www.training.fema.gov/EMIW
                                                            Implementing the  whose primary responsibility is emergency management. FEMA's Web                      eb/IS/is200HC.asp;
                                                            National Incident site has additional information on NIMS implementation activities for                 http://www.fema.gov/emergency/ni
                                                            Management System hospitals. Other professional groups such as the American Society for                 ms/compliance/assist_non_govt.sh
Feb           2007 Emergency Preparedness                   (NIMS)            Healthcare Engineering also offer similar training courses for ICS.                   tm




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                                                                                          Premier Safety Share



                                                                                                                                                                    IHI
   Month        Year               Topic by Tab                       Tool                                          Description                                    Tool                Location


                                                                                     Providing Mass Medical Care with Scarce Resources: A Community
                                                                                     Planning Guide (.pdf) (1.1 MB) is the product of a collaborative effort
                                                                                     between AHRQ and the Office of Public Health Emergency
                                                                                     Preparedness. Experts in the areas of mass casualty care, including pre-
                                                                                     hospital care, hospital and acute care, alternative care sites, palliative
                                                                                     care, ethical issues, and legal considerations, contributed to this guide.
                                                                                     It describes shortages (such as of hospital beds and ambulances)
                                                                                     healthcare workers may face and gives planners specific
                                                                                     recommendations, such as providing off-site care and using taxis,                    http://www.premierinc.com/quality-
                                                              AHRQ emergency         buses, and private cars to transport sick or injured patients. The report            safety/tools-services/safety/safety-
                                                              planning – Mass        provides planning checklists and tips for making wise use of limited                 share/12-06-downloads/08-ahrq-
Dec             2006 Emergency Preparedness                   casualty care guide    medical resources.                                                                   mce-guide.pdf


                                                                                  A Web-based interactive decision tool designed to assist emergency
                                                                                  preparedness and recovery planners is available from the Department of
                                                                                  Health and Human Services. The new tool helps determine how to
                                                                                  access and use health information about various populations such as
                                                              HIPAA Privacy Rule: the elderly and those with disabilities, and is consistent with the Health
                                                              Disclosures for     Insurance Portability and Accountability Act's privacy rule in emergency
                                                              Emergency           preparedness situations. The tool should help planners organize their                   Go to:
                                                              Preparedness - A    activities, and provide useful information to a range of potential                      http://www.hhs.gov/ocr/hipaa/decisi
July            2006 Emergency Preparedness                   Decision Tool       programs.                                                                               ontool/.


                                                                                  The 27-minute training video teaches hospital personnel how to
                                                                                  decontaminate children after being exposed to hazardous chemicals
                                                                                  during a bioterrorist attack or other type of disaster. It reviews strategies,
                                                                                  tools and key preparedness planning issues. The training video is
                                                                                  intended for hospitals and emergency and pediatric professionals
                                                                                  because it explains the unique needs of children versus adults during
                                                              The Decontamination public health emergencies. The video also covers three main areas: a
                                                              of Children:        step-by-step presentation of the decontamination process; a real-time
                                                              Preparedness and    demonstration of the decontamination of children from infancy to                        To obtain a free single copy,
                                                              Response for        adolescence, and; a section for administrators that outlines the steps                  contact the AHRQ Publications
                                                              Hospital Emergency involved in establishing and maintaining a pediatric decontamination                     Clearinghouse at 800.358.9295, or
April           2006 Emergency Preparedness                   Departments         facility in any emergency department.                                                   via email at ahrqpubs@ahrq.gov.




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                                                                                                                                                              IHI
  Month     Year               Topic by Tab                       Tool                                         Description                                   Tool                Location


                                                                                The Joint Commission on Accreditation of Healthcare Organizations
                                                                                (JCAHO) has issued a guide, "Surge Hospitals: Providing Safe Care in
                                                                                Emergencies". A "surge hospital" is designed to treat a surge in the
                                                                                number of patients needing care, triage, treatment, and even surgical
                                                                                interventions. They are temporary facilities, such as shuttered hospitals,
                                                                                closed wards in existing hospitals, and mobile facilities designed to               Go to:
                                                                                serve as a stopgap measure to provide medical care until an area's                  http://www.premierinc.com/all/safet
                                                          Surge Hospitals:      healthcare organizations can reopen. The guide also includes case                   y/resources/disaster_readiness/do
                                                          Providing Safe Care   studies that describe how surge hospitals were established during the               wnloads/surge-hospitals-jcr-12-08-
January     2006 Emergency Preparedness                   in Emergencies        recent hurricanes on the Gulf Coast.                                                05.pdf


                                                                               The Centers for Disease Control and Prevention's (CDC) National
                                                                               Institute for Occupational Safety and Health (NIOSH) has released its
                                                                               2005 NIOSH Pocket Guide to Chemical Hazards. Key general industrial
                                                                               hygiene information is included on several hundred chemicals and
                                                                               substances groups such as cyanides, fluorides, and manganese
                                                                               compounds. The information includes a physical description, exposure
                                                                               limits, substances with which the chemical is incompatible or will react,
                                                                               and recommended personal protection equipment. The booklet also
                                                                               provides information on sanitation measures, first aid procedures,
                                                          NIOSH pocket guide - respirator recommendations, exposure routes and symptoms, target                     http://www.cdc.gov/niosh/npg/defau
December    2005 Emergency Preparedness                   Chemical hazards     organs, and cancer sites.                                                            lt.html
                                                          Mold: Prevention      Mold: Prevention Strategies and Possible Health Effects in the
                                                          Strategies and        Aftermath of Hurricanes Katrina and Rita and a mold table includes
                                                          Possible Health       population specific recommendations for protection from exposure to
                                                          Effects in the        mold in buildings flooded after hurricanes by specific activity and risk
                                                          Aftermath of          factors, as well as information on how to identify and prevent mold-                http://www.premierinc.com/all/safet
                                                          Hurricanes Katrina    related health effects. The documents include recommendations for                   y/resources/disaster_readiness/do
November    2005 Emergency Preparedness                   and Rita              control of mold exposure.                                                           wnloads/2005-mold-report.pdf




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                                                                                      Premier Safety Share



                                                                                                                                                               IHI
  Month     Year               Topic by Tab                       Tool                                         Description                                    Tool                Location




                                                                                                                                                                     http://www.premierinc.com/all/safet
                                                                                                                                                                     y/public-health/downloads/03-
                                                                                                                                                                     reoccupancy-post-hurricane-10-18-
                                                                                 A fact sheet and checklist were recently developed by the Centers for               05.pdf,
                                                                                 Disease Control and Prevention to assist healthcare facilities with the             http://www.premierinc.com/all/safet
                                                                                 tasks involved during clean-up and reopening following extensive water              y/public-health/downloads/02-ic-
                                                                                 damage. "Remediation and Infection Control Considerations for                       checklist-reoccupancy-post-
                                                                                 Reopening Healthcare Facilities Closed due to Extensive Water and                   hurricane-10-18-05.doc, and
                                                                                 Wind Damage" notes that implementation of these measures is meant                   http://www.premierinc.com/all/safet
                                                                                 to be followed in accordance with state and local certification                     y/public-health/downloads/01-ic-
                                                                                 requirements, completion of building and fire inspections, and other                checklist-reoccupancy-post-
November    2005 Emergency Preparedness                   Reopening a facility   relevant state or local regulations.                                                hurricane-10-18-05.pdf


                                                                                 The Joint Commission on Accreditation of Healthcare Organizations
                                                                                 (JCAHO) has issued a step-by-step guide, "Standing Together: An
                                                                                 Emergency Planning Guide for America's Communities," for small, rural
                                                                                 and suburban communities to both prepare for and successfully respond
                                                                                 to major local and regional emergencies such as hurricanes, floods,
                                                          Standing Together:     terrorist attacks, major infectious outbreaks, hazardous materials spills,
                                                          An Emergency           or other catastrophic occurrences. This comprehensive planning guide
                                                          Planning Guide for     provides 13 essential steps that local government and public health                 http://www.premierinc.com/all/safet
                                                          America's              leaders can use to establish an effective community-based emergency                 y/publications/10-05-downloads/10-
October     2005 Emergency Preparedness                   Communities            management planning and response process.                                           emergency-planning-guide.pdf




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                                                                                                                                                                IHI
  Month     Year               Topic by Tab                       Tool                                         Description                                     Tool                Location




                                                                                A recently released Archives of Internal Medicine article describes
                                                                                improvements in a physician's ability to diagnose and manage diseases
                                                                                caused by bioterrorism agents. Such improvements were documented
                                                                                after the completion of an online pre-test that assessed physicians'
                                                                                baseline knowledge and ability to diagnose and manage potential cases
                                                                                of smallpox, anthrax, botulism, and plague. An educational module
                                                                                following the pre-test reviewed diagnosis and decision-making for
                                                                                patients presenting with anthrax, botulism, plague, smallpox, or a
                                                                                common disorder that has clinical overlap with these diseases. The
                                                                                educational module was followed by a post-test, which measured the
                                                                                module's effectiveness. Extra cases were presented to the physicians                  The bioterrorism-education module
                                                                                between the pre- and post-tests on each of the four potential                         is available for registered users on
                                                          Educational module    bioterrorism agents. Improvement in results led the study's authors to                the Johns Hopkins Medicine's
                                                          for physicians –      conclude that the online education module may improve physician's                     Internet Learning Center at:
October     2005 Emergency Preparedness                   Bioterrorism agents   diagnosis and management of diseases caused by these agents.                          http://www.hopkinsilc.org.

                                                          Premier Safety
                                                          Institute's Emergency The Premier Safety Institute's Emergency and Public Health
                                                          and Public Health     Preparedness page also contains relevant and timely news and                          http://www.premierinc.com/all/safet
September   2005 Emergency Preparedness                   Preparedness          resources related to the disaster.                                                    y/public-health/
                                                                               During clean up and recovery operations following hurricanes, OSHA
                                                                               issues alerts on the dangers associated with cleanup and recovery from                 http://www.osha.gov/OshDoc/hurric
September   2005 Emergency Preparedness                   Keeping workers safe hurricanes.                                                                            aneRecovery.html
                                                                                Increased incidence of acute diarrhea may occur in post-disaster
                                                          Acute diarrhea -      situations where access to electricity, clean water, and sanitary facilities          http://www.premierinc.com/all/safet
                                                          guidelines for        are limited. In addition, usual hygiene practices may be disrupted and                y/publications/09-05-downloads/14-
September   2005 Emergency Preparedness                   management            healthcare seeking behaviors may be altered.                                          guide-acute-diarrhea.pdf

                                                                                Food may not be safe to eat during and after a natural disaster or power              http://www.premierinc.com/all/safet
                                                                                outage. Safe water guidelines provide guidance for using bottled, boiled,             y/publications/09-05-downloads/13-
September   2005 Emergency Preparedness                   Safe food and water   or treated water for drinking, cooking, and personal hygiene.                         food-water-safety.pdf
                                                                                Information on water supply disruptions excerpted from the CDC
                                                                                Guidelines for Environmental Infection Control in Health-Care Facilities,             http://www.premierinc.com/all/safet
                                                                                2003 - Recommendations of CDC and the Healthcare Infection Control                    y/publications/09-05-downloads/12-
September   2005 Emergency Preparedness                   Water system repair   Advisory Committee (HICPAC).                                                          water-system-repair.pdf




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                                                                                                                                                                  IHI
  Month     Year              Topic by Tab                       Tool                                            Description                                     Tool                Location


                                                                                 Community shelters provide housing for persons displaced from their
                                                                                 homes following natural disasters such as hurricanes, floods, and
                                                                                 earthquakes. In these settings, individuals share living space. Some
                                                                                 individuals may have health problems, including acute or chronic
                                                         Community shelter       infectious diseases. These recommendations provide basic infection                     http://www.premierinc.com/all/safet
                                                         guidance following      control information that will help to prevent exposure to or transmission              y/publications/09-05-downloads/11-
September   2005 Emergency Preparedness                  disasters               of infectious agents.                                                                  community-shelters.pdf


                                                                              Immunization recommendations (.pdf) (85 KB) are available for
                                                                              individuals displaced by Hurricane Katrina. Although measles and
                                                                              rubella are no longer endemic to the United States, introductions do
                                                                              occur, and crowded conditions may facilitate their spread. Although
                                                                              Hepatitis A incidence is low in the affected areas, post-exposure
                                                                              prophylaxis in these settings would be logistically difficult. Consequently,
                                                                              vaccination is recommended. In addition, the influenza season will begin                  http://www.premierinc.com/all/safet
                                                         Interim immunization soon and influenza can spread easily under crowded conditions. Interim                    y/publications/09-05-downloads/09-
September   2005 Emergency Preparedness                  after hurricane      recommendations are provided.                                                             cdc-advisory-interim-immun.pdf



                                                                                                                                                                        http://www.premierinc.com/all/safet
                                                                              After an emergency, it can be difficult to find running water. However, it                y/publications/09-05-downloads/06-
                                                                              is still important to wash your hands (.pdf) (75 KB) to avoid illness. It is              handwashing-emergencies.pdf and
                                                                              best to wash your hands with soap and water but when water isn't                          http://www.premierinc.com/all/safet
                                                         Hand hygiene in      available, you can use alcohol-based products (.pdf) (34 KB) made for                     y/publications/09-05-downloads/21-
September   2005 Emergency Preparedness                  emergency situations washing hands.                                                                            clean-hands-cards.pdf


                                                                                 This summary addresses preventing electrocutions associated with
                                                                                 generators plugged into household circuits. Homeowners should not
                                                                                 attempt to install any generator that requires hard-wiring into an existing            http://www.premierinc.com/all/safet
                                                         Electrical safety and   electrical circuit or that requires a trained, qualified electrician to hard-          y/publications/09-05-downloads/05-
September   2005 Emergency Preparedness                  generators              wire any generator into a household circuit.                                           electrical-safety.pdf


                                                                                 After a natural disaster, snakes may have been forced from their natural
                                                                                 habitats and move into areas where they would not normally be seen or
                                                                                 expected. When you return to your home, be cautious of snakes that                     http://www.premierinc.com/all/safet
                                                         Snake bite - How to     may have sought shelter in your home. If you see a snake in your home,                 y/publications/09-05-downloads/08-
September   2005 Emergency Preparedness                  prevent or respond      immediately call the animal control agency in your county.                             snake-bite.pdf




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                                                                                                                                                                   IHI
  Month     Year               Topic by Tab                       Tool                                           Description                                      Tool                Location


                                                          Animal disposal        Most states have guidelines on disposal of dead animals so people with                  http://www.premierinc.com/all/safet
                                                          following an           questions regarding the specific situation in their state are encouraged                y/publications/09-05-downloads/07-
September   2005 Emergency Preparedness                   emergency              to contact local or state health and agricultural officials for clarification.          animal-disposal.pdf


                                                                                 ASHE's Hurricane Relief Resources provides a link to the University of
                                                                                 Minnesota, "Managing Water Infiltration into Buildings: A Systematized                  See also CDC's "Healthcare Water
                                                                                 Approach for Remediating Water Problems in Buildings due to Floods,                     System Repair" at
                                                                                 Roof Leaks, Potable Water Leaks, Sewage Backup, Steam Leaks and                         http://www.dehs.umn.edu/iaq/flood.
September   2005 Emergency Preparedness                   Flood remediation      Groundwater Infiltration."                                                              html.




                                                                                                                                                                         The information is available at
                                                                                                                                                                         http://www.ahrq.gov/research/shutt
                                                                                The new report from the Agency for Healthcare Research and Quality                       ered/. Related: Use of shuttered
                                                                                (AHRQ) entitled "Use of Former (Shuttered) Hospitals to Expand Surge                     hospitals report
                                                                                Capacity" that gives emergency responders and public health officials                    http://www.premierinc.com/all/safet
                                                                                useful, practical tools for opening shuttered hospitals when an                          y/publications/09-05-downloads/02-
                                                                                emergency is underway. The information is available at                                   ahrq-shutreport.pdf, Tool kit to
                                                                                http://www.ahrq.gov/research/shuttered/. The report gives surrounding                    open a facility
                                                                                communities that aren't immediately affected by the hurricane a way to                   http://www.premierinc.com/all/safet
                                                                                assess their existing facilities to meet future needs. It includes lists of              y/publications/09-05-downloads/03-
                                                                                supplies and medications needed by stable medical/surgical patients                      ahrq-toolkit.pdf, and Checklist to
                                                          Use of Former         and checklists to assess facility readiness, staffing needs and levels,                  open a facility found at
                                                          (Shuttered) Hospitals and patient transport readiness. The report also contains a tool kit with a              http://www.premierinc.com/all/safet
                                                          to Expand Surge       list of supplies and equipment needed for operation of a reopened                        y/publications/09-05-downloads/04-
September   2005 Emergency Preparedness                   Capacity              facility.                                                                                ahrq-checklist.pdf.


                                                                                 Although terrorists use a variety of methods to inflict harm and create
                                                                                 fear, bombs are used most frequently. According to the FBI, bombings
                                                                                 accounted for nearly 70 percent of all terrorist attacks in the United
                                                                                 States and its territories between 1980 and 2001. This practical
                                                                                 summary focuses on common sense principles that will be useful in a
                                                                                 bombing event. It describes how every person, family or organization
                                                                                 should prepare for an emergency or disaster, including knowledge of
                                                                                 work, school and community disaster plans. If you are not familiar with
                                                                                 the plans, contact your supervisor, school administrators, or your local
                                                          Preparing for a        fire department for more information. This document details what
August      2005 Emergency Preparedness                   terrorist bombing      should be done if a bomber is suspected.                                                This CDC document can be downloaded at http:




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                                                                                                                                                                 IHI
  Month     Year               Topic by Tab                        Tool                                          Description                                    Tool                Location

                                                                                 The Occupational Safety and Health Administration (OSHA) has
                                                                                 released a best practices document (.pdf) (1.9 MB) for hospital-based
                                                                                 first receivers of victims of chemical, biological, and radiological events.
                                                                                 The "Hospital-Based First Receivers of Victims from Mass Casualty
                                                                                 Incidents Involving the Release of Hazardous Substances" document
                                                                                 will assist hospitals in developing and implementing emergency
                                                                                 management plans that address the protection of emergency
                                                                                 department personnel, while receiving contaminated victims from mass
                                                          OSHA 'best practice' casualty incidents. It also includes information on victim                              http://www.premierinc.com/all/safet
                                                          guidance for hospital- decontamination, personal protective equipment (PPE), and employee                    y/publications/01-05-downloads/08-
January     2005 Emergency Preparedness                   based first receivers training                                                                               first-receivers-hosp.pdf


                                                                                   The Department of Homeland Security has released a new National
                                                                                   Response Plan. The Department of Health and Human Services will
                                                                                   lead the federal government in providing public health and medical
                                                                                   services during major disasters and emergencies. The National                       The Plan can be downloaded at:
                                                          National Response        Response Plan establishes a comprehensive all-hazards approach to                   http://www.dhs.gov/dhspublic/intera
January     2005 Emergency Preparedness                   Plan                     enhance the ability of the United States to manage domestic incidents.              pp/
                                                                                                                                                                       To register: Go to:
                                                          Clinician Registry for                                                                                       www.bt.cdc.gov/coca and follow the
                                                          Terrorism and                                                                                                links to ―Clinician Resources‖ and
                                                          Emergency                The registry provides real-time information to help healthcare providers            ―Registry.‖ The direct registration
                                                          Response Updates         prepare for (and possibly respond to) emerging diseases and terrorism               link is:
                                                          and Training             events. CDC also uses the registry to announce new clinician training               http://www.bt.cdc.gov/clinregistry/in
October     2004 Emergency Preparedness                   Opportunities            opportunities related to terrorism and emergency response topics.                   dex.asp.

                                                                                                                                                                       http://my.premierinc.com/all/safety/
                                                          Minnesota's surge                                                                                            publications/08-04-downloads/08-
August      2004   Emergency Preparedness                 capacity plan            Minnesota's surge capacity plan                                                     surge-amacdc-email.ppt

                                                          Healthcare Facility      A study conducted by several disaster medicine experts on strategies to             The plan is available from the
                                                          and Community            manage patient surges in healthcare facilities following a biological or            Annals of Emergency Medicine
                                                          Strategies for Patient   chemical terrorist attack, provides sample response plans for                       (contact Colleen Hughes at
August      2004   Emergency Preparedness                 Care Surge Capacity      communities in Colorado, Massachusetts, Minnesota, and Virginia.                    202.728.0610, Ext. 3010).
                                                                                   The tool helps regional planners locate and rank potential alternative              To view the full report and tool, go
                                                                                   sites such as stadiums, schools and recreation centers based on                     to:
                                                          Surge capacity           whether they have adequate ventilation, plumbing, food supply, kitchen              http://www.ahrq.gov/research/altsit
August      2004   Emergency Preparedness                 planning                 facilities and other factors.                                                       es.htm.




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                                                                                                                                                                       IHI
  Month        Year               Topic by Tab                       Tool                                             Description                                     Tool                Location


                                                                                      The Centers for Disease Control and Prevention (CDC) has established
                                                                                      partnerships with national clinician organizations for the purpose of
                                                                                      disseminating timely information on disease outbreaks and terrorism
                                                                                      events. COCA's Web site was successfully launched July 20. The site
                                                             Clinician Outreach       offers many resources for COCA members, including past COCA
                                                             and Communication        conference call summaries and slides, listings of COCA members,                        Visit the COCA Web site at
August         2004   Emergency Preparedness                 Activity (COCA)          information on future conference calls and training updates.                           www.bt.cdc.gov/coca/index.asp.

                                                                                      The Centers for Disease Control and Prevention has a Web-based                         The module can be completed at
                                                             Plague training          module designed to teach the natural epidemiology of plague and how                    http://www.bt.cdc.gov/agent/plague
July           2004   Emergency Preparedness                 module                   to manage it as both a natural disease and an intentional attack.                      /trainingmodule/.
                                                                                                                                                                             The full report, Evidence
                                                                                                                                                                             Report/Technology Assessment
                                                                                                                                                                             No. 95, Training of Hospital Staff to
                                                             Training of Clinicians   This evidence report updates the evidence report "Training of Clinicians               Respond to a Mass Casualty
                                                             for Public Health        for Public Health Events Relevant to Bioterrorism Preparedness" and                    Incident, may be obtained free from
                                                             Events Relevant to       focuses on the effectiveness of hospital disaster drills, computer                     the AHRQ Publications
                                                             Bioterrorism             simulations, and tabletop or other exercises used in training hospital                 Clearinghouse by calling
June            2004 Emergency Preparedness                  Preparedness             staff to respond to a mass casualty incident.                                          800.358.9295.

                                                                                      The tool, developed by the Evidence-based Practice Center at the
                                                                                      Johns Hopkins University, helps hospitals identify their strengths and
                                                                                      weaknesses during a disaster drill and improve their ability to meet
                                                                                      required emergency management plans. Areas assessed include pre-
                                                                                      drill planning, incident command, decontamination, triage and treatment.
                                                             Evaluation of            The tool also includes checklists to help hospitals tailor drills to specific
                                                             Hospital Disaster        health threats, such as a biological or radiation incidents, and a
                                                             Drills: A Module-        spreadsheet to track and compare drill performance among hospital
June           2004   Emergency Preparedness                 Based Approach           units or hospitals.


                                                                                The plan calls for specialized response teams, an emergency
                                                                                preparedness executive steering committee, and regional emergency
                                                                                response plans during a national emergency. The agency recently
                                                                                published its National Emergency Management Plan that details the
                                                                                agency's roles and responsibilities during responses to national
                                                             National Emergency emergencies and outlines procedures to ensure assistance is in place                         http://www.osha.gov/SLTC/emerge
March          2004 Emergency Preparedness                   Management Plan    for responder and recovery workers' health and safety.                                       ncypreparedness/index.html




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                                                                                                                                                                IHI
  Month        Year               Topic by Tab                       Tool                                         Description                                  Tool                Location


                                                                                  The report, HHS bioterrorism preparedness programs: States reported
                                                                                  progress but fell short of program goals for 2002, examines the extent to
                                                                                  which states completed 2002 cooperative agreement requirements and
                                                                                  whether they identified any factors that hindered implementation of the       http://www.premierinc.com/all/safet
                                                                                  Centers for Control and Prevention (CDC) and Health Resources and             y/publications/03-04-downloads/04-
March           2004 Emergency Preparedness                                       Services programs: States reported progress agreement of program
                                                             HHS bioterrorism preparedness Administration’s (HRSA) cooperativebut fell shortprograms. goals for 2002
                                                                                                                                                                d04360r.pdf
                                                                                                                                                                      An Excel program version (1.4 MB)
                                                             Computer staffing    A new computer model is available to help hospitals and health systems              may be downloaded from:
                                                             model - Bioterrorism plan antibiotic dispensing and vaccination campaigns to respond to                  http://www.ahrq.gov/research/biom
July           2003 Emergency Preparedness                   Response             bioterrorism or large-scale natural disease outbreaks.                              odel.htm.
                                                                                                                                                                      The Evacuation Planning Matrix,
                                                                                                                                                                      available at
                                                             Evacuation Planning                                                                                      http://www.osha.gov/dep/evacmatri
June           2003 Emergency Preparedness                   Matrix              Online tool to help employers with emergency planning.                               x/index.html


                                                             Guidance for
                                                             Protecting Building
                                                             Environments from      A new federal guidance is now available to help facility specialists in           http://my.premierinc.com/all/safety/
                                                             Airborne Chemical,     business and government strategically select and use air-filtration and           publications/06-
                                                             Biological, or         air-cleaning systems for protecting occupants in buildings from                   03_downloads/08_NIOSH_2003-
June           2003 Emergency Preparedness                   Radiological Attacks   chemical, biological, or radiological attacks.                                    136.pdf
                                                             Disaster
                                                             Preparedness and
                                                             Response in Texas                                                                                        http://www.healthpolicyinstitute.org/
                                                             Hospitals: Part I,                                                                                       projects/disaster_response/dis_res
May            2003 Emergency Preparedness                   Bioterrorism           A bioterrorism disaster preparedness guide for hospitals.                         p.asp

                                                                                Information on agents likely to be used in a chemical terrorist attack.
                                                                                This resource highlights agent-specific identification, medical symptoms,
                                                             Emergency          personal protective equipment, and decontamination considerations for                 http://www.cdc.gov/niosh/topics/em
May            2003 Emergency Preparedness                   Response Resources responding to events involving cyanide, sarin, and nitrogen mustard.                  res/chemagent.html
                                                                                    Disaster drills are most effective when designed by an interdisciplinary
                                                                                    team that clearly establishes goals before the drill begins. A
                                                             Planning and           teleconference on disaster drills and readiness assessment asserts that           http://www.hsrnet.net/ahrq-
                                                             executing disaster     the drills should also include a plan to evaluate whether the goals were          ulp/bioterrorism/events/0415/materi
May            2003 Emergency Preparedness                   drills                 reached.                                                                          als.htm




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                                                                                                                                                                    IHI
   Month        Year               Topic by Tab                        Tool                                           Description                                  Tool                Location
                                                              Addressing the
                                                              Smallpox Threat:                                                                                            http://www.hsrnet.net/ahrq-
                                                              Issues, Strategies,      Copies of a 90-minute audiotape may be purchased for $10 from the                  ulp/bioterrorism/events/0218/materi
May             2003 Emergency Preparedness                   and Tools                AHRQ Publications Clearinghouse                                                    als.htm



                                                              Clinician Registry for
                                                              E-mail Updates on        Clinician's registry to provide real-time information to help prepare for
                                                              Terrorism and            and respond to terrorism and emergency situations. As participants,
                                                              Emergency                physicians will receive regular updates on terrorism and emergency
April           2003 Emergency Preparedness                   Response                 response issues targeted to clinicians.                                            http://www.bt.cdc.gov/

                                                              Smallpox Vaccine     A guide addressing legal and risk management issues for hospitals                      http://biotech.law.lsu.edu/blaw/bt/s
March           2003 Emergency Preparedness                   Injury and Law Guide related to the smallpox vaccine.                                                       mallpox/svlaw.htm
                                                              Risk Management
                                                              Guidance for Health,
                                                              Safety and
                                                              Environmental            The report covers several issues related to infrastructure and
                                                              Security under           environmental risks during disaster events, including food, mail, and              http://my.premierinc.com/all/safety/
                                                              Extraordinary            personnel security and safety; transportation; childcare; and building             publications/03-
March           2003 Emergency Preparedness                   Incidents                access                                                                             03_downloads/11_extraordinary.pdf



                                                                                       The chart presents a concise summary of signs and symptoms to assist
                                                              Chemical terrorism       with early recognition, as well as to alert healthcare workers about the
February        2003 Emergency Preparedness                   agents                   potential for chemical terrorism agents.                                           http://www.unc.edu/depts/spice/
                                                                                   The program provides basic information required to implement a
                                                              Bioterrorism Update: smallpox vaccination preparedness program. Presented in a series of
                                                              Smallpox             modules, it is directed at state and local health department and clinical              http://bookstore.phf.org/prod250.ht
February        2003 Emergency Preparedness                   Preparedness         personnel.                                                                             m



                                                                                                                                                                          http://my.premierinc.com/all/safety/
                                                              Vaccine Information      The smallpox VIS must be used with a separate consent form that                    publications/01-
January         2003 Emergency Preparedness                   Statement (VIS)          requires a signature.                                                              03_downloads/11_small02.pdf



                                                                                       This comprehensive module addresses the vaccine, methods of
                                                              Smallpox training        inoculation, prevention of contact transmission, laboratory testing and
December        2002 Emergency Preparedness                   module                   use of vaccinia immunoglobulins (VIGs).                                            http://www.bt.cdc.gov/




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                                                                                                                                                            IHI
  Month     Year               Topic by Tab                       Tool                                          Description                                Tool                Location


                                                                               More than 70 metropolitan hospital executives heard how hospitals near
                                                                               "Ground Zero" in lower Manhattan and the Pentagon responded to the
                                                          National Symposium immediate tragedies of September 11, 2001, as well as strategies                     http://www.hospitalconnect.com/ah
                                                          on Hospital Disaster related to ongoing disaster readiness preparations against possible                a/key_issues/disaster_readiness/E
December    2002 Emergency Preparedness                   Readiness            future biological, and chemical, and natural disasters.                            mWhatsNew.html
                                                                                                                                                                  Go to
                                                          Emergency                                                                                               http://www.premierinc.com/all/safet
                                                          preparedness           On-line catalogs provide emergency preparedness supplies available               y/resources/disaster_readiness/pro
November    2002 Emergency Preparedness                   materials              from several companies                                                           d_equip.htm.




                                                          AHRQ's Bioterrorism
                                                          Emergency Planning                                                                                      http://my.premierinc.com/all/safety/
                                                          and Preparedness      Biological weapons training for personnel, procedures to permit rapid             publications/09-
                                                          Questionnaire for     recognition of credentialed staff from other facilities, on-call nursing          02_downloads/11_AHRQ_bioterror
October     2002 Emergency Preparedness                   Healthcare Facilities policies, and designated areas of emergency overflow for patients                 _checklist.pdf

                                                          Disaster kit — Tools
                                                          to meet children’s     To aid pediatricians, community leaders, parents, and others in
October     2002 Emergency Preparedness                   needs                  preparing for and meeting children's needs during a disaster.                    http://www.aap.org/terrorism/
                                                          Preparing for
                                                          Terrorism: Tools for
                                                          Evaluating the         A set of measurement tools and a process for evaluating the extent to
                                                          Metropolitan Medical   which communities have implemented the disaster preparedness plans
                                                          Response System        required by the Department of Health and Human Services’ Metropolitan            http://www.nap.edu/catalog/10412.
August      2002 Emergency Preparedness                   Program                Medical Response System program.                                                 html


                                                          Guidance for
                                                          Protecting Building
                                                          Environments from                                                                                       http://my.premierinc.com/all/safety/
                                                          Airborne Chemical,   The guidelines address the physical security of ventilation systems,               publications/06-
                                                          Biological, or       airflow and filtration, systems maintenance, program administration, and           02_downloads/05_36_2002_niosh_
June        2002 Emergency Preparedness                   Radiological Attacks maintenance staff training.                                                        ventilation_139.pdf




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                                                                                                                                                                   IHI
  Month       Year               Topic by Tab                       Tool                                           Description                                    Tool                Location
                                                                                     Resources on bioterrorism – including an evidence report on training
                                                            Training of Clinicians   clinicians, a summary of a workshop on strengthening the nation's
                                                            for Public Health        response capabilities, the results of a survey noting the gaps and
                                                            Events Relevant to       resources needed by local public health agencies to respond effectively
                                                            Bioterrorism             to bioterrorism, and a report from ECRI on personal protective
May           2002 Emergency Preparedness                   Preparedness             equipment.                                                                          http://www.ahrq.gov/

                                                                                A training course originally developed by the World Health Organization
                                                                                and Centers for Disease Control and Prevention for training smallpox                     Order at
                                                                                response teams, these presentations help planners and first responders                   http://www.bt.cdc.gov/agent/smallp
January       2004 Emergency Preparedness                   CDC Training Slides prepare for the possibility of the use of smallpox as a terrorist weapon.                ox/training/overview/index.asp
                                                                                     OSHA has a Web-based training tool on implementing an incident
                                                                                     command system as part of emergency response preparedness. The
                                                            Incident command         toolprovides guidance on planning for an incident command system and                http://www.osha.gov/SLTC/etools/ic
December      2003 Emergency Preparedness                   syatem                   addresses applicable OSHA standards.                                                s/index.html
                                                                                                                                                                         http://www.premierinc.com/all/safet
                                                                                                                                                                         y/publications/11-03-downloads/09-
                                                            Recognizing                                                                                                  illness-associated-exposure-chem-
                                                            chemical agent                                                                                               agents.doc
November      2003   Emergency Preparedness                 exposure
                                                                                   A health information bulletin, provides recommendations on preventing                 http://www.osha.gov/dts/shib/shib1
                                                            Brief Guide to Mold in mold growth, proper use of personal protective equipment, and safe                    01003.html
November      2003   Emergency Preparedness                 the Workplace          cleanup methods.
                                                                                   A matrix tool, provides information on how facilities can reduce
                                                            Fire and Explosion     vulnerability to and consequences of a terrorist attack that involves fire            http://www.osha.gov/dep/fire-
November      2003   Emergency Preparedness                 Planning Matrix        or an explosive device.                                                               expmatrix/index.html.
                                                                                  The Pink Book – ―Epidemiology and Prevention of Vaccine Preventable
                                                            Epidemiology and      Diseases,‖ the 7th edition from 2002, is now in its second printing.                   The book is available for download
                                                            Prevention of                                                                                                or purchase at
                                                            Vaccine Preventable                                                                                          http://www.cdc.gov/nip/publications
October       2003   Emergency Preparedness                 Diseases                                                                                                     /pink/default.htm
                                                                                  Provides employers with information on helping to protect workers from
                                                                                  injuries and illnesses resulting from possible terrorist incidents related to
                                                            Chemical, Biological, chemical, biological, radiological, or nuclear attacks.
                                                            Radiological, and
                                                            Nuclear (CBRN)                                                                                               http://www.osha.gov/dts/shib/revCB
                                                            Warfare Agents                                                                                               RN_EscapeRespirators_8-29-
October       2003   Emergency Preparedness                 Escape Respirators                                                                                           03.html




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                                                                                                                                                                IHI
  Month       Year               Topic by Tab                        Tool                                         Description                                  Tool                Location


                                                                                 The Food and Drug Administration joined with the CDC, the EPA and
                                                                                 OSHA in releasing guidelines on how to prevent hazards due to
                                                                                 inappropriate use of cleaners and disinfectants on electronic medical
                                                                                 equipment. Such solutions can cause the equipment to malfunction.
                                                                                 Many stakeholders, including AHA, APIC, and ASHE, provided input to
                                                                                 the guidelines for handling and cleaning of electronic medical devices.
                                                                                 Minimizing the potential for cross contamination and patient and worker              http://www.premierinc.com/quality-
                                                            FDA guidance –       injuries is critical, but of equal importance is the emphasis on the                 safety/tools-services/safety/safety-
                                                            Electronic equipment process of proper cleaning and disinfecting in accordance with                       share/12-07-downloads/5_FDA-
December      2007   Environmental and Safety Products      cleaning hazards     manufacturers’ guidelines in the interest of safety                                  Equipment-10_31_07.doc

                                                                                    The newsletter provides news and success stories about topics such as
                                                                                    reduction of medical waste, computer recycling, green cleaning
                                                                                    programs, conversion to reusable products, laboratory chemical
                                                                                    recycling, energy efficient lighting and light bulb recycling. Premier's
                                                                                    EPP program is a collaboration of the Premier Safety Institute and
                                                                                    Premier's group purchasing services. The program is part of Premier's
                                                                                    commitment to helping healthcare facilities with their environmental
                                                                                    efforts, including waste minimization and the elimination of the use of           Go to:
March         2006 Environmental and Safety Products        Green Link              mercury.                                                                          http://www.premierinc.com/safety



                                                                                    The Clinician Outreach and Communication Activity (COCA) offered a
                                                                                    program in Medical Waste Management on August 23, 2005. Lynne
                                                                                    Sehulster, Ph.D, M(ASCP), of the Centers for Disease Control and
                                                                                    Prevention (CDC) Division of Healthcare Quality Promotion presented
                                                                                    materials addressing: identification of general categories of medical
                                                                                    waste; regulations governing the management of medical waste; insight
                                                            Medical waste           into how the recent influenza A (H2N2) situation revealed weaknesses in           http://www.premierinc.com/all/safet
                                                            management              the current system of waste management; and understanding the                     y/publications/10-05-downloads/09-
October       2005 Environmental and Safety Products        teleconference          importance of reinstating on-site capacity for medical waste treatment.              waste-management-slides.ppt


                                                                                    The American Society for Healthcare Environmental Services has
                                                                                    partnered with Orkin, Inc. to promote more effective and environmentally
                                                                                    friendly pest-control practices in healthcare settings, including the
                                                                                    release of a guide on integrated pest management. The partners also               See Premier Safety Institute's
                                                                                    plan to publish educational articles and host two educational sessions            Environmental and Safety Product
                                                            Environmentally         on the recommended practice at ASHES' annual conference in                        list at:
                                                            friendly pest control   September. The partnership was launched in response to a growing                  http://www.premierinc.com/all/safet
May           2005   Environmental and Safety Products      practices               movement in healthcare toward hazardous-chemical reduction.                       y/resources/lists/




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                                                                                                                                                               IHI
   Month        Year               Topic by Tab                       Tool                                        Description                                 Tool                Location


                                                                                     Two new handbooks are available online from Occupational Safety and
                                                                                     Health Administration (OSHA): "Best Practices for the Safe Use of
                                                                                     Glutaraldehyde in Health Care," which helps employers and employees
                                                                                     understand and control exposures to glutaraldehyde, a chemical used to          Go to:
                                                                                     disinfect and clean heat-sensitive medical, surgical and dental                 http://www.osha.gov/Publications/gl
                                                                                     equipment, and "Preventing Mold-Related Problems in the Indoor                  utaraldehyde.pdf and
                                                              OSHA online            Workplace," which offers recommendations to owners, managers, and               http://www.osha.gov/Publications/p
May             2006   Environmentally Preferred Purchasing   handbooks              occupants on how to fix mold problems in buildings                              reventing_mold.pdf


                                                              nvironmentally       A four-CD set containing all the presentations from "Environmentally              Order free copies of the book and
                                                              Preferable           Preferable Purchasing and Healthcare Practices Conference" held in                CDs from the Premier Safety Store
                                                              Purchasing and       Boston, April 29, 2004. Topics include green buildings, mercury                   at:
                                                              Healthcare Practices elimination, recycling medical waste processing, solvent recovery, and            http://www.premierinc.com/all/safet
December        2004   Environmentally Preferred Purchasing   Conference           more.                                                                             y/store/.
                                                                                   An online resource that aids employers in addressing air quality                  http://www.cdc.gov/niosh/topics/ind
                                                                                   concerns. The Indoor Environmental Quality topic page provides links to           oorenv
                                                                                   a variety of air quality topics, including how to identify, correct, and
                                                                                   prevent indoor air problems; how to implement an effective air quality
                                                              Indoor Environmental plan; and resources on mold, asbestos, asthma and allergies, and
November        2003   Environmentally Preferred Purchasing   Quality topic page   chemical safety.

                                                                                     Premier's Safety Institute has added one more important section to the
                                                                                     Environmental Preferable Purchasing (EPP) module addressing
                                                              Environmental          chemical cleaners and pesticides. The EPP "Topic summary" describes
                                                              Preferable             a number of important and useful resources. "Key documents" includes
                                                              Purchasing (EPP)       a case study of a safer, successful integrated pest management                  http://www.premierinc.com/all/safet
September       2004 Environmentally Preferred Purchasing     module                 program.                                                                        y/resources/EPP/index.htm

                                                              Cleaning for Health:                                                                                   http://my.premierinc.com/all/safety/
                                                              Products and          One-stop guide to environmentally preferable cleaning products and               publications/04-
                                                              Practices for a Safer methods that have been effectively used in office buildings, schools,            03_downloads/04_cleaning_for_he
April           2003 Environmentally Preferred Purchasing     Indoor Environment hospitals and other facilities in the United States and Canada.                     alth.pdf

                                                              Environmentally      A checklist is available which can be used by healthcare organizations
                                                              preferred purchasing to guide purchasing decisions or by manufacturers to assess the                   http://www.ahrmm.org/info/HCEPT/
October         2002 Environmentally Preferred Purchasing     checklist            environmental friendliness of products.                                           tool.html




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                                                                                                                                                                     IHI
  Month       Year               Topic by Tab                        Tool                                           Description                                     Tool                Location


                                                                                                                                                                           The handbook is available for a
                                                                              The most current knowledge on concepts and methods of human                                  discounted price of $95 at
                                                                              factors and ergonomics and their applications to help improve quality,                       http://www.erlbaum.com/ME2/dirm
                                                                              safety, efficiency, and effectiveness in patient care. The handbook                          od.asp?sid=28807ECF50FE49F08
                                                                              provides specific information on how to analyze medical errors with the                      37125BE640E681F&nm=&type=eC
                                                            Handbook of Human fundamental goal of reducing errors and the potential harm that results.                     ommerce&mod=CommerceProduct
                                                            Factors and       Contributors discuss the design of work environment and working                              Catalog&mid=CD22EA0F118949C
                                                            Ergonomics in     conditions to improve satisfaction and well being, and the reduction of                      09A932248C040F650&tier=3&id=1
                                                            Healthcare and    burnout and other ailments often experienced by healthcare providers                         19DCAD843B64A54BC20DE1F72
Nov           2006 Fall Prevention                          Patient Safety    and professionals.                                                                           531996&itemid=0-8058-4885-1
                                                                                The draft document titled "Safe Patient Handling and Movement
                                                                                Principles," a collaboration between NIOSH, the American Nurses                            Available at the NIOSH Web site
                                                            Safe Patient        Association and the Veterans Affairs Patient Safety Center, is a new                       at:
                                                            Handling and        Safe Patient Handling and Movement curriculum module to be used in                         http://www.cdc.gov/niosh/review/pu
June          2006 Fall Prevention                          Movement Principles schools of nursing.                                                                        blic/safe-patient


                                                                                      Minimizing the risk of falls and falls injuries: Guidelines for acute, sub-
                                                                                      acute and residential care settings from the Victorian Quality Council of
                                                                                      Australia provides a framework and supporting resources to support falls
                                                                                      prevention activities in hospital and residential care settings. This falls          available for download from the
                                                            Minimizing the risk of reduction guideline packet, or tool kit, contains research, tools, and                  Premier Safety Institute's Falls
                                                            falls and falls injuries: education materials, including a sample Microsoft® Excel spreadsheet                 module
                                                            Guidelines for acute, report to track falls data and trends, as well as algorithms for assessing               http://www.premierinc.com/all/safet
                                                            sub-acute and             and reassessing an individual's fall risk. The packet includes numerous              y/resources/falls/procedures-
                                                            residential care          tips for screening, assessing risk, reducing personal and environmental              tools.jsp#Tool (under "Sample
January       2006 Fall Prevention                          settings                  risk factors, and properly responding to falls.                                      Procedures").
                                                                                                                                                                           http://www.osha.gov/SLTC/hospital
May           2002 Fall Prevention                          Ergonomic eTools        OSHA ergonomic plan and eTools                                                         _etool/mainpage.html




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                                                                                                                                                                  IHI
  Month        Year               Topic by Tab                       Tool                                         Description                                    Tool                Location


                                                                                    The ALFA Institute of Biomedical Sciences Educational Portal contains
                                                                                    medical education material on topics that include pediatric infections,
                                                                                    zoonoses, infectious diseases, internal medicine, dermatology, upper
                                                                                    and lower respiratory infections, surgical infections, antimicrobial
                                                                                    resistance, clinical research tools, biomedical databases, critical care
                                                                                    and sepsis, cardiovascular infections, nosocomial infections, hepatitis B
                                                                                    virus, orthopedic infections, OB/GYN infections and urogenital
                                                                                    infections. A selection of case studies that can be used as interactive
                                                                                    case-based learning tools from the Academy of Infection Management
                                                             Web-based              are also available. The case studies include the specialties of surgery,
                                                             educational tools –    pediatrics, ICU, and pneumonia. Specific topics include patient
                                                             Infection prevention   outcomes related to antibiotic usage and healthcare associated                      Go to http://www.e-meducation.org/
February       2008 Guidelines                               case studies           infections                                                                          and http://infectionacademy.org/


                                                                                    Diseases are spread by poor coughing and sneezing techniques. Most
                                                                                    people put their hands in front of their mouths and noses to stop germs
                                                                                    from getting into the air. Unfortunately, this technique puts the germs on
                                                                                    their hands. The germs are then spread to telephones and doorknobs
                                                                                    and many other surfaces, where the next user then acquires. This five-
                                                                                    minute video was designed by three Maine hospitals to encourage
                                                                                    people to cough and sneeze according to the infection control guidelines
                                                                                    put forth by the Centers for Disease Control and Prevention (CDC). It is
                                                                                    aimed at the common citizen. The message is serious, but it is
                                                                                    presented with humor in such a way that it engages the viewer's
                                                             Why Don’t We Do It     attention for a full five minutes while the message is repeated in
February       2008 Guidelines                               in Our Sleeves?        interesting new ways. and Educational Trust (HRET) has developed a
                                                                                    The Health Research                                                                 http://coughsafe.com/
                                                                                   comprehensive guide for clinicians and administrators to help
                                                             AHA/HRET –            incorporate routine HIV testing in their emergency departments (EDs).
                                                             Comprehensive tool This practical guide describes different approaches, considerations, and
July           2007 Guidelines                               for HIV testing in ED resources for making HIV testing routine in ED care. It is based on                  http://www.edhivtestguide.org/




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                                                                                        Premier Safety Share



                                                                                                                                                                  IHI
  Month        Year               Topic by Tab                       Tool                                         Description                                    Tool                Location


                                                                                  Nine presentations from Premier's conference on "Healthcare-
                                                                                  associated infections – What everyone needs to know," held June 19,
                                                                                  2007, in Orlando, FL, are available online for download. Featured faculty
                                                                                  include: Graeme Forrest, M.D., University Maryland Medical Center;
                                                                                  Peter Gross, M.D., Hackensack University Medical Center; Carol
                                                                                  Haraden, Ph.D., IHI; Eli Perencevich, M.D., M.S., VA Maryland
                                                             Premier – Healthcare Healthcare System; Chesley Richards, M.D., M.P.H, FACP,
                                                             associated infection CDC/DHQP; Richard Van Enk, Ph.D., Bronson Methodist Hospital;                         Download from:
                                                             presentations        Daniel Varga, M.D., SSM Healthcare; and Premier's Dan Peterson, M.D,                  http://www.premierinc.com/advisorli
July           2007 Guidelines                               available online     M.P.H.; Gina Pugliese, R.N., M.S.; and Scott Pope, Pharm.D.                           ve/


                                                                                   The Association for Professional in Infection Control and Epidemiology
                                                                                   (APIC) has released a white paper on healthcare associated infections
                                                                                   (HAI) titled "Dispelling the Myths: The True Cost of Healthcare-
                                                                                   Associated Infections." Featured in the March issue of Healthcare
                                                                                   Financial Management magazine, the white paper presents the
                                                                                   business case for reducing HAIs from the perspective of the healthcare
                                                                                   executive. Case studies of cost saving are detailed, along with a
                                                                                   methodology for determining the cost of different categories of HAIs.
                                                             APIC – A business     APIC's goal with the white paper is to help healthcare executives                    http://www.premierinc.com/quality-
                                                             case for preventing   understand the costs involved with these infections, evaluate HAIs in                safety/tools-
                                                             healthcare-           their own institutions and take a more aggressive approach to infection              services/safety/topics/guidelines/an
Mar            2007 Guidelines                               associated infections prevention.                                                                          timicrobials.jsp#business-case


                                                                                   Patients undergoing MRI exams while wearing ECG electrodes and
                                                                                   cables have experienced second and third degree burns sometimes
                                                             FDA – Avoiding        requiring plastic surgery to repair. After a FDA investigation into reports
                                                             burns from            received regarding these burns, precautions that can be taken to                     http://www.premierinc.com/quality-
                                                             electrodes and        prevent these types of burns were released. The problem is the                       safety/tools-services/safety/safety-
                                                             cables during MRI     radiofrequency fields created during an MRI exam can heat ECG cables                 share/03-07-downloads/07-burns-
Mar            2007 Guidelines                               exams                 and electrodes, seriously burning the underlying skin.                               during-mri.doc




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                                                                                        Premier Safety Share



                                                                                                                                                                IHI
  Month       Year               Topic by Tab                       Tool                                           Description                                 Tool               Location
                                                                                  AHRQ released a new Evidence Report/Technology Assessment
                                                                                  (Number 9), which concludes that several approaches and practices
                                                                                  implemented to prevent healthcare-associated infections (HAI) are
                                                                                  promising and warrant additional research. The objective of the report
                                                                                  was to determine the effects of quality improvement strategies on HAI
                                                                                  and on HAI rates. The selected infections (.pdf) (785 KB) included
                                                                                  surgical site infections (SSI), central line-associated bloodstream
                                                                                  infections (CLABSI), ventilator-associated pneumonia (VAP), and
                                                                                  catheter-associated urinary tract infections (CAUTI) The AHRQ
                                                                                  Evidence Report concludes that there is insufficient evidence to
                                                                                  recommend quality improvement strategies that will improve adherence
                                                                                  to preventive interventions for healthcare-associated infections. The
                                                                                  evidence is generally of suboptimal quality, consisting primarily of single-
                                                                                  center, simple before-after studies of limited internal and external
                                                                                  validity. Results from the limited data suggest that certain strategies
                                                                                  require additional study and potential wider implementation. Those
                                                            AHRQ – Report on      strategies include reducing unnecessary catheter use by using "stop               http://www.premierinc.com/quality-
                                                            strategies to prevent orders" (which require that a catheter be removed after a certain period          safety/tools-services/safety/safety-
                                                            healthcare-           of time if it is no longer needed), reminders to improve surgical antibiotic      share/02-07-downloads/12-
Feb           2007 Guidelines                               associated infections prophylaxis, the use of checklists to improve adherence to central line           hainfgap.pdf




                                                                                  A new toolkit designed to provide guidance on issues that should be
                                                                                  considered when designing measures for public reporting of healthcare-
                                                                                  associated infections (HAI) is available from the Centers for Disease
                                                                                  Control and Prevention (CDC). The kit was designed in conjunction with            Access the CDC Web site for the
                                                                                  the Association of Professionals in Infection Control and Epidemiology            Public Reporting of Healthcare-
                                                                                  (APIC), the Society for Healthcare Epidemiology of America (SHEA) and             Associated Infections
                                                                                  other professional groups. Many states are considering making HAI                 (http://www.cdc.gov/ncidod/dhqp/P
                                                                                  reporting mandatory. "Essentials of Public Reporting of Healthcare-               ublicReportingHAIs.html) for the
                                                                                  Associated Infections: A Tool Kit" (.pdf) (199 KB) details recommended            toolkit, as well as the February
                                                                                  steps, including the identification or creation of a responsible agency at        2005 American Journal of Infection
                                                            CDC – Tools for       the state level, personnel for data collection and quality improvement,           Control article, Guidance on Public
                                                            reporting healthcare- strategies to prevent unintended consequences of public reporting, and            Reporting of Healthcare-Associated
Feb           2007 Guidelines                               associated infections recommended outcome measures.                                                     Infections (.pdf) (150 KB).




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                                                                                                                                                                  IHI
  Month        Year                Topic by Tab                      Tool                                         Description                                    Tool                Location


                                                                                  Several new tools have recently been added to the Surgical Care
                                                                                  Improvement Project (SCIP) Web site. The first, "Preventive Antibiotics
                                                                                  in Colon and Rectal Surgery: Discontinuation Within 24 Hours After
                                                                                  Operation," is a presentation that discusses the importance of giving
                                                                                  recommended antibiotics in colorectal surgery with the equally important              VTE guidelines are available from
                                                                                  factor of discontinuing the antibiotics within 24 hours. Other tools related          the Premier Safety Institute
                                                                                  to venous thromboembolism include: Deep Vein Thrombosis                               Infection Prevention and Safety
                                                             SCIP – New surgical, Prophylaxis Risk Factor Assessment, and Thrombosis Screen and                         Module under "Other guidelines,
Dec            2006   Guidelines                             VTE tools            Prophylaxis Recommendations.                                                          selected resources."


                                                                                    Cough hygiene video, NSF Scrub Club provides an interactive Web-
                                                                                    based educational program with music, games and cartoons that aims
                                                             Humor in infection     to help protect children from dangerous food borne illnesses as well as
                                                             control – Online       infectious diseases, and MARR has useful antibiotic information                     http://www.coughsafe.com/;
                                                             educational            downloads on fighting antibiotic resistance, a parent's guide for colds,            http://www.scrubclub.org/;
                                                             resources for adults   runny noses, and otitis media. Posters on handwashing include a                     http://www.mi-
Sept           2006 Guidelines                               and children           reminder for children on when to wash their hands.                                  marr.org/cons_materials.html


                                                                                  The Advisory Committee on Immunization Practices (ACIP) has issued
                                                                                  recommendations for preventing rotavirus gastroenteritis in infants and
                                                                                  children. The recommendations call for American infants to be
                                                                                  immunized with the recently licensed rotavirus vaccine. Infants should
                                                                                  receive three doses of the vaccine, administered orally at two, four and
                                                                                  six months. It is the most common cause of severe gastroenteritis in
                                                                                  infants and young children worldwide. Although rotavirus causes few
                                                                                  deaths among U.S. children, almost all children will become infected                  http://www.premierinc.com/quality-
                                                                                  with rotavirus by age five. Most of them will develop gastroenteritis,                safety/tools-services/safety/safety-
                                                             ACIP – New rotavirus resulting in up to 272,000 emergency department visits and 70,000                     share/09-06-downloads/12-mmwr-
Sept           2006 Guidelines                               vaccine              hospitalizations each year.                                                           rotavirus.pdf

                                                             Antibiotic Prophylaxis
                                                             in Cardiac Surgery –                                                                                       Go to:
                                                             Duration of            This guideline provides for one recently CMS approved exception for                 http://www.premierinc.com/all/safet
March          2006 Guidelines                               prophylaxis            discontinuance of antibiotic prophylaxis.                                           y/resources/guidelines/other.jsp




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                                                                                                                                                                 IHI
  Month     Year               Topic by Tab                        Tool                                         Description                                     Tool                Location


                                                          Antimicrobial
                                                          Prophylaxis for
                                                          Surgery: An Advisory
                                                          Statement from the     This advisory statement provides an overview of issues related to
                                                          National Surgical      antimicrobial prophylaxis, including specific suggestions regarding                   Go to:
                                                          Infection Prevention   antimicrobial selection, initiation and discontinuance of prophylactic                http://www.premierinc.com/all/safet
March       2006 Guidelines                               Project                antimicrobials.                                                                       y/resources/guidelines/other.jsp


                                                                                 New guidelines are designed specifically for the cardiovascular
                                                                                 catheterization laboratory and provide information on such issues as the
                                                                                 selection of antibacterial soaps, the circumstances under which patients              Go to:
                                                          CV Cath Lab:           should receive an antibiotic, protective masks and other garb to be worn              http://www.premierinc.com/all/safet
                                                          Infection control      by catheterization lab staff, and the acceptable level of air circulation in          y/resources/guidelines/other.jsp#ca
January     2006 Guidelines                               guidelines             the catheterization lab.                                                              rd-cath


                                                                             New resources on community-acquired MRSA CA-MRSA and a
                                                                             Template for Gene Vector Guidance have been made available from the
                                                                             Association for Professionals in Infection Control and Epidemiology
                                                                             (APIC) Practice Guidance Council. These resources were developed in
                                                                             collaboration with APIC's Emerging Issues Committee. The CA-MRSA                          Go to :
                                                                             resource identifies key resources available via national, state, and local                http://www.premierinc.com/all/safet
                                                          Community-acquired public health agencies. The Template for Gene Vector Guidance is                          y/publications/01-06-downloads/11-
                                                          MRSA CA-MRSA       intended to assist facilities in developing infection control policies to                 ca-mrsa.pdf and
                                                          and a Template for regulate gene vector therapy. APIC recommends any study be reviewed                       http://www.premierinc.com/all/safet
                                                          Gene Vector        and approved by their Institutional Review Board (IRB) but also include                   y/publications/01-06-downloads/12-
January     2006 Guidelines                               Guidance           the involvement of an affiliated Biosafety Committee.                                     gene-vector-therapy.pdf


                                                                                 The U.S. Public Health Service has updated the recommendations for
                                                                                 the management of healthcare personnel (HCP) with occupational
                                                                                 exposure to blood and other body fluids that might contain human
                                                                                 immunodeficiency virus (HIV). Published in the September 30, 2005
                                                                                 Morbidity and Mortality Weekly Report (MMWR) , the recommendations
                                                                                 (.pdf) (267 KB) emphasize adherence to postexposure prophylaxis
                                                                                 (PEP) regimens when indicated, expert consultation in managing                        http://www.premierinc.com/all/safet
                                                          HIV post-exposure      exposures, follow-up to improve HCP adherence to PEP, and monitoring                  y/publications/10-05-downloads/11-
October     2005 Guidelines                               prophylaxis            for adverse events, including seroconversion.                                         hiv-rr5409.pdf




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                                                                                                                                                               IHI
  Month       Year               Topic by Tab                       Tool                                        Description                                   Tool                Location


                                                                                  A "Profile of the Healthcare Industry" that includes hospitals, physician
                                                                                  offices, dental offices, nursing homes, and more as part of its Sector
                                                                                  Notebook Project. The project helps various industry sectors in pollution
                                                                                  prevention, waste minimization, and regulatory compliance efforts. The
                                                            EPA Notebook -        EPA document contains information on waste and emissions profiles,                 The Notebook can be accessed at:
                                                            Healthcare waste      pollution prevention opportunities, a summary of federal statutes and              http://www.epa.gov/compliance/res
                                                            management            regulations, compliance and enforcement history, and compliance                    ources/publications/assistance/sect
June          2005 Guidelines                               profiles, resources   activities and initiatives.                                                        ors/notebooks/health.html


                                                                                A guide to assist with compliance with the JCAHO Environmental of
                                                                                Care Standards. Hospitals for a Healthy Environment (H2E) is working
                                                                                on a clipboard version for JCAHO surveyors. This guide relates each
                                                                                JCAHO Element of Performance (EP) to specific federal regulations, to
                                                                                help facilities be in compliance with both. The guide also suggests steps
                                                            JCAHO/H2E guide - that facilities can take to encourage environmental performance
                                                            Environment-of-care improvements. A comprehensive environmental program, including                       To view this guide, go to:
                                                            compliance and      waste minimization and pollution prevention initiatives, can help ensure             http://ecm.ncms.org/herc/jcaho3.10
June          2005 Guidelines                               improvement         compliance and reduce costs.                                                         .3.html.




                                                                                  Two new guidance documents from the Association for the
                                                                                  Advancement of Medical Instrumentation (AAMI) are designed to assist
                                                                                  manufacturers in assessing the device reprocessing information they
                                                                                  provide. These documents help address concerns that manufacturer's
                                                                                  instructions are often inadequate or don't consider the common
                                                                                  reprocessing methods facilities use. The first document, entitled
                                                                                  "Designing, testing, and labeling reusable medical devices for
                                                                                  reprocessing in healthcare facilities: A guide for device manufacturers"
                                                                                  (TIR12: 2004), is intended to help manufacturers validate the
                                                                                  reprocessing procedures they recommend and guide them in choosing
                                                            AAMI guidance         facility protocols. The second, "Sterilization of medical devices -
                                                            documents -           Information to be provided by the manufacturer for the processing of re-
                                                            Cleaning and          sterilizable medical devices" (ANSI/AAMI/ISO ST81: 2004), sets forth               To order, call 800.332.2264, Ext.
May           2005 Guidelines                               sterilization         requirements for labeling and reprocessing instructions.                           217, or visit www.aami.org.

                                                                                  The comprehensive lists published by the Food and Drug Administration
                                                                                  (FDA) are available on the FDA Web site. The FDA Guidance
                                                            FDA Guidance          Documents for Regulated Industry - Annual Comprehensive List of                    http://www.fda.gov/opacom/morech
March         2005 Guidelines                               Documents             Guidance Documents - and the corrections to that list                              oices/industry/guidedc.htm




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                                                                                                                                                                  IHI
  Month        Year               Topic by Tab                       Tool                                          Description                                   Tool                Location


                                                                                   A presentation titled, From SIP to SCIP (referring to the National
                                                                                   Surgical Infection Prevention Project and the current Surgical Care
                                                                                   Improvement Project) is available from the Surgical Care Improvement
                                                             From SIP to SCIP      Project. Dale W. Bratzler, M.D., provides a background summary of the
                                                             (referring to the     Surgical Infection Prevention Project (SIP) and shows some of the
                                                             National Surgical     national data that has been collected, as well as findings in the clinical
                                                             Infection Prevention literature. The presentation also highlights the transition of the SIP into           View a PowerPoint® summary
                                                             Project and the       the Surgical Care Improvement Project (SCIP), which goes beyond just                 (.ppt) (1.6 MB) or watch a full
                                                             current Surgical Care preventing surgical infection and focuses on improving the outcomes for              presentation with sound in a video
January        2005 Guidelines                               Improvement Project) surgery patients.                                                                     clip at:


                                                                                   A new telephone hotline that provides clinicians with immediate access
                                                                                   to expert advice on treating HIV-infected pregnant women and their
                                                                                   children is available through the federal Health Resources and Services
                                                                                   Administration's National HIV/AIDS Clinicians' Consultation Center at
                                                                                   San Francisco (CA) General Hospital. The Perinatal Hotline
                                                                                   (888.448.8765) provides 24-hour consultation from HIV experts,                       More information is available from:
                                                                                   including advice on interpreting HIV testing in pregnancy and                        http://www.ucsf.edu/hivcntr/Hotline
December       2004 Guidelines                               The Perinatal Hotline implementing the U.S. Public Health Service's clinical care guidelines.              s/Perinatal.html

                                                                                                                                                                        http://my.premierinc.com/all/safety/
                                                                                    CDC also provides PowerPoint presentations that describe West Nile                  publications/07-04-downloads/12-
July           2004 Guidelines                               West Nile Virus        Virus and methods of treatment and prevention.                                      wnv-coca-talk.ppt


                                                                                    New practice guidelines are available to assist with the administration of
                                                                                    outpatient antimicrobial therapy (OPAT). Due to the lack of evidence-
                                                                                    based studies, these guidelines were formulated from the collective
                                                                                    experience of the Infectious Diseases Society of America Guidelines
                                                                                    Committee and advisors from related organizations. The Practical
                                                                                    Guidelines for Outpatient Parenteral Antimicrobial Therapy updates the
                                                                                    1997 guidelines and are intended to aid in the successful
                                                             Practical Guidelines   implementation of parenteral antimicrobial services for patients in a
                                                             for Outpatient         variety of outpatient settings including the home, physician offices, and
                                                             Parenteral             skilled nursing facilities. The guidelines are general and need to be               http://my.premierinc.com/all/safety/
                                                             Antimicrobial          adapted for each specific setting.                                                  publications/07-04-downloads/11-
July           2004 Guidelines                               Therapy                                                                                                    opat-cid-06-04.pdf




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                                                                                                                                                                   IHI
   Month        Year                Topic by Tab                      Tool                                             Description                                Tool                Location
                                                                                       The poster provides clinical guideline reminders for surgical infection
                                                                                       prevention, acute myocardial infarction, congestive heart failure, and            http://my.premierinc.com/all/safety/
                                                                                       community-acquired pneumonia. The tool is intended to be displayed in             publications/07-04-downloads/10-
                                                              CMS clinical             areas where staff document the care provided, such as in nurses'                  clinical-guideline-poster-ar-02-
July            2004 Guidelines                               guideline reminder       stations, doctors' dictation areas, and medical record areas, among               04.pdf


                                                                                     A printed copy of the Centers for Disease Control and Prevention’s
                                                                                     (CDC) "Guidelines for Environmental Infection Control in Health-Care
                                                                                     Facilities - 2003" has been published by the American Society of
                                                                                     Healthcare Engineering (ASHE). Topics covered in this publication
                                                              Guidelines for         include indoor air quality, construction, ventilation in specialized care
                                                              Environmental          areas, water quality, water quality in hemodialysis settings, cleaning and
                                                              Infection Control in   disinfection of environmental surfaces, pest control, principles of
                                                              Health-Care Facilities environmental sampling, laundry and bedding, animals in health care,                http://www.premierinc.com/all/safet
May             2004   Guidelines                             - 2003                 and regulated medical waste.                                                        y/resources/guidelines/index.htm
                                                              Guidelines for
                                                              Environmental
                                                              Infection Control in
                                                              Health-Care Facilities                                                                                     http://www.premierinc.com/all/safet
May             2004   Guidelines                             - 2003                                                                                                     y/resources/guidelines/index.htm
                                                                                       New guidelines for preventing healthcare-associated pneumonia and
                                                                                       other severe lower respiratory infections. These guidelines update and
                                                                                       replace the 1981 guideline. In addition to the latest pneumonia and
                                                                                       respiratory infection recommendations, the guidelines expand the list of
                                                              Guidelines for           recommended antiviral treatments for influenza patients and
                                                              Preventing Health-       recommends that potable water be kept at temperatures above 124                   http://www.premierinc.com/all/safet
                                                              Care-Associated          degrees Fahrenheit or below 68 degrees Fahrenheit to reduce the risk of           y/resources/guidelines/cdc_guidelin
April           2004   Guidelines                             Pneumonia, 2003          Legionnaire's disease.                                                            es.htm#Pneumonia2003
                                                              National Surgical
                                                              Infection Prevention     New web site for accessing current information on the National Surgical
January         2004 Guidelines                               (SIP)                    Infection Prevention (SIP)                                                        www.MedQIC.org/sip

                                                              Pneumonia Medicare New web site for accessing current information on the Pneumonia
January         2004 Guidelines                               National Project   Medicare National Project                                                               www.MedQIC.org/pneumonia




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                                                                                                                                                                IHI
  Month       Year               Topic by Tab                       Tool                                        Description                                    Tool                Location


                                                                                  The CDC Hand Hygiene Resource Web page provides an interactive
                                                                                  training course on hand hygiene and other standard precautions to
                                                                                  prevent healthcare associated infections. The course reviews key
                                                                                  concepts of both hand hygiene and standard precautions. The learner is
                                                            The CDC Hand          asked a series of hand hygiene questions as they work through the
                                                            Hygiene Resource      module and again at the end. The course also contains a short 60-                   http://www.cdc.gov/handhygiene/tra
September     2008 Hand Hygiene Guideline                   Web page              second video on hand hygiene.                                                       ining/interactiveEducation/


                                                                                  Diseases are spread by poor coughing and sneezing techniques. Most
                                                                                  people put their hands in front of their mouths and noses to stop germs
                                                                                  from getting into the air. Unfortunately, this technique puts the germs on
                                                                                  their hands. The germs are then spread to telephones and doorknobs
                                                                                  and many other surfaces, where the next user then acquires. This five-
                                                                                  minute video was designed by three Maine hospitals to encourage
                                                                                  people to cough and sneeze according to the infection control guidelines
                                                                                  put forth by the Centers for Disease Control and Prevention (CDC). It is
                                                                                  aimed at the common citizen. The message is serious, but it is
                                                                                  presented with humor in such a way that it engages the viewer's
                                                            Why Don’t We Do It    attention for a full five minutes while the message is repeated in
February      2008 Hand Hygiene Guideline                   in Our Sleeves?       interesting new ways.                                                               Order at: http://coughsafe.com/



                                                                               The World Health Organization's (WHO) first global patient safety
                                                                               challenge, "Clean Care is Safer Care," acknowledges the importance of
                                                                               addressing the global challenge of healthcare-associated infections
                                                                               (.pdf) ( 2 MB). Low-cost WHO strategies that help reduce infection risks
                                                                               in areas such as blood products and their use, injection practices and
                                                                               immunization, safe water, basic sanitation and waste management, and                   The draft is available for download
                                                                               clinical procedures, particularly in first-level emergency care, are already           at:
                                                            WHO – Testing hand available. These strategies are combined with efforts to implement the                 http://www.who.int/gpsc/resources/
Mar           2007 Hand Hygiene Guideline                   hygiene guidelines WHO Guidelines on Hand Hygiene in Healthcare (Advanced Draft).                         newsalert/jan2007/en/


                                                                                  An eight-minute video on proper handwashing technique titled "Last
                                                                                  Clean Chance" has been produced by the Mecklenburg (NC) County
                                                                                  Health Department. The science fantasy thriller is set in a bio-research
                                                                                  lab. The video involves a doomsday scenario in which a virus is leaked              Access the video and information
                                                                                  into the lab space. Tailored for the young viewer, the video teaches a              online at
                                                                                  valuable skill and reminds us that handwashing is the number one way                http://www.charmeck.org/Departme
May           2006 Hand Hygiene Guideline                   Last Clean Chance     to prevent the spread of disease.                                                   nts/Health+Department/




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                                                                                                                                                                  IHI
  Month        Year               Topic by Tab                       Tool                                          Description                                   Tool                Location



                                                                                                                                                                        http://www.premierinc.com/all/safet
                                                                                  After an emergency, it can be difficult to find running water. However, it            y/publications/09-05-downloads/06-
                                                                                  is still important to wash your hands (.pdf) (75 KB) to avoid illness. It is          handwashing-emergencies.pdf and
                                                                                  best to wash your hands with soap and water but when water isn't                      http://www.premierinc.com/all/safet
                                                             Hand hygiene in      available, you can use alcohol-based products (.pdf) (34 KB) made for                 y/publications/09-05-downloads/21-
September      2005 Hand Hygiene Guideline                   emergency situations washing hands.                                                                        clean-hands-cards.pdf
                                                                                                                                                                        The CDC slide sets are available
                                                             Slides - Hand                                                                                              at:
                                                             hygiene educational    The educational slide sets are available as both core and supplemental              http://www.cdc.gov/handhygiene/m
July           2003 Hand Hygiene Guideline                   resource               slides, with or without speaker notes and in different formats.                     aterials.htm.
                                                             Hand Hygiene           Provides updated educational materials dealing with hand hygiene
November       2002 Hand Hygiene Guideline                   Resource Center        practices.                                                                          http://www.handhygiene.org/

                                                                                                                                                                        Word:
                                                                                    Premier's Safety Institute is now offering a checklist to save on your              http://www.premierinc.com/quality-
                                                                                    computer and complete or update at your own pace. The Word                          safety/tools-
                                                                                    document (.doc) (463 KB) retains the HTML format and features                       services/safety/topics/influenza/ind
                                                                                    developed by the Centers for Disease Control and Prevention (CDC),                  ex.jsp#checklist; also offers this as
                                                                                    with input from other federal partners. It is intended to help hospitals            an Adobe® PDF (2 MB) or online
                                                                                    assess and improve their preparedness for responding to pandemic                    at:
                                                             Comprehensive          influenza. Because of differences among hospitals (e.g., characteristics            http://www.pandemicflu.gov/plan/he
                                                             hospital checklist –   of the patient population, size of the hospital/community and scope of              althcare/
                                                             pandemic influenza     services), each hospital will need to adapt this checklist to meet its              hospitalchecklist.html.
July           2007 Influenza - pandemic                     preparation            unique needs and circumstances.


                                                                                    New York City has released a pandemic flu preparedness and response
                                                                                    plan (.pdf) (2.3 MB). The plan is a blueprint for identifying an outbreak,
                                                                                    containing its spread and distributing scarce resources like ventilators
                                                                                    and antiviral medications. It also emphasizes that the city must rely on
                                                                                    itself, not Washington, to plan for and react to potential disasters. The
                                                                                    plan describes the importance of early detection to help contain the                http://www.premierinc.com/quality-
                                                             New York City          spread of the illness and includes disease monitoring, laboratory                   safety/tools-services/safety/safety-
                                                             pandemic influenza     capacity, vaccine and medicine delivery, hospital preparedness, mental              share/07-06-downloads/12-ny-
July           2006 Influenza - pandemic                     plan                   health and communications.                                                          pandemic-flu-plan.pdf




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                                                                                                                                                                  IHI
  Month     Year               Topic by Tab                        Tool                                          Description                                     Tool                Location
                                                                                 checklist that describes steps that long-term care and other residential
                                                                                facilities can take to prepare for influenza pandemic is available from the
                                                                                Department of Health and Human Services (HHS) and the Centers for
                                                                                Disease Control and Prevention (CDC). The checklist was developed to
                                                                                help long-term care and other residential facilities assess and improve
                                                                                their preparedness for responding to pandemic influenza. Based on
                                                                                differences among facilities (e.g., patient/resident characteristics, facility
                                                                                size, scope of services, hospital affiliation), each facility will need to
                                                                                adapt this checklist to meet its unique needs and circumstances. The
                                                                                checklist states that facilities should have a structure for planning and
                                                                                decision-making, overseen by a multidisciplinary group focused on
                                                                                pandemic flu planning, and to develop a written influenza plan. The
                                                                                written influenza plan should include flu surveillance and detection
                                                                                measures; communications; education and training in basic prevention
                                                                                and control measures for personnel, residents, and residents' family
                                                                                members; and an infection control plan for managing residents and
                                                          Pandemic flu          visitors with pandemic influenza; an occupational health plan to address                The checklist is available at:
                                                          checklist – Long-term staff absences and related issues; and plans for vaccine and antiviral                  http://www.pandemicflu.gov/plan/
June        2006 Influenza - pandemic                     care                  use and surge capacity.                                                                 LongTermCareChecklist.html.




                                                                                The new handbook provides information to help Americans understand
                                                                                the threat of pandemic influenza and specific actions they can take to
                                                                                protect themselves and their families and explains topics such as the
                                                                                differences between seasonal and pandemic flu and what to expect in a
                                                                                pandemic. The handbook includes an emergency health sheet for
                                                                                recording personal health information on each family member. A
                                                                                checklist divides actions into three categories: planning for a pandemic,
                                                                                limiting the spread of germs and preventing infection, and items to
                                                                                gather for an extended stay at home. Other important issues include
                                                          Pandemic Influenza plans for having nonprescription drugs and other health supplies on                        Go to:
                                                          Planning: A Guide for hand, discussing within a family how care will be given if a member                     http://www.premierinc.com/all/safet
                                                          Individuals and       becomes ill, teaching proper hand washing and cough etiquette to                        y/publications/01-06-downloads/16-
January     2006 Influenza - pandemic                     Families              children, and having supplies of food and water on hand.                                pandemic-flu-guide.pdf




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                                                                                                                                                               IHI
  Month       Year               Topic by Tab                       Tool                                         Description                                  Tool                Location

                                                                                 A home care influenza toolkit, published by Montgomery County's
                                                                                 Advanced Practice Center, is designed to help people manage influenza
                                                                                 at home. This simple toolkit, "Stay At Home Toolkit for Influenza,"
                                                                                 includes checklists on what to keep in the home, tips on how to
                                                                                 recognize flu signs and symptoms, instructions on using thermometers,
                                                                                 isolating the sick, making disinfectant with bleach, and cleaning
                                                                                 potentially contaminated areas, a personal care log to help caregivers              http://www.premierinc.com/quality-
                                                                                 track observations and action, guidelines for those returning to work               safety/tools-services/safety/safety-
                                                            Stay At Home Toolkit after recovering from flu, and items to keep on hand for pets for disaster          share/02-08_downloads/13_Stay-at-
February      2008 Influenza - seasonal                     for Influenza        preparedness.                                                                       home-toolkit.pdf


                                                                                    For the beginning of the new influenza season, the Centers for Disease
                                                                                    Control and Prevention (CDC) is releasing updates of a few new flu
                                                                                    resources. The CDC's flu Web site at www.cdc.gov/flu has been revised
                                                                                    and is easy to navigate as a resource. This year, the CDC is                     Downloads are available for
                                                            CDC updates             emphasizing high-risk children (such as those with asthma or diabetes)           printing at:
                                                            influenza tools for the and their caregivers, as well as focusing on protecting infants and the          http://www.cdc.gov/flu/professional
October       2007 Influenza - seasonal                     new season              elderly through family and community vaccination.                                s/flugallery/.




                                                                                  A Web site sponsored by the National Influenza Vaccine Summit called
                                                                                  "Prevent Influenza Now!" provides information updates on the current
                                                                                  influenza vaccination season. The site contains vaccine information for
                                                                                  the public about influenza, the benefits of vaccination, who should be
                                                                                  vaccinated, how to find a clinic, media such as public service
                                                                                  announcements and press releases issued for this season's influenza
                                                                                  vaccination campaign, clinic procedures, patient materials, and other
                                                                                  useful tools to help prevent influenza. Information for healthcare
                                                                                  professionals includes a section on the vaccination of healthcare
                                                            New Web site          workers. This section has many resources on how to increase
                                                            provides influenza    healthcare worker vaccination, including many toolkits that can be used
Dec           2006 Influenza - seasonal                     vaccination updates   to implement or expand healthcare worker immunization programs.                    http://www.preventinfluenza.org/




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                                                                                                                                                                IHI
   Month        Year               Topic by Tab                       Tool                                        Description                                  Tool                Location




                                                                                    Online resources and information from the California Distance Learning
                                                                                    Health Network (CDLHN), a non-profit organization of the Graduate
                                                                                    School of Public Health at San Diego State University. The section on
                                                                                    pandemic influenza resources includes the U.S. national strategy for
                                                                                    pandemic influenza and World Health Organization avian influenza
                                                                                    updates. A summit designed to inform California leaders in business,
                                                                                    education, local government, healthcare, social services and other
                                                                                    sectors to better prepare California for influenza pandemic is available          Go to:
                                                              California Distance   as a Webcast. The summit presents the current threat of avian influenza           http://cdlhn.com/create_frameset.cf
                                                              Learning Health       and the risk of a human influenza pandemic and several training videos            m?id=32&CFID=523799&CFTOKE
May             2006 Influenza -seasonal                      Network (CDLHN)       related to mass vaccinations and disease investigation.                           N=19783253


                                                                                    The Department of Health and Human Services (HHS) has developed a                 Go to: English -
                                                                                    checklist to help home healthcare providers care for the sick during an           http://www.premierinc.com/all/safet
                                                                                    influenza pandemic. The checklist will help organizations assess their            y/publications/04-06-downloads/06-
                                                                                    readiness to respond by identifying strengths and weaknesses. It also             healthcare-checklist.pdf; Spanish -
                                                              Home Healthcare       explains that building community contacts will provide a strategic                http://www.premierinc.com/all/safet
                                                              Services Pandemic     advantage if a pandemic influenza strikes. The checklist was designed             y/publications/04-06-
                                                              Influenza Planning    with a pandemic influenza in mind, although it may be used in other               downloads/06a-spanish-healthcare-
April           2006 Influenza -seasonal                      Checklist             types of emergencies.                                                             checklist.pdf


                                                                                   The U.S. Food and Drug Administration (FDA) has published "Questions
                                                                                   and Answers about Using Personal Protective Equipment (PPE) during
                                                                                   Influenza Outbreaks, including Bird Flu (Avian Influenza)"(.doc) (50 KB).          http://www.premierinc.com/all/safet
                                                                                   Consistent with the Centers for Disease Control and Prevention (CDC),              y/publications/12-05-downloads/10-
                                                              Use of personal      the document discusses PPE, how the use of PPE prevents the spread                 questions-answers-ppe-during-flu-
                                                              protective equipment of infection, and how PPE for healthcare workers is different from those           outbreaks.doc and
                                                              during influenza     in other industries. The document shows how to search for items                    http://www.premierinc.com/all/safet
December        2005 Influenza - seasonal                     outbreaks            cleared by the FDA.                                                                y/resources/influenza/index.jsp




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                                                                                                                                                             IHI
  Month     Year                Topic by Tab                      Tool                                        Description                                   Tool                Location


                                                                                The National Foundation for Infectious Diseases' "Kids Need Flu
                                                                                Vaccine" initiative now includes a new patient education resource for
                                                                                physicians and healthcare providers. The new patient education
                                                                                resource kit includes a parental brochure, fact sheet and poster in both
                                                                                English and Spanish. The kit provides useful strategies to help
                                                                                physicians and providers improve pediatric influenza vaccination rates
                                                                                among high-risk children with chronic medical conditions, such as
                                                                                asthma or diabetes. It also facilitates the implementation of
                                                                                recommendations by the CDC, AAP and other leading organizations to
                                                                                vaccinate all infants and toddlers 6 through 23 months of age as well as
                                                          Children's vaccine    household contacts and out-of-home caregivers of children between
October     2005 Influenza - seasonal                     education kit         birth and 2 years.                                                                 http://64.242.251.230/index1.html


                                                                                The purpose of the guide is to provide frontline healthcare personnel
                                                                                with information about indications and contraindications for the two               Last year's National Influenza
                                                                                types of influenza vaccines, as well as groups to be vaccinated and how            Vaccine Summit guide is available
                                                                                to administer the vaccines. The draft of the guide for the 2005-06                 online at
                                                                                influenza vaccination season contains product-specific information for             http://www.immunize.org/influenza/
                                                          Influenza Vaccination three injectable influenza vaccines. This information has been included            pocketguide.htm, and this site
                                                          Pocket Information    even though their licensure and availability may not be known before the           should be checked periodically for
August      2005 Influenza - seasonal                     Guide                 start of the influenza vaccination season.                                         the 2005-2006 version.


                                                                                As reports of influenza increase during the current season, the Centers
                                                                                for Disease Control and Prevention (CDC) continues to offer new
                                                                                resources in the fight to prevent the illness. The "Cover Your Cough"
                                                                                campaign has new language-specific flyers and posters for healthcare
                                                                                settings, as well as community settings such as schools and child care
                                                                                settings. In addition to English, the materials are available in Spanish,
                                                          New posters in five   Vietnamese, Chinese and Tagalog. Links are also provided to influenza
                                                          languages for         vaccination information statements (VIS) and materials at the "Be a                http://www.cdc.gov/flu/protect/cover
January     2005 Influenza - seasonal                     healthcare, schools   Germ Stopper" site.                                                                cough.htm

                                                          Summary of
                                                          resources to prevent                                                                                     http://www.premierinc.com/all/safet
                                                          spread of flu in the This latest tool from the CDC provides various resources, including                 y/publications/11-04-downloads/08-
November    2004   Influenza - seasonal                   workplace            important telephone numbers, Web pages, and poster/flyer links.                     flu-tools.pdf




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                                                                                                                                                              IHI
  Month     Year               Topic by Tab                       Tool                                          Description                                  Tool                Location


                                                                                   A free online resource to help health care providers conduct influenza
                                                                                  immunization programs for children is available from The National
                                                                                  Foundation for Infectious Diseases (NFID). The "Kids Need Flu Vaccine,
                                                                                  Too!" program aims to increase immunization rates among children 6-
                                                                                  23 months of age and those with chronic medical conditions; facilitate
                                                                                  implementation of pediatric influenza immunization recommendations
                                                                                  issued by the Centers for Disease Control and Prevention, American                tool is supported by the National
                                                                                  Academy of Pediatrics and American Academy of Family Physicians;                  Influenza Vaccine Summit and can
                                                          Kids Need Flu           and help educate parents and healthcare providers about the                       be accessed through the NFID
August      2004 Influenza - seasonal                     Vaccine, Too!           importance of preventing influenza among children.                                Web site at http://64.242.251.230/.

                                                                                  The newsletter provides news and success stories about topics such as
                                                                                  reduction of medical waste, computer recycling, green cleaning
                                                                                  programs, conversion to reusable products, laboratory chemical
                                                                                  recycling, energy efficient lighting and light bulb recycling. Premier's
                                                                                  EPP program is a collaboration of the Premier Safety Institute and
                                                                                  Premier's group purchasing services. The program is part of Premier's
                                                                                  commitment to helping healthcare facilities with their environmental
                                                                                  efforts, including waste minimization and the elimination of the use of           Go to:
March       2006 Mercury Pollution Prevention             Green Link              mercury.                                                                          http://www.premierinc.com/safety

                                                                                  Pollution prevention reduces some of the regulatory compliance issues,
                                                                                  such as the hazardous waste rules, by encouraging the use of less toxic
                                                                                  materials. The fact sheets are:                  Mercury in Healthcare
                                                                                  Lab Reagents
                                                                                  Mercury in Labs and Pharmacies
                                                                                  Mercury in Patient Care Areas
                                                                                  Mercury in Non-Patient Care Areas                                                 The fact sheets may be obtained
                                                                                  Formalin Recovery in Health Care Labs                                             from the MnTAP Web site at
                                                                                  Suction Canister Waste Reduction                                                  http://www.mntap.umn.edu (click
                                                                                  Ten Tools To Get Below the Regulatory Radar                                       on "Industries" and "Healthcare" for
August      2004 Mercury Pollution Prevention             Mercury fact sheets     MnTAP Profile, a general fact sheet on MnTAP's services                           more information).
                                                                                  This resource provides information on such topics as the health effects
                                                          Healthcare Hazard       of mercury exposure; reducing occupational exposures, including
                                                          Control System          thorough training and personal protective equipment; and applicable               http://www.osha.gov/SLTC/mercury
September 2003 Mercury Pollution Prevention               Volume 2                OSHA standards and guidelines.                                                    /index.html
September 2008 Patient Safety                             Patient Safety and      This three-volume, 1,400-page handbook for nurses on patient safety               http://www.ahrq.gov/qual/nurseshd
                                                          Quality: An Evidence-   and quality resources contains 89 contributions that represent the work           bk/
                                                          Based Handbook for      of a broad range of nurses and other patient safety researchers
                                                          Nurses                  throughout the nation. The handbook is grouped into six sections:
                                                                                  Patient Safety and Quality; Evidence-based Practice; Patient-centered
                                                                                  Care; Working Conditions and the Work Environment for Nurses;




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                                                                                                                                                                IHI
  Month     Year                Topic by Tab                      Tool                                           Description                                   Tool                 Location
February    2008   Patient Safety                         AHRQ toolkits – 17       The Agency for Healthcare Research and Quality (AHRQ) has                          http://www.ahrq.gov/qual/pips
                                                          patient safety           developed a series of toolkits designed to help reduce medical errors.
                                                          resources                These 17 toolkits, "Patient Safety at the Point of Care," range from
                                                                                   checklists to help reconcile medications when patients are discharged
                                                                                   from the hospital to processes to enhance effective communication
                                                                                   among caregivers and with patients, to toolkits to help patients taking
                                                                                   medications, and can be adapted to most healthcare settings.


February    2008   Patient Safety                         FDA – Downloadable The latest FDA medication safety-related videos, including some                          http://www.ismp.org/Tools/fdavideo
                                                          medication safety  developed in cooperation with ISMP, are now available free for viewing                   s.asp
                                                          videos             or downloading on the ISMP Web site.The videos added from October
                                                                             include warnings about Vincristine errors, luer misconnection, and how
                                                                             the use of a disposable straw with Exactacain, a local anesthetic spray,
                                                                             may pose a safety risk to patients. November videos highlight side
                                                                             effects of codeine in nursing mothers, avoiding mix-ups with
                                                                             Amphotericin B formulations, and warnings for Rocephin use with any IV
                                                                             product that contains calcium.


February    2008   Patient Safety                         NIH tool kit – Online                                                                                       http://nihseniorhealth.gov/toolkit/too
                                                          health information for                                                                                      lkit.html
                                                          seniors
February    2008   Patient Safety                         Free tool for            A free DVD from the Agency for Healthcare Research and Quality,                    Order at:
                                                          designing hospitals      "Transforming Hospitals: Designing for Safety and Quality," reviews                http://www.ahrq.gov/qual/transform.
                                                          for patient safety       evidence-based hospital design and how it increases patient and staff              htm
                                                                                   satisfaction and safety, quality of care, employee retention, and results
                                                                                   in a positive return on investment. Key concepts of evidence-based
                                                                                   design in a hospital include single-patient rooms, the use of noise
                                                                                   reducing construction materials, easily accessible workstations, and
                                                                                   improved layout for patients and staff. Patient safety issues addressed
                                                                                   are falls, hospital-associated infections and medical errors. The DVD
                                                                                   also presents cases of three hospitals that have incorporated evidence-
                                                                                   based design elements in their construction and renovation.




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                                                                                                                                                              IHI
  Month     Year                Topic by Tab                      Tool                                         Description                                   Tool                Location
December    2007   Patient Safety                         AHRQ free DVD –       A new free DVD addressing patient safety consists of eight modules                  Order at:
                                                          Patient safety        involving one to five separate lessons, and provides processes and tools            http://www.ahrq.gov/qual/psicdvd.ht
                                                                                that can be used to develop a systems-based approach to patient                     m
                                                                                safety. The modules include the investigation of medical errors and their
                                                                                root causes; identification, implementation and evaluation of system-
                                                                                level interventions to address patient safety concerns; and steps
                                                                                necessary to promote a culture of safety within a hospital or other
                                                                                healthcare facility.


December    2007   Patient Safety                         Advancing the                                                                                       √     http://www.premierinc.com/quality-
                                                          Practice of Patient-                                                                                      safety/tools-services/safety/safety-
                                                          and Family-Centered The Institute for Healthcare Improvement (IHI) recently released a report             share/12-07-downloads/6_Patient-
                                                          Care                 titled ―Advancing the Practice of Patient- and Family-Centered Care‖                 Family-Centered-Care-2007.pdf
                                                                               that includes assessment tools to help hospitals determine the degree
                                                                               to which patient- and family-centered approaches exist in their current
                                                                               organizational culture; IHI also released a tool that helps gather
                                                                               information about the perceptions and attitudes of staff and
                                                                               administrative leaders. The report describes how hospitals can get
                                                                               started with understanding how quality and safety are advanced by
                                                                               bringing patients and families directly into the planning, delivery and
                                                                               evaluation processes. This 25-page report provides rationale for a
                                                                               patient- and family-centered approach to care and defines its core
                                                                               concepts and outlines steps that a hospital can take to create
                                                                               partnerships with patients and families.
October     2007   Patient Safety                         Drug safety          The FDA has released the first issue of its new Drug Safety newsletter.              A fact sheet and the inaugural
                                                          newsletter from FDA The online newsletter will be published quarterly and provide information             issue of the newsletter can be
                                                                               for healthcare professionals, such as physicians, physician assistants,              found at
                                                                               nurse practitioners, nurses, pharmacists, dentists, other allied                     http://www.fda.gov/cder/dsn/.
                                                                               healthcare professionals, health professional associations and drug
                                                                               information centers. The newsletter will feature findings of selected post-
                                                                               marketing drug safety reviews from the agency's Center for Drug
                                                                               Evaluation and Research (CDER), important emerging drug safety
                                                                               issues, and recently approved new drugs. The newsletter provides post-
                                                                               marketing information to healthcare professionals to enhance
                                                                               communication of new drug safety information, raise awareness of
                                                                               reported adverse events, and stimulate additional adverse event
                                                                               reporting.




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                                                                                                                                                               IHI
  Month    Year                Topic by Tab                      Tool                                          Description                                    Tool                Location
September 2007    Patient Safety                         NCI – End-of-life care The National Cancer Institute (NCI) has published a free palliative-care             The CD can be ordered or a
                                                         tool                   training program for health professionals caring for cancer patients. The            brochure downloaded online. For
                                                                                "Education in Palliative and End-of-Life Care for Oncology" CD-ROM                   more information, go to the NCI
                                                                                and DVD teaches palliative care competencies and interventions for                   Web site at
                                                                                cancer patients. The curriculum is designed to provide the practicing                http://www.nci.nih.gov/aboutnci/epe
                                                                                clinician with information and strategies necessary to provide palliative            co
                                                                                interventions to his or her patients and to provide educational tools and
                                                                                materials to use in teaching the core competencies of palliative care to
                                                                                trainees. This curriculum is eligible for continuing education credit for
                                                                                physicians and nurses.


September 2007    Patient Safety                         Webcast – Best         Catheter-related blood stream infections (BSI) are a significant source of           http://www.cardinal.com/clinicalcent
                                                         practices to reduce    morbidity and mortality associated with a variety of devices used to                 er/materials/webcasts/index.asp
                                                         catheter-related       access the vascular system. Meticulous aseptic technique is both
                                                         blood stream           required and effective to prevent BSI. Faculty share their observations,
                                                         infections             best practices, and outcome data as they discuss this important topic.
                                                                                This free webcast is a replay from the original August 17, 2007, webcast
                                                                                provided by Cardinal Health's Center for Safety and Clinical Excellence
                                                                                and will remain available for one full year. Continuing education credit is
                                                                                also provided.


September 2007    Patient Safety                         FDA – Free patient     The latest medication safety-related videos, developed by the FDA in                 http://www.ismp.org/Tools/fdavideo
                                                         safety videos          cooperation with ISMP, are now available free for viewing or                         s.asp
                                                                                downloading on the ISMP Web site
                                                                                (http://www.ismp.org/Tools/fdavideos.asp).
                                                                                The National Cancer Institute (NCI) has published a free palliative-care             The CD can be ordered or a
                                                         NCI – End-of-life care training program for health professionals caring for cancer patients. The            brochure downloaded online. For
September 2007    Patient Safety                         tool                   "Education in Palliative and End-of-Life Care for Oncology" CD-ROM                   more information, go to the NCI


                                                                                Catheter-related blood stream infections (BSI) are a significant source of
                                                                                morbidity and mortality associated with a variety of devices used to
                                                                                access the vascular system. Meticulous aseptic technique is both
                                                                                required and effective to prevent BSI. Faculty share their observations,
                                                         Webcast – Best         best practices, and outcome data as they discuss this important topic.
                                                         practices to reduce    This free webcast is a replay from the original August 17, 2007, webcast
                                                         catheter-related       provided by Cardinal Health's Center for Safety and Clinical Excellence
                                                         blood stream           and will remain available for one full year. Continuing education credit is          http://www.cardinal.com/clinicalcent
September 2007    Patient Safety                         infections             also provided.                                                                       er/materials/webcasts/index.asp




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                                                                                                                                                                  IHI
  Month        Year                Topic by Tab                      Tool                                         Description                                    Tool                Location
                                                                                    The latest medication safety-related videos, developed by the FDA in
                                                                                    cooperation with ISMP, are now available free for viewing or
                                                             FDA – Free patient     downloading on the ISMP Web site                                                    http://www.ismp.org/Tools/fdavideo
September 2007        Patient Safety                         safety videos          (http://www.ismp.org/Tools/fdavideos.asp).
                                                                                    The new Healthcare Industry Quick Start module is directed primarily to             s.asp
                                                             OSHA – New             small employers in the healthcare field. The module is designed to help
                                                             healthcare "Quick      users find free resources on the OSHA Web site related to the
                                                             Start" compliance      healthcare industry. The eight-step module includes information on                  http://www.osha.gov/dcsp/complian
August         2007 Patient Safety                           tool                   OSHA requirements that apply to many healthcare employers;                          ce_assistance/quickstarts/

                                                             ACR – Updated          The white paper titled "ACR Guidance Document for Safe MR Practices"                http://www.premierinc.com/quality-
                                                             guidance on            (.pdf) (335 KB) details MR safety, from the design of the MR suite and              safety/tools-services/safety/safety-
                                                             magnetic resonance     the qualifications of personnel to screening patients and what to do in an          share/07-07-downloads/08-safe-
July           2007   Patient Safety                         safety                 emergency.                                                                          mr07.pdf




                                                                                                                                                                        English:
                                                                                                                                                                        http://www.premierinc.com/quality-
                                                                                                                                                                        safety/tools-services/safety/safety-
                                                                                                                                                                        share/07-07-downloads/04-
                                                                                                                                                                        meninge-survivor-story-
                                                             CDC – New              One young man's experience with meningococcal meningitis and his                    english.doc; Spanish:
                                                             meningococcal          subsequent recovery is available in both English (.doc) ( KB) and                   http://www.premierinc.com/quality-
                                                             vaccine information    Spanish (.doc) (59 KB) to be shared with patients and staff (.doc) (1.9             safety/tools-services/safety/safety-
                                                             available in Spanish   MB). His story emphasizes the importance of receiving the available                 share/07-07-downloads/05-
July           2007   Patient Safety                         and English            vaccine.                                                                            meninge-survivor-story-spanish.rtf


                                                                                    The new Health Care Report Card Compendium is a searchable
                                                                                    directory of more than 200 samples of report cards produced by a
                                                                                    variety of organizations. The samples show formats and approaches for
                                                                                    providing comparative information on the quality of health plans,
                                                                                    hospitals, medical groups, individual physicians, nursing homes, and
                                                                                    other providers of care. The purpose of the AHRQ Report Card
                                                                                    Compendium is to inform and support the various organizations that
                                                             AHRQ – Sample          develop healthcare quality reports, to provide easy access to examples
                                                             healthcare quality     of different approaches to content and presentation, and to meet the                http://www.talkingquality.gov/comp
June           2007   Patient Safety                         report cards           needs of health services researchers.                                               endium/




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                                                                                                                                                              IHI
  Month       Year                Topic by Tab                      Tool                                        Description                                  Tool                Location

                                                                                  A new guide available from the Agency for Healthcare Research and
                                                                                  Quality (AHRQ) titled "Mistake-Proofing the Design of Health Care
                                                                                  Processes" describes simple, low-cost interventions that organizations
                                                                                  can undertake to improve patient safety that includes more than 150
                                                                                  real world examples of process or design features that have been
                                                            AHRQ toolkit –        implemented as a result of root-cause analyses and other interventions            http://www.premierinc.com/quality-
                                                            "Mistake-proofing"    to help ensure that processes help prevent errors or the negative impact          safety/tools-services/safety/safety-
                                                            healthcare process    of an error.                                                                      share/06-07-downloads/07-
June          2007   Patient Safety                         design                                                                                                  mistakeproofing.pdf


                                                                               The AORN "Patient Hand-Off Toolkit" helps caregivers effectively
                                                                               communicate key information such as the patient’s current and past
                                                            AORN Patient Hand- condition, ongoing treatments, and possible changes or complications                 The toolkit can be downloaded free
                                                            Off toolkit – Free that should be monitored closely. The kit includes sample checklists and             of charge at:
                                                            Web-based surgical forms, slide presentations on standardizing communication and                        http://www.aorn.org/PracticeResour
June          2007   Patient Safety                         patient transfer   information exchanges, and a guide to additional resources.                          ces/ToolKits/


                                                                              The CDC has published a national estimate of the number of healthcare-
                                                                              associated infections (HAI) and HAI-related deaths in the United States               http://www.premierinc.com/quality-
                                                                              in a March-April issue of Public Health article, "Estimating Health Care-             safety/tools-
                                                                              Associated Infections and Deaths in U.S. Hospitals, 2002." The authors                services/safety/topics/guidelines/an
                                                                              concluded that the method they used for estimating the number of HAIs                 timicrobials.jsp#hc-assoc-
                                                                              made the best use of existing national data. Data were obtained from                  infections;
                                                                              the National Nosocomial Infections Surveillance (NNIS) System (1990-                  http://www.premierinc.com/quality-
                                                                              2002), the National Discharge Survey (2002), and the American Hospital                safety/tools-
                                                            CDC – HAI summary Association Survey (2000). Study findings are summarized in a                         services/safety/topics/guidelines/an
May           2007   Patient Safety                         and slide set     PowerPoint presentation.                                                              timicrobials.jsp#hc-assoc-infections


                                                                              The new information explains what the Joint Commission is looking for
                                                                              in adverse tissue reaction policies, such as the reporting of potential
                                                                              disease transmission to the recipient when notified by the donor source
                                                                              facility and reporting adverse patient reactions to the donor source
                                                                              facility. These actions must be carried out and the tissue's unique
                                                                              identifier must also allow the organization to easily trace the records
                                                                              when notified of a problem by either the donor facility or the patient's              http://www.premierinc.com/quality-
                                                            The Joint         physician. Tracing the tissue records includes the complete chain of                  safety/tools-
                                                            Commission – FAQs events, including who handled the tissue, how it was transported, stored              services/safety/topics/patient_safet
May           2007   Patient Safety                         on tissue storage and processed, dates and times such activities occurred.                              y/downloads/jc-standards-faqs.doc




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                                                                                                                                                                 IHI
  Month       Year                Topic by Tab                      Tool                                         Description                                    Tool                Location

                                                                                  The second in a series of collaborative leadership tools for CEOs,
                                                                                  "Clarifying Expectations: A First Step in Developing Truly Effective
                                                                                  Relationships Between CEOs and Trustees," focuses on clarifying
                                                                                  trustees' and CEOs' mutual expectations. It includes a simple exercise
                                                                                  for helping trustees and CEOs refine the way they work together. It also
                                                                                  includes information on the sources of misunderstandings and typical                 Tool 2 is available at
                                                                                  expectations and describes the roles of and relationships between the                http://www.americangovernance.co
                                                            AHA – CEO             CEO and the board.                                                                   m/americangovernance/resources/
May           2007   Patient Safety                         leadership tools                                                                                           CLT/CLTtool2.html
                                                                                  This site provides the agency's latest healthcare research findings,
                                                                                  news, and information. This site enables viewers to also hear the                    This link is available from the
                                                            AHRQ – Audio          newscasts through a computer or permit a download to a portable digital              Safety Institute's Patient safety web
Mar           2007 Patient Safety                           newscast series       player such as an iPod.                                                              site under "Resources."




                                                                                  An online tool created by the Foundation for Healthy Communities in
                                                                                  New Hampshire has a directory that enables healthcare workers working
                                                                                  with culturally and linguistically diverse communities to easily find
                                                                                  translated health forms and documents. The directory provides access
                                                                                  to documents created and translated by New Hampshire health
                                                                                  agencies and organizations. The documents are intended for use by any
                                                                                  healthcare organization. Translated documents include consent forms,
                                                                                  patient bills of rights, financial assistance applications, and information
                                                                                  about cholesterol, asthma and child immunizations. Part of the
                                                            New Hampshire –       Foundation's Cultural Effectiveness and Quality Health Care Project, the
                                                            Health forms in       tool will be updated with documents and language translations. Access                http://www.healthynh.com/fhc/reso
Feb           2007 Patient Safety                           multiple languages    the tool on the Foundation Web site.                                                 urces/translateddocuments.php



                                                                                  The FDA Hospital Bed Safety Workgroup's (HBSW), final guidance on
                                                                                  hospital bed design, "Guidance for Industry and FDA Staff; Hospital Bed              http://www.premierinc.com/quality-
                                                                                  System Dimensional and Assessment Guidance to Reduce                                 safety/tools-services/safety/safety-
                                                                                  Entrapment", identifies special issues associated with hospital bed                  share/01-07-full-txt.jsp#tool-01. The
                                                                                  systems and provides design recommendations for manufacturers of                     HBSW also has a Bed Safety
                                                                                  new hospital beds and suggestions for healthcare facilities on ways to               Entrapment Kit containing
                                                                                  assess existing beds. "A Guide for Modifying Bed Systems and Using                   information and tools that can be
                                                                                  Accessories to Reduce the Risk of Entrapment", released by the HBSW                  used to assess the risk of
                                                            FDA – Updates on      in June 2006, focuses on modifying bed systems and using add-on or                   entrapment in hospital beds
                                                            hospital bed safety   replacement equipment and accessories to reduce the entrapment risks                 http://www.fda.gov/cdrh/beds/entra
Jan           2007 Patient Safety                           guidance              posed by openings in existing bed systems.                                           pmentkit.html.




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                                                                                                                                                                 IHI
  Month       Year                Topic by Tab                      Tool                                         Description                                    Tool                Location



                                                                                   Beginning in June 2007, all hospitals, including Critical Access Hospitals
                                                                                   (CAH), will have 30-day (risk adjusted) mortality rates for acute
                                                                                   myocardial infarction (AMI) and heart failure (HF) published on the
                                                                                   Hospital Compare Web site through an initiative led by the Hospital
                                                                                   Quality Alliance (HQA) . The data reported in June will cover the period
                                                                                   July 1, 2005, to June 30, 2006; reported data will also soon include
                                                                                   pneumonia patients. So that hospitals may become familiar with the
                                                                                   background of the measures and their own mortality rates, Centers for               Hospital Compare Web site
                                                                                   Medicare and Medicaid Services (CMS) will provide a mock report                     (http://www.hospitalcompare.hhs.g
                                                                                   based on 2003 Medicare claims. The rates contained in these initial                 ov/). Information and updates about
                                                                                   reports will not be posted publicly on the Hospital Compare Web site.               this initiative will be posted
                                                                                   IThe CMS timeline from November 2006 contains additional information,               periodically to
                                                            Hospital Compare -     including the important dates for public reporting. More information is             http://www.qualitynet.org/ under the
Jan           2007   Patient Safety                         Mock data              available at QNet exchange.                                                         "Hospitals" section.


                                                                                   Hospitals for a Healthy Environment (H2E) has developed an
                                                                                   "Environmental Compliance and Improvement Guide" that matches
                                                                                   each JCAHO Element of Performance to specific federal regulations.
                                                                                   This guide helps facilities identify how to be in compliance with both.
                                                                                   The guide also suggests steps that facilities can take to encourage
                                                                                   environmental performance improvements. A comprehensive
                                                                                   environmental program, including waste minimization and pollution
                                                                                   prevention initiatives, not only ensures compliance, but can also help
                                                                                   reduce the costs of compliance. The guide provides links, tips and tools
                                                            H2E – New              that enumerate specific management practices, materials, regulatory
                                                            environmental          requirements, and facility infrastructure relevant to the specific JCAHO            http://www.h2e-
                                                            compliance and         Element of Performance (EP).                                                        online.org/regsandstandards/jcahoi
Dec           2006   Patient Safety                         improvement guide      The first tool is a "Global Trigger Tool" designed to help get started in           ntro.html Trigger Tools
                                                                                                                                                                       Access IHI
                                                            IHI – Patient safety   the approach; the other tools focus on specific areas such as measuring             at:http://www.ihi.org/IHI/Topics/Pati
Dec           2006   Patient Safety                         trigger tools          adverse drug events,Medical Center, Omaha, NE, intensive a tool and
                                                                                   Creighton University perioperative care, neonatal provides care, to                 entSafety/SafetyGeneral/Tools/Intr
                                                                                                                                                                       http://www.premierinc.com/quality-
                                                            Medication safety      guide considerations of resource requirements when evaluating the                   safety/tools-services/safety/safety-
                                                            guide – Ambulatory     ambulatory care environment for medication safety. The guide is titled              share/12-06-downloads/07-chrp-
Dec           2006   Patient Safety                         care                   "Medication Safety Best Practices Guide for Ambulatory Care Use"                    best-practices.pdf




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                                                                                        Premier Safety Share



                                                                                                                                                                 IHI
  Month       Year                Topic by Tab                      Tool                                         Description                                    Tool                Location


                                                                                 Several new tools have recently been added to the Surgical Care
                                                                                 Improvement Project (SCIP) Web site. The first, "Preventive Antibiotics
                                                                                 in Colon and Rectal Surgery: Discontinuation Within 24 Hours After
                                                                                 Operation," is a presentation that discusses the importance of giving
                                                                                 recommended antibiotics in colorectal surgery with the equally important              VTE guidelines are available from
                                                                                 factor of discontinuing the antibiotics within 24 hours. Other tools related          the Premier Safety Institute
                                                                                 to venous thromboembolism include: Deep Vein Thrombosis                               Infection Prevention and Safety
                                                            SCIP – New surgical, Prophylaxis Risk Factor Assessment, and Thrombosis Screen and                         Module under "Other guidelines,
Dec           2006   Patient Safety                         VTE tools            Prophylaxis Recommendations.                                                          selected resources."


                                                                                  Information in the report includes discussions of the scope of WPV,
                                                                                  barriers to violence prevention, prevention programs and strategies, and
                                                                                  research needs. The report discusses information on barriers and gaps
                                                                                  that impede the development and implementation of WPV prevention
                                                                                  programs, and summarizes the best workplace violence                                 http://www.premierinc.com/quality-
                                                            Workplace Violence strategy/program practices presented by conference participants,                        safety/tools-services/safety/safety-
                                                            Prevention Strategies general research needs and the importance of linking research findings               share/11-06-downloads/10-
November      2006   Patient Safety                         and Research Needs to practical prevention efforts.                                                        workplace-violence-prevention.pdf
                                                                                   The Med Form tool helps patients maintain a single, updated record of
                                                                                   their medications, vitamins, immunizations and allergies to share with
                                                                                   their healthcare providers. The Arizona Hospital and Healthcare
                                                                                   Association's Safe & Sound Patient Safety Initiative, Arizona Medical
                                                                                   Association, and Arizona Partnership for Implementing Patient Safety                The Med Form is available in
                                                                                   sponsored the form and it is available statewide in physician offices and           Spanish and English at
November      2006   Patient Safety                         The Med Form tool      hospitals.                                                                          http://www.themedform.com/.


                                                                                   Meeting the Joint Commission's 2007 National Patient Safety Goals, is
                                                                                   available as a tool for all accredited organizations preparing to
                                                                                   implement the 2007 National Patient Safety Goals. The publication
                                                                                   explains how to comply with the 2007 goals and requirements of the
                                                            New JCAHO              goals, through a compilation of articles, book excerpts and tips. Detailed          To order, call JCR Customer
                                                            resource – 2007        topics such as identifying safety risks inherent in patient populations,            Service toll-free at 877.223.6866, 8
                                                            National Patient       and encouraging the involvement of patients and families in patient care            a.m. to 8 p.m. CT, weekdays, or
Oct           2006   Patient Safety                         Safety Goals           are among those covered in the book.                                                visit www.jcrinc.com




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                                                                                                                                                               IHI
  Month        Year                Topic by Tab                      Tool                                        Description                                  Tool                Location


                                                                                   The Joint Commission on Accreditation of Healthcare Organizations has
                                                                                   a secure extranet Web site that offers new automated tools for reporting
                                                                                   sentinel events and complaints. Full transition to the online tools is
                                                                                   required by January 1, 2007. Locate the tool on the extranet home page
                                                                                   under "Self Report Sentinel Event" in the "Continuous Compliance
                                                                                   Tools" section. Root cause analyses (RCA), action plans, and sentinel             The automated complaint tool is
                                                                                   event measures of success may be submitted to the Joint Commission                also available on the Joint
                                                                                   using an online RCA collection tool, also accessible from the                     Commission Web site at:
                                                             Sentinel event and    "Continuous Compliance Tools" section under the "Sentinel Event                   http://www.jointcommission.org/Ge
Sept           2006 Patient Safety                           complaint reporting   Activities" link.                                                                 neralPublic/Complaint/


                                                                                  A new consensus report from the American Medical Association Ethical
                                                                                  Force Program offers guidelines to help healthcare organizations ensure
                                                                                  effective, patient-centered communications with patients of diverse
                                                                                  backgrounds. This report lists a number of specific, measurable
                                                                                  expectations for performance that organizations can use as a framework             http://www.premierinc.com/quality-
                                                             AMA – Guidelines for for evaluating performance, as well as a guide for improving                       safety/tools-services/safety/safety-
                                                             improving patient    communication quality. An organizational self-assessment toolkit based             share/07-06-downloads/06-
July           2006 Patient Safety                           communications       on the report is being field-tested.                                               improving-communication.pdf


                                                                                  The Surgical Care Improvement Project (SCIP) Web site has added                    http://www.premierinc.com/quality-
                                                                                  practical tools for the four SCIP areas: cardiac, infections, venous               safety/tools-services/safety/safety-
                                                                                  thromboembolism, and respiratory. Tools include help with antibiotic               share/07-06-downloads/13-scip-
                                                                                  timing, glucose management, and prevention of deep vein thrombosis.                antibiotics-pocket-card.pdf,
                                                             SCIP – Surgical care Visitors can download a DVT order set, an antibiotic recommendations               additional tools at
July           2006 Patient Safety                           improvement tools    chart, and a glucose management protocol order set.                                http://www.medqic.org/scip


                                                                                   The Joint Commission International Center for Patient Safety has a new
                                                                                   online resource that links to resources related to sentinel events and
                                                                                   Joint Commission on Accreditation of Healthcare Organizations
                                                                                   (JCAHO) National Patient Safety Goals. The site, "Patient Safety
                                                                                   Practices," contains tools and resources addressing issues related to
                                                                                   the causes and types of adverse events, U.S. and International Patient
                                                             Patient Safety        Safety Goals and free access to many of their articles from a variety of
                                                             Practices - JCAHO     journals, including the "Environment of Care."                                    Go to:
May            2006   Patient Safety                         web site              http://www.jcipatientsafety.org/psp                                               http://www.jcipatientsafety.org/psp




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                                                                                                                                                                  IHI
   Month        Year                Topic by Tab                      Tool                                         Description                                   Tool                Location


                                                                                   The National Institute for Occupational Safety and Health (NIOSH) draft,
                                                                                   "Evaluation of Safe Patient Handling and Movement Principles",
                                                                                   available for comment until May 30, 2006. The presentation was
                                                                                   developed for use in nursing schools to improve work practices for
                                                                                   patient care workers. It covers the definition of ergonomics, risk factors
                                                                                   for musculoskeletal injury during patient handling and movement,
                                                              Evaluation of Safe   recognizing high-risk patient care activities and conditions that result in          Go to:
                                                              Patient Handling and high-risk patient-care environments, and identifying the best solutions              http://www.cdc.gov/niosh/review/pu
April           2006   Patient Safety                         Movement Principles for patient handling.                                                                 blic/safe-patient/
                                                                                    The toolkit presents strategies for comprehensively redesigning and
                                                                                    transforming processes of care in a hospital. It details how healthcare
                                                                                    systems can redesign (including the planning steps needed for such
                                                                                    transformation) and presents strategies for translating information
                                                                                    gathered into proposed projects for implementation. Many of the                     Go to:
                                                              AHRQ toolkit –        techniques included in the toolkit can be used to guide process                     http://www.premierinc.com/all/safet
                                                              Hospital process      improvements without embarking on comprehensive system                              y/publications/03-06-downloads/09-
March           2006   Patient Safety                         redesign strategies   transformation.                                                                     hospital-redesign-toolkit.pdf


                                                                                    guide is designed to help outpatient physician practices incorporate
                                                                                    safer systems for medication sample prescribing and dispensing. The
                                                                                    checklist format helps users rate their current medication use processes
                                                                                    (prescribing, dispensing, administering, counseling, and monitoring) so
                                                                                    plans for improvements can be prioritized and implemented. The guide                Go to:
                                                              Medication safety     also addresses processes in technology and safety, office environment,              http://www.premierinc.com/all/safet
                                                              tool – ambulatory     error management, workplace conditions, safety education, and safety                y/publications/03-06-downloads/08-
March           2006   Patient Safety                         care                  perceptions.                                                                        best-practices-ambulatory-care.pdf




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                                                                                      Premier Safety Share



                                                                                                                                                                IHI
  Month     Year                Topic by Tab                       Tool                                         Description                                    Tool                Location




                                                                                 Having Surgery? What You Need to Know is designed to help patients
                                                                                 make informed decisions when planning for surgery. The brochure
                                                                                 suggests questions to help patients obtain needed information including
                                                                                 how and where their operation will be performed, what kind of
                                                                                 anesthesia will be used, whether non-surgical medical treatment and                  Go to
                                                                                 watchful waiting are options, possible risks of not having the surgery,              :http://www.premierinc.com/all/safe
                                                                                 potential risks and expected benefits if they have the surgery, and how              ty/publications/01-06-downloads/13-
                                                                                 long recovery is expected to take. Additional questions include cost,                surgery.pdf. A Spanish language
                                                                                 insurance and whether a second opinion is required and/or covered. The               version,
                                                          Having Surgery?        publication is part of a series of healthcare resources from AHRQ to                 http://www.premierinc.com/all/safet
                                                          What You Need to       help people be more active in making informed decisions that can help                y/publications/01-06-downloads/14-
January     2006   Patient Safety                         Know"                  them obtain high-quality Anesthesiologists (ASA) has approved a
                                                                                 The American Society ofhealthcare.                                                   sp-surgery.pdf, is available.
                                                          ASA Practice           practice advisory on anesthesia awareness intended to help
                                                          Advisory – reduce      anesthesiologists reduce the risk of unintended patient awareness under              http://www.premierinc.com/all/safet
                                                          awareness under        general anesthesia. The ASA reports that one to two out of every 1,000               y/publications/11-05-downloads/09-
December    2005   Patient Safety                         anesthesia             patients receiving general anesthesia regains consciousness and may                  aware-advisory-10-05.pdf


                                                                                 This module applies the AHRQ QI to improve population health using
                                                                                 the AHRQ QI as a catalyst for quality improvement, implications of ICD-
                                                                                 9-CM coding practices, the use of the AHRQ QI in the National
                                                                                 Healthcare Quality Reports, methods for creating aggregate
                                                          Pediatric Indicator    performance indices, and considerations in using the AHRQ QI for                     http://qualityindicators.ahrq.gov/use
November    2005   Patient Safety                         Module                 comparative reporting and pay-for-performance.                                       rmeeting_presentations_2005.htm



                                                                                 A free multimedia safety tool kit is available and contains a five-minute,
                                                                                 Web based version of the patient safety Emmi TM tool that explains the
                                                                                 patient's role in preventing mistakes and infections in hospitals. The tool
                                                                                 kit is sponsored by the American Society of Hospital Risk Management
                                                                                 (ASHRM), Rightfield Solutions, the creators of Emmi patient education
                                                                                 system, and the Health Research and Educational Trust (HRET) of the
                                                          Multimedia safety      American Hospital Association. Hospitals can post this program on their
                                                          tool kit for patient   Web sites for patients to view prior to coming to the hospital, or
November    2005   Patient Safety                         education              broadcast the two-minute version on an in-house television network.                  http://www.emmisafety.com/ashrm




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                                                                                                                                                               IHI
  Month     Year                Topic by Tab                      Tool                                          Description                                   Tool                Location


                                                                                 The South Carolina Hospital Association (SCHA) Patient Safety
                                                                                 Committee has developed three tools to help consumers, healthcare
                                                                                 facilities, and healthcare workers keep track of all personal medications.
                                                                                 These tools can help consumers, hospital inpatients and outpatients,
                                                                                 hospitals, nursing homes, physician offices, emergency medical
                                                                                 workers, and pharmacists "stay on the same page" so that everyone
                                                                                 knows all of the medications a person takes. The tools are: Universal
                                                          Toolkit – Medication   Medication Form (UMF), Patient Medication Brochure, and Medication                  http://scha.org/document.asp?docu
October     2005   Patient Safety                         safety                 Reconciliation Form (MRF)                                                           ment_id=2,3,32,3491


                                                                                 The agenda at the regional forums and networking meetings includes                  For more information about these
                                                          Regional               results from the CMS-Premier Hospital Quality Improvement                           programs and a schedule and
                                                          Performance            Demonstration project (how-to's and success stories from top decile                 registration, visit:
                                                          Improvement forums,    performers), patient safety, managing length of stay, physician                     http://www.premierinc.com/all/confe
                                                          Rapid Improvement      engagement, interactive working groups, and live demonstrations of the              rences/ceo/index.jsp?ref=october-
October     2005   Patient Safety                         Web tool               Rapid Improvement Program and Web portal).                                          safety-share


                                                                                 The Joint Commission's August issue of Perspectives on Patient Safety
                                                                                 offers suggestions on meeting the 2006 National Patient Safety Goals
                                                                                 (.pdf) (345 KB). The special issue, provided free for a limited time,
                                                                                 describes each goal and accompanying requirements and offers
                                                                                 compliance tips. For example, JCAHO describes measures
                                                                                 implemented by some organizations to increase compliance with hand
                                                                                 hygiene guidelines from the Centers for Disease Control and Prevention
                                                          Suggestions on         (CDC), which is required under the goal for reducing the risk of                    Access the suggestions at
                                                          meeting the 2006       healthcare-associated infections. Tips for non-hospital settings, such as           http://www.premierinc.com/all/safet
                                                          National Patient       home care or long-term care, are also included where compliance needs               y/publications/08-05-downloads/11-
August      2005   Patient Safety                         Safety Goals           could differ from acute care settings.                                              perspectives-07-05.pdf

                                                                                 A new Institute for Healthcare Improvement (IHI) Innovation Series white
                                                                                 paper expands on a previous paper, "Move Your Dot: Measuring,
                                                                                 Evaluating, and Reducing Hospital Mortality Rates," that introduced a
                                                                                 novel perspective and methodology for understanding and reducing
                                                          Move Your Dot:         inpatient deaths. "Reducing Hospital Mortality Rates (Part 2)"
                                                          Measuring,             summarizes preliminary results from a three-year pilot project in which             White papers are free and available
                                                          Evaluating, and        eight hospitals, working with IHI, are testing the theory that hospital             online at:
                                                          Reducing Hospital      mortality can be consistently reduced through a combination of evidence-            http://www.ihi.org/IHI/Products/Whit
August      2005   Patient Safety                         Mortality Rates        based interventions.                                                          √     ePapers/




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                                                                                                                                                                  IHI
  Month        Year                Topic by Tab                      Tool                                         Description                                    Tool                Location
                                                                                   Premier's Safety Institute has developed a Spanish version of the
                                                                                   Agency for Healthcare Research and Quality's (AHRQ) Hospital Survey
                                                             Hospital Survey on    on Patient Safety Culture survey tool, as well as a customized                       The survey tool can be accessed at
                                                             Patient Safety        Microsoft® Excel data tool for easy entry and rapid display of survey                http://www.premierinc.com/all/safet
August         2005   Patient Safety                         Culture               results.                                                                             y/culture/




                                                                                   ―Self-Study Modules on Tuberculosis,‖ a new education tool specifically
                                                                                   designed for healthcare workers and other professionals involved in the
                                                                                   identification, treatment, and care of individuals with tuberculosis and
                                                                                   latent tuberculosis infection is now available. The tool is the result of a
                                                                                   partnership between the Centers for Disease Control and Prevention’s
                                                                                   (CDC) Division of Tuberculosis Elimination and the Division of Media
                                                                                   and Training Services. These courses are also appropriate for staff of
                                                                                   correctional facilities, drug treatment centers, migrant clinics, nursing
                                                                                   homes, homeless shelters, or other facilities serving persons with or at
                                                                                   risk for tuberculosis. Each course has a separate set of modules,
                                                                                   registration process, exam, and credits. The modules can also be
                                                                                   worked through without registering. Content from both the print-based
                                                                                   Self-Study Modules on Tuberculosis and the video-based "A Satellite                  The modules can be accessed at
                                                             Self-Study Modules    Primer on Tuberculosis" was used to create Self-Study Modules on                     http://www.phppo.cdc.gov/phtn/tbm
July           2005 Patient Safety                           on Tuberculosis       Tuberculosis that can be delivered via the World Wide Web.                           odules/Default.htm.


                                                                                   Alternatives to using medical waste incinerators for treating regulated
                                                                                   medical waste were the focus of a free teleconference July 8, 2005, and              Additional information is available
                                                                                   hosted by Hospitals for a Healthy Environment (H2E). Teleconference                  from H2E at www.h2e-
                                                                                   speaker Sally M. Patterson, regulated medical waste program                          online.org/events/teleconf/index.cf
                                                                                   coordinator, New York State Department of Health, discussed the                      m. The slide presentation, (Append
                                                                                   advantages and disadvantages of using alternative treatment                          8_RMW_NY.ppt) as well as a chart
                                                                                   technologies approved in the state of New York, including low-heat                   of alternative technologies can be
                                                             Alternative medical   treating systems, high-heat treating systems, and chemical treatment                 downloaded. (Append
July           2005 Patient Safety                           waste treatment       systems.                                                                             9_alttechchart.pdf




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                                                                                                                                                                IHI
  Month        Year                Topic by Tab                       Tool                                        Description                                  Tool                Location

                                                                                    A checklist that can aid safety and environmental managers managing
                                                                                    obese patients is now available on the Healthcare Hazard Control (HHC)            To review the checklist and
                                                                                    Members' Web site. The list can help staff ensure that a healthcare               assessment tool, login at
                                                                                    facility's physical structures and equipment safely accommodates                  http://www.ecri.org, click "HHC
                                                                                    extremely obese patients and visitors. An assessment tool to guide                Homepage," and click the "Sample
                                                                                    caregivers on the safe handling of extremely obese patients has also              Policies" link on the left-hand side
                                                                                    been added. An analysis on the safe accommodation of extremely                    of the screen. The tools can be
                                                             Tools for managing     obese patients and visitors will be published in the August 2005 HHC              found under the "Miscellaneous"
July           2005 Patient Safety                           obese patients         mailing.                                                                          heading.


                                                                                    The American Medical Association (AMA) has released a new primer
                                                                                    designed to help physicians improve immunization rates, particularly in
                                                                                    minority populations. The primer, ―Roadmaps for Clinical Practice,
                                                                                    Improving Immunization: Addressing Racial and Ethnic Populations,‖
                                                                                    addresses the leading health indicator of immunization and infectious
                                                                                    diseases, with a special focus on reducing racial and ethnic disparities
                                                                                    in immunizations. In addition to resources, the primer provides tools to
                                                             Roadmaps for           help physicians ensure that patients are up-to-date with their
                                                             Clinical Practice,     vaccinations and includes immunization schedules for both children and
                                                             Improving              adults. The primer is the latest volume in the AMA’s ―Roadmaps for                The project is supported by an
                                                             Immunization:          Clinical Practice: Case Studies in Disease Prevention and Health                  unrestricted educational grant from
                                                             Addressing Racial      Promotion‖ series, which provides physicians and other health                     Sanofi Pasteur and is available
                                                             and Ethnic             professionals with clinical strategies and tools to address the leading           online at www.ama-
July           2005 Patient Safety                           Populations            causes of preventable morbidity and premature mortality.                          assn.org/go/roadmaps.


                                                                                    A new pocket guide recently released by Health and Human Services
                                                                                    (HHS), "Helping Smokers Quit: A Guide for Nurses," was developed by
                                                                                    AHRQ in collaboration with "Tobacco Free Nurses," a national initiative
                                                                                    funded by The Robert Wood Johnson Foundation. This new tool is
                                                                                    designed to give nurses evidence-based information that they can use
                                                                                    to help their patients quit smoking. The free guide gives nurses' easy            Download the guide at
                                                                                    access to information based on the "5 A's" approach to cessation                  http://www.premierinc.com/all/safet
                                                             HHS pocket guide       intervention: Ask, Advise, Assess, Assist, and Arrange. It also includes          y/publications/06-05-downloads/13-
                                                             offers resources to    a current listing of smoking cessation medications approved by Food               hlpsmksqt.pdf or go to
                                                             assist patients with   and Drug Administration (FDA) and a referral to HHS' National Quitline,           http://www.ahrq.gov/about/nursing/
June           2005   Patient Safety                         smoking cessation      1-800-QUIT NOW.                                                                   hlpsmksqt.htm




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                                                                                                                                                                IHI
  Month       Year                Topic by Tab                      Tool                                         Description                                   Tool                Location


                                                                                  The Commonwealth Fund's chart book assesses the quality of care
                                                                                  provided to elderly and disabled Medicare beneficiaries. This is just one
                                                                                  of several chart books available from the Commonwealth Fund on
                                                                                  health policy matters. The chart books are available in either Adobe or
                                                                                  PowerPoint Other topics available include insurance, access, and
                                                                                  quality of care among Hispanic populations, the state of child health
                                                            Quality of Care for   care in the United States, adults' primary care experiences in five
                                                            Medicare              industrialized countries, the health of women in New York City, and the             All chart books are available at:
June          2005   Patient Safety                         Beneficiaries         value of state pharmacy assistance programs.                                        http://www.cmwf.org/index.htm.
                                                                                  The 5th annual collection of charts and graphs depicts key trends
                                                                                  affecting hospitals and health systems. Sections include trends in the              Go to:
                                                                                  overall health care market, organizational trends, utilization and volume,          http://www.ahapolicyforum.org/aha
                                                            TrendWatch            trends in hospital financing, workforce, and the economic contribution of           policyforum/trendwatch/chartbook2
June          2005   Patient Safety                         Chartbook 2005        hospitals.                                                                          005.html


                                                                                  A compendium of 140 peer-reviewed articles on patient safety studies
                                                                                  by government-sponsored researchers. These studies include findings
                                                                                  on medication safety, technology, and investigative approaches to better
                                                                                  treatment, process analyses, human factors and practical tools for
                                                                                  preventing medical errors. The 140 articles in the four-volume set cover
                                                                                  a wide range of research paradigms, clinical settings, and patient
                                                                                  populations. Where the research is complete, the findings are
                                                            AHRQ-DOD              presented; where the research is still in process, the articles report on
                                                            compendium - Four- its progress. In addition to articles with a research and methodological
                                                            volume set of patient focus, the compendium includes articles that address implementation                 Go to:
                                                            safety research       issues or present useful tools and products that can be used to improve             http://www.ahrq.gov/qual/advances/
June          2005   Patient Safety                         studies               patient safety.                                                                     .


                                                                                The Institute for Safe Medication Practices (ISMP) announced it has
                                                                                developed a new tool (.doc) (33 KB) designed to assist hospitals in
                                                                                evaluating antithrombotic therapy. The survey has been mailed to
                                                                                hospitals with a submission deadline of September 1, 2005. The self-                  Find the tool at
                                                                                assessment will help organizations examine medication safety practices                http://www.premierinc.com/all/safet
                                                            New self-assessment associated with the use of antithrombotic drugs in their facilities.                  y/publications/05-05-downloads/11-
                                                            survey for          Hospitals may submit data through a secure Web-based form, which will                 ismp-self-assessment-launch.doc.
                                                            antithrombotic      allow them to compare their weighted scores with aggregate data from                  Further information is available at
May           2005   Patient Safety                         therapy             similar hospitals.                                                                    http://www.ismp.org.




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                                                                                                                                                                 IHI
 Month        Year                Topic by Tab                       Tool                                         Description                                   Tool                Location


                                                                                    The American Society for Healthcare Environmental Services has
                                                                                    partnered with Orkin, Inc. to promote more effective and environmentally
                                                                                    friendly pest-control practices in healthcare settings, including the
                                                                                    release of a guide on integrated pest management. The partners also                See Premier Safety Institute's
                                                                                    plan to publish educational articles and host two educational sessions             Environmental and Safety Product
                                                            Environmentally         on the recommended practice at ASHES' annual conference in                         list at:
                                                            friendly pest control   September. The partnership was launched in response to a growing                   http://www.premierinc.com/all/safet
May           2005   Patient Safety                         practices               movement in healthcare toward hazardous-chemical reduction.                        y/resources/lists/


                                                                                    The Health Research & Educational Trust, an affiliate of the American
                                                                                    Hospital Association (HRET/AHA), has developed two charts to help
                                                                                    hospitals select the best rapid HIV test for their needs. The charts,
                                                                                    developed with input from the Centers for Disease Control and
                                                                                    Prevention (CDC), are designed to help hospitals as they implement the
                                                                                    CDC's recommendation that the test be offered to all women presenting
                                                                                    to labor and delivery with undocumented HIV status. One chart
                                                                                    compares information on test price, external controls, numbers of tests
                                                                                    per case, catalog number, storage temperature, operating temperature,
                                                                                    shelf lives of tests and controls, time required to conduct test, and
                                                                                    validity window periods; the other chart compares information on FDA-
                                                                                    approval date, specimen type, CLIA-status, specificity, sensitivity,               To view the charts go to:
                                                            Rapid HIV antibody      manufacturer, HIV-2 detection capabilities, list price, and external               http://www.hret.org/hret/programs/h
May           2005   Patient Safety                         screening tests         controls.                                                                          ivtransmrpd.html


                                                                                 Advance directives, the legal documents that allow individuals to make
                                                                                 their personal healthcare wishes known before a serious illness or
                                                                                 injury, can be confusing and difficult to understand. The Institute for               The forms are available in both
                                                                                 Healthcare Advancement has an advance directive form designed for                     English
                                                                                 American adults who read below a fifth-grade level. The forms are                     http://www.premierinc.com/all/safet
                                                                                 available in both English (.pdf) (906 KB) and Spanish (.pdf) (911 KB).                y/publications/05-05-downloads/09-
                                                                                 The form is designed in a simple fill-in-the-blank format with illustrations          advance-directive-english.pdf (.pdf)
                                                                                 and easy-to-read bullet points. Low-literacy Americans will be able to                (906 KB) and Spanish
                                                                                 choose an agent to make medical decisions for them, make their                        http://www.premierinc.com/all/safet
                                                                                 healthcare wishes known so that their loved ones don't have to guess                  y/publications/05-05-downloads/10-
                                                            Simplifying advanced for them, and provide the necessary signatures to make the document                   advance-directive-spanish.pdf
May           2005   Patient Safety                         directives           legally binding.                                                                √     (.pdf) (911 KB).




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                                                                                                                                                                 IHI
  Month    Year                Topic by Tab                       Tool                                          Description                                     Tool                Location
                                                                                 The February issue of the Joint Commission Journal on Quality and
                                                                                 Patient Safety has been made available for a free download now online,                http://www.jcrinc.com/subscribers/j
                                                         Communicating           the issue focuses on communicating critical test results and includes                 ournal.asp?durki=8739&site=14&re
March      2005   Patient Safety                         critical test results   numerous important topics.                                                            turn=455#FEBRUARY%202005


                                                                                 The American Hospital Association's (AHA) Health Research and
                                                                                 Educational Trust (HRET) Web site has a section with information on
                                                                                 studies that describe the use of clinical simulations to train physicians
                                                                                 and other healthcare workers in the latest medical developments. An
                                                                                 advantage of clinical simulations training is that skills are learned
                                                                                 without risking harm to real patients. Simulation-based training also
                                                                                 provides trainees with a broad range of learning experiences, including
                                                                                 the treatment of uncommon conditions unlikely to be encountered in
                                                         Clinical Simulation     traditional patient-based training. The Clinical Simulation Tools site links          http://www.hret.org/hret/programs/s
March      2005   Patient Safety                         Tools                   to AHA simulation resources.                                                          imulations.html


                                                                                 The Joint Commission on Accreditation of Healthcare Organizations has
                                                                                 released a white paper (.pdf) (643 KB) recommending demonstration
                                                                                 projects to test alternatives to the nation's medical liability system. A
                                                                                 commission of medical liability and patient safety experts states that the
                                                                                 current liability system does not do enough to reduce negligence and
                                                                                 compensate victims of medical errors. The paper recommends
                                                                                 encouraging the adoption of information and simulation technology by
                                                                                 considering plans to offset implementation costs and by expanding
                                                                                 evidence-based reporting. The white paper states that any medical
                                                                                 liability changes need to ensure that the greatest number of injured
                                                                                 patients is fairly compensated, while allowing practitioners and providers            http://www.premierinc.com/all/safet
                                                         Medical liability White the opportunity to report errors, learn from them, and ensure that those              y/publications/03-05-downloads/08-
March      2005   Patient Safety                         parper                  errors are not repeated.                                                              medical-liability.pdf




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                                                                                                                                                                  IHI
  Month     Year                Topic by Tab                      Tool                                           Description                                     Tool                Location



                                                                                 The recently passed Consolidated Appropriations Act for fiscal year
                                                                                 2005 includes an appropriations restriction. This restriction states that
                                                                                 during FY 2005, employers may not be inspected or cited for the
                                                                                 requirement to do annual fit testing of respirators for occupational
                                                                                 exposure to tuberculosis. OSHA can still cite for the non-annual fit
                                                                                 testing requirements of 29 CFR 1910.134 as it relates to tuberculosis,
                                                                                 including the provisions of 29 CFR 1910.134(f)(2) for the lack of initial fit
                                                                                 testing or whenever a different respirator face piece is used. The
                                                                                 standard interpretation is described in an OSHA memo (.doc) (33 KB)
                                                                                 and also states that only annual fit testing of respirators used for
                                                                                 protection against tuberculosis are exempt from citations All other
                                                                                 requirements of the respiratory protection standard, including annual fit
                                                                                 testing, may continue to be cited for respirator use against other                     http://www.premierinc.com/all/safet
                                                                                 hazards, such as Severe Acute Respiratory Syndrome (SARS) or other                     y/publications/02-05-downloads/14-
February    2005   Patient Safety                         OSHA Memo              bioaerosols.                                                                           standard-interpretations.doc


                                                                                 The American Society for Healthcare Risk Management (ASHRM) has a
                                                                                 CD-ROM tool kit created for the various healthcare professionals who
                                                                                 work in the physician practice area. Risk managers can use it to conduct
                                                                                 an on-site survey of a practice for auditing purposes and also as a                    A sample tool kit has been made
                                                                                 baseline tool to develop additional checklist items. Key areas covered in              available,
                                                                                 the tool kit include principles of documentation; what to report to the                http://www.premierinc.com/all/safet
                                                                                 insurance claims representative; medical practice office systems risk                  y/publications/02-05-downloads/13-
                                                                                 prevention strategies; qualities of effective patient relations for office             physician-office-toolkit-sample.pdf,
                                                                                 staff; and risks and strategies related to effective telephone                         and the complete kit can be
                                                                                 communication. The tool kit also can be used as a pre-assessment tool                  purchased at
                                                          Tool kit for physician to identify potential risk areas. The tool kit contains Adobe Acrobat® and             http://www.ashrm.org/ashrm/resour
February    2005   Patient Safety                         office risk managers PowerPoint® files.                                                                       ces/products.html#toolkits.




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                                                                                                                                                                      IHI
  Month     Year                Topic by Tab                      Tool                                             Description                                       Tool                Location




                                                                                   Health information managers are directly involved in clinical quality
                                                                                   issues and outcomes through quality management programs, according
                                                                                   to the January practice brief titled, "The HIM Role in Patient Safety and
                                                                                   Quality of Care." Issued by the American Health Information
                                                                                   Management Association, the document discusses the legal and
                                                                                   regulatory environment, data standards, and return on investment in
                                                                                   technology. Health Information Managers also affect quality through
                                                                                   improved medical record documentation, accurate coding, and index
                                                                                   integrity. The author concludes that the health information managers'
                                                          Health information       ability to affect patient safety is great, particularly through data reporting.          To read the complete article, go to:
                                                          manager role in          As the coordinators of data quality, the health information managers are                 http://library.ahima.org/xpedio/grou
February    2005   Patient Safety                         patient safety           the "overseers" of consistent and accurate quality data.                                 ps/public/


                                                                                   One of the special resources developed from past issues of Safety
                                                                                   Share is an archive of all safety tools published in the monthly
                                                                                   newsletter. The resources are organized in an Excel® spreadsheet, with
                                                                                   descriptions of each tool and where they can be accessed. The
                                                                                   spreadsheet is categorized by topic and includes many tools that are                     http://www.premierinc.com/all/safet
                                                                                   available from the Institute for Healthcare Improvement. These are listed                y/publications/tool-list-by-
January     2005   Patient Safety                         Safety Share toolkit     separately as well as included under each pertinent topic.                               category.xls
                                                                                   A free copy of the book, "Preventing Occupational Exposures to
                                                          Preventing               Bloodborne Pathogens," a collection of articles from Advances in
                                                          Occupational             Exposure Prevention (1994 to 2003), is available from the Premier                        Order free copies of the book from
                                                          Exposures to             Safety Store. This 235-page book is edited by Jeannie Jagger and Jane                    the Premier Safety Store at:
                                                          Bloodborne               Perry from the International Healthcare Worker Safety Center at the                      http://www.premierinc.com/all/safet
December    2004   Patient Safety                         Pathogens                University of Virginia.                                                                  y/store/

                                                          First, Do No Harm™,
                                                          Part 3: Healing Lives,                                                                                            For ordering and more information,
December    2004   Patient Safety                         Changing Cultures                                                                                                 go to: www.p4ps.org.




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                                                                                                                                                                  IHI
  Month        Year                Topic by Tab                      Tool                                          Description                                   Tool                Location


                                                                                                                                                                        Obtain the booklets at the following
                                                                                    The National Diabetes Education Program (NDEP) has two new                          addresses:
                                                                                    evidence-based publications for healthcare providers and patients. The              http://www.premierinc.com/all/safet
                                                                                    first helps providers identify people with pre-diabetes and undiagnosed             y/publications/11-04-downloads/06-
                                                             Guiding Principles for diabetes, and provide patient-centered care. The second booklet                     guide-prin-hc-eng.pdf;
                                                             Diabetes Care; 4       complements the first and is for people with diabetes. It helps                     http://www.premierinc.com/all/safet
                                                             Steps to Control Your healthcare providers educate patients about self-care principles and                 y/publications/11-04-downloads/07-
November       2004   Patient Safety                         Diabetes for Life      how to be active partners in their own care.                                        4-steps.pdf


                                                                                     This conference brought together a diverse group of medication safety
                                                                                     leaders from nursing, pharmacy and technology to explore the newest                To learn more about this or past
                                                                                     generation of medication safety technology – designed to help prevent              conferences,
                                                             Measuring Safety        infusion programming errors and to collect data on IV delivery practices.          http://my.premierinc.com/all/safety/
                                                             with Smart IV           The specific focus of this conference was using the data the technology            publications/08-04-downloads/09-
August          2004 Patient Safety                          systems                 yields as a road map for process improvement at hospitals                          alaris-conf-grid4.doc


                                                                                 The database is intended to raise awareness among healthcare
                                                                                 purchasers, providers and plans to improve care quality. The Leapfrog
                                                                                 Compendium documents and categorizes financial and non-financial
                                                                                 programs, such as those that reward providers with quality bonuses,
                                                                                 and those that reward providers with public recognition. Incorporated are
                                                                                 the Leapfrog standards of computerized physician order entry, evidence-
                                                                                 based hospital referrals and hospital intensivist programs. The site can               The Leapfrog Compendium can be
                                                                                 be searched by state for programs targeting hospitals, physicians,                     freely accessed at
                                                             Pay-for-performance consumers and health plans, or it can be searched from a nationwide                    http://www.leapfroggroup.org/ircom
July            2004 Patient Safety                          programs            list.                                                                                  pendium.htm.


                                                                                     Hospital flow can be measured at five levels: patient and community;
                                                                                     hospital throughput; hospital activity; hospital performance; and unit
                                                             Measurement guide       performance. Each level provides a portion of the total measurement                http://www.ihi.org/IHI/Topics/Flow/P
                                                             for hospital flow       picture. Use this guide to learn how to measure data in these key areas            atientFlow/EmergingContent/Hospit
July            2004 Patient Safety                          patterns                to help you improve patient flow.                                            √     alFlowMeasurementGuide.htm
                                                             Guidance for Using      Using the AHRQ Inpatient Quality Indicators or Patient Safety Indicators
                                                             the AHRQ Quality        to report on hospital quality or make payment decisions are discussed in
                                                             Indicators for          a new guide. AHRQ's Quality Indicators are measurement tools that
                                                             Hospital-Level Public   were developed by AHRQ and researchers to help individual hospitals
                                                             Reporting or            use their own discharge data to better understand and improve the care
October        2004   Patient Safety                         Payment                 they provide.




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                                                                                                                                                               IHI
  Month     Year                Topic by Tab                      Tool                                          Description                                   Tool                Location
                                                                                                                                                                     http://www.jcaho.org/accredited+or
                                                          Look alike/Sound        The JCAHO has updated its frequently asked questions (FAQs) on the                 ganizations/patient+safety/05+npsg
October      2004 Patient Safety                          alike drug list         2005 NPSGs and included a new look-alike/sound alike drug list.                    /05_npsg_faqs.htm


                                                          Rationale and
                                                          Interpretive
                                                          Guidelines" for the                                                                                        http://www.premierinc.com/all/safet
                                                          2005 National Patient This document provides insight into how surveyors will be interpreting               y/publications/10-04-downloads/11-
October     2004   Patient Safety                         Safety Goals          the goals next year.                                                                 npsg-guidelines-09-04.pdf


                                                                                  The National Patient Safety Foundation (NPSF) has a brochure and
                                                                                  companion video entitled "Patient Safety: Your Role in Making
                                                                                  Healthcare Safer." It was created to help patients become more involved
                                                                                  in their healthcare safety. The companion video will help supplement
                                                                                  and reinforce the safety message with patients. The brochure and video             Purchase information at:
                                                          Patient Safety: Your    are part of the National Patient Safety Foundation's Stand up for Patient          http://www.mederrors.org/Merchant
                                                          Role in Making          Safety campaign, which is designed to help patients learn practical ways           2/merchant.mv?Screen=SFNT&Sto
June         2004 Patient Safety                          Healthcare Safer        to help ensure their safety in both inpatient and outpatient settings.             re_Code=NO
                                                                                                                                                                     http://my.premierinc.com/all/safety/
                                                          Five steps to patient   The poster, available in English and Spanish, succinctly describes the             publications/06-
June         2004 Patient Safety                          safety                  five steps patients can take to ensure safer care.                                 04_full_txt.htm#Safety_tools


                                                                               The webcast features researchers, design professionals, and hospital
                                                                               leaders presenting and discussing how hospitals of the future should be
                                                                               built, organized, and managed to maximize patient safety and outcomes
                                                                               and improve staff performance and satisfaction. Featured are up-to-the-
                                                                               minute evidence-based design concepts for healthcare buildings. With
                                                                               an anticipated $20 billion in new hospital construction and major
                                                          Designing the 21st   renovations projected annually for the next decade, the central question
                                                          Century Hospital:    of the conference was how hospitals' physical design, operating
                                                          Serving Patients and systems, and "corporate culture" affect patients, staff, and hospitals'               http://www.rwjf.org/news/hospitalde
June         2004 Patient Safety                          Staff                bottom line.                                                                          sign




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                                                                                          Premier Safety Share



                                                                                                                                                                    IHI
   Month        Year                Topic by Tab                      Tool                                           Description                                   Tool                Location


                                                                                     A new NIOSH Alert is meant to increase healthcare worker awareness
                                                                                     about the health risks when working with hazardous drugs. The alert
                                                              Preventing             also is intended to educate workers on the steps they can take to
                                                              Occupational           protect their health. ―Preventing Occupational Exposures to
                                                              Exposures to           Antineoplastic and other Hazardous Drugs in healthcare Settings‖ may
                                                              Antineoplastic and     be downloaded in prepublication form. Pharmaceutical agents are
                                                              other Hazardous        classified as hazardous drugs if research indicates that they may cause              http://www.premierinc.com/all/safet
                                                              Drugs in healthcare    cancer, have developmental or reproductive toxicity, or harm organs in               y/publications/05-04-downloads/11-
May             2004   Patient Safety                         Settings               exposure at low doses.                                                               2004-hazdrug-alert.pdf
                                                              JCAHO tips -
                                                              Compliance with                                                                                             http://www.premierinc.com/all/safet
                                                              prohibited             Suggestions on how to comply with the National Patient Safety Goal                   y/publications/05-04-downloads/10-
May             2004   Patient Safety                         abbreviations          related to dangerous abbreviations are now available from the JCAHO.                 implementation-tips.doc


                                                                                   The Ohio Hospital Association and Patient Safety Institute have
                                                                                   developed a surgical protocol (232 KB) to help Ohio providers prevent
                                                              Prevention of wrong- the incidence of wrong-site; wrong-patient and wrong-procedure surgery.
                                                              site, wrong-patient, The protocol outlines three steps for caregivers to follow prior to surgery:           http://www.premierinc.com/all/safet
                                                              wrong-procedure      patient verification, marking of the surgical site and a "time-out" before             y/publications/05-04-downloads/08-
May             2004   Patient Safety                         errors               incision to conduct a final checklist.                                                 ohio-surgical-protocol.pdf
                                                              The Tools and          A new Web site, "The Tools and Techniques of Improved Medication
                                                              Techniques of          Use," is intended for those in the healthcare community who design
                                                              Improved Medication    medication safety programs and/or seek information to enhance existing               http://www.aahp.org/content/naviga
April           2004   Patient Safety                         Use                    patient safety efforts.                                                              tionmenu/medcollab/medcollab.htm


                                                                                     A new easy-to-use Web site to help consumers and health professionals
                                                                                     find information about FDA-approved drug products more quickly and
                                                                                     efficiently. The new interface, Drugs @ FDA, is a searchable database
                                                                                     that includes information on approved prescription drugs, some over-the-             http://www.accessdata.fda.gov/scri
April           2004   Patient Safety                         Drugs @ FDA            counter drugs, and discontinued drugs.                                               pts/cder/drugsatfda/


                                                                                     A peer-reviewed newsletter published by the Institute for Safe
                                                                                     Medication Practices (ISMP), Nurse Advise-ERR (February, 2004),
                                                                                     addresses issues such as mixing up IV lines while setting up or
                                                                                     programming a multiple-channel IV pump, the risks of leaving an
                                                                                     unnecessary intra-arterial line in place, a list of high-alert medications,
                                                                                     and questions to use when evaluating infusion pumps. Nurse Advise-                   Register at
                                                                                     ERR, a medication safety newsletter written especially for nurses by                 www.ismp.org/NursingArticles/inde
April           2004   Patient Safety                         Nurse Advise-ERR       nurses, is offered free for the remainder of 2004.                                   x.htm




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                                                                                          Premier Safety Share



                                                                                                                                                                  IHI
   Month        Year                Topic by Tab                       Tool                                        Description                                   Tool                Location
                                                                                     The Institute for Family Centered Care has produced a number of useful
                                                                                     resources to support the involvement of patients on hospital/healthcare
                                                                                     advisory committees and boards. These resources have been
                                                              Patient                developed from the experiences of many hospitals/healthcare facilities
                                                              representative on      and the patients, family members and community representatives who
April           2004   Patient Safety                         safety committee       have worked with them.                                                             http://www.familycenteredcare.org/
                                                                                     OSHA’s Hospital e-tool is a Web-based training tool for safety and                 http://www.premierinc.com/all/safet
                                                                                     health hazard assessments in hospitals that provides a virtual hospital            y/resources/needlestick/resources.
March           2004 Patient Safety                           Hospital e-tool        using graphics and visual assists for learning.                                    html#OSHA
                                                                                                                                                                        http://www.premierinc.com/all/safet
                                                                                     A free electronic bi-monthly newsletter produced by OSHA to inform the             y/resources/needlestick/resources.
March           2004 Patient Safety                           Quick Takes            public about recent OSHA activities.                                               html#OSHA


                                                                                     This book includes stories of all types of medical errors such as wrong
                                                              Internal Bleeding:     patient cases, judgment calls gone awry, and retained sponges. The
                                                              The Truth Behind       analysis of the causes of errors leads to their suggestions of what
                                                              America's Terrifying   providers, patients, policymakers, and healthcare leaders need to do to            The book can be purchased from
                                                              Epidemic of Medical    cure this epidemic. The 320-page hardcover book includes an extensive              Rugged Land at
 February       2004 Patient Safety                           Mistakes               bibliography and 40 pages of footnotes.                                            http://www.ruggedland.com.
                                                                                     Tips for conducting a self-evaluation of compressed gas and cylinder
                                                                                     safety. The article includes a checklist of 10 questions addressing
                                                              Checklist -            proper storage, use, and handling of compressed gas cylinders to                   http://www.premierinc.com/all/safet
                                                              Compressed gas         prevent associated hazards such as oxygen displacement, fires,                     y/publications/02-04-downloads/09-
 February       2004 Patient Safety                           safety                 explosions, and toxic exposure.                                                    oregon-OSHA-checklist.doc
                                                                                     The National Fire Protection Association (NFPA) provides information
                                                                                     on how to interface elevators and fire alarm systems. The information              http://www.premierinc.com/all/safet
                                                                                     ensures safe emergency operation of modern elevators that meet                     y/publications/01-04-downloads/08-
                                                                                     requirements under NFPA and American Society of Mechanical                         interfacing-elevators-fire-
January         2004 Patient Safety                           Fire safety tips       Engineers codes.                                                                   alarms.doc
                                                                                     Safety tips for preventing hospital bed fires, the safety recommendations
                                                                                     apply to both electrically powered and manual healthcare beds, as well             http://www.premierinc.com/all/safet
                                                                                     as adjustable medical beds. Some of the initial safety-check                       y/publications/01-04-downloads/07-
January         2004 Patient Safety                           Fire safety tips       suggestions involve simple observations.                                           FDA-bedfires-12-18-03.pdf




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                                                                                                                                                              IHI
  Month     Year                Topic by Tab                      Tool                                          Description                                  Tool                Location
                                                                               Through interviews, narration and a viewer's guide, the program
                                                                               highlights actions that trustees can take to improve patient safety within
                                                                                                                                                                    The video can be purchased for
                                                                               their organizations. This video can also aid orientation efforts for new
                                                                                                                                                                    $275 using order code V02/03AAH.
                                                                               trustees while reinforcing current trustees' understanding of their role in
                                                          Governance, Quality                                                                                       To order, call Joint Commission
                                                                               creating an organizational culture that focuses on patient safety.
                                                          and Safety: The                                                                                           Resources (JCR) Customer
                                                          Impact of Joint                                                                                           Service at 877.223.6866 weekdays
                                                          Commission                                                                                                from 8 a.m. to 8 p.m. CT, or visit
                                                          Accreditation on                                                                                          Infomart on the JCR Web site at:
January     2004 Patient Safety                           Health Care Delivery                                                                                      www.jcrinc.com.
                                                          Healthy Hospitals:   The report offers tips and resources for how hospitals can manage
                                                          Controlling Pests    pests while also protecting the health of people and the environment.                http://my.premierinc.com/all/safety/
                                                          Without Harmful                                                                                           publications/12-03-downloads/11-
December    2003 Patient Safety                           Pesticides                                                                                                pesticides.pdf
                                                                               The paper is an educational tool designed to provide consensus-based,                http://my.premierinc.com/all/safety/
                                                          Magnetic resonance valid and medically credible information and features detailed, useful                 publications/12-03-
December    2003 Patient Safety                           safety               checklists.                                                                          downloads/12_MR-safety.pdf
                                                                                  A resource guide designed to help the elderly and their children start            http://www.premierinc.com/all/safet
                                                                                  discussions about end-of-life wishes before an unexpected illness                 y/publications/11-03-downloads/08-
                                                                                  arises. The booklet is geared toward the elderly and children of the              crisis-convo.pdf
                                                                                  aging, and includes a resources list with helpful books and Web sites.
                                                          Conversations Before
November    2003   Patient Safety                         the Crisis
                                                                                  A resource folder designed to help hospitals communicate with patients
                                                          Strategies for          and families.
                                                          Leadership:
                                                          Improving                                                                                                 http://www.premierinc.com/all/safet
                                                          Communications with                                                                                       y/publications/11-03-downloads/10-
November    2003   Patient Safety                         Patients and Families                                                                                     pcp-english.pdf
                                                                              The Pink Book – ―Epidemiology and Prevention of Vaccine Preventable
                                                          Epidemiology and    Diseases,‖ the 7th edition from 2002, is now in its second printing.                  The book is available for download
                                                          Prevention of                                                                                             or purchase at
                                                          Vaccine Preventable                                                                                       http://www.cdc.gov/nip/publications
October     2003   Patient Safety                         Diseases                                                                                                  /pink/default.htm
                                                                              This guide is intended to remind providers to deliver appropriate                     The guide is available in English at
                                                                              preventive services while involving patients directly in their preventive             http://www.ahrq.gov/ppip/adguide/
                                                          The Pocket Guide to care. It includes recommendations on screening tests and
                                                          Good Health for     immunizations, questions for patients to ask health care providers, and
October     2003   Patient Safety                         Adults              resources for additional information.




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                                                                                                                                                               IHI
  Month     Year               Topic by Tab                       Tool                                          Description                                   Tool                Location
                                                                               The Failure Modes and Effects Analysis (FMEA) tool is a method for
                                                                               analyzing any process to see where it is likely to fail; to see how
                                                          The Failure Modes    changes you are considering might affect the safety of the process; and
                                                          and Effects Analysis to track changes in the Risk Priority Number (or RPN) of the process
September   2003 Patient Safety                           (FMEA)               over time.                                                                      √     http://www.qualityhealthcare.org/.


                                                                                 The Trigger Tool for Measuring Adverse Drug Events (ADEs),
                                                                                 developed with Premier, is a simple yet powerful method of identifying
                                                          The Trigger Tool for   and tracking the number of medication errors in your hospital – using a
                                                          Measuring Adverse      retrospective review of patient records to look for sentinel clues or
September   2003 Patient Safety                           Drug Events (ADEs)     "triggers" that indicate a medication error has occurred.                     √     http://www.qualityhealthcare.org/.


                                                          Learning from Each
                                                          Other: Success
                                                          Stories and Ideas for
                                                          Reducing                                                                                                   http://www.premierinc.com/all/safet
                                                          Restraint/Seclusion The award recognizes excellence in graphic design, editorial content,                  y/publications/09-03_downloads/08-
September   2003 Patient Safety                           in Behavioral Health and the ability to achieve overall communications excellence.                         learning-from-each-other.pdf
                                                                                 Sessions on patient safety officer training, along with general
                                                          Quality Colloquium     conference sessions on error reduction and quality enhancements; the                The CD-ROMs can be purchased
                                                          conference at          role of technology; informatics; competition for quality and six sigma              at
September   2003 Patient Safety                           Harvard University     process improvement.                                                                http://www.qualitycolloquium.com/.
                                                                                 This season's flu campaign emphasizes protecting yourself and the
                                                                                 ones you love by getting a flu vaccine. You'll find materials for parents,
                                                                                 Spanish speakers, those at high risk for flu complications, and
                                                                                 immunization providers. Materials are free and can be downloaded                    http://www.cdc.gov/nip/flu/gallery.ht
September   2003 Patient Safety                           Flu Gallery            easily.                                                                             m
                                                                                 The fourth installment of the Joint Commission's free video information
                                                                                 series, "The Priority Focus Process and Tracer Methodology". The five
                                                          The Priority Focus     to seven-minute videos highlight the key components of the new                      To view this video, go to:
                                                          Process and Tracer     accreditation process.                                                              http://www.jcaho.org/accredited+or
August      2003 Patient Safety                           Methodology                                                                                                ganizations/svnp/svnp_video.htm
                                                                                                                                                                     http://www.premierinc.com/all/safet
                                                                                                                                                                     y/publications/08-
                                                          Resource for PCA                                                                                           03_downloads/09_ISMP_PCA_pu
August      2003 Patient Safety                           pumps                  The ISMP Medication Safety Alert's a two-part series on PCA pumps.                  mpsafety_07-03.doc
                                                                                 Posters and fact sheets providing tips to help patients avoid errors                http://www.premierinc.com/all/safet
                                                          5 Steps to Safer       related to prescription medicines, laboratory tests, procedures and                 y/publications/08-
August      2003 Patient Safety                           Healthcare             surgery                                                                             03_downloads/10_5-steps.pdf




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                                                                                         Premier Safety Share



                                                                                                                                                                    IHI
   Month        Year               Topic by Tab                        Tool                                        Description                                     Tool                Location
                                                                                                                                                                          All materials are available at:
                                                                                                                                                                          http://www.qualityhealthcare.org/Q
                                                                                    QHC requires free registration to access all tools. The site will include             HC/
                                                              Surgical Site         results from teams that participated in the collaborative, as well as tools,          Topics/PatientSafety/SurgicalSiteIn
July            2003 Patient Safety                           Infection Tools       such as forms, policies and order sets.                                         √     fections/

                                                              The Effect of Health                                                                                        http://my.premierinc.com/all/safety/
                                                              Care Working                                                                                                publications/07-
                                                              Conditions on Patient Evidence in the scientific literature to make specific recommendations                03_downloads/11_AHRQ_worksum
July            2003 Patient Safety                           Safety Report         about these strategies for improving patient safety.                                  .pdf
                                                                                                                                                                          http://www.ahrq.gov/consumer/safe
                                                                                                                                                                          meds/safemeds.htm for the English
                                                                                                                                                                          version,
                                                                                                                                                                          http://www.ahrq.gov/consumer/safe
                                                              Your Medicine: Play                                                                                         medsp/safemedsp.htm for the
June            2003 Patient Safety                           It Safe               To help consumers use prescription medicines safely.                                  Spanish version.
                                                              IHI’s global online
                                                              improvement
June            2003 Patient Safety                           resource              Improving access in the office practice                                         √     http://www.QualityHealthCare.org

                                                                                                                                                                          http://www.ama-
                                                                                                                                                                          assn.org/ama/pub/article/2403-
June            2003 Patient Safety                           Standing Orders       A collaborative effort to improve influenza vaccination rates                         7702.html


                                                                                                                                                                          These algorithms and a ―stop‖ sign
                                                                                                                                                                          that can be printed and used in
                                                                                                                                                                          these settings – if this becomes
                                                                                                                                                                          necessary – are available on
                                                                                    Tools for rapid assessment of a patient who may present with one or                   Premier’s Emergency and Public
May             2003 Patient Safety                           SARS Triage Tools     more symptoms suggestive of SARS                                                      Health Preparedness site.
                                                                                                                                                                          http://www.qualityhealthcare.org/Q
                                                                                                                                                                          HC/Topics/PatientSafety/Medicatio
                                                              Trigger Tool for      The trigger tool measures adverse drug events and provides instructions               nSystems/Tools/Trigger+Tool+for+
                                                              Measuring Adverse     for conducting a retrospective review of patient records using triggers to            Measuring+Adverse+Drug+Events
May             2003 Patient Safety                           Drug Events (ADEs)    identify possible ADEs.                                                         √     +(IHI+Tool).htm
                                                                                                                                                                          http://my.premierinc.com/all/safety/
April           2003 Patient Safety                           First, Do No Harm     Case studies and safety responses                                                     store/P4PS_video_form.doc




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                                                                                          Premier Safety Share



                                                                                                                                                                  IHI
   Month        Year               Topic by Tab                       Tool                                         Description                                   Tool                Location


                                                                                     The site enables searching for measures by specific disease, treatment,
                                                              National Quality       age range, gender, and a variety of other topics. The clearinghouse also
                                                              Measures               permits side-by-side comparative measurements that identify which will             http://www.qualitymeasures.ahrq.g
April           2003 Patient Safety                           Clearinghouse™         best work for a given organization.                                                ov/


                                                                                                                                                                        1.
                                                                                     A set of tools designed to reduce medication errors and help hospitals             http://www.premierinc.com/all/safet
                                                                                     take a system-based approach to address such errors. the three main                y/publications/03-
                                                                                     Pathways components help hospital leaders and professionals                        03_downloads/01_b.pdf 2.
                                                                                     incorporate medication safety into an organization's strategic plan;               http://www.premierinc.com/all/safet
                                                                                     identify specific error-prone processes and devise safe alternatives               y/publications/03-
                                                                                     using a process flow diagram; learn from case scenarios and the ISMP's             03_downloads/01_d.pdf 3.
                                                                                     10 Key Elements of Medication Use System; and prepare to implement                 http://www.premierinc.com/all/safet
                                                                                     a bedside bar-coding system for administering medications. 1. An                   y/publications/03-
                                                                                     executive rounds tool describing how a culture of safety can be fostered           03_downloads/01_g.pdf 4.
                                                                                     2. A sample medication error reporting form designed to collect and                http://www.premierinc.com/all/safet
                                                                                     analyze actual and potential medication errors 3. A checklist/action plan          y/publications/03-
                                                                                     for the safe use of high-alert medications 4. A sample policy detailing a          03_downloads/01_h.pdf 5.
                                                              Medication safety      blame-free adverse drug event reporting program 5. A patient safety tool           http://www.premierinc.com/all/safet
                                                              strategic plan, case   helping patients understand their rights and responsibilities regarding            y/publications/03-
March           2003 Patient Safety                           studies, resources     safe medication use.                                                               03_downloads/01_j.pdf

                                                                                                                                                                        http://my.premierinc.com/all/safety/
                                                              Pathways for           A set of tools designed to reduce medication errors and help hospitals             publications/03-
March           2003 Patient Safety                           Medication Safety      take a system-based approach to address such errors.                               03_downloads/11_extraordinary.pdf

                                                                                                                                                                        http://my.premierinc.com/all/safety/
                                                              Wrong-site surgery     Recommendations for eliminating as well as managing the discovery of               publications/03-
March           2003 Patient Safety                           checklist              a wrong-site surgery.                                                              03_downloads/11_extraordinary.pdf

                                                                                                                                                                        http://my.premierinc.com/all/safety/
                                                              Perspectives on        The report is devoted entirely to JCAHO'S 2003 National Patient Safety             publications/02-
February        2003 Patient Safety                           Patient Safety         Goals and provides practical advice and tips for meeting those goals.              03_downloads/13_ps_01-03.pdf
                                                                                     A new online peer-reviewed journal to showcase patient safety lessons
                                                              Web M & M (Web         drawn from actual cases of medical errors. The journal is designed to
                                                              Morbidity and          educate healthcare providers about medical errors in an engaging,
February        2003 Patient Safety                           Mortality),            blame-free environment.                                                            http://www.webmm.ahrq.gov/




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                                                                                     Premier Safety Share



                                                                                                                                                           IHI
  Month     Year               Topic by Tab                       Tool                                         Description                                Tool                Location

                                                          Pathways for          A set of tools designed to reduce medication errors and help hospitals
January     2003 Patient Safety                           Medication Safety     take a system-based approach to address such errors                              http://www.medpathways.info/
                                                                              The site provides safety resources, injury and exposure data, industry
                                                          www.orprecautions.c information, information about the Needlestick Safety Act, and
January     2003 Patient Safety                           om                  convenient links to much more OR safety information.                               http://www.orprecautions.com/
                                                                                                                                                                 http://my.premierinc.com/all/safety/
                                                          Veterans’                                                                                              publications/01-
                                                          Administration guide Tools to help reduce the potential for entrapment in hospital bed                 03_downloads/12_VHA_bed_entra
January     2003 Patient Safety                           on bed safety zones systems.                                                                           pment.pdf



                                                                                                                                                                 http://my.premierinc.com/all/safety/
                                                                                                                                                                 publications/01-
                                                                                                                                                                 03_downloads/12_VHA_bed_entra
                                                                                                                                                                 pment.pdf,
                                                                                                                                                                 http://my.premierinc.com/all/safety/
                                                                                                                                                                 publications/01-
                                                                                                                                                                 03_downloads/14_CorrSurgPt.pdf,
                                                          Sample OR guides - Increased attention to medical errors and patient safety as they relate to          http://my.premierinc.com/all/safety/
                                                          Veterans'          correct surgery sites is leading institutions to develop guides and other           publications/01-
January     2003 Patient Safety                           Administration     instructional materials to help reduce such errors.                                 03_downloads/14_CorrSurgPt.pdf
                                                          First, Do No Harm
                                                          Part 2: Taking the
December    2002 Patient Safety                           Lead                  Takes the dialog within the patient safety movement to new levels                http://www.fdnh.com/
                                                          AHRQ WebM&M
                                                          (Morbidity and
                                                          Mortality Rounds on   Peer-reviewed, Web-based medical journal to showcase patient safety
December    2002 Patient Safety                           the Web)              lessons drawn from actual cases of medical errors.                               http://www.webmm.ahrq.gov/

                                                                                It organizes the technology into four categories based on function: (1)          http://my.premierinc.com/all/safety/
                                                                                electronic drug references, (2) e-prescribing solutions, (3) integrated          publications/12-
                                                          Physician drug e-     drug references and formulary tools, and (4) integrated electronic               02_downloads/07_improv_drug_pr
December    2002 Patient Safety                           prescribing           medical records and e-prescribing systems.                                       escrib.pdf
                                                                                                                                                                 http://my.premierinc.com/all/safety/
                                                          Role of the Patient   Valuable tips on how patients can choose "advocates" to look out for             publications/11-
November    2002 Patient Safety                           Advocate              their best healthcare interests                                                  02_downloads/08_nspf.pdf
                                                                                This site includes details of the design process, infection control and          http://www.ordesignandconstruction
November    2002 Patient Safety                           OR design tools       case studies.                                                                    .com/




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                                                                                         Premier Safety Share



                                                                                                                                                                 IHI
  Month        Year               Topic by Tab                       Tool                                         Description                                   Tool                Location


                                                             Preventing Infections
                                                             in the Hospital —     Provides patients with helpful principles for managing their healthcare
                                                             What You as a         and becoming an active partner with their healthcare team through                   http://www.npsf.org/download/Prev
October        2002 Patient Safety                           Patient Can Do        infection prevention                                                                entingInfections.pdf

                                                                                    Step-by-step instructions on how to disclose medical errors, why
                                                                                    disclosure is important, and how open communication can strengthen                 http://www.npsf.org/htm/prevent_inf
October        2002 Patient Safety                           Let's Talk             the patient-provider relationship are some of the subjects on the video.           ections.html
                                                             Videotapes: Patient,
                                                             worker, environment                                                                                       Case studies of successful safety
                                                             and medication                                                                                            programs –Order from Premier
October        2002 Patient Safety                           safety               Case studies of successful safety programs                                           Safety Institute online Safety Store.
                                                             Resources to reduce
                                                             pediatric medicine                                                                                        http://66.77.20.158/ahrq/childhealth
September      2002 Patient Safety                           errors              The materials outline methods for reducing errors in pediatric medicine.              webconf/
                                                                                                                                                                       http://my.premierinc.com/all/safety/
                                                                                  A recent study cautions doctors that air mattresses used in hospitals,               publications/09-
                                                                                  nursing homes, and home care can have deadly consequences for                        02_downloads/08_Air_mattresses_
September      2002 Patient Safety                           Air mattress dangers some patients                                                                        abstract.doc
                                                                                    The Web notification will disseminate device-related safety information
                                                             Web-based safety       useful to healthcare providers but inappropriate for the FDA’s existing            http://www.fda.gov/cdrh/safety.html
September      2002 Patient Safety                           notification program   notifications.                                                                     #web
                                                                                                                                                                       http://my.premierinc.com/all/safety/
                                                             American Society of    A new survey indicates that larger hospitals reporting a shortage of               publications/09-
                                                             Anesthesiologists      anesthesiologists are also delaying elective surgery and limiting access           02_downloads/09_ASA_07-30-
September      2002 Patient Safety                           survey                 to operating rooms                                                                 02.doc
                                                             Radiation safety                                                                                          http://www.orau.gov/reacts/define.h
August         2002 Patient Safety                           basics                 An excellent resource for radiation information and training                       tm



                                                                                    Hospital emergency departments (EDs) are the source of more than 50                http://www.jcaho.org/about+us/new
                                                                                    percent of all reported cases of patient death or permanent injury due to          s+letters/sentinel+event+alert/index
July           2202 Patient Safety                           ED delays              delays in treatment                                                                .htm

                                                                                                                                                                       http://my.premierinc.com/all/safety/
                                                                                    Institute for Safe Medication Practices (ISMP) offers six tips to reduce           publications/06-
                                                             Medication Safety      the risk of overdoses from patient- controlled analgesia (PCA) by proxy.           02_downloads/05_36_2002_niosh_
June           2002 Patient Safety                           Alert - May 29, 2002   Tips include selection criteria, protocols, monitoring, and education.             ventilation_139.pdf




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  Month       Year               Topic by Tab                       Tool                                          Description                                 Tool                 Location


                                                                                                                                                                     "Reducing Medication Errors," one
                                                                                                                                                                     of a four-part videotape series titled
                                                                                More than 40 nationally recognized safety experts sharing their                      "Safety Issues in Healthcare,"s is
                                                            Reducing Medication strategies for successful programs on patient safety, prevention of                  available from the Safety Institute's
June          2002 Patient Safety                           Errors              medication errors, and occupational and environmental safety.                        Safety Store.
                                                                                                                                                                     http://my.premierinc.com/all/safety/
                                                            Quality of Health      The book describes the state of healthcare in the United States by                publications/06-
                                                            Care in the United     examining medical mistakes, substandard care for chronic conditions,              02_downloads/02_quality_care_US
June          2002 Patient Safety                           States: A Chartbook    disparities in care, and the lack of preventive care.                             _status_rpt.pdf
                                                                                   The manual summarizes the report’s themes for improvements in the
                                                                                   U.S. healthcare system using a four-level framework: patients’                    http://my.premierinc.com/all/safety/
                                                                                   experiences; functioning of small units of care delivery; functioning of          publications/06-
                                                            Crossing the Quality   the organizations that support microsystems; and the supporting                   02_downloads/03_IOM2_manual.p
June          2002 Patient Safety                           Chasm                  environment that shapes the organization                                          df

                                                            Nursing Home           A pilot Web site that lists health deficiencies for nursing homes that
June          2002 Patient Safety                           Compare                have been filed, examined, and confirmed following complaints.                    http://www.medicare.gov/




                                                            How to Protect                                                                                           http://my.premierinc.com/all/safety/
                                                            Yourself and Your                                                                                        publications/05-
                                                            Family from Medical    The brochure outlines specific steps for preventing medication errors,            02_downloads/12_AHRQ_Protect_
May           2002 Patient Safety                           Errors                 wrong-site surgery, and infections                                                Yourself_Family.doc




                                                                                                                                                                     http://my.premierinc.com/all/safety/
                                                            Ways to Help Your                                                                                        publications/05-
                                                            Family Prevent         A patient fact sheet with 20 tips on preventing medical errors and a              02_downloads/13_AHRQ_Patient_
May           2002 Patient Safety                           Medical Errors         family-oriented brochure                                                          Fact_Sheet_20-Tips.doc




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                                                                                  Audio files and slides are available from a recent Premier webcast that
                                                                                  describes how hospitals can bring their organizations into compliance
                                                                                  with current EPA hazardous waste regulations and Joint Commission
                                                                                  requirements while preparing for future disposal restrictions. Increasing
                                                                                  national interest in a sustainable environment has accelerated the
                                                                                  healthcare industry's attention to waste management and recycling
                                                                                  practices. Among those challenges in waste management and recycling
                                                                                  is safe disposal of leftover medications, antibiotics, and other chemicals
                                                                                  that may find their way into our drinking water and food chain. Premier
                                                                                  hosted a public webcast titled ―Implementing a pharmacy waste
                                                                                  management system‖ to understand the problem of pharmaceutical
                                                                                  waste and suggest solutions and tips on how to separate, label and
                                                                                  dispose of common chemicals and drugs. Charlotte Smith, president of
                                                            Implementing a        PharmEcology Associates, LLC, presented the topic, noting that                      http://www.premierinc.com/quality-
                                                            pharmaceutical        managing pharmaceutical waste is becoming a nationwide issue, and                   safety/tools-
                                                            waste management      highlighted the impact on the ecosystem from disposal of leftover drugs             services/safety/news/2007/11/Phar
December      2007 Pharmaceutical Waste Management          system                through flushing and landfilling.                                                   maSafetyStory_11162007.jsp


                                                                                  A standardized hazardous waste manifest form that must be used by all
                                                                                  hazardous waste generators and treatment, storage, and disposal                     More information on the Uniform
                                                                                  facilities to track waste's progress from generation to disposal is                 Hazardous Waste Manifest,
                                                                                  available from the U.S. Environmental Protection Agency (EPA).                      including a list of printers approved
                                                                                  Handlers of waste (generators, or treatment, storage or disposal                    by EPA to supply the new form and
                                                                                  facilities) must obtain the new forms from any source that has been                 state requirements for use of the
                                                                                  approved for printing and distribution by the EPA Manifest Registry.                new form, can be found at:
                                                            Uniform Hazardous     Some states have additional requirements regarding the use of the new               http://www.epa.gov/epaoswer/hazw
Oct           2006 Pharmaceutical Waste Management          Waste Manifest        Uniform Hazardous Waste Manifest.                                                   aste/gener/manifest/
                                                                                  The document, "Managing Pharmaceutical Waste: A 10-Step Blueprint,"
                                                                                  is designed to help hospitals develop and implement a comprehensive
                                                                                  pharmaceutical hazardous waste management program. The plan
                                                            Managing              combines regulatory compliance and best management practices with                   http://www.premierinc.com/quality-
                                                            Pharmaceutical        waste minimization while minimizing risk in a cost effective manner. It is          safety/tools-services/safety/safety-
                                                            Waste: A 10-Step      organized to permit using the steps as needed, and not necessarily                  share/06-06-downloads/13-h2e-
June          2006 Pharmaceutical Waste Management          Blueprint             consecutively.                                                                      pharma-blueprint-04-15-06.pdf




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  Month       Year               Topic by Tab                       Tool                                         Description                                  Tool                Location




                                                                                   Hospitals for a Healthy Environment (H2E) hosted a March 11
                                                                                   teleconference on disposal of chemotherapeutic wastes. Presenters
                                                                                   from a waste consultancy and H2E offered an overview of proper
                                                                                   chemotherapeutic waste segregation, treatment, and minimization
                                                                                   techniques to reduce the safety, health, and environmental impacts of
                                                                                   managing this hazardous waste stream. The conference included
                                                                                   education on safest practices, with the understanding that many
                                                                                   chemotherapeutic agents in use today are not regulated under
                                                                                   Environmental Protection Agency's (EPA) Resource Conservation and                 Teleconference materials are at
                                                                                   Recovery Act, but should be included from a safety and health                     http://www.h2e-
                                                                                   perspective. H2E as provided six free Microsoft® Excel spreadsheets to            online.org/events/teleconf/molydes
                                                                                   help hospitals collect and manage waste data (solid waste, solid waste            c.cfm?Date=2005-03-11&t. at
                                                                                   recyclables, hazardous waste, hazardous waste recyclables, infectious             http://www.hercenter.org/wms.html
                                                            H2E resources -        waste and general facility information). The bottom half of the                   to access the H2E Waste
                                                            Chemo conference;      spreadsheet contains basic data and the top half of the spreadsheet               Management System and receive
                                                            waste disposal         does the calculations. Users register and then receive a notice if the            updates about the tool.
May           2005 Pharmaceutical Waste Management          management tools       database is updated.


                                                                                   The Environmental Protection Agency (EPA) has new guidance about
                                                                                   how the general public should handle used syringes/needles and other
                                                                                   sharps generated at home or other non-healthcare locations. The
                                                                                   guidance suggests that syringe users dispose of used syringes in ways
                                                                                   that keep the sharps out of the general trash, with a goal of protecting
                                                                                   workers along the solid waste "stream" and at land fills. The new EPA
                                                                                   guidance is published in two brochures: Protecting Your Community
                                                                                   from Sharps: Options for Safe Disposal of Sharps and Protect Yourself,
                                                            EPA guidance -         Protect Others: Safe Options for Needle Disposal.
                                                            Safer needle, sharps                                                                                     http://www.premierinc.com/all/safet
                                                            disposal in public                                                                                       y/publications/02-05-downloads/10-
February      2005 Pharmaceutical waste management          areas                                                                                                    med-govt.pdf
                                                            Preventing
                                                            Occupational
                                                            Exposures to
                                                            Antineoplastic and                                                                                       http://www.premierinc.com/all/safet
                                                            Other Hazardous                                                                                          y/resources/pharma-
                                                            Drugs in Healthcare                                                                                      waste/downloads/2004-
September     2004 Pharmaceutical waste management          Settings               NIOSH Alert on antineoplastic drugs                                               HazDrugAlert.pdf




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                                                             The Guidance for
                                                             Industry and FDA
                                                             Staff: Frequently       The Food and Drug Administration's (FDA) Center for Devices and
                                                             Asked Questions         Radiological Health (CDRH) has released a new FAQ on single-use
                                                             (FAQs) on the Status    devices. The document, titled, "The Guidance for Industry and FDA
                                                             of Reprocessed          Staff: Frequently Asked Questions (FAQs) on the Status of
                                                             Single Use Devices      Reprocessed Single Use Devices (SUDs) that receive a Not
                                                             (SUDs) that receive a   Substantially Equivalent (NSE) Letter," (.pdf) (140 KB) explains
                                                             Not Substantially       instances in which a NSE letter pertains to a reprocessed SUD and                     http://www.premierinc.com/all/safet
                                                             Equivalent (NSE)        whether in-stock, reprocessed SUDs can be used once the reprocessor                   y/publications/12-04-downloads/14-
December       2004 Reuse of Single Use Devices              Letter                  can no longer distribute the SUDs as a result of a NSE letter.                        sud-guidance-nse-ltr.pdf
                                                                                                                                                                           The CD-ROM is $475 for AAMI
                                                                                                                                                                           members and $655 for non-
                                                                                     The collection has every AAMI document covering sterilization in                      members. Contact AAMI at
                                                                                     healthcare facilities, sterilization equipment, and industrial sterilization          800.332.2264, Ext. 217, or visit
                                                             AAMI sterilization      process control. It includes FDA and CDC guidance documents and the                   http://aami.org and click on
July           2004 Reuse of Single Use Devices              documents               Code of Federal Regulations sections pertaining to sterilization.                     "marketplace."
                                                                                Revised forms and instructions for voluntary and mandatory reporting to
                                                                                MedWatch for healthcare facilities and others to use in reporting
                                                             MedWatch reporting adverse events involving single-use medical devices that have been                         http://www.fda.gov/medwatch/getfo
March          2004 Reuse of Single Use Devices              forms              reprocessed for reuse.                                                                     rms.htm
                                                             An Overview of the
                                                             Regulatory
                                                             Requirements for
                                                             Reprocessing of
                                                             Single-Use Devices      A two-CD set that covers the regulatory requirements that a hospital                  http://www.fda.gov/cdrh/reuse/reus
August         2002 Reuse of Single Use Devices              by Hospitals            must meet if it reprocesses single-use devices (SUDs).                                e-important.shtml


                                                                                  A new pamphlet being released by the CDC – Sharps Safety for
                                                                                  Healthcare Personnel – describes healthcare worker risk, how and when
                                                                                  injuries occur, how sharps safety devices reduce injuries, and the
                                                                                  importance of developing a "culture of safety" for sharps injury
                                                                                  prevention. This and other sharps injury prevention brochures are
                                                                                  publicly accessible on the Safety Institute Web site to assist frontline                 http://www.premierinc.com/quality-
                                                                                  workers in selecting safety devices to evaluate for their institutions. The              safety/tools-
                                                                                  Web site also contains links to national lists of sharps safety products. A              services/safety/topics/needlestick/d
                                                             Sharps Safety for    new addition to the available tools is the needlestick prevention booklet                ownloads/cdc-sharps-brochure-10-
October        2007 Sharps Injury Prevention                 Healthcare Personnel for non-acute care.                                                                      01-07.pdf




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                                                                                    The U.S. Public Health Service has updated the recommendations for
                                                                                    the management of healthcare personnel (HCP) with occupational
                                                                                    exposure to blood and other body fluids that might contain human
                                                                                    immunodeficiency virus (HIV). Published in the September 30, 2005
                                                                                    Morbidity and Mortality Weekly Report (MMWR) , the recommendations
                                                                                    (.pdf) (267 KB) emphasize adherence to postexposure prophylaxis
                                                                                    (PEP) regimens when indicated, expert consultation in managing                    http://www.premierinc.com/all/safet
                                                             HIV post-exposure      exposures, follow-up to improve HCP adherence to PEP, and monitoring              y/publications/10-05-downloads/11-
October        2005 Sharps Injury Prevention                 prophylaxis            for adverse events, including seroconversion.                                     hiv-rr5409.pdf


                                                                               A resource book for healthcare organizations, clinicians and others
                                                                               designed to make it easier to find sharps injury prevention, blood                     The Compendium is now available
                                                                               exposure prevention and infection control products that can protect                    for immediate purchase as in e-
                                                                               patients, healthcare workers and others. A cooperative effort from                     book. The printed version will be
                                                                               medical device and infection control product manufacturers, the                        available in a few months. The
                                                                               Compendium is sponsored by the Premier Safety Institute, ISIPS,                        price will be $129.95, but for a
                                                                               Managing Infection Control Magazine, AOHP and NAPPSI. It will be                       limited time, a pre-publication price
                                                                               published both as a printed book and as an e-book. In the printed book,                of $89.95 is available. For more
                                                             The Compendium of each device is paired with a custom evaluation form to facilitate record               information, call 801.280.8797 or
                                                             Infection Control keeping. The digital edition of the Compendium will have each product                  send an e-mail to
July           2005 Sharps Injury Prevention                 Technologies      linked directly to the Sample Procurement Center.                                      info@medicalsafetybook.com.


                                                                                    The Environmental Protection Agency (EPA) has new guidance about
                                                                                    how the general public should handle used syringes/needles and other
                                                                                    sharps generated at home or other non-healthcare locations. The
                                                                                    guidance suggests that syringe users dispose of used syringes in ways
                                                                                    that keep the sharps out of the general trash, with a goal of protecting
                                                                                    workers along the solid waste "stream" and at land fills. The new EPA
                                                                                    guidance is published in two brochures: Protecting Your Community
                                                                                    from Sharps: Options for Safe Disposal of Sharps and Protect Yourself,
                                                             EPA guidance -         Protect Others: Safe Options for Needle Disposal.
                                                             Safer needle, sharps                                                                                     http://www.premierinc.com/all/safet
                                                             disposal in public                                                                                       y/publications/02-05-downloads/10-
February       2005 Sharps Injury Prevention                 areas                                                                                                    med-govt.pdf




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   Month        Year               Topic by Tab                       Tool                                           Description                                     Tool                 Location
                                                                                      A free copy of the book, "Preventing Occupational Exposures to
                                                              Preventing              Bloodborne Pathogens," a collection of articles from Advances in
                                                              Occupational            Exposure Prevention (1994 to 2003), is available from the Premier                     Order free copies of the book from
                                                              Exposures to            Safety Store. This 235-page book is edited by Jeannie Jagger and Jane                 the Premier Safety Store at:
                                                              Bloodborne              Perry from the International Healthcare Worker Safety Center at the                   http://www.premierinc.com/all/safet
December        2004   Sharps Injury Prevention               Pathogens               University of Virginia.                                                               y/store/



                                                                                      A list of journal articles published between 1988 and 2004 that pertains              Document:
                                                                                      to the review, selection, testing, or evaluation of safer needle devices.             http://www.premierinc.com/all/safet
                                                                                      The document, titled "Articles and abstracts," includes a list of selected            y/resources/needlestick/downloads/
                                                              Literature review for   references, followed by the citation and full abstract. Detailed analysis of          sharps-journal-lit-listing-abstract-08-
                                                              review, selection,      the same journal list is provided in a tabular summary format (link                   04.doc               Tabular format:
                                                              testing or evaluation   below), permitting ease in sorting the journals by: study focus, author,              http://www.premierinc.com/all/safet
                                                              of safer needle         journal, title, population-setting, study design, key findings-summary,               y/resources/needlestick/downloads/
Sept             2004 Sharps Injury Prevention                devices                 conclusions and key words for searching.                                              sharps-journal-lit-analysis-08-04.xls
                                                              Sequence for
                                                              Donning and
                                                              Removing Personal                                                                                             http://www.premierinc.com/all/safet
                                                              Protective Equipment                                                                                          y/publications/05-04-downloads/09-
May             2004   Sharps Injury Prevention               (PPE)                                                                                                         ppeposter-1322.pdf


                                                                                      The ―Frequently Asked Questions‖ (FAQs) regarding sharps safety were
                                                                                      updated following a recent Premier-sponsored audio conference that
                                                                                      featured speakers from OSHA and CDC. Issues addressed include
                                                                                      specific devices, device selection, evaluation and replacement, worker                http://www.premierinc.com/all/safet
                                                              Frequently Asked        training and compliance, record keeping, schedules and implementation                 y/resources/needlestick/downloads/
April           2004   Sharps Injury Prevention               Questions               and a list of OSHA resources.                                                         OSHA-FAQs.pdf


                                                                                                                                                                            http://www.epa.gov/epaoswer/other
                                                                                                                                                                            /medical/sharps.htm, Disposal Tips
                                                                                                                                                                            for Home Health Care (patient
                                                                                                                                                                            flyer) (.pdf), Disposal Tips for
                                                                                                                                                                            Home Health Care (professional
                                                                                      A new at-home sharps disposal options based on the recommendations                    brochure) (.pdf), New Information
                                                                                      of the Coalition for Safe Community Needle Disposal. It has added to its              About Disposing of Medical Sharps
                                                              Sharps disposal         current recommendations additional new options for disposal of medical                (.pdf)
March           2004 Sharps Injury Prevention                 information flyers      sharps outside the healthcare setting.




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                                                                                                                                                                    A link to an order form, is available
                                                                                                                                                                    at:
                                                                                  ECRI presents ratings of eight sharps disposal containers designed for            http://www.ecri.org/Newsroom/PR_
September     2003 Sharps Injury Prevention                 Health Devices        patient rooms or patient treatment areas.                                         Detail.asp?DN=20030828_73

                                                                                  The Premier Safety Institute's Bloodborne Pathogen (BBP) Assessment
                                                            Bloodborne            Tool provides a comprehensive checklist for assessing compliance with
                                                            Pathogen (BBP)        OSHA's complete bloodborne pathogen rule, including considerations                Download the tool from the Sharps
August        2003 Sharps Injury Prevention                 Assessment Tool       for a complete sharps injury prevention program.                                  Injury Prevention module
                                                                                                                                                                    http://www.premierinc.com/all/safet
                                                                               This site from the CDC’s Business/Labor division provides helpful                    y/publications/08-
                                                            HIV/AIDS workplace information and toolkits that help businesses tailor a program specific to           03_downloads/12_HIV_wkpl_mgr_
August        2003 Sharps Injury Prevention                 policy materials   their workplace.                                                                     kit.pdf
                                                            ECRI - General        In addition to standard performance and human-factors design issues,
                                                            infusion pumps and    the report addresses patient safety, reflecting some exciting
December      2002 Sharps Injury Prevention                 patient safety        advancements in infusion pump technology                                          info@ecri.org
                                                            OSHA Compliance       OSHA compliance tools and resources for implementing a                            Premier Safety Web resource:
May           2002 Sharps Injury Prevention                 Tools                 comprehensive sharps injury prevention program.                                   OSHA compliance tools
                                                                                  States the agency's policy on disposal of contaminated needles and
                                                                                  blood tube holders following blood-drawing procedures. The bulletin also
                                                                                  provides the most recent sharps injury data from the Exposure
                                                                                  Prevention Information Network. OSHA developed this ―Information
                                                                                  Regarding the Disposal of Contaminated Needles and Blood Tube
                                                            Policy on             Holders Used for Phlebotomy‖ to provide relevant information regarding            http://my.premierinc.com/all/safety/
                                                            contaminated blood    its policy on the prohibition of contaminated needle removal from                 publications/12-03-downloads/10-
December      2003 Sharps Injury Prevention                 tube holders          medical devices.                                                                  OSHA-tib-10-15-03.pdf




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                                                                               Available resources include: An audio-conference with downloadable
                                                                               materials, including DVT research slides, physician and nurse
                                                                               assessments, sample order sets, and a recording of the audio
                                                                               conference. A webcast on anticoagulation therapy includes speakers
                                                                               from hospitals with successful anticoagulation therapy programs who
                                                                               share their journey to reduce adverse events and discuss The Joint
                                                                               Commission's 2008 National Patient Safety Goals for anticoagulation
                                                                               therapy. Slides and an audio file of the webcast and other resources
                                                                               also are available. An Informatics comparative data tools help users
                                                                               identify potential problems, track progress and monitor variations,
                                                                               enabling users to actively reduce the rates of DVT and other serious
                                                                               avoidable conditions, establish performance benchmarks and share
                                                                               best practice interventions. Premier’s "Performance Improvement
                                                         Premier Safety        Portal" is a resource for clinicians to get information on performance            http://www.premierinc.com/quality-
                                                         Institute – QI and    improvement advice and best practices on key clinical quality and safety          safety/tools-
                                                         patient education     issues, including prevention of VTE. AHRQ Consumer’s Guide –just                  services/safety/topics/Venous-
                                                         tools for VTE         released in August 2008 Your Guide to Preventing and Treating Blood               Thromboembolism/venous-
September   2008 Venous Thromboembolism                  prevention            Clots.                                                                            thromboembolism.jsp




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Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety Share
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Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety Share
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Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety Share
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Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety Share
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Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety Share
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Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety Share
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Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety Share
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Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety Share
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Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety Share
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Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety Share
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Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety Share
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Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety Share
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Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety Share
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Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety Share
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be downloaded at http://www.premierinc.com/all/safety/public-health/downloads/preparingterroristbombing.pdf




               Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety Share
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Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety Share
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Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety Share
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Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety Share
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Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety Share
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Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety Share
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Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety Share
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Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety Share
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Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety Share
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Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety Share
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Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety Share
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Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety Share
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Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety Share
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Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety Share
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Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety Share
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Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety Share
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Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety Share
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Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety Share
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Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety Share
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Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety Share
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Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety Share
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Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety Share
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Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety Share
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Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety Share
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Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety Share
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Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety Share
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Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety Share
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Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety Share
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Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety Share
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Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety Share
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Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety Share
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Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety Share
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Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety Share
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Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety Share
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Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety Share
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Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety Share
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Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety Share
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Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety Share
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Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety Share
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Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety Share
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Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety Share
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Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety Share
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Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety Share
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Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety Share
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Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety Share
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Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety Share
                                                                                                  IHI Tools




  Month          Year          Topic/Module by Tab                  Tool                                  Description                             IHI Tool                   Location



                                                                                  The first tool is a "Global Trigger Tool" designed to help
                                                                                  get started in the approach; the other tools focus on                      Access IHI Trigger Tools
                                                                                  specific areas such as measuring adverse drug events,                      at:http://www.ihi.org/IHI/Topics/PatientSaf
                                                             IHI – Patient        perioperative care, neonatal intensive care, and adverse                   ety/SafetyGeneral/Tools/IntrotoTriggerTo
Dec            2006     PSS News                             safety trigger tools events in outpatient settings.                                     √       olsforIdentifyingAEs.htm



                                                                                                                                                             1.) http://www.premierinc.com/quality-
                                                                                                                                                             safety/tools-services/safety/safety-
                                                                                                                                                             share/07-06-downloads/07-sbar-nurse-
                                                                                                                                                             survey.pdf; 2.)
                                                                                                                                                             http://www.premierinc.com/quality-
                                                                                                                                                             safety/tools-services/safety/safety-
                                                                                   A toolkit containing five SBAR (Situation-Background-                     share/07-06-downloads/08-sbar-survey-
                                                                                   Assessment-Recommendation) tools adapted for                              physician.pdf; 3.)
                                                                                   improving communication in labor and delivery is                          http://www.premierinc.com/quality-
                                                                                   available from the Institute for Healthcare Improvement                   safety/tools-services/safety/safety-
                                                                                   (IHI). The SBAR technique provides a framework for                        share/07-06-downloads/09-sbar-perinatal-
                                                                                   communication between members of the healthcare                           report.pdf; 4.)
                                                                                   team about a patient's condition. SBAR is an easy-to-                     http://www.premierinc.com/quality-
                                                                                   remember, concrete mechanism useful for framing any                       safety/tools-services/safety/safety-
                                                                                   conversation, especially critical ones, requiring a                       share/07-06-downloads/10-sbar-fetal-
                                                                                   clinician's immediate attention and action. It allows for an              heartrate-tracing.pdf; 5.)
                                                                                   easy and focused way to set expectations for what will                    http://www.premierinc.com/quality-
                                                                                   be communicated and how between members of the                            safety/tools-services/safety/safety-
                                                             Perinatal SBAR        team, which is essential for developing teamwork and                      share/07-06-downloads/11-sbar-physician-
July           2006     PSS News                             toolkit               fostering a culture of patient safety.                            √       critical-situation.pdf


                                                                                   Changes in four key elements of the service delivery
                                                                                   system are described in the IHI white paper. The
                                                                                   changes include the care team, patient activation, clinical
                                                                                   information system, and leadership. IHI identifies the
                                                             IHI white paper –     challenges faced in the current system, introduces a new                  http://www.premierinc.com/quality-
                                                             Planning a            design for the delivery of primary care, and encourages                   safety/tools-services/safety/safety-
                                                             primary care          office practices and clinics to move ahead with their own                 share/06-06-downloads/14-planned-care-
June           2006     PSS News                             delivery system       efforts to strive for better patient outcomes.                    √       white-paper-2006.pdf




       Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / IHI
                                                                                              IHI Tools



  Month       Year          Topic/Module by Tab                  Tool                                  Description                            IHI Tool                   Location




                                                                                Reviews of perinatal care have consistently pointed to
                                                                                failures of communication among the care team and
                                                                                documentation of care as common factors in adverse
                                                                                events that occur in labor and delivery. Such failures also
                                                                                have been shown to be prime factors leading to
                                                                                malpractice claims. A new white paper from the Institute
                                                                                for Healthcare Improvement (IHI), "Idealized Design of
                                                                                Perinatal Care," is an innovative project based on the
                                                                                principles of reliability science and the IHI's model for
                                                                                applying these principles to improve care. The Idealized                 Go to:
                                                                                Design model focuses on comprehensive redesign to                        http://www.premierinc.com/all/safety/publi
                                                          IHI white paper –     enable a care system to perform substantially better in                  cations/03-06-downloads/10-idealized-
March       2006     PSS News                             perinatal care        the future than the best it can do at present.                   √       design-perinatal-care-2005.pdf




                                                                            A leadership guide offering eight steps for senior health
                                                                            care leaders to help their organizations achieve patient
                                                                            safety and high reliability is available from the Institute
                                                                            for Healthcare Improvement (IHI). "The Leadership
                                                                            Guide to Patient Safety: Resources and Tools for
                                                                            Establishing and Maintaining Patient Safety" introduces
                                                          The Leadership    the concept of "reliability," defined as patients getting the
                                                          Guide to Patient intended tests, medications, information, and procedures
                                                          Safety: Resources at the appropriate time and in accordance with their
                                                          and Tools for     values and preferences. Strategies for redesign of
                                                          Establishing and healthcare systems are presented using examples that                          http://www.premierinc.com/all/safety/publi
                                                          Maintaining       IHI has gleaned from its experience in guiding                               cations/11-05-full-txt.jsp#story-06-
November    2005     PSS News                             Patient Safety    organizations in improving patient safety.                           √       downloads


                                                                            A new Institute for Healthcare Improvement (IHI)
                                                                            Innovation Series white paper expands on a previous
                                                                            paper, "Move Your Dot: Measuring, Evaluating, and
                                                                            Reducing Hospital Mortality Rates," that introduced a
                                                                            novel perspective and methodology for understanding
                                                                            and reducing inpatient deaths. "Reducing Hospital
                                                          Move Your Dot:    Mortality Rates (Part 2)" summarizes preliminary results
                                                          Measuring,        from a three-year pilot project in which eight hospitals,                    White papers are free and available
                                                          Evaluating, and   working with IHI, are testing the theory that hospital                       online at:
                                                          Reducing Hospital mortality can be consistently reduced through a                              http://www.ihi.org/IHI/Products/WhitePap
August        2005 Patient Safety                         Mortality Rates   combination of evidence-based interventions.                         √       ers/




    Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / IHI
                                                                                            IHI Tools



  Month      Year            Topic/Module by Tab                Tool                                Description                              IHI Tool                   Location




                                                                              To assist institutions in making the business case for
                                                                              quality programs, the Institute for Healthcare
                                                                              Improvement (IHI) is unveiling the Adverse Events
                                                                              Prevented Calculator. This tool helps model the financial
                                                                              implications of reductions in adverse event rates in an
                                                                              organization and assists in translating actual and
                                                                              potential improvement results into projected lives and
                                                                              dollars saved. The tool allows one to track the change in
                                                                              rate of any one type of adverse event over time and,
                                                                              when appropriate additional data are added, the
                                                                              consequent change in unnecessary deaths ("lives
                                                                              saved"), real and additional potential cost savings ("dark
                                                         IHI tool – Adverse green dollar" savings and "light green dollar" savings,                     http://www.ihi.org/IHI/Topics/PatientSafet
                                                         Events Prevented respectively), and the return on investment of quality                        y/SafetyGeneral/Tools/adverseeventspre
September 2008      Culture - Safety - Tool              Calculator           improvement work targeting those adverse events.                  √       ventedcalculator.htm
December 2007       Patient Safety                       Advancing the                                                                          √       http://www.premierinc.com/quality-
                                                         Practice of Patient-                                                                           safety/tools-services/safety/safety-
                                                         and Family-                                                                                    share/12-07-downloads/6_Patient-Family-
                                                         Centered Care        The Institute for Healthcare Improvement (IHI) recently                   Centered-Care-2007.pdf
                                                                              released a report titled ―Advancing the Practice of Patient-
                                                                              and Family-Centered Care‖ that includes assessment
                                                                              tools to help hospitals determine the degree to which
                                                                              patient- and family-centered approaches exist in their
                                                                              current organizational culture; IHI also released a tool
                                                                              that helps gather information about the perceptions and
                                                                              attitudes of staff and administrative leaders. The report
                                                                              describes how hospitals can get started with
                                                                              understanding how quality and safety are advanced by
                                                                              bringing patients and families directly into the planning,
                                                                              delivery and evaluation processes. This 25-page report
                                                                              provides rationale for a patient- and family-centered
                                                                              approach to care and defines its core concepts and
                                                                              outlines steps that a hospital can take to create
                                                                              partnerships with patients and families.




   Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / IHI
                                                                                                  IHI Tools



  Month          Year           Topic/Module by Tab                 Tool                                  Description                             IHI Tool                   Location



                                                                                   Advance directives, the legal documents that allow
                                                                                   individuals to make their personal healthcare wishes
                                                                                   known before a serious illness or injury, can be
                                                                                   confusing and difficult to understand. The Institute for
                                                                                   Healthcare Advancement has an advance directive form
                                                                                   designed for American adults who read below a fifth-
                                                                                   grade level. The forms are available in both English
                                                                                   (.pdf) (906 KB) and Spanish (.pdf) (911 KB). The form is                  The forms are available in both English
                                                                                   designed in a simple fill-in-the-blank format with                        http://www.premierinc.com/all/safety/publi
                                                                                   illustrations and easy-to-read bullet points. Low-literacy                cations/05-05-downloads/09-advance-
                                                                                   Americans will be able to choose an agent to make                         directive-english.pdf (.pdf) (906 KB) and
                                                                                   medical decisions for them, make their healthcare                         Spanish
                                                             Simplifying           wishes known so that their loved ones don't have to                       http://www.premierinc.com/all/safety/publi
                                                             advanced              guess for them, and provide the necessary signatures to                   cations/05-05-downloads/10-advance-
May              2005 Patient Safety                         directives            make the document legally binding.                                √       directive-spanish.pdf (.pdf) (911 KB).
                                                                                   A method for analyzing any process to see where it is
                                                             Failure Modes         likely to fail; to see how changes you are considering
                                                             and Effects           might affect the safety of the process; and to track
                                                             Analysis (FMEA)       changes in the Risk Priority Number (or RPN) of the
September        2003 Patient Safety                         Tool                  process over time.                                                √
                                                                                   A simple yet powerful method of identifying and tracking
                                                             Trigger Tool for      the number of medication errors in your hospital — using
                                                             Measuring             a retrospective review of patient records to look for
                                                             Adverse Drug          sentinel clues or "triggers" that indicate a medication                   http://www.ihi.org/IHI/Topics/PatientSafet
May              2003 Patient Safety                         Events (ADEs)         error has occurred.                                               √       y/MedicationSystems/Tools/
                                                                                The brochure outlines how a patient can become an
                                                             Ensuring Safety in active, involved, and informed member of the health care                     Adobe;Patient Safety/Medication
July             2004 Patient Safety                         Surgery            team.                                                                √       Systems/Tools; Under: Culture of Safety
                                                                                   The tool was developed by safety administrators at Iowa
                                                                                   Health System (IHS) to help front-line staff initiate Device
                                                                                   Use – Safety Briefings, which provide a forum for shared
                                                             Device Use –          observations and concerns related to the use of medical
                                                             Safety Briefing       devices, equipment, and complex software in the                           Word;Patient Safety/Medication
IHI                     Patient Safety                       Model                 institution.                                                      √       Systems/Tools; Under: Culture of Safety
                                                                                   A simple, easy-to-use tool that front-line staff can use to
                                                                                   share information about potential safety problems and
                                                             Safety Briefings      concerns on a daily basis, to promote safety                              Adobe;Patient Safety/Medication
IHI                     Patient Safety                       (IHI Tool)            consciousness and learning                                        √       Systems/Tools; Under: Culture of Safety
                                                                                The tool enumerates data elements to collect during a
                                                             Safety Huddle      test of Safety Briefings, including medication safety
                                                             Results Collection issues and "near miss" medication errors that are                            Word;Patient Safety/Medication
IHI                     Patient Safety                       Tool               identified before they cause harm.                                   √       Systems/Tools; Under: Culture of Safety
                                                             Decision Tree for     A decision tree that can be followed when analyzing an
                                                             Unsafe Acts           error or adverse event; developed by Partners                             Patient Safety/Medication Systems/Tools;
IHI                     Patient Safety                       Culpability           HealthSystem                                                      √       Under: Culture of Safety


       Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / IHI
                                                                                                 IHI Tools



  Month          Year            Topic/Module by Tab                Tool                                  Description                           IHI Tool                   Location
                                                             Patient Safety
                                                             Tracking                                                                                      Patient Safety/Medication Systems/Tools;
IHI                     Patient Safety                       Database              Example of a database for tracking patient safety issues        √       Under: Culture of Safety


                                                                                   Senior leaders conduct weekly WalkRounds™ in
                                                                                   different areas of the hospital, to have informal
                                                                                   conversations with front-line staff about safety issues
                                                             Patient Safety        and to demonstrate their support of an organizational                   http://www.ihi.org/IHI/Topics/PatientSafet
                                                             Leadership            culture that promotes nonpunitive reporting of errors,                  y/MedicationSystems/Tools/PatientSafety
July             2004 Patient Safety                         WalkRounds™           adverse events, near misses, and unsafe conditions              √       LeadershipWalkRoundsDatabase.htm
                                                             Checklist for
                                                             Assessing             A short self-assessment survey for use by any health
                                                             Institutional         care organization wishing to gauge its patient safety                   Word;Patient Safety/Medication
IHI                     Patient Safety                       Resilience            climate                                                         √       Systems/Tools; Under: Culture of Safety
                                                             Strategies for
                                                             Leadership:
                                                             Hospital                                                                                      http://www.ihi.org/IHI/Topics/PatientSafet
                        Culture - Safety -Tool Adobe;Patient Executives and                                                                                y/MedicationSystems/Tools/Strategiesfor
                        Safety/Medication Systems/Tools;     Their Role in         A compilation of leadership strategies for enhancing                    LeadershipHospitalExecutivesandTheirR
HSOPSC                  Under: Culture of Safety             Patient Safety        patient safety                                                  √       oleinPatientSafety.htm
                                                                                   A tool for conducting brief, ad hoc staff meetings focused
                                                             Device Use –          on sharing observations and concerns about safety
                                                             Safety Briefing       hazards related to the use of medical devices and                       Word;Patient Safety/Medication
IHI                     Patient Safety                       Model                 equipment                                                       √       Systems/Tools; Under: Culture of Safety

                                                             Executive Review
                                                             of Projects (IHI A guide for executives on how to channel senior                              Word;Improvement Methods/Tools;
IHI                     Patient Safety                       Tool)            management attention to quality projects                             √       Under: Information Gathering Tools
                                                                                   Sampling is used to simplify the gathering of data for
                                                             Sampling (IHI         improvement and to prevent unnecessary data                             Excel;Improvement Methods/Tools;
IHI                     Patient Safety                       Tool)                 collection.                                                     √       Under: Information Gathering Tools

                                                                               Walk-throughs enable providers to better understand the                     http://www.ihi.org/IHI/Topics/Improvemen
                                                             Walk-through (IHI experience of care from the patient’s and family’s points                   t/ImprovementMethods/Tools/Walk-
HSOPSC                  Culture - Safety - Tool              Tool)             of view — by going through the experience themselves                √       through.htm
                                                                                 An institution-wide policy regarding non-punitive
                                                                                 reporting, this brochure reinforces the non-punitive
                                                                                 reporting policy and encourages all co-workers to report                  http://www.premierinc.com/all/safety/publi
                                                             Living a Culture of errors, it was signed by the hospital president and mailed                cations/02-04-downloads/10-st-john-
February         2004 Patient Safety                         Patient Safety      to all co-worker homes.                                           √       nonpunitive-brochure.pdf

                                                             Patient Safety        Collects data and then keeps track of how the                           http://www.ihi.org/IHI/Topics/PatientSafet
                                                             Leadership            information is used, what actions are taken, and                        y/MedicationSystems/Tools/PatientSafety
July             2004 Patient Safety                         WalkRounds            generate feedback and reports.                                  √       LeadershipWalkRoundsDatabase.htm




       Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / IHI
                                                                                                 IHI Tools



  Month          Year          Topic/Module by Tab                  Tool                                  Description                            IHI Tool                   Location


                                                                                   Hospital flow can be measured at five levels: patient and
                                                                                   community; hospital throughput; hospital activity; hospital
                                                                                   performance; and unit performance. Each level provides
                                                             Measurement           a portion of the total measurement picture. Use this                     http://www.ihi.org/IHI/Topics/Flow/Patient
                                                             guide for hospital    guide to learn how to measure data in these key areas to                 Flow/EmergingContent/HospitalFlowMea
July             2004 Patient Safety                         flow patterns         help you improve patient flow.                                   √       surementGuide.htm




       Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / IHI
                                                                            IHI Tools




Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / IHI
                                                                            IHI Tools




Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / IHI
                                                                            IHI Tools




Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / IHI
                                                                            IHI Tools




Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / IHI
                                                                                   IHI Tools




Resource        Print




Tool            Electronic




       Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / IHI
                                                                                   IHI Tools




Tool            Electronic




       Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / IHI
                                                                                                     Premier Safety Share




                                                                                                                              IHI
 Month   Year   Topic by Tab            Tool                                      Description                                Tool              Location



                                                     The RFID Resource Center includes an implementation guide describing
                                                     the use of HIBC (Health Industry Bar Code) Standards with RFID, an
                                RFID – Web-based     overview of RFID technology (including its potential applications and
                                resource center      costs), a white paper, "RFID In Healthcare: Benefits, Limitations &            http://www.hibcc.org/AUTOIDUPN/
May      2007 Bar Coding        available            Recommendations," and other related articles.                                  RFID.htm




           Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Bar Coding
                                                                                                            Premier Safety Share




                                                                                                                                       IHI
  Month    Year   Topic by Tab            Tool                                         Description                                    Tool                Location



                                                        Catheter-related blood stream infections (BSI) are a significant source of
                                                        morbidity and mortality associated with a variety of devices used to
                                                        access the vascular system. Meticulous aseptic technique is both
                                                        required and effective to prevent BSI. Faculty share their observations,
                                  Webcast – Best        best practices, and outcome data as they discuss this important topic.
                                  practices to reduce   This free webcast is a replay from the original August 17, 2007, webcast
               Bundling -         catheter-related      provided by Cardinal Health's Center for Safety and Clinical Excellence
               evidence based     blood stream          and will remain available for one full year. Continuing education credit is          http://www.cardinal.com/clinicalcent
September 2007 practice           infections            also provided.                                                                       er/materials/webcasts/index.asp


                                                      A recent AHRQ audio newscast series featured an interview with Peter
                                                      Pronovost, M.D., Ph.D., of The Johns Hopkins University School of
                                                      Medicine. Dr. Pronovost discussed his research about interventions to
                                                      reduce bloodstream infections in hospital ICUs caused by central venous
                                                      catheters. Patients in the United States spend about 18 million days in
                                                      the intensive care unit per year and in more than 50 percent of the
                                                      cases, an ICU patient will have a central venous catheter inserted.
                Bundling -        AHRQ tools –        Unfortunately, approximately 80,000 patients each year develop catheter-               AHRQ podcast:
                evidence based    Podcast on reducing related bloodstream infections, and about 28,000 of them will die from                 http://www.healthcare411.org/podc
May        2007 practice          BSI                 the infection.                                                                         ast.aspx?id=197




             Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Bundling
                                                                                                               Premier Safety Share




                                                                                                                                           IHI
  Month     Year    Topic by Tab          Tool                                            Description                                     Tool                 Location




                                                         A free interactive video module that will help identify and treat C. difficile
                                                         is available from the British Medical Journal (BMJ) and the Department of
                                                         Health. Titled "How you can reduce C. difficile infections," the video
                                                         demonstrates how a major UK hospital successfully managed an
                                                         outbreak and introduced measures that can be applied to prevent
                                                         infections. The module discusses how to diagnose and treat patients with
                                                         C. diffcile infections, the importance of hand hygiene in preventing
                 C. difficile                            infection, the cautious use of prescribing antibiotics, and understanding
                 associated         Online learning      the patient experience. To begin the module, go to
September   2007 disease           module – C. difficile http://bmjlearning.com/cdifficile.                                                      http://bmjlearning.com/cdifficile




              Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / CDAD
                                                                                                        Premier Safety Share




                                                                                                                                 IHI
  Month   Year   Topic by Tab            Tool                                       Description                                 Tool                Location



                                                    Community hospitals implementing computerized physician order entry                http://my.premierinc.com/all/safety/
               Computerized                         are succeeding in gaining physician participation and addressing the               publications/07-
               physician order                      gaps in safety and quality they were targeting, according to a new report          03_downloads/10_CPOE_comm_h
July      2003 entry             CPOE Report & Tips by the California HealthCare Foundation and First Consulting Group.                osp.pdf

               Computerized                                                                                                            http://www.hospitalconnect.com/ah
               physician order   CPOE evaluation and The report explores CPOE implementation, costs, challenges, benefits,             a/key_issues/patient_safety/resourc
March     2003 entry             case studies        and lessons learned.                                                              es/index.html#patientsafety




            Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / CPOE
                                                                                                            Premier Safety Share




                                                                                                                                      IHI
  Month   Year   Topic by Tab            Tool                                          Description                                   Tool                Location


                                                       The recommendations include the assessment of the electromagnetic
                               Recommendations         environment of the facility, identification of areas where critical medical          http://my.premierinc.com/all/safety/
                               for Electromagnetic     devices are used, coordination of the purchase and management of all                 publications/01-
               Cell Phones and Compatibility in        electronic equipment, and the reporting of problems to FDA MedWatch                  02_downloads/CDRH-%20EMC-12-
January   2002 EMC             Healthcare Facilities   program.                                                                             01.doc




            Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Cell Phones
                                                                                                          Premier Safety Share




                                                                                                                                    IHI
  Month    Year   Topic by Tab           Tool                                         Description                                  Tool                Location




                                                      Advances in technology are making it easier to improve patient safety.
                                                      The September/October issue of Patient Safety and Quality Healthcare
                                                      focuses on recent technology designed to reduce the risk of medical
                Computers and    On-line resources – errors. Among the topics featured in this issue are bar coding to reduce
                electronics in   bar coding, RFID and medication errors, electronic medical records (EMR) and radio frequency             http://www.psqh.com/sepoct05/tocc
November   2005 healthcare       patient safety       identification (RFID) systems.                                                      .html


                                                        Premier, the first GPO to win Hospitals for a Healthy Environment's
                                 Web-based resource     (H2E) Champions of Change Award (in 2003) and again in 2004, has
                                 to assist healthcare   launched a new Web-based resource to assist healthcare organizations
                                 organizations with     with environmentally friendly selection, recycling and disposal of
                                 environmentally        computers and electronics. These resources are also being used to
                                 friendly selection,    guide the selection of electronic device manufacturers for Premier
                                 recycling and          members and for recycling of electronics in Premier's corporate offices.
                Computers and    disposal of            The Web-based resource was produced by Premier's Safety Institute
                electronics in   computers and          with assistance and support from Health Care Without Harm and the                 http://www.premierinc.com/all/safet
March      2005 healthcare       electronics.           Computer Take Back Campaign.                                                      y/resources/computers/index.jsp




            Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Computers
  Month   Year   Topic by Tab           Tool                                       Description



                                                     This manual was written to assist hospitals in developing strategies for
                                                     temporary negative pressure isolation and provides instruction on the
                                                     use of equipment used for airborne infectious disease management. In
                                                     addition to graphic "how to" portrayals, the guide includes tools such as
                                Minnesota manual –   preventative maintenance schedules and a sample log for measuring
                                Methods for          particle counts for performance improvement planning. Additional
               Construction -   temporary negative   information, including education/training slides, are located at the Web
Mar       2007 ICRA             pressure isolation   site below.


                                                     Created by the University of Minnesota, InformeDesign®
                                                     www.informedesign.umn.edu brings research and practice aspects of
                                                     the design professions together. Designers face a multitude of complex
                                                     challenges that are environmental, behavioral, and design in nature.
                                                     This Web site focuses on providing the design community with
                                                     reputable research sources that address those challenges. A monthly
                                                     publication, Implications, addresses the issues facing practitioners and
                                                     researchers who focus on design and human behavior. Under the links,
                                Inform eDesign –     "SPACE," then "Healthcare," there is a wide variety of healthcare related
               Construction -   Healthcare design    articles and research summaries on topics from ambulatory care to
Feb       2007 ICRA             implications         wellness centers.
                                                     The construction and ICRA concept and matrix as described and
                                                     promoted by the Association for Professionals in Infection Control and
                                                     Epidemiology (APIC) and the American Society for Healthcare
                                                     Engineering (ASHE) are available in two training videos. One is directed
                                                     to healthcare professionals (20 minutes) and one to construction
               Construction -   Construction; ICRA   personnel (eight minutes), with availability in English and Spanish. Go to
Sept      2006 ICRA             training             www.EnvisionInc.net.
 IHI
Tool                Location




       Download the manual from the
       Safety Institute's Construction,
       ICRA, risk assessment web site, or
       go to:
       http://www.health.state.mn.us/oep/t
       raining/bhpp/isolation.html




       http://www.informedesign.umn.edu/
       Rs.aspx?s=space&tId=664
       For more information on and
       resources about construction on
       Premiers Web site:
       www.premierinc.com/quality-
       safety/tools-
       services/safety//resources/construc
       tion/.
                                                                                                         Premier Safety Share



                                                                                                                                                          IHI
  Month         Year               Topic by Tab                 Tool                                       Description                                   Tool                 Location



                                                                            This model program engages nurses and leaders at all levels of the
                                                                            organization to improve the quality and safety of patient care on medical
                                                                            and surgical units. Ten hospitals graduated from the third phase of the
                                                                            five-year program in May. TCAB is not a traditional quality improvement
                                                                            program; one primary characteristic that sets it apart is its focus on
                                                                            engaging frontline staff and unit managers. Ideas for transforming the
                                                                            way care is delivered on medical/surgical units come from the nurses
                                                       Transforming Care at and other care team members who spend the most time with patients                   http://www.rwjf.org/pr/product.jsp?id
September       2008         Culture - Safety - Tool   the Bedside          and their families.                                                                 =30051&c=EMC-CA137


                                                                             To assist institutions in making the business case for quality programs,
                                                                             the Institute for Healthcare Improvement (IHI) is unveiling the Adverse
                                                                             Events Prevented Calculator. This tool helps model the financial
                                                                             implications of reductions in adverse event rates in an organization and
                                                                             assists in translating actual and potential improvement results into
                                                                             projected lives and dollars saved. The tool allows one to track the
                                                                             change in rate of any one type of adverse event over time and, when
                                                                             appropriate additional data are added, the consequent change in
                                                                             unnecessary deaths ("lives saved"), real and additional potential cost
                                                       IHI tool – Adverse    savings ("dark green dollar" savings and "light green dollar" savings,             http://www.ihi.org/IHI/Topics/Patient
                                                       Events Prevented      respectively), and the return on investment of quality improvement work            Safety/SafetyGeneral/Tools/adverse
September       2008         Culture - Safety - Tool   Calculator            targeting those adverse events.                                              √     eventspreventedcalculator.htm


                                                                             The Joint Commission offers an Internet-based collaborative forum to
                                                                             help frontline workers; healthcare administrators, researchers and other
                                                                             healthcare professionals collaborate on developing performance
                                                                             improvement solutions. One feature currently being test piloted allows
                                                                             registered users to discuss solutions, edit existing solutions and create
                                                                             new solutions that will then be available to the entire healthcare                 The site, titled WikiHealthCareTM,
                                                                             community. The first quality improvement topics posted to the site                 can be accessed through a link on
                                                                             address smoking cessation counseling programs and smoke-free                       The Joint Commission's home page,
                                                                             hospital campuses. Development of the site was funded, in part, through            or directly at
                                                                             a research grant from the Smoking Cessation Leadership Center at the               http://wikihealthcare.jointcommission
October         2007         Culture - Safety - Tool   WikiHealthCareTM      University of California, San Francisco.                                           .org.


                                                                             Now AHRQ is providing a new tool developed for small and critical
                                                                             access hospitals to benchmark and compare their results from the AHRQ
                                                                             Hospital Survey on Patient Safety Culture. However, the tool can be
                                                                             used by any size hospital because it allows the addition of any
                                                                             benchmarking data. The tool is from Statis Health and the Oklahoma
                                                       Small hospital        Foundation for Medical Quality and the Hospital Interventions Quality              http://www.premierinc.com/quality-
                                                       benchmarking tool for Improvement Organization Support Center (HIQIOSC) and is adapted                   safety/tools-
                                                       AHRQ hospital         with permission for a benchmarking tool developed by the Nebraska                  services/safety/topics/culture/bench
July            2007         Culture - Safety - Tool   survey                Center for Rural Health Research.                                                  marking-data.jsp#cah-tool




            Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Culture - Safety
                                                                                                          Premier Safety Share



                                                                                                                                                           IHI
  Month          Year              Topic by Tab                 Tool                                         Description                                  Tool                Location


                                                                          The Premier Performance Suite is a comprehensive offering of hospital                  For more information on the Premier
                                                                          performance tools to integrate quality and safety, labor management,                   Performance Suite, visit the home
                                                                          and supply chain channels for a global approach to improving overall                   page at:
                                                                          quality and cost. The Performance Suite provides Web-based                             http://www.premierinc.com/quality-
                                                       Premier – New      performance measurement and benchmarking, real time surveillance,                      safety/tools-services/performance-
Mar              2007        Culture - Safety - Tool   Performance Suite™ and best practices to allow hospitals to make better decisions.                        suite/.


                                                                           The first monograph, "Are You Rolling the Dice on CEO Succession?" is
                                                                           designed to help trustees navigate the CEO selection process. The
                                                                           monograph contains a Leadership Continuity Risk Management Model to                   To order any of the monographs,
                                                                           help trustees understand how to effectively define the requirements for a             contact the Center at 888.540.6111
                                                                           new CEO, assess candidates and approach the final selection process.                  or e-mail at:
                                                                           The second, "The Board's Fiduciary Role: Legal Responsibilities of                    info@americangovernance.com.
                                                                           Health Care Governing Boards," describes the basic legal duties and                   Access the tool at:
                                                                           obligations of the boards of not-for-profit hospitals. This guidance can be           http://www.americangovernance.co
                                                       CEO assessment tool used to support trustee recruitment and orientation, and as a reference               m/americangovernance/ctool/welco
Feb              2007        Culture - Safety - Tool   for leadership      tool for existing board members.                                                      me.html.




                                                                           The Center for Healthcare Governance has provided the first tool in a
                                                                           series of Collaborative Leadership Tools. "Collaborative Leadership: A
                                                                           New Model for Developing Truly Effective Relationships Between CEOs
                                                                           and Trustees" explores the board/CEO relationship in the context of
                                                                           governance reform, which calls for boards in all sectors to raise the bar
                                                                           on their performance and accountability. This CEO resource discusses
                                                                           what governance reform means in terms of how boards and CEOs work
                                                                           together to lead their healthcare organizations. It also provides an
                                                                           assessment tool and process that CEOs can use to take the lead in
                                                                           diagnosing their current relationship with their board, and to work                   Access the tool at:
                                                                           together with board leaders to re-energize and strengthen the                         http://www.americangovernance.co
                                                       CEO assessment tool relationship to achieve maximum effectiveness and value. If completed                 m/americangovernance/ctool/welco
Jan              2007        Culture - Safety - Tool   for leadership      online, all responses are confidential.                                               me.html



                                                                              The tool is for physician practices to use to enhance awareness of
                                                                              patient safety issues, heighten awareness of characteristics that make a
                                                                              practice safer, and create a new reference point and baseline for
                                                                              practices to enhance and support patient safety. The tool can be                   There is a $200 per practice fee to
                                                                              completed electronically so users can receive a feedback report                    complete the assessment online and
                                                                              comparing themselves to other practices (percentile rankings on each               access the comparative report site.
                                                       Assessing physician    question). Users also can receive a workbook with information and                  Download the file or use online at
Nov       2006               Culture - Safety - Tool   practices              resources on how the practice can improve their performance.                       http://www.physiciansafetytool.org.


                                                                              The tool is designed to help hospital CEOs and their boards forge a
                                                       Collaborative          stronger relationship. This CEO resource discusses what governance
                                                       Leadership: A New      reform means in terms of how boards and CEOs work together to lead
                                                       Model for Developing   their healthcare organizations. It also provides an assessment tool and
                                                       Truly Effective        process that CEOs can use to take the lead in diagnosing their current
                                                       Relationships          relationship with their board, and to work together with board leaders to          Access the tool at:
                                                       Between CEOs and       re-energize and strengthen the relationship to achieve maximum                     http://www.americangovernance.co
Nov       2006               Culture - Safety - Tool   Trustees               effectiveness and value.                                                           m/americangovernance/


            Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Culture - Safety
                                                                                                           Premier Safety Share



                                                                                                                                                             IHI
   Month          Year              Topic by Tab                 Tool                                         Description                                   Tool                 Location




                                                                              The consensus statement is intended to provide a deeper understanding
                                                                              of preventable adverse events, their impact on patients, families, and
                                                                              providers, and how to manage such events. The report provides detailed
                                                                              guidelines based on the premise that all care should be safe and patient-
                                                                              centered and proposes a full disclosure when adverse events or medical
                                                                              errors occur, including an apology to the patient. The report is divided
                                                                              into three major sections: the patient and family experience, the
                                                                              caregiver experience, and the management of the event. Each section
                                                                              contains a summary of the expert consensus of the issue, including the
                                                                              reasoning and evidence behind the consensus, and recommendations.
                                                                              The report also offers appendices that include recommendations, a case               Go to:
                                                        When Things Go        study on communicating with patients and families, elements of                       http://www.premierinc.com/all/safety/
                                                        Wrong: Responding     emotional support of caregivers, and a bibliography on medical                       publications/04-06-downloads/07-
April      2006               Culture - Safety - Tool   to Adverse Events     disclosure.                                                                          responding-adverse-events.pdf
                                                                              A recent directive from the U.S. Veterans Health Administration provides
                                                                              background information on the disclosure of adverse events related to
                                                                              clinical care to patients or their representatives. VA Directive 2005-049
                                                                              (.pdf) (163 KB), "Disclosure of Adverse Events to Patients," is consistent
                                                                              with the Joint Commission on Accreditation of Healthcare Organizations
                                                        Directive on          requirements, and includes key definitions and a policy statement on                 http://www.premierinc.com/all/safety/
                                                        disclosure of adverse disclosure for all VA hospitals.                                                     publications/12-05-downloads/09-va-
December   2005               PSS News                  events                                                                                                     adverse-events.pdf



                                                                              A leadership guide offering eight steps for senior health care leaders to
                                                                              help their organizations achieve patient safety and high reliability is
                                                                              available from the Institute for Healthcare Improvement (IHI). "The
                                                        The Leadership        Leadership Guide to Patient Safety: Resources and Tools for
                                                        Guide to Patient      Establishing and Maintaining Patient Safety" introduces the concept of
                                                        Safety: Resources     "reliability," defined as patients getting the intended tests, medications,
                                                        and Tools for         information, and procedures at the appropriate time and in accordance
                                                        Establishing and      with their values and preferences. Strategies for redesign of healthcare             http://www.premierinc.com/all/safety/
                                                        Maintaining Patient   systems are presented using examples that IHI has gleaned from its                   publications/11-05-full-txt.jsp#story-
November   2005               PSS News                  Safety                experience in guiding organizations in improving patient safety.               √     06-downloads
                                                                              Premier's Safety Institute has developed a Spanish version of the
                                                                              Agency for Healthcare Research and Quality's (AHRQ) Hospital Survey
                                                        Hospital Survey on    on Patient Safety Culture survey tool, as well as a customized                       The survey tool can be accessed at
                                                        Patient Safety        Microsoft® Excel data tool for easy entry and rapid display of survey                http://www.premierinc.com/all/safety/
August     2005               Culture - Safety - Tool   Culture               results.                                                                             culture/


                                                                            The long awaited Patient Safety and Quality Improvement Act (P.L.109-
                                                                            41) was signed into law on July 29, 2005, to encourage a culture of
                                                                            safety in healthcare organizations by providing legal protection of
                                                        Patient Safety and  information on medical errors and adverse events voluntarily reported to               http://thomas.loc.gov/cgi-
                                                        Quality Improvement patient safety organizations (PSOs). Lawmakers intend the information                  bin/bdquery/z?d109:SN00544:|TOM:
August            2005        PSS News                  Act (P.L.109-41)    to be used to improve patient safety and reduce medical errors.                        /bss/d109query.html




             Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Culture - Safety
                                                                                                            Premier Safety Share



                                                                                                                                                               IHI
  Month           Year              Topic by Tab                 Tool                                          Description                                    Tool                 Location


                                                                               Reconciling medications across the continuum of care is a new 2005
                                                                               JCAHO safety goal. Experience has shown that poor communication of
                                                                               medical information at transition points is responsible for as many as 50
                                                                               percent of all medication errors in the hospital and up to 20 percent of
                                                                               adverse drug events. A Massachusetts Coalition Web site describes how
                                                                               a group of hospitals in Massachusetts implemented a medication                        Go to http://www.macoalition.org
                                                        Medication strategy    reconciliation strategy and provides various tools and forms for others to            and look under ―Coalition Initiatives,‖
July              2005        Culture - Safety - Tool   tools                  adopt or adapt.                                                                       then ―Reconciling Medications.‖


                                                                                                                                                                     Copies of "5 Steps to Safer Health
                                                                               A campaign designed to help distribute valuable information about                     Care" and the public service
                                                                               improving patient safety to healthcare providers and patients across the              announcement are available on the
                                                                               country has been initiated by the Agency for Healthcare Research and                  AHRQ's Web site: English version:
                                                                               Quality (AHRQ), the American Hospital Association (AHA). The                          http://www.ahrq.gov/consumer/5step
                                                                               campaign, called "5 Steps to Safer Health Care," includes posters and                 s.htm
                                                                               fact sheets that offer evidence-based, practical tips on the role patients            Spanish version:
                                                        5 Steps to Safer       can play to help avoid errors related to prescription medicines, laboratory           http://www.ahrq.gov/consumer/cinco
June       2005               Culture - Safety - Tool   Health Care            tests, procedures, and surgery.                                                       rec.htm


                                                                               The Agency for Healthcare Research and Quality (AHRQ) has published                   View entire document at
                                                                               a new fact sheet entitled "30 Safe Practices for Better Health Care"                  http://www.premierinc.com/all/safety/
                                                                               (.doc) (42 KB). These are AHRQ-supported, evidence-based practices                    publications/05-05-downloads/07-
                                                                               from the National Quality Forum (NQF) that demonstrate they can work                  fact-sheet-30-practices.doc; An
                                                                               to reduce or prevent adverse events and medical errors. The safe                      executive summary (.pdf) (495 KB)
                                                                               practices were endorsed by the NQF member organizations, which                        of the report is available from AHRQ
                                                        30 safe practices in   strongly urge that these 30 safe practices be universally adopted in all              and contains information on how to
May        2005               Culture - Safety - Tool   healthcare             applicable healthcare settings to reduce the risk of harm to patients.                obtain copies of the com


                                                                               Most hospital leaders are concerned that mandatory, non-confidential
                                                                               public reporting would discourage internal reporting of patient incidents             http://www.premierinc.com/all/safety/
                                                                               and encourage lawsuits while failing to provide substantial benefits to               publications/05-05-downloads/04-
                                                        Error Reporting and    patient safety, according to a recent survey of hospital executives in the            abst-error-report-disclosure-
May               2005        PSS News                  Disclosure Systems     Journal of the American Medical Association.                                          systems.doc
                                                                             Premier has developed a customized data collection and analysis tool
                                                                             that provides immediate feedback on the results of the hospital culture
                                                                             survey tool released by the Agency for Healthcare Research and Quality
                                                        Premier - customized (AHRQ). The customized Excel™ data tool was developed for easy entry                    http://www.premierinc.com/all/safety/
                                                        data collection and  and rapid display of the results from the surveys to provide immediate                  publications/03-05-full-txt.jsp#story-
March      2005               PSS News                  analysis tool        internal review and feedback.                                                           08-downloads


                                                                               A new tool to assess the safety culture of a hospital as a whole, or in
                                                                               specific units within hospitals, as well as to track changes in patient
                                                                               safety over time and evaluate the impact of patient safety interventions.
                                                                               Premier's Safety Institute is providing the complete tool kit, which                  All components may be downloaded
                                                        Hospital Survey on     includes the survey, detailed user's guide for administration of paper or             at
                                                        Patient Safety         web-based methods, data collection and analysis, customizable                         www.premierinc.com/all/safety/cultur
November   2004               Culture - Safety - Tool   Culture                templates for reporting results, references, and results of the pilot study.          e.




             Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Culture - Safety
                                                                                                           Premier Safety Share



                                                                                                                                                             IHI
  Month            Year              Topic by Tab                 Tool                                        Description                                   Tool                 Location
                                                                               The video discusses how best to inform patients and their families in the
                                                         Discussing            event of a medical error that causes harm. The video includes clinical
                                                         Unanticipated         scenarios and comments from a medical ethicist, a hospital risk                     For information on how to obtain the
                                                         Outcomes and          manager, and two healthcare attorneys. The comments offer                           videotape, go to:
                                                         Disclosing Medical    suggestions on how to effectively disclose adverse events to patients               http://www.gha.org/pha/video/index.
October     2004               Culture - Safety - Tool   Errors                and their families.                                                                 asp.
                                                                                                                                                                   http://www.ihi.org/IHI/Topics/Patient
                                                         Patient Safety                                                                                            Safety/MedicationSystems/Tools/Pat
                                                         Leadership            Collects data and then keeps track of how the information is used, what             ientSafetyLeadershipWalkRoundsD
July                      2004 Culture - Safety - Tool   WalkRounds            actions are taken, and generate feedback and reports.                         √     atabase.htm



                                                                                                                                                                   http://www.premierinc.com/safety/re
                                                                               The majority of hospitals responding to a Premier survey have formal,               sources/disclosure/downloads/Premi
                                                                               board approved policies to disclose medical errors to patients, according           er-disclosure-survey-results.pdf;
                                                                               to a survey conducted by Premier, Inc. The survey uncovered some                    survey discussion:
                                                         Premier Patient       promising trends in medical error disclosure practices. A full discussion           http://www.premierinc.com/all/safety/
                                                         Safety Culture        of the survey may be downloaded.                                                    publications/08-04-downloads/02-
June               2004        PSS News                  Survey results                                                                                            disclosure-release.doc

                                                                               Michigan Hospital Association toolkit is a series of recommendations
                                                                               based on current research and best practices. It was developed by a                 http://my.premierinc.com/all/safety/p
                                                                               nine-member volunteer workgroup of health professionals experienced in              ublications/06-04-downloads/09-icu-
June                      2004 Culture - Safety - Tool   ICU toolkit           leading ICUs and improving patient safety and quality of care.                      toolkit.pdf
                                                                               An institution-wide policy regarding non-punitive reporting, this brochure
                                                                               reinforces the non-punitive reporting policy and encourages all co-                 http://www.premierinc.com/all/safety/
                                                         Living a Culture of   workers to report errors, it was signed by the hospital president and               publications/02-04-downloads/10-st-
 February          2004        Culture - Safety - Tool   Patient Safety        mailed to all co-worker homes.                                                √     john-nonpunitive-brochure.pdf
                                                                               Improvements in medication list accuracy, allergy list accuracy, and safe
                                                                               prescription writing practices that were observed by Gundersen Lutheran
                                                         Ambulatory Patient    Medical Center.
December           2003        Culture - Safety - Tool   Safety - Toolkit                                                                                          http://www.gundluth.org/SCOPE
                                                                               ―Disclosure of unanticipated events: Creating an effective patient
                                                                               communication policy," the monograph covers considerations for
                                                                               developing policies and procedures in specific settings such as acute               http://my.premierinc.com/all/safety/p
                                                         Disclosure policy     care, long-term care and pediatric care. It also examines the effect of             ublications/12-03-downloads/09-
December           2003        Culture - Safety - Tool   guide                 disclosure policies on litigation.                                                  disclosure-part2-1-policy.pdf
                                                                               In a report released by the Institute of Medicine, a panel recommends
                                                                               work hour limits and other changes to the work environment for nurses to
                                                         Keeping Patients      strengthen patient safety. The panel also noted that regulators and
                                                         Safe: Transforming    healthcare leaders should work to reduce workplace inefficiencies, such
                                                         the Work              as excessive paperwork and documentation, which reduce the time                     Purchase the report online at
                                                         Environment of        nurses have to spend with patients.                                                 http://books.nap.edu/catalog/10851.
November           2003        PSS News                  Nurses                                                                                                    html?onpi_newsdoc110403
                                                                                                                                                                   http://www.qualityhealthcare.org/QH
                                                                                                                                                                   C/Topics/PatientSafety/MedicationS
                                                         Safety Climate        Organizations working to develop or improve a culture of safety need a              ystems/Tools/Safety+Climate+Surve
July               2003        Culture - Safety - Tool   Survey Tool           reliable measure to monitor the success of their initiatives.                 √     y+(IHI+Tool).htm




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                                                                                                                                                             IHI
   Month       Year               Topic by Tab                 Tool                                           Description                                   Tool                 Location
                                                      Disclosure of
                                                      Unanticipated           Focus on three aspects of the disclosure process: 1.The initial impact of
                                                      Events: The Next        the Joint Commission for Accreditation of Healthcare Organizations                   http://my.premierinc.com/all/safety/p
                                                      Step in Better          (JCAHO) Patient Safety Standards 2.Psychological and legal barriers                  ublications/06-
                                                      Communication with      that can impede disclosure, and 3.Successful models used by                          03_downloads/07_disclosure_ASHR
June           2003         Culture - Safety - Tool   Patients                organizations to manage the disclosure process.                                      M_part1of3.pdf


                                                                          The Agency for Healthcare Research and Quality (AHRQ) PSIs are a
                                                                          tool to help health system leaders identify potential adverse events
                                                                          occurring during hospitalization. They are a set of indicators providing
                                                      AHRQ Patient Safety information on potential in-hospital complications and adverse events                    http://www.qualityindicators.ahrq.gov
April          2003         PSS News                  Indicators          following surgeries, procedures, and childbirth.                                         /psi_download.htm
                                                                              Senior leaders conduct weekly WalkRounds™ in different areas of the
                                                      Creating a Culture of   hospital, to have informal conversations with front-line staff about safety
                                                      Safety Through          issues and to demonstrate their support of an organizational culture that            http://www.premierinc.com/safety/pu
                                                      Executive               promotes nonpunitive reporting of errors, adverse events, near misses,               blications/03-
                                                                  TM
March          2003         Culture - Safety - Tool   WalkRounds              and unsafe conditions                                                                03_downloads/01_b.pdf
                                                                                                                                                                   http://www.premierinc.com/all/safety/
                                                      Medication System       A sample medication error reporting form designed to collect and analyze             publications/03-
                                                                  TM
March          2003         Culture - Safety - Tool   Analyze-ERR             actual and potential medication errors.                                              03_downloads/01_d.pdf

                                                      Checklist/Action Plan
                                                      for the Management                                                                                           http://www.premierinc.com/all/safety/
                                                      of High-Alert                                                                                                publications/03-
March          2003         Culture - Safety - Tool   Medications           A checklist/action plan for the safe use of high-alert medications.                    03_downloads/01_g.pdf
                                                      Policy for Non-
                                                      punitive, System-
                                                      based Adverse Drug                                                                                           http://www.premierinc.com/all/safety/
                                                      Event Reporting    A sample policy detailing a blame-free adverse drug event reporting                       publications/03-
March          2003         Culture - Safety - Tool   Program            program.                                                                                  03_downloads/01_h.pdf
                                                                                                                                                                   http://www.premierinc.com/all/safety/
                                                      Medication Safety       A patient safety tool helping patients understand their rights and                   publications/03-
March          2003         Culture - Safety - Tool   Pledge for Patients     responsibilities regarding safe medication use.                                      03_downloads/01_j.pdf



                                                                              The video provides step-by-step instructions on how to disclose medical
                                                                              errors, why disclosure is important, and how open communication can
February       2003         Culture - Safety - Tool   Let's Talk              strengthen the patient-provider relationship.                                        http://www.npsf.org/
                                                                          Participating organizations will work to create a system of safety,
                                                      Breakthrough Series including changing organizational culture and attitudes of leadership and
                                                      Collaborative on    front line staff, improving critical core processes, encouraging                         http://www.ihi.org/collaboratives/bre
                                                      Improving Patient   appropriate use of technology, and establishing an effective system for                  akthroughseries/PatientSafety/index.
August         2002         Culture - Safety - Tool   Safety              measuring harm.                                                                    √     asp

                                                      Patient Safety          A job description for a safety officer, an organization-wide safety plan,
                                                      Program Resource        Power Point slides of program elements and key committees, sample
June           2002         Culture - Safety - Tool   Guide                   grids for documenting interdisciplinary components, and other tools.                 Download at Safety Store.
                            Patient Safety Topics -                                                                                                                http://my.premierinc.com/all/safety/re
                            Patient safety -          Patient Safety          The intent of the sample Patient Safety Program is to provide tools to               sources/patient_safety/patient_safet
HSOPSC                      downloads (*.doc)         Program                 assist organizations in implementation of a patient safety program.                  y_downloads.htm




           Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Culture - Safety
                                                                                                       Premier Safety Share



                                                                                                                                                      IHI
 Month       Year               Topic by Tab                 Tool                                         Description                                Tool                Location
                                                                        The ED is part of a larger, complex system. Given the complexity of the
                                                                        system, for the thousands of patients treated each day, there are many
                                                                        opportunities for medical errors, as well as opportunities to reduce such           http://www.premierinc.com/all/safety/
                          Patient Safety Topics -                       errors. This document includes the recommendations of the Patient                   resources/patient_safety/downloads/
                          Patient safety -          ACEP Patient Safety Safety Task Force and the Principles of Patient Care in the Emergency               24_ACEP_patient_safety_program.d
HSOPSC                    downloads (*.doc)         Program             Care Environment.                                                                   oc

                          Patient Safety Topics -   ECRI Disclosure of      Reviews the JCAHO's disclosure standard, discusses how to develop a             http://www.premierinc.com/all/safety/
                          Patient safety -          unanticipated           disclosure policy and what the policy should address, and analyzes the          resources/patient_safety/downloads/
HSOPSC                    downloads (*.pdf)         outcomes                impact of the standard on medical malpractice claims.                           disclosure_ecri.pdf



                                                    ASHRM: Perspective
                          Patient Safety Topics -   on Disclosure of    A perspective paper on the disclosure of information involving                      http://www.premierinc.com/all/safety/
                          Patient safety -          Unanticipated       unanticipated outcomes of diagnostic tests, medical treatments, and                 resources/patient_safety/downloads/
HSOPSC                    downloads (*.pdf)         Outcome Information surgical interventions.                                                             ASHRM_disclosure_05-01.pdf
                                                                                                                                                            http://www.premierinc.com/all/safety/
                          Patient Safety Topics -                           Provides guidance for minimizing the chance of the occurance of                 resources/patient_safety/downloads/
                          Patient safety -          VA Patient Safety       untoward outcomes consequent to medical care. This handbook                     25_VA_patient_safety_handbook.pd
HSOPSC                    downloads (*.pdf)         Handbook                incorporates Root Cause Analysis.                                               f


                                                    Disclosure: What
                                                    works now & what
                                                    can work even better
                                                    of unanticipated
                          Patient Safety Topics -   events: the next step   ASHRM Monograh addresses the components of effective
                          Patient safety - sample   in better               communication of unanticipated outcome, considerations for each of the          http://www.premierinc.com/all/safety/
                          policies - disclosure     communication with      components and the unique perspectives to be taken in various clinical          resources/patient_safety/downloads/
HSOPSC                    resources and policies    patients                settings.                                                                       disclosure-part3-02-04.pdf


                                                                            ASHRM American Society of Healthcare Risk Management: Disclosure
                          Patient Safety Topics -   Disclosure of Medical   of Medical Errors: Demonstrated Strategy to Enhance Communication, a
                          Patient safety -          Errors: Demonstrated    one-hour video produced by ASHRM, focuses on practical risk                     http://www.ahaonlinestore.com/Prod
                          Education & training -    Strategy to Enhance     management strategies to approach disclosure. The video is available            uctDisplay.asp?ProductID=555&cartI
HSOPSC                    ASHRM                     Communication           for $50 to ASHRM members, $60 to non-members. Catalog #169520.                  D=163827&PCatID=25
                          Culture - Safety -Tool
                          Adobe;Patient             Strategies for                                                                                          http://www.ihi.org/IHI/Topics/Patient
                          Safety/Medication         Leadership: Hospital                                                                                    Safety/MedicationSystems/Tools/Str
                          Systems/Tools; Under:     Executives and Their                                                                                    ategiesforLeadershipHospitalExecuti
HSOPSC                    Culture of Safety         Role in Patient Safety A compilation of leadership strategies for enhancing patient safety        √     vesandTheirRoleinPatientSafety.htm
                                                                            Walk-throughs enable providers to better understand the experience of           http://www.ihi.org/IHI/Topics/Improv
                                                    Walk-through (IHI       care from the patient’s and family’s points of view — by going through          ement/ImprovementMethods/Tools/
HSOPSC                    Culture - Safety - Tool   Tool)                   the experience themselves                                                 √     Walk-through.htm




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                                                                                                                                     IHI
  Month   Year   Topic by Tab           Tool                                          Description                                   Tool               Location




                                                       The Emergency Preparedness Atlas includes maps showing the location
                                                       of hospitals and nursing homes in each state, and case studies for six
                                                       states that show bed capacity and the emergency management and
                                                       bioterrorism preparedness regions for each facility. The Atlas is intended
                                                       to help nursing homes plan how they may be used to handle a surge of
                                                       patients in response to emergency situations; it is not a review of the
                                                       quality or adequacy of preparedness efforts in any area. The Atlas can
                                                       help explain the state-specific regulatory environment of nursing homes
                                                       with respect to surge capacity and illustrate nursing home geographic
                                                       distribution in the United States. A separate report, "Nursing Homes in
                                AHRQ – Emergency       Public Health Emergencies – Special Needs and Potential Roles,"
                                prep guide to locate   addresses the role that nursing homes could play in regional
               Emergency        healthcare sites       preparedness, and is based on focus groups with nursing homes in the                http://www.ahrq.gov/prep/nursingho
August    2007 Preparedness     during disaster        case study states.                                                                  mes/atlas.htm


                                                       The Department of Health & Human Services' (HHS) Agency for
                                                       Healthcare Research and Quality (AHRQ) has released a DVD titled,
                                                       "Cross Training Respiratory Extenders for Medical Emergencies (Project
                                                       XTREME)," that trains healthcare professionals who are not respiratory
                                                       care specialists to provide basic respiratory care and ventilator
                                                       management to adult patients in any mass casualty event. The DVD
                                                       includes six training modules with interactive quizzes to test viewers'
                                                       knowledge. Meant for physicians, physician assistants, nurses and
                                                       others, the modules cover topics such as infection control, respiratory
                                                       care terms and definitions, manual ventilation (using hand-held bags),              A free, single copy of the DVD and
                                AHRQ DVD –             mechanical ventilation (using the two types of ventilators included in the          a CD-ROM with the report may be
                                Training for           federal government's Strategic National Stockpile of medicines and                  ordered by calling 800.358.9295 or
               Emergency        respiratory care/vents medical supplies for emergencies), airway maintenance, and airway                   by sending an e-mail to
June      2007 Preparedness     in disasters           suctioning.                                                                         ahrqpubs@ahrq.hhs.gov.


                                                   AHRQ has released a questionnaire that hospitals and other healthcare
                                                   facilities can use to plan and evaluate their readiness for a public health
                                                   emergency involving a chemical, biological, radiological, nuclear or
                                                   explosive event. The 43-question document is divided into eight
                                                   categories: administration and planning; education and training;
                                                   communication and notification; patient (surge) capacity; staffing and
               Emergency        Emergency response support; isolation and decontamination; supplies, pharmaceuticals, and
May       2007 Preparedness     planning tool      laboratory support; and surveillance.                                                   http://www.ahrq.gov/prep/cbrne/


                                                      The CDC has provided advance data from vital and health statistics
                                                      demonstrating wide variations in terrorism preparedness training. A study            The report and many updates on
                                CDC – QuickStats on by Niska et al., "Training for terrorism-related conditions in hospitals:              Emergency Preparedness may be
                                training ER staff for United States, 2003-04; No. 380," used data to determine which hospital              downloaded from the Safety
               Emergency        emergency             characteristics are associated with providing terrorism preparedness                 Institute's Emergency
May       2007 Preparedness     preparedness          training to clinical staff.                                                          Preparedness Web site.




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                                                                                                                                       IHI
  Month   Year   Topic by Tab           Tool                                          Description                                     Tool                Location



                                                  Two courses designed to help hospital personnel implement the National
                                                  Incident Management System (NIMS) are available from the Federal
                                                  Emergency Management Agency (FEMA). NIMS was developed so
                                                  responders from different jurisdictions and disciplines can better
                                                  collaborate to respond to natural disasters and other emergencies.
                                                  Course IS-100. HC, "Introduction to the Incident Command System for
                                                  Healthcare/Hospitals," describes the history, features, principles and
                                                  organizational structure of ICS. FEMA notes that the course is for
                                                  hospital personnel who would have a direct role in emergency
                                                  preparedness, incident management, and/or emergency preparedness.
                                                  Course IS-200. HC, "Applying ICS to Healthcare Organizations," is                          http://www.training.fema.gov/EMIW
                                                  designed to enable healthcare personnel to operate efficiently during an                   eb/IS/is100HC.asp;
                                FEMA –            incident or event within the ICS and is for personnel whose primary                        http://www.training.fema.gov/EMIW
                                Implementing the  responsibility is emergency management. FEMA's Web site has                                eb/IS/is200HC.asp;
                                National Incident additional information on NIMS implementation activities for hospitals.                    http://www.fema.gov/emergency/ni
               Emergency        Management System Other professional groups such as the American Society for Healthcare                      ms/compliance/assist_non_govt.sht
Feb       2007 Preparedness     (NIMS)            Engineering also offer similar training courses for ICS.                                   m


                                                      Providing Mass Medical Care with Scarce Resources: A Community
                                                      Planning Guide (.pdf) (1.1 MB) is the product of a collaborative effort
                                                      between AHRQ and the Office of Public Health Emergency
                                                      Preparedness. Experts in the areas of mass casualty care, including pre-
                                                      hospital care, hospital and acute care, alternative care sites, palliative
                                                      care, ethical issues, and legal considerations, contributed to this guide. It
                                                      describes shortages (such as of hospital beds and ambulances)
                                                      healthcare workers may face and gives planners specific
                                                      recommendations, such as providing off-site care and using taxis, buses,               http://www.premierinc.com/quality-
                                AHRQ emergency        and private cars to transport sick or injured patients. The report provides            safety/tools-services/safety/safety-
               Emergency        planning – Mass       planning checklists and tips for making wise use of limited medical                    share/12-06-downloads/08-ahrq-
Dec       2006 Preparedness     casualty care guide   resources.                                                                             mce-guide.pdf


                                                    A Web-based interactive decision tool designed to assist emergency
                                                    preparedness and recovery planners is available from the Department of
                                                    Health and Human Services. The new tool helps determine how to
                                                    access and use health information about various populations such as the
                                HIPAA Privacy Rule: elderly and those with disabilities, and is consistent with the Health
                                Disclosures for     Insurance Portability and Accountability Act's privacy rule in emergency
                                Emergency           preparedness situations. The tool should help planners organize their                    Go to:
               Emergency        Preparedness - A    activities, and provide useful information to a range of potential                       http://www.hhs.gov/ocr/hipaa/decisi
July      2006 Preparedness     Decision Tool       programs.                                                                                ontool/.




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                                                                                                             Premier Safety Share



                                                                                                                                        IHI
   Month   Year   Topic by Tab           Tool                                          Description                                     Tool                Location


                                                     The 27-minute training video teaches hospital personnel how to
                                                     decontaminate children after being exposed to hazardous chemicals
                                                     during a bioterrorist attack or other type of disaster. It reviews strategies,
                                                     tools and key preparedness planning issues. The training video is
                                                     intended for hospitals and emergency and pediatric professionals
                                                     because it explains the unique needs of children versus adults during
                                 The Decontamination public health emergencies. The video also covers three main areas: a
                                 of Children:        step-by-step presentation of the decontamination process; a real-time
                                 Preparedness and    demonstration of the decontamination of children from infancy to                         To obtain a free single copy,
                                 Response for        adolescence, and; a section for administrators that outlines the steps                   contact the AHRQ Publications
                Emergency        Hospital Emergency involved in establishing and maintaining a pediatric decontamination                      Clearinghouse at 800.358.9295, or
April      2006 Preparedness     Departments         facility in any emergency department.                                                    via email at ahrqpubs@ahrq.gov.


                                                        The Joint Commission on Accreditation of Healthcare Organizations
                                                        (JCAHO) has issued a guide, "Surge Hospitals: Providing Safe Care in
                                                        Emergencies". A "surge hospital" is designed to treat a surge in the
                                                        number of patients needing care, triage, treatment, and even surgical
                                                        interventions. They are temporary facilities, such as shuttered hospitals,
                                                        closed wards in existing hospitals, and mobile facilities designed to serve           Go to:
                                                        as a stopgap measure to provide medical care until an area's healthcare               http://www.premierinc.com/all/safet
                                 Surge Hospitals:       organizations can reopen. The guide also includes case studies that                   y/resources/disaster_readiness/dow
                Emergency        Providing Safe Care    describe how surge hospitals were established during the recent                       nloads/surge-hospitals-jcr-12-08-
January    2006 Preparedness     in Emergencies         hurricanes on the Gulf Coast.                                                         05.pdf

                Emergency        NIOSH pocket guide -                                                                                         http://www.cdc.gov/niosh/npg/defau
December   2005 Preparedness     Chemical hazards                                                                                             lt.html
                                 Mold: Prevention       Mold: Prevention Strategies and Possible Health Effects in the Aftermath
                                 Strategies and         of Hurricanes Katrina and Rita and a mold table includes population
                                 Possible Health        specific recommendations for protection from exposure to mold in
                                 Effects in the         buildings flooded after hurricanes by specific activity and risk factors, as
                                 Aftermath of           well as information on how to identify and prevent mold-related health                http://www.premierinc.com/all/safet
                Emergency        Hurricanes Katrina     effects. The documents include recommendations for control of mold                    y/resources/disaster_readiness/dow
November   2005 Preparedness     and Rita               exposure.                                                                             nloads/2005-mold-report.pdf




                                                                                                                                              http://www.premierinc.com/all/safet
                                                                                                                                              y/public-health/downloads/03-
                                                                                                                                              reoccupancy-post-hurricane-10-18-
                                                        A fact sheet and checklist were recently developed by the Centers for                 05.pdf,
                                                        Disease Control and Prevention to assist healthcare facilities with the               http://www.premierinc.com/all/safet
                                                        tasks involved during clean-up and reopening following extensive water                y/public-health/downloads/02-ic-
                                                        damage. "Remediation and Infection Control Considerations for                         checklist-reoccupancy-post-
                                                        Reopening Healthcare Facilities Closed due to Extensive Water and                     hurricane-10-18-05.doc, and
                                                        Wind Damage" notes that implementation of these measures is meant to                  http://www.premierinc.com/all/safet
                                                        be followed in accordance with state and local certification requirements,            y/public-health/downloads/01-ic-
                Emergency                               completion of building and fire inspections, and other relevant state or              checklist-reoccupancy-post-
November   2005 Preparedness     Reopening a facility   local regulations.                                                                    hurricane-10-18-05.pdf




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                                                                                                                                        IHI
  Month     Year   Topic by Tab           Tool                                          Description                                    Tool                Location


                                                        The Joint Commission on Accreditation of Healthcare Organizations
                                                        (JCAHO) has issued a step-by-step guide, "Standing Together: An
                                                        Emergency Planning Guide for America's Communities," for small, rural
                                                        and suburban communities to both prepare for and successfully respond
                                                        to major local and regional emergencies such as hurricanes, floods,
                                  Standing Together:    terrorist attacks, major infectious outbreaks, hazardous materials spills,
                                  An Emergency          or other catastrophic occurrences. This comprehensive planning guide
                                  Planning Guide for    provides 13 essential steps that local government and public health                   http://www.premierinc.com/all/safet
                 Emergency        America's             leaders can use to establish an effective community-based emergency                   y/publications/10-05-downloads/10-
October     2005 Preparedness     Communities           management planning and response process.                                             emergency-planning-guide.pdf




                                                        A recently released Archives of Internal Medicine article describes
                                                        improvements in a physician's ability to diagnose and manage diseases
                                                        caused by bioterrorism agents. Such improvements were documented
                                                        after the completion of an online pre-test that assessed physicians'
                                                        baseline knowledge and ability to diagnose and manage potential cases
                                                        of smallpox, anthrax, botulism, and plague. An educational module
                                                        following the pre-test reviewed diagnosis and decision-making for
                                                        patients presenting with anthrax, botulism, plague, smallpox, or a
                                                        common disorder that has clinical overlap with these diseases. The
                                                        educational module was followed by a post-test, which measured the
                                                        module's effectiveness. Extra cases were presented to the physicians                  The bioterrorism-education module
                                                        between the pre- and post-tests on each of the four potential bioterrorism            is available for registered users on
                                  Educational module    agents. Improvement in results led the study's authors to conclude that               the Johns Hopkins Medicine's
                 Emergency        for physicians –      the online education module may improve physician's diagnosis and                     Internet Learning Center at:
October     2005 Preparedness     Bioterrorism agents   management of diseases caused by these agents.                                        http://www.hopkinsilc.org.

                                  Premier Safety
                                  Institute's Emergency The Premier Safety Institute's Emergency and Public Health
                 Emergency        and Public Health     Preparedness page also contains relevant and timely news and                          http://www.premierinc.com/all/safet
September   2005 Preparedness     Preparedness          resources related to the disaster.                                                    y/public-health/
                                                       During clean up and recovery operations following hurricanes, OSHA
                 Emergency                             issues alerts on the dangers associated with cleanup and recovery from                 http://www.osha.gov/OshDoc/hurric
September   2005 Preparedness     Keeping workers safe hurricanes.                                                                            aneRecovery.html
                                                        Increased incidence of acute diarrhea may occur in post-disaster
                                  Acute diarrhea -      situations where access to electricity, clean water, and sanitary facilities          http://www.premierinc.com/all/safet
                 Emergency        guidelines for        are limited. In addition, usual hygiene practices may be disrupted and                y/publications/09-05-downloads/14-
September   2005 Preparedness     management            healthcare seeking behaviors may be altered.                                          guide-acute-diarrhea.pdf

                                                        Food may not be safe to eat during and after a natural disaster or power              http://www.premierinc.com/all/safet
                 Emergency                              outage. Safe water guidelines provide guidance for using bottled, boiled,             y/publications/09-05-downloads/13-
September   2005 Preparedness     Safe food and water   or treated water for drinking, cooking, and personal hygiene.                         food-water-safety.pdf
                                                        Information on water supply disruptions excerpted from the CDC
                                                        Guidelines for Environmental Infection Control in Health-Care Facilities,             http://www.premierinc.com/all/safet
                 Emergency                              2003 - Recommendations of CDC and the Healthcare Infection Control                    y/publications/09-05-downloads/12-
September   2005 Preparedness     Water system repair   Advisory Committee (HICPAC).                                                          water-system-repair.pdf




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                                                                                                                                           IHI
  Month     Year   Topic by Tab           Tool                                            Description                                     Tool                Location


                                                          Community shelters provide housing for persons displaced from their
                                                          homes following natural disasters such as hurricanes, floods, and
                                                          earthquakes. In these settings, individuals share living space. Some
                                                          individuals may have health problems, including acute or chronic
                                  Community shelter       infectious diseases. These recommendations provide basic infection                     http://www.premierinc.com/all/safet
                 Emergency        guidance following      control information that will help to prevent exposure to or transmission              y/publications/09-05-downloads/11-
September   2005 Preparedness     disasters               of infectious agents.                                                                  community-shelters.pdf


                                                       Immunization recommendations (.pdf) (85 KB) are available for
                                                       individuals displaced by Hurricane Katrina. Although measles and rubella
                                                       are no longer endemic to the United States, introductions do occur, and
                                                       crowded conditions may facilitate their spread. Although Hepatitis A
                                                       incidence is low in the affected areas, post-exposure prophylaxis in these
                                                       settings would be logistically difficult. Consequently, vaccination is
                                                       recommended. In addition, the influenza season will begin soon and                        http://www.premierinc.com/all/safet
                 Emergency        Interim immunization influenza can spread easily under crowded conditions. Interim                             y/publications/09-05-downloads/09-
September   2005 Preparedness     after hurricane      recommendations are provided.                                                             cdc-advisory-interim-immun.pdf



                                                                                                                                                 http://www.premierinc.com/all/safet
                                                       After an emergency, it can be difficult to find running water. However, it                y/publications/09-05-downloads/06-
                                                       is still important to wash your hands (.pdf) (75 KB) to avoid illness. It is              handwashing-emergencies.pdf and
                                                       best to wash your hands with soap and water but when water isn't                          http://www.premierinc.com/all/safet
                 Emergency        Hand hygiene in      available, you can use alcohol-based products (.pdf) (34 KB) made for                     y/publications/09-05-downloads/21-
September   2005 Preparedness     emergency situations washing hands.                                                                            clean-hands-cards.pdf


                                                          This summary addresses preventing electrocutions associated with
                                                          generators plugged into household circuits. Homeowners should not
                                                          attempt to install any generator that requires hard-wiring into an existing            http://www.premierinc.com/all/safet
                 Emergency        Electrical safety and   electrical circuit or that requires a trained, qualified electrician to hard-          y/publications/09-05-downloads/05-
September   2005 Preparedness     generators              wire any generator into a household circuit.                                           electrical-safety.pdf


                                                          After a natural disaster, snakes may have been forced from their natural
                                                          habitats and move into areas where they would not normally be seen or
                                                          expected. When you return to your home, be cautious of snakes that                     http://www.premierinc.com/all/safet
                 Emergency        Snake bite - How to     may have sought shelter in your home. If you see a snake in your home,                 y/publications/09-05-downloads/08-
September   2005 Preparedness     prevent or respond      immediately call the animal control agency in your county.                             snake-bite.pdf

                                  Animal disposal         Most states have guidelines on disposal of dead animals so people with                 http://www.premierinc.com/all/safet
                 Emergency        following an            questions regarding the specific situation in their state are encouraged to            y/publications/09-05-downloads/07-
September   2005 Preparedness     emergency               contact local or state health and agricultural officials for clarification.            animal-disposal.pdf


                                                          ASHE's Hurricane Relief Resources provides a link to the University of
                                                          Minnesota, "Managing Water Infiltration into Buildings: A Systematized                 See also CDC's "Healthcare Water
                                                          Approach for Remediating Water Problems in Buildings due to Floods,                    System Repair" at
                 Emergency                                Roof Leaks, Potable Water Leaks, Sewage Backup, Steam Leaks and                        http://www.dehs.umn.edu/iaq/flood.
September   2005 Preparedness     Flood remediation       Groundwater Infiltration."                                                             html.




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  Month     Year   Topic by Tab           Tool                                          Description                                     Tool                Location




                                                                                                                                               The information is available at
                                                                                                                                               http://www.ahrq.gov/research/shutt
                                                                                                                                               ered/. Related: Use of shuttered
                                                        The new report from the Agency for Healthcare Research and Quality                     hospitals report
                                                        (AHRQ) entitled "Use of Former (Shuttered) Hospitals to Expand Surge                   http://www.premierinc.com/all/safet
                                                        Capacity" that gives emergency responders and public health officials                  y/publications/09-05-downloads/02-
                                                        useful, practical tools for opening shuttered hospitals when an                        ahrq-shutreport.pdf, Tool kit to
                                                        emergency is underway. The information is available at                                 open a facility
                                                        http://www.ahrq.gov/research/shuttered/. The report gives surrounding                  http://www.premierinc.com/all/safet
                                                        communities that aren't immediately affected by the hurricane a way to                 y/publications/09-05-downloads/03-
                                                        assess their existing facilities to meet future needs. It includes lists of            ahrq-toolkit.pdf, and Checklist to
                                  Use of Former         supplies and medications needed by stable medical/surgical patients and                open a facility found at
                                  (Shuttered) Hospitals checklists to assess facility readiness, staffing needs and levels, and                http://www.premierinc.com/all/safet
                 Emergency        to Expand Surge       patient transport readiness. The report also contains a tool kit with a list           y/publications/09-05-downloads/04-
September   2005 Preparedness     Capacity              of supplies and equipment needed for operation of a reopened facility.                 ahrq-checklist.pdf.


                                                         Although terrorists use a variety of methods to inflict harm and create
                                                         fear, bombs are used most frequently. According to the FBI, bombings
                                                         accounted for nearly 70 percent of all terrorist attacks in the United
                                                         States and its territories between 1980 and 2001. This practical summary
                                                         focuses on common sense principles that will be useful in a bombing
                                                         event. It describes how every person, family or organization should                   This CDC document can be
                                                         prepare for an emergency or disaster, including knowledge of work,                    downloaded at
                                                         school and community disaster plans. If you are not familiar with the                 http://www.premierinc.com/all/safet
                                                         plans, contact your supervisor, school administrators, or your local fire             y/public-
                 Emergency        Preparing for a        department for more information. This document details what should be                 health/downloads/preparingterrorist
August      2005 Preparedness     terrorist bombing      done if a bomber is suspected.                                                        bombing.pdf


                                                         The Occupational Safety and Health Administration (OSHA) has
                                                         released a best practices document (.pdf) (1.9 MB) for hospital-based
                                                         first receivers of victims of chemical, biological, and radiological events.
                                                         The "Hospital-Based First Receivers of Victims from Mass Casualty
                                                         Incidents Involving the Release of Hazardous Substances" document will
                                                         assist hospitals in developing and implementing emergency management
                                                         plans that address the protection of emergency department personnel,
                                  OSHA 'best practice' while receiving contaminated victims from mass casualty incidents. It                   http://www.premierinc.com/all/safet
                 Emergency        guidance for hospital- also includes information on victim decontamination, personal protective              y/publications/01-05-downloads/08-
January     2005 Preparedness     based first receivers equipment (PPE), and employee training                                                 first-receivers-hosp.pdf


                                                         The Department of Homeland Security has released a new National
                                                         Response Plan. The Department of Health and Human Services will lead
                                                         the federal government in providing public health and medical services
                                                         during major disasters and emergencies. The National Response Plan                    The Plan can be downloaded at:
                 Emergency        National Response      establishes a comprehensive all-hazards approach to enhance the ability               http://www.dhs.gov/dhspublic/intera
January     2005 Preparedness     Plan                   of the United States to manage domestic incidents.                                    pp/




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                                                                                                                                           IHI
  Month   Year   Topic by Tab            Tool                                            Description                                      Tool                 Location

                                Clinician Registry for
                                Terrorism and
                                Emergency                The registry provides real-time information to help healthcare providers
                                Response Updates         prepare for (and possibly respond to) emerging diseases and terrorism
               Emergency        and Training             events. CDC also uses the registry to announce new clinician training
October   2004 Preparedness     Opportunities            opportunities related to terrorism and emergency response topics.                       editorial/editorial_0566.xml.

                                                                                                                                                 http://my.premierinc.com/all/safety/
               Emergency        Minnesota's surge                                                                                                publications/08-04-downloads/08-
August    2004 Preparedness     capacity plan            Minnesota's surge capacity plan                                                         surge-amacdc-email.ppt

                                Healthcare Facility      A study conducted by several disaster medicine experts on strategies to                 The plan is available from the
                                and Community            manage patient surges in healthcare facilities following a biological or                Annals of Emergency Medicine
               Emergency        Strategies for Patient   chemical terrorist attack, provides sample response plans for                           (contact Colleen Hughes at
August    2004 Preparedness     Care Surge Capacity      communities in Colorado, Massachusetts, Minnesota, and Virginia.                        202.728.0610, Ext. 3010).
                                                         The tool helps regional planners locate and rank potential alternative                  To view the full report and tool, go
                                                         sites such as stadiums, schools and recreation centers based on                         to:
               Emergency        Surge capacity           whether they have adequate ventilation, plumbing, food supply, kitchen                  http://www.ahrq.gov/research/altsite
August    2004 Preparedness     planning                 facilities and other factors.                                                           s.htm.


                                                         The Centers for Disease Control and Prevention (CDC) has established
                                                         partnerships with national clinician organizations for the purpose of
                                                         disseminating timely information on disease outbreaks and terrorism
                                                         events. COCA's Web site was successfully launched July 20. The site
                                Clinician Outreach       offers many resources for COCA members, including past COCA
               Emergency        and Communication        conference call summaries and slides, listings of COCA members,                         Visit the COCA Web site at
August    2004 Preparedness     Activity (COCA)          information on future conference calls and training updates.                            www.bt.cdc.gov/coca/index.asp.

                                                         The Centers for Disease Control and Prevention has a Web-based                          The module can be completed at
               Emergency        Plague training          module designed to teach the natural epidemiology of plague and how to                  http://www.bt.cdc.gov/agent/plague/
July      2004 Preparedness     module                   manage it as both a natural disease and an intentional attack.                          trainingmodule/.
                                                                                                                                                 The full report, Evidence
                                                                                                                                                 Report/Technology Assessment
                                                                                                                                                 No. 95, Training of Hospital Staff to
                                Training of Clinicians   This evidence report updates the evidence report "Training of Clinicians                Respond to a Mass Casualty
                                for Public Health        for Public Health Events Relevant to Bioterrorism Preparedness" and                     Incident, may be obtained free from
                                Events Relevant to       focuses on the effectiveness of hospital disaster drills, computer                      the AHRQ Publications
                Emergency       Bioterrorism             simulations, and tabletop or other exercises used in training hospital staff            Clearinghouse by calling
June       2004 Preparedness    Preparedness             to respond to a mass casualty incident.                                                 800.358.9295.


                                                       The tool, developed by the Evidence-based Practice Center at the Johns
                                                       Hopkins University, helps hospitals identify their strengths and
                                                       weaknesses during a disaster drill and improve their ability to meet
                                                       required emergency management plans. Areas assessed include pre-drill
                                Evaluation of Hospital planning, incident command, decontamination, triage and treatment. The
                                Disaster Drills: A     tool also includes checklists to help hospitals tailor drills to specific health
               Emergency        Module-Based           threats, such as a biological or radiation incidents, and a spreadsheet to
June      2004 Preparedness     Approach               track and compare drill performance among hospital units or hospitals.




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  Month    Year   Topic by Tab            Tool                                          Description                                     Tool                Location


                                                        The plan calls for specialized response teams, an emergency
                                                        preparedness executive steering committee, and regional emergency
                                                        response plans during a national emergency. The agency recently
                                                        published its National Emergency Management Plan that details the
                                                        agency's roles and responsibilities during responses to national
                Emergency        National Emergency     emergencies and outlines procedures to ensure assistance is in place for               http://www.osha.gov/SLTC/emerge
March      2004 Preparedness     Management Plan        responder and recovery workers' health and safety.                                     ncypreparedness/index.html


                                                      The report, HHS bioterrorism preparedness programs: States reported
                                                      progress but fell short of program goals for 2002, examines the extent to
                                                      which states completed 2002 cooperative agreement requirements and
                                                      whether they identified any factors that hindered implementation of the        http://www.premierinc.com/all/safet
                Emergency                             Centers for Control and Prevention (CDC) and Health Resources and              y/publications/03-04-downloads/04-
March      2004 Preparedness                          Services programs: States reported progress agreement of program
                                 HHS bioterrorism preparedness Administration’s (HRSA) cooperativebut fell shortprograms. goals for 2002
                                                                                                                                     d04360r.pdf

                                                        A training course originally developed by the World Health Organization
                                                        and Centers for Disease Control and Prevention for training smallpox                   Order at
                Emergency                               response teams, these presentations help planners and first responders                 http://www.bt.cdc.gov/agent/smallp
January    2004 Preparedness     CDC Training Slides    prepare for the possibility of the use of smallpox as a terrorist weapon.              ox/training/overview/index.asp
                                                        OSHA has a Web-based training tool on implementing an incident
                                                        command system as part of emergency response preparedness. The
                Emergency        Incident command       toolprovides guidance on planning for an incident command system and                   http://www.osha.gov/SLTC/etools/ic
December   2003 Preparedness     syatem                 addresses applicable OSHA standards.                                                   s/index.html
                                                                                                                                               http://www.premierinc.com/all/safet
                                                                                                                                               y/publications/11-03-downloads/09-
                                                                                                                                               illness-associated-exposure-chem-
                Emergency        Recognizing chemical                                                                                          agents.doc
November   2003 Preparedness     agent exposure
                                                        A health information bulletin, provides recommendations on preventing                  http://www.osha.gov/dts/shib/shib1
                                                        mold growth, proper use of personal protective equipment, and safe                     01003.html
                Emergency        Brief Guide to Mold in cleanup methods.
November   2003 Preparedness     the Workplace
                                                        A matrix tool, provides information on how facilities can reduce
                Emergency        Fire and Explosion     vulnerability to and consequences of a terrorist attack that involves fire or          http://www.osha.gov/dep/fire-
November   2003 Preparedness     Planning Matrix        an explosive device.                                                                   expmatrix/index.html.
                                                       The Pink Book – ―Epidemiology and Prevention of Vaccine Preventable
                                 Epidemiology and      Diseases,‖ the 7th edition from 2002, is now in its second printing.                    The book is available for download
                                 Prevention of                                                                                                 or purchase at
                Emergency        Vaccine Preventable                                                                                           http://www.cdc.gov/nip/publications/
October    2003 Preparedness     Diseases                                                                                                      pink/default.htm
                                                       Provides employers with information on helping to protect workers from
                                                       injuries and illnesses resulting from possible terrorist incidents related to
                                 Chemical, Biological, chemical, biological, radiological, or nuclear attacks.
                                 Radiological, and
                                 Nuclear (CBRN)                                                                                                http://www.osha.gov/dts/shib/revCB
                Emergency        Warfare Agents                                                                                                RN_EscapeRespirators_8-29-
October    2003 Preparedness     Escape Respirators                                                                                            03.html
                                                                                                                                               An Excel program version (1.4 MB)
                                 Computer staffing      A new computer model is available to help hospitals and health systems                 may be downloaded from:
                Emergency        model - Bioterrorism   plan antibiotic dispensing and vaccination campaigns to respond to                     http://www.ahrq.gov/research/biom
July       2003 Preparedness     Response               bioterrorism or large-scale natural disease outbreaks.                                 odel.htm.


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                                                                                                                                          IHI
   Month   Year   Topic by Tab            Tool                                            Description                                    Tool                Location
                                                                                                                                                The Evacuation Planning Matrix,
                                                                                                                                                available at
                Emergency        Evacuation Planning                                                                                            http://www.osha.gov/dep/evacmatri
June       2003 Preparedness     Matrix              Online tool to help employers with emergency planning.                                     x/index.html


                                 Guidance for
                                 Protecting Building
                                 Environments from        A new federal guidance is now available to help facility specialists in               http://my.premierinc.com/all/safety/
                                 Airborne Chemical,       business and government strategically select and use air-filtration and air-          publications/06-
                Emergency        Biological, or           cleaning systems for protecting occupants in buildings from chemical,                 03_downloads/08_NIOSH_2003-
June       2003 Preparedness     Radiological Attacks     biological, or radiological attacks.                                                  136.pdf
                                 Disaster
                                 Preparedness and
                                 Response in Texas                                                                                              http://www.healthpolicyinstitute.org/
                Emergency        Hospitals: Part I,                                                                                             projects/disaster_response/dis_res
May        2003 Preparedness     Bioterrorism             A bioterrorism disaster preparedness guide for hospitals.                             p.asp

                                                    Information on agents likely to be used in a chemical terrorist attack. This
                                                    resource highlights agent-specific identification, medical symptoms,
                Emergency        Emergency          personal protective equipment, and decontamination considerations for                       http://www.cdc.gov/niosh/topics/em
May        2003 Preparedness     Response Resources responding to events involving cyanide, sarin, and nitrogen mustard.                        res/chemagent.html
                                                          Disaster drills are most effective when designed by an interdisciplinary
                                                          team that clearly establishes goals before the drill begins. A
                                 Planning and             teleconference on disaster drills and readiness assessment asserts that               http://www.hsrnet.net/ahrq-
                Emergency        executing disaster       the drills should also include a plan to evaluate whether the goals were              ulp/bioterrorism/events/0415/materi
May        2003 Preparedness     drills                   reached.                                                                              als.htm
                                 Addressing the
                                 Smallpox Threat:                                                                                               http://www.hsrnet.net/ahrq-
                Emergency        Issues, Strategies,      Copies of a 90-minute audiotape may be purchased for $10 from the                     ulp/bioterrorism/events/0218/materi
May        2003 Preparedness     and Tools                AHRQ Publications Clearinghouse                                                       als.htm



                                 Clinician Registry for
                                 E-mail Updates on        Clinician's registry to provide real-time information to help prepare for
                                 Terrorism and            and respond to terrorism and emergency situations. As participants,
                Emergency        Emergency                physicians will receive regular updates on terrorism and emergency
April      2003 Preparedness     Response                 response issues targeted to clinicians.                                               http://www.bt.cdc.gov/

                Emergency        Smallpox Vaccine     A guide addressing legal and risk management issues for hospitals                         http://biotech.law.lsu.edu/blaw/bt/s
March      2003 Preparedness     Injury and Law Guide related to the smallpox vaccine.                                                          mallpox/svlaw.htm
                                 Risk Management
                                 Guidance for Health,
                                 Safety and
                                 Environmental            The report covers several issues related to infrastructure and
                                 Security under           environmental risks during disaster events, including food, mail, and                 http://my.premierinc.com/all/safety/
                Emergency        Extraordinary            personnel security and safety; transportation; childcare; and building                publications/03-
March      2003 Preparedness     Incidents                access                                                                                03_downloads/11_extraordinary.pdf




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                                                        The chart presents a concise summary of signs and symptoms to assist
                Emergency        Chemical terrorism     with early recognition, as well as to alert healthcare workers about the
February   2003 Preparedness     agents                 potential for chemical terrorism agents.                                           http://www.unc.edu/depts/spice/

                                                      The program provides basic information required to implement a
                                 Bioterrorism Update: smallpox vaccination preparedness program. Presented in a series of
                Emergency        Smallpox             modules, it is directed at state and local health department and clinical            http://bookstore.phf.org/prod250.ht
February   2003 Preparedness     Preparedness         personnel.                                                                           m




                                                                                                                                           http://my.premierinc.com/all/safety/
                Emergency        Vaccine Information    The smallpox VIS must be used with a separate consent form that                    publications/01-
January    2003 Preparedness     Statement (VIS)        requires a signature.                                                              03_downloads/11_small02.pdf




                                                        This comprehensive module addresses the vaccine, methods of
                Emergency        Smallpox training      inoculation, prevention of contact transmission, laboratory testing and
December   2002 Preparedness     module                 use of vaccinia immunoglobulins (VIGs).                                            http://www.bt.cdc.gov/


                                                      More than 70 metropolitan hospital executives heard how hospitals near
                                                      "Ground Zero" in lower Manhattan and the Pentagon responded to the
                                 National Symposium immediate tragedies of September 11, 2001, as well as strategies related               http://www.hospitalconnect.com/ah
                Emergency        on Hospital Disaster to ongoing disaster readiness preparations against possible future                   a/key_issues/disaster_readiness/E
December   2002 Preparedness     Readiness            biological, and chemical, and natural disasters.                                     mWhatsNew.html
                                                                                                                                           Go to
                                 Emergency                                                                                                 http://www.premierinc.com/all/safet
                Emergency        preparedness           On-line catalogs provide emergency preparedness supplies available                 y/resources/disaster_readiness/pro
November   2002 Preparedness     materials              from several companies                                                             d_equip.htm.




                                 AHRQ's Bioterrorism
                                 Emergency Planning                                                                                        http://my.premierinc.com/all/safety/
                                 and Preparedness      Biological weapons training for personnel, procedures to permit rapid               publications/09-
                Emergency        Questionnaire for     recognition of credentialed staff from other facilities, on-call nursing            02_downloads/11_AHRQ_bioterror
October    2002 Preparedness     Healthcare Facilities policies, and designated areas of emergency overflow for patients                   _checklist.pdf



                                 Disaster kit — Tools
                Emergency        to meet children’s     To aid pediatricians, community leaders, parents, and others in preparing
October    2002 Preparedness     needs                  for and meeting children's needs during a disaster.                                http://www.aap.org/terrorism/
                                 Preparing for
                                 Terrorism: Tools for
                                 Evaluating the         A set of measurement tools and a process for evaluating the extent to
                                 Metropolitan Medical   which communities have implemented the disaster preparedness plans
                Emergency        Response System        required by the Department of Health and Human Services’ Metropolitan              http://www.nap.edu/catalog/10412.
August     2002 Preparedness     Program                Medical Response System program.                                                   html


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  Month   Year   Topic by Tab            Tool                                          Description                                  Tool                Location


                                Guidance for
                                Protecting Building
                                Environments from                                                                                          http://my.premierinc.com/all/safety/
                                Airborne Chemical,       The guidelines address the physical security of ventilation systems,              publications/06-
               Emergency        Biological, or           airflow and filtration, systems maintenance, program administration, and          02_downloads/05_36_2002_niosh_
June      2002 Preparedness     Radiological Attacks     maintenance staff training.                                                       ventilation_139.pdf
                                                         Resources on bioterrorism – including an evidence report on training
                                Training of Clinicians   clinicians, a summary of a workshop on strengthening the nation's
                                for Public Health        response capabilities, the results of a survey noting the gaps and
                                Events Relevant to       resources needed by local public health agencies to respond effectively
               Emergency        Bioterrorism             to bioterrorism, and a report from ECRI on personal protective
May       2002 Preparedness     Preparedness             equipment.                                                                        http://www.ahrq.gov/




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                                                       The Food and Drug Administration joined with the CDC, the EPA and
                                                       OSHA in releasing guidelines on how to prevent hazards due to
                                                       inappropriate use of cleaners and disinfectants on electronic medical
                                                       equipment. Such solutions can cause the equipment to malfunction.
                                                       Many stakeholders, including AHA, APIC, and ASHE, provided input to
                                                       the guidelines for handling and cleaning of electronic medical devices.
                                                       Minimizing the potential for cross contamination and patient and worker                  http://www.premierinc.com/quality-
                Environmental     FDA guidance –       injuries is critical, but of equal importance is the emphasis on the process             safety/tools-services/safety/safety-
                and Safety        Electronic equipment of proper cleaning and disinfecting in accordance with manufacturers’                    share/12-07-downloads/5_FDA-
December   2007 Products          cleaning hazards     guidelines in the interest of safety                                                     Equipment-10_31_07.doc


                                                          The newsletter provides news and success stories about topics such as
                                                          reduction of medical waste, computer recycling, green cleaning
                                                          programs, conversion to reusable products, laboratory chemical
                                                          recycling, energy efficient lighting and light bulb recycling. Premier's EPP
                                                          program is a collaboration of the Premier Safety Institute and Premier's
                Environmental                             group purchasing services. The program is part of Premier's commitment
                and Safety                                to helping healthcare facilities with their environmental efforts, including          Go to:
March      2006 Products          Green Link              waste minimization and the elimination of the use of mercury.                         http://www.premierinc.com/safety



                                                          The Clinician Outreach and Communication Activity (COCA) offered a
                                                          program in Medical Waste Management on August 23, 2005. Lynne
                                                          Sehulster, Ph.D, M(ASCP), of the Centers for Disease Control and
                                                          Prevention (CDC) Division of Healthcare Quality Promotion presented
                                                          materials addressing: identification of general categories of medical
                                                          waste; regulations governing the management of medical waste; insight
                Environmental     Medical waste           into how the recent influenza A (H2N2) situation revealed weaknesses in               http://www.premierinc.com/all/safet
                and Safety        management              the current system of waste management; and understanding the                         y/publications/10-05-downloads/09-
October    2005 Products          teleconference          importance of reinstating on-site capacity for medical waste treatment.               waste-management-slides.ppt


                                                          The American Society for Healthcare Environmental Services has
                                                          partnered with Orkin, Inc. to promote more effective and environmentally
                                                          friendly pest-control practices in healthcare settings, including the
                                                          release of a guide on integrated pest management. The partners also                   See Premier Safety Institute's
                                                          plan to publish educational articles and host two educational sessions on             Environmental and Safety Product
                Environmental     Environmentally         the recommended practice at ASHES' annual conference in September.                    list at:
                and Safety        friendly pest control   The partnership was launched in response to a growing movement in                     http://www.premierinc.com/all/safet
May        2005 Products list     practices               healthcare toward hazardous-chemical reduction.                                       y/resources/lists/




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   Month    Year   Topic by Tab            Tool                                          Description                                 Tool                Location



                                                           Two new handbooks are available online from Occupational Safety and
                                                           Health Administration (OSHA): "Best Practices for the Safe Use of
                                                           Glutaraldehyde in Health Care," which helps employers and employees
                                                           understand and control exposures to glutaraldehyde, a chemical used to           Go to:
                                                           disinfect and clean heat-sensitive medical, surgical and dental                  http://www.osha.gov/Publications/gl
                 Environmentally                           equipment, and "Preventing Mold-Related Problems in the Indoor                   utaraldehyde.pdf and
                 Preferred         OSHA online             Workplace," which offers recommendations to owners, managers, and                http://www.osha.gov/Publications/pr
May         2006 Purchasing        handbooks               occupants on how to fix mold problems in buildings                               eventing_mold.pdf


                                   Environmentally         A four-CD set containing all the presentations from "Environmentally             Order free copies of the book and
                                   Preferable              Preferable Purchasing and Healthcare Practices Conference" held in               CDs from the Premier Safety Store
                 Environmentally   Purchasing and          Boston, April 29, 2004. Topics include green buildings, mercury                  at:
                 Preferred         Healthcare Practices    elimination, recycling medical waste processing, solvent recovery, and           http://www.premierinc.com/all/safet
December    2004 Purchasing        Conference              more.                                                                            y/store/.


                                                        Premier's Safety Institute has added one more important section to the
                                   Environmental        Environmental Preferable Purchasing (EPP) module addressing
                 Chemical          Preferable           chemical cleaners and pesticides. The EPP "Topic summary" describes
                 cleaners and      Purchasing (EPP)     a number of important and useful resources. "Key documents" includes a              http://www.premierinc.com/all/safet
September   2004 pesticides        module               case study of a safer, successful integrated pest management program.               y/resources/EPP/index.htm
                                                        An online resource that aids employers in addressing air quality                    http://www.cdc.gov/niosh/topics/ind
                                                        concerns. The Indoor Environmental Quality topic page provides links to             oorenv
                                                        a variety of air quality topics, including how to identify, correct, and
                                                        prevent indoor air problems; how to implement an effective air quality
                 Environmental     Indoor Environmental plan; and resources on mold, asbestos, asthma and allergies, and
November    2003 Safety            Quality topic page   chemical safety.


                                   Cleaning for Health:                                                                                     http://my.premierinc.com/all/safety/
                 Environmentally   Products and            One-stop guide to environmentally preferable cleaning products and               publications/04-
                 Preferred         Practices for a Safer   methods that have been effectively used in office buildings, schools,            03_downloads/04_cleaning_for_he
April       2003 Purchasing        Indoor Environment      hospitals and other facilities in the United States and Canada.                  alth.pdf

                 Environmentally   Environmentally      A checklist is available which can be used by healthcare organizations to
                 Preferred         preferred purchasing guide purchasing decisions or by manufacturers to assess the                        http://www.ahrmm.org/info/HCEPT/t
October     2002 Purchasing        checklist            environmental friendliness of products.                                             ool.html




              Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Env Preferred Purchasing
                                                                                                               Premier Safety Share




                                                                                                                                          IHI
  Month   Year   Topic by Tab             Tool                                           Description                                     Tool                Location



                                                                                                                                                The handbook is available for a
                                                   The most current knowledge on concepts and methods of human factors                          discounted price of $95 at
                                                   and ergonomics and their applications to help improve quality, safety,                       http://www.erlbaum.com/ME2/dirmo
                                                   efficiency, and effectiveness in patient care. The handbook provides                         d.asp?sid=28807ECF50FE49F083
                                                   specific information on how to analyze medical errors with the                               7125BE640E681F&nm=&type=eCo
                                 Handbook of Human fundamental goal of reducing errors and the potential harm that results.                     mmerce&mod=CommerceProductC
                                 Factors and       Contributors discuss the design of work environment and working                              atalog&mid=CD22EA0F118949C09
                                 Ergonomics in     conditions to improve satisfaction and well being, and the reduction of                      A932248C040F650&tier=3&id=119
                                 Healthcare and    burnout and other ailments often experienced by healthcare providers                         DCAD843B64A54BC20DE1F72531
Nov       2006 Fall Prevention   Patient Safety    and professionals.                                                                           996&itemid=0-8058-4885-1
                                                       The draft document titled "Safe Patient Handling and Movement
                                                       Principles," a collaboration between NIOSH, the American Nurses
                                 Safe Patient Handling Association and the Veterans Affairs Patient Safety Center, is a new                     Available at the NIOSH Web site at:
                                 and Movement          Safe Patient Handling and Movement curriculum module to be used in                       http://www.cdc.gov/niosh/review/pu
June      2006 Fall Prevention   Principles            schools of nursing.                                                                      blic/safe-patient


                                                           Minimizing the risk of falls and falls injuries: Guidelines for acute, sub-
                                                           acute and residential care settings from the Victorian Quality Council of
                                                           Australia provides a framework and supporting resources to support falls
                                                           prevention activities in hospital and residential care settings. This falls          available for download from the
                                 Minimizing the risk of reduction guideline packet, or tool kit, contains research, tools, and                  Premier Safety Institute's Falls
                                 falls and falls injuries: education materials, including a sample Microsoft® Excel spreadsheet                 module
                                 Guidelines for acute, report to track falls data and trends, as well as algorithms for assessing               http://www.premierinc.com/all/safet
                                 sub-acute and             and reassessing an individual's fall risk. The packet includes numerous              y/resources/falls/procedures-
                                 residential care          tips for screening, assessing risk, reducing personal and environmental              tools.jsp#Tool (under "Sample
January   2006 Fall Prevention   settings                  risk factors, and properly responding to falls.                                      Procedures").
                                                                                                                                                http://www.osha.gov/SLTC/hospital
May       2002 Fall Prevention   Ergonomic eTools        OSHA ergonomic plan and eTools                                                         _etool/mainpage.html




            Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Fall Prevention
                                                                                                                                      IHI
  Month    Year   Topic by Tab           Tool                                         Description                                    Tool




                                                        The ALFA Institute of Biomedical Sciences Educational Portal contains
                                                        medical education material on topics that include pediatric infections,
                                                        zoonoses, infectious diseases, internal medicine, dermatology, upper
                                                        and lower respiratory infections, surgical infections, antimicrobial
                                                        resistance, clinical research tools, biomedical databases, critical care
                                                        and sepsis, cardiovascular infections, nosocomial infections, hepatitis B
                                                        virus, orthopedic infections, OB/GYN infections and urogenital
                                                        infections. A selection of case studies that can be used as interactive
                                                        case-based learning tools from the Academy of Infection Management
                                 Web-based              are also available. The case studies include the specialties of surgery,
                                 educational tools –    pediatrics, ICU, and pneumonia. Specific topics include patient
                                 Infection prevention   outcomes related to antibiotic usage and healthcare associated
February   2008 Guidelines       case studies           infections


                                                        Diseases are spread by poor coughing and sneezing techniques. Most
                                                        people put their hands in front of their mouths and noses to stop germs
                                                        from getting into the air. Unfortunately, this technique puts the germs on
                                                        their hands. The germs are then spread to telephones and doorknobs
                                                        and many other surfaces, where the next user then acquires. This five-
                                                        minute video was designed by three Maine hospitals to encourage
                                                        people to cough and sneeze according to the infection control guidelines
                                                        put forth by the Centers for Disease Control and Prevention (CDC). It is
                                                        aimed at the common citizen. The message is serious, but it is
                                                        presented with humor in such a way that it engages the viewer's
                                 Why Don’t We Do It     attention for a full five minutes while the message is repeated in
February   2008 Guidelines       in Our Sleeves?        interesting new ways. and Educational Trust (HRET) has developed a
                                                        The Health Research
                                                       comprehensive guide for clinicians and administrators to help
                                 AHA/HRET –            incorporate routine HIV testing in their emergency departments (EDs).
                                 Comprehensive tool This practical guide describes different approaches, considerations, and
August     2007 Guidelines       for HIV testing in ED resources for making HIV testing routine in ED care. It is based on


                                                      Nine presentations from Premier's conference on "Healthcare-
                                                      associated infections – What everyone needs to know," held June 19,
                                                      2007, in Orlando, FL, are available online for download. Featured faculty
                                                      include: Graeme Forrest, M.D., University Maryland Medical Center;
                                                      Peter Gross, M.D., Hackensack University Medical Center; Carol
                                                      Haraden, Ph.D., IHI; Eli Perencevich, M.D., M.S., VA Maryland
                                 Premier – Healthcare Healthcare System; Chesley Richards, M.D., M.P.H, FACP,
                                 associated infection CDC/DHQP; Richard Van Enk, Ph.D., Bronson Methodist Hospital;
                                 presentations        Daniel Varga, M.D., SSM Healthcare; and Premier's Dan Peterson, M.D,
August     2007 Guidelines       available online     M.P.H.; Gina Pugliese, R.N., M.S.; and Scott Pope, Pharm.D.


                                                       The Association for Professional in Infection Control and Epidemiology
                                                       (APIC) has released a white paper on healthcare associated infections
                                                       (HAI) titled "Dispelling the Myths: The True Cost of Healthcare-
                                                       Associated Infections." Featured in the March issue of Healthcare
                                                       Financial Management magazine, the white paper presents the
                                                       business case for reducing HAIs from the perspective of the healthcare
                                                       executive. Case studies of cost saving are detailed, along with a
                                                       methodology for determining the cost of different categories of HAIs.
                                 APIC – A business     APIC's goal with the white paper is to help healthcare executives
                                 case for preventing   understand the costs involved with these infections, evaluate HAIs in
                                 healthcare-           their own institutions and take a more aggressive approach to infection
Mar        2007 Guidelines       associated infections prevention.
                                                Patients undergoing MRI exams while wearing ECG electrodes and
                                                cables have experienced second and third degree burns sometimes
                         FDA – Avoiding         requiring plastic surgery to repair. After a FDA investigation into reports
                         burns from             received regarding these burns, precautions that can be taken to
                         electrodes and         prevent these types of burns were released. The problem is the
                         cables during MRI      radiofrequency fields created during an MRI exam can heat ECG cables
Mar    2007 Guidelines   exams                  AHRQ released seriously burningReport/Technology Assessment
                                                and electrodes, a new Evidence the underlying skin.
                                               (Number 9), which concludes that several approaches and practices
                                               implemented to prevent healthcare-associated infections (HAI) are
                                               promising and warrant additional research. The objective of the report
                                               was to determine the effects of quality improvement strategies on HAI
                                               and on HAI rates. The selected infections (.pdf) (785 KB) included
                                               surgical site infections (SSI), central line-associated bloodstream
                                               infections (CLABSI), ventilator-associated pneumonia (VAP), and
                                               catheter-associated urinary tract infections (CAUTI) The AHRQ
                                               Evidence Report concludes that there is insufficient evidence to
                                               recommend quality improvement strategies that will improve adherence
                                               to preventive interventions for healthcare-associated infections. The
                                               evidence is generally of suboptimal quality, consisting primarily of single-
                                               center, simple before-after studies of limited internal and external
                                               validity. Results from the limited data suggest that certain strategies
                                               require additional study and potential wider implementation. Those
                         AHRQ – Report on      strategies include reducing unnecessary catheter use by using "stop
                         strategies to prevent orders" (which require that a catheter be removed after a certain period
                         healthcare-           of time if it is no longer needed), reminders to improve surgical antibiotic
Feb    2007 Guidelines   associated infections prophylaxis, the use of checklists to improve adherence to central line




                                               A new toolkit designed to provide guidance on issues that should be
                                               considered when designing measures for public reporting of healthcare-
                                               associated infections (HAI) is available from the Centers for Disease
                                               Control and Prevention (CDC). The kit was designed in conjunction with
                                               the Association of Professionals in Infection Control and Epidemiology
                                               (APIC), the Society for Healthcare Epidemiology of America (SHEA) and
                                               other professional groups. Many states are considering making HAI
                                               reporting mandatory. "Essentials of Public Reporting of Healthcare-
                                               Associated Infections: A Tool Kit" (.pdf) (199 KB) details recommended
                                               steps, including the identification or creation of a responsible agency at
                         CDC – Tools for       the state level, personnel for data collection and quality improvement,
                         reporting healthcare- strategies to prevent unintended consequences of public reporting, and
Feb    2007 Guidelines   associated infections recommended outcome measures.


                                              Several new tools have recently been added to the Surgical Care
                                              Improvement Project (SCIP) Web site. The first, "Preventive Antibiotics
                                              in Colon and Rectal Surgery: Discontinuation Within 24 Hours After
                                              Operation," is a presentation that discusses the importance of giving
                                              recommended antibiotics in colorectal surgery with the equally important
                                              factor of discontinuing the antibiotics within 24 hours. Other tools related
                                              to venous thromboembolism include: Deep Vein Thrombosis
                         SCIP – New surgical, Prophylaxis Risk Factor Assessment, and Thrombosis Screen and
Dec    2006 Guidelines   VTE tools            Prophylaxis Recommendations.


                                                Cough hygiene video, NSF Scrub Club provides an interactive Web-
                                                based educational program with music, games and cartoons that aims
                         Humor in infection     to help protect children from dangerous food borne illnesses as well as
                         control – Online       infectious diseases, and MARR has useful antibiotic information
                         educational            downloads on fighting antibiotic resistance, a parent's guide for colds,
                         resources for adults   runny noses, and otitis media. Posters on handwashing include a
Sept   2006 Guidelines   and children           reminder for children on when to wash their hands.
                                                 The Advisory Committee on Immunization Practices (ACIP) has issued
                                                 recommendations for preventing rotavirus gastroenteritis in infants and
                                                 children. The recommendations call for American infants to be
                                                 immunized with the recently licensed rotavirus vaccine. Infants should
                                                 receive three doses of the vaccine, administered orally at two, four and
                                                 six months. It is the most common cause of severe gastroenteritis in
                                                 infants and young children worldwide. Although rotavirus causes few
                                                 deaths among U.S. children, almost all children will become infected
                                                 with rotavirus by age five. Most of them will develop gastroenteritis,
                            ACIP – New rotavirus resulting in up to 272,000 emergency department visits and 70,000
Sept      2006 Guidelines   vaccine              hospitalizations each year.

                            Antibiotic Prophylaxis
                            in Cardiac Surgery –
                            Duration of            This guideline provides for one recently CMS approved exception for
March     2006 Guidelines   prophylaxis            discontinuance of antibiotic prophylaxis.


                            Antimicrobial
                            Prophylaxis for
                            Surgery: An Advisory
                            Statement from the     This advisory statement provides an overview of issues related to
                            National Surgical      antimicrobial prophylaxis, including specific suggestions regarding
                            Infection Prevention   antimicrobial selection, initiation and discontinuance of prophylactic
March     2006 Guidelines   Project                antimicrobials.


                                                   New guidelines are designed specifically for the cardiovascular
                                                   catheterization laboratory and provide information on such issues as the
                                                   selection of antibacterial soaps, the circumstances under which patients
                            CV Cath Lab:           should receive an antibiotic, protective masks and other garb to be worn
                            Infection control      by catheterization lab staff, and the acceptable level of air circulation in
January   2006 Guidelines   guidelines             the catheterization lab.


                                               New resources on community-acquired MRSA CA-MRSA and a
                                               Template for Gene Vector Guidance have been made available from the
                                               Association for Professionals in Infection Control and Epidemiology
                                               (APIC) Practice Guidance Council. These resources were developed in
                                               collaboration with APIC's Emerging Issues Committee. The CA-MRSA
                                               resource identifies key resources available via national, state, and local
                            Community-acquired public health agencies. The Template for Gene Vector Guidance is
                            MRSA CA-MRSA       intended to assist facilities in developing infection control policies to
                            and a Template for regulate gene vector therapy. APIC recommends any study be reviewed
                            Gene Vector        and approved by their Institutional Review Board (IRB) but also include
January   2006 Guidelines   Guidance           the involvement of an affiliated Biosafety Committee.


                                                   The U.S. Public Health Service has updated the recommendations for
                                                   the management of healthcare personnel (HCP) with occupational
                                                   exposure to blood and other body fluids that might contain human
                                                   immunodeficiency virus (HIV). Published in the September 30, 2005
                                                   Morbidity and Mortality Weekly Report (MMWR) , the recommendations
                                                   (.pdf) (267 KB) emphasize adherence to postexposure prophylaxis
                                                   (PEP) regimens when indicated, expert consultation in managing
                            HIV post-exposure      exposures, follow-up to improve HCP adherence to PEP, and monitoring
October   2005 Guidelines   prophylaxis            for adverse events, including seroconversion.
                             EPA Notebook -
                             Healthcare waste
                             management
June       2005 Guidelines   profiles, resources


                                                 A guide to assist with compliance with the JCAHO Environmental of
                                                 Care Standards. Hospitals for a Healthy Environment (H2E) is working
                                                 on a clipboard version for JCAHO surveyors. This guide relates each
                                                 JCAHO Element of Performance (EP) to specific federal regulations, to
                                                 help facilities be in compliance with both. The guide also suggests steps
                             JCAHO/H2E guide - that facilities can take to encourage environmental performance
                             Environment-of-care improvements. A comprehensive environmental program, including
                             compliance and      waste minimization and pollution prevention initiatives, can help ensure
June       2005 Guidelines   improvement         compliance and reduce costs.




                                                   Two new guidance documents from the Association for the
                                                   Advancement of Medical Instrumentation (AAMI) are designed to assist
                                                   manufacturers in assessing the device reprocessing information they
                                                   provide. These documents help address concerns that manufacturer's
                                                   instructions are often inadequate or don't consider the common
                                                   reprocessing methods facilities use. The first document, entitled
                                                   "Designing, testing, and labeling reusable medical devices for
                                                   reprocessing in healthcare facilities: A guide for device manufacturers"
                                                   (TIR12: 2004), is intended to help manufacturers validate the
                                                   reprocessing procedures they recommend and guide them in choosing
                             AAMI guidance         facility protocols. The second, "Sterilization of medical devices -
                             documents -           Information to be provided by the manufacturer for the processing of re-
                             Cleaning and          sterilizable medical devices" (ANSI/AAMI/ISO ST81: 2004), sets forth
May        2005 Guidelines   sterilization         requirements for labeling and reprocessing instructions.

                                                   The comprehensive lists published by the Food and Drug Administration
                                                   (FDA) are available on the FDA Web site. The FDA Guidance
                             FDA Guidance          Documents for Regulated Industry - Annual Comprehensive List of
March      2005 Guidelines   Documents             Guidance Documents - and the corrections to that list


                                                   A presentation titled, From SIP to SCIP (referring to the National
                                                   Surgical Infection Prevention Project and the current Surgical Care
                                                   Improvement Project) is available from the Surgical Care Improvement
                             From SIP to SCIP      Project. Dale W. Bratzler, M.D., provides a background summary of the
                             (referring to the     Surgical Infection Prevention Project (SIP) and shows some of the
                             National Surgical     national data that has been collected, as well as findings in the clinical
                             Infection Prevention literature. The presentation also highlights the transition of the SIP into
                             Project and the       the Surgical Care Improvement Project (SCIP), which goes beyond just
                             current Surgical Care preventing surgical infection and focuses on improving the outcomes for
January    2005 Guidelines   Improvement Project) surgery patients.


                                                   A new telephone hotline that provides clinicians with immediate access
                                                   to expert advice on treating HIV-infected pregnant women and their
                                                   children is available through the federal Health Resources and Services
                                                   Administration's National HIV/AIDS Clinicians' Consultation Center at
                                                   San Francisco (CA) General Hospital. The Perinatal Hotline
                                                   (888.448.8765) provides 24-hour consultation from HIV experts,
                                                   including advice on interpreting HIV testing in pregnancy and
December   2004 Guidelines   The Perinatal Hotline implementing the U.S. Public Health Service's clinical care guidelines.
                                                   CDC also provides PowerPoint presentations that describe West Nile
July       2004 Guidelines   West Nile Virus       Virus and methods of treatment and prevention.
                                                   New practice guidelines are available to assist with the administration of
                                                   outpatient antimicrobial therapy (OPAT). Due to the lack of evidence-
                                                   based studies, these guidelines were formulated from the collective
                                                   experience of the Infectious Diseases Society of America Guidelines
                                                   Committee and advisors from related organizations. The Practical
                                                   Guidelines for Outpatient Parenteral Antimicrobial Therapy updates the
                                                   1997 guidelines and are intended to aid in the successful
                            Practical Guidelines   implementation of parenteral antimicrobial services for patients in a
                            for Outpatient         variety of outpatient settings including the home, physician offices, and
                            Parenteral             skilled nursing facilities. The guidelines are general and need to be
                            Antimicrobial          adapted for each specific setting.
July      2004 Guidelines   Therapy                The poster provides clinical guideline reminders for surgical infection
                                                   prevention, acute myocardial infarction, congestive heart failure, and
                                                   community-acquired pneumonia. The tool is intended to be displayed in
                            CMS clinical           areas where staff document the care provided, such as in nurses'
July      2004 Guidelines   guideline reminder     stations, doctors' dictation areas, and medical record areas, among


                                                   A printed copy of the Centers for Disease Control and Prevention’s
                                                   (CDC) "Guidelines for Environmental Infection Control in Health-Care
                                                   Facilities - 2003" has been published by the American Society of
                                                   Healthcare Engineering (ASHE). Topics covered in this publication
                            Guidelines for         include indoor air quality, construction, ventilation in specialized care
                            Environmental          areas, water quality, water quality in hemodialysis settings, cleaning and
                            Infection Control in   disinfection of environmental surfaces, pest control, principles of
                            Health-Care Facilities environmental sampling, laundry and bedding, animals in health care,
May       2004 Guidelines   - 2003                 and regulated medical waste.
                                                   New guidelines for preventing healthcare-associated pneumonia and
                                                   other severe lower respiratory infections. These guidelines update and
                                                   replace the 1981 guideline. In addition to the latest pneumonia and
                                                   respiratory infection recommendations, the guidelines expand the list of
                            Guidelines for         recommended antiviral treatments for influenza patients and
                            Preventing Health-     recommends that potable water be kept at temperatures above 124
                            Care-Associated        degrees Fahrenheit or below 68 degrees Fahrenheit to reduce the risk of
April     2004 Guidelines   Pneumonia, 2003        Legionnaire's disease.
                            National Surgical
                            Infection Prevention   New web site for accessing current information on the National Surgical
January   2004 Guidelines   (SIP)                  Infection Prevention (SIP)

                            Pneumonia Medicare New web site for accessing current information on the Pneumonia
January   2004 Guidelines   National Project   Medicare National Project
             Location




Go to http://www.e-meducation.org/
and http://infectionacademy.org/




http://coughsafe.com/




http://www.edhivtestguide.org/




Download from:
http://www.premierinc.com/advisorli
ve/




http://www.premierinc.com/quality-
safety/tools-
services/safety/topics/guidelines/an
timicrobials.jsp#business-case
http://www.premierinc.com/quality-
safety/tools-services/safety/safety-
share/03-07-downloads/07-burns-
during-mri.doc




http://www.premierinc.com/quality-
safety/tools-services/safety/safety-
share/02-07-downloads/12-
hainfgap.pdf




Access the CDC Web site for the
Public Reporting of Healthcare-
Associated Infections
(http://www.cdc.gov/ncidod/dhqp/P
ublicReportingHAIs.html) for the
toolkit, as well as the February
2005 American Journal of Infection
Control article, Guidance on Public
Reporting of Healthcare-Associated
Infections (.pdf) (150 KB).




VTE guidelines are available from
the Premier Safety Institute
Infection Prevention and Safety
Module under "Other guidelines,
selected resources."




http://www.coughsafe.com/;
http://www.scrubclub.org/;
http://www.mi-
marr.org/cons_materials.html
http://www.premierinc.com/quality-
safety/tools-services/safety/safety-
share/09-06-downloads/12-mmwr-
rotavirus.pdf



Go to:
http://www.premierinc.com/all/safet
y/resources/guidelines/other.jsp




Go to:
http://www.premierinc.com/all/safet
y/resources/guidelines/other.jsp




Go to:
http://www.premierinc.com/all/safet
y/resources/guidelines/other.jsp#ca
rd-cath




Go to :
http://www.premierinc.com/all/safet
y/publications/01-06-downloads/11-
ca-mrsa.pdf and
http://www.premierinc.com/all/safet
y/publications/01-06-downloads/12-
gene-vector-therapy.pdf




http://www.premierinc.com/all/safet
y/publications/10-05-downloads/11-
hiv-rr5409.pdf
The Notebook can be accessed at:
http://www.epa.gov/compliance/res
ources/publications/assistance/sect
ors/notebooks/health.html




To view this guide, go to:
http://ecm.ncms.org/herc/jcaho3.10
.3.html.




To order, call 800.332.2264, Ext.
217, or visit www.aami.org.




http://www.fda.gov/opacom/morech
oices/industry/guidedc.htm




View a PowerPoint® summary
(.ppt) (1.6 MB) or watch a full
presentation with sound in a video
clip at:




http://www.medqic.org/scip/scip_ne
ws_fromsiptoscip.html
http://my.premierinc.com/all/safety/
publications/07-04-downloads/11-
opat-cid-06-04.pdf
http://my.premierinc.com/all/safety/
publications/07-04-downloads/10-
clinical-guideline-poster-ar-02-
04.pdf




http://www.premierinc.com/all/safet
y/resources/guidelines/index.htm




http://www.premierinc.com/all/safet
y/resources/guidelines/cdc_guidelin
es.htm#Pneumonia2003



www.MedQIC.org/sip



www.MedQIC.org/pneumonia
                                                                                                           Premier Safety Share




                                                                                                                                      IHI
  Month     Year   Topic by Tab            Tool                                       Description                                    Tool                Location



                                                        The CDC Hand Hygiene Resource Web page provides an interactive
                                                        training course on hand hygiene and other standard precautions to
                                                        prevent healthcare associated infections. The course reviews key
                                                        concepts of both hand hygiene and standard precautions. The learner is
                                  The CDC Hand          asked a series of hand hygiene questions as they work through the
                 Hand Hygiene     Hygiene Resource      module and again at the end. The course also contains a short 60-                   http://www.cdc.gov/handhygiene/tra
September   2008 Guideline        Web page              second video on hand hygiene.                                                       ining/interactiveEducation/



                                                        Diseases are spread by poor coughing and sneezing techniques. Most
                                                        people put their hands in front of their mouths and noses to stop germs
                                                        from getting into the air. Unfortunately, this technique puts the germs on
                                                        their hands. The germs are then spread to telephones and doorknobs
                                                        and many other surfaces, where the next user then acquires. This five-
                                                        minute video was designed by three Maine hospitals to encourage
                                                        people to cough and sneeze according to the infection control guidelines
                                                        put forth by the Centers for Disease Control and Prevention (CDC). It is
                                                        aimed at the common citizen. The message is serious, but it is presented
                 Hand Hygiene     Why Don’t We Do It    with humor in such a way that it engages the viewer's attention for a full
February    2008 Guideline        in Our Sleeves?       five minutes while the message is repeated in interesting new ways.                 Order at: http://coughsafe.com/



                                                     The World Health Organization's (WHO) first global patient safety
                                                     challenge, "Clean Care is Safer Care," acknowledges the importance of
                                                     addressing the global challenge of healthcare-associated infections (.pdf)
                                                     ( 2 MB). Low-cost WHO strategies that help reduce infection risks in
                                                     areas such as blood products and their use, injection practices and
                                                     immunization, safe water, basic sanitation and waste management, and                   The draft is available for download
                                                     clinical procedures, particularly in first-level emergency care, are already           at:
                 Hand Hygiene     WHO – Testing hand available. These strategies are combined with efforts to implement the                 http://www.who.int/gpsc/resources/
Mar         2007 Guideline        hygiene guidelines WHO Guidelines on Hand Hygiene in Healthcare (Advanced Draft).                         newsalert/jan2007/en/


                                                        An eight-minute video on proper handwashing technique titled "Last
                                                        Clean Chance" has been produced by the Mecklenburg (NC) County
                                                        Health Department. The science fantasy thriller is set in a bio-research
                                                        lab. The video involves a doomsday scenario in which a virus is leaked              Access the video and information
                                                        into the lab space. Tailored for the young viewer, the video teaches a              online at
                 Hand Hygiene                           valuable skill and reminds us that handwashing is the number one way to             http://www.charmeck.org/Departme
May         2006 Guideline        Last Clean Chance     prevent the spread of disease.                                                      nts/Health+Department/



                                                                                                                                            http://www.premierinc.com/all/safet
                                                                                                                                            y/publications/09-05-downloads/06-
                                                                                                                                            handwashing-emergencies.pdf and
                                                                                                                                            http://www.premierinc.com/all/safet
                 Hand Hygiene     Hand hygiene in                                                                                           y/publications/09-05-downloads/21-
September   2005 Guideline        emergency situations Communications/Last+Clean+Chance.htm.                                                clean-hands-cards.pdf




              Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Hand Hygiene
                                                                                                        Premier Safety Share



                                                                                                                                IHI
  Month    Year   Topic by Tab            Tool                                      Description                                Tool               Location
                                                                                                                                      The CDC slide sets are available
                                 Slides - Hand                                                                                        at:
                Hand Hygiene     hygiene educational                                                                                  http://www.cdc.gov/handhygiene/m
July       2003 Guideline        resource                                                                                             aterials.htm.
                Hand Hygiene     Hand Hygiene          Provides updated educational materials dealing with hand hygiene
November   2002 Guideline        Resource Center       practices.                                                                     http://www.handhygiene.org/




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                                                                                                              Premier Safety Share




                                                                                                                                         IHI
  Month   Year   Topic by Tab             Tool                                           Description                                    Tool                Location



                                                                                                                                               Word:
                                                         Premier's Safety Institute is now offering a checklist to save on your                http://www.premierinc.com/quality-
                                                         computer and complete or update at your own pace. The Word                            safety/tools-
                                                         document (.doc) (463 KB) retains the HTML format and features                         services/safety/topics/influenza/inde
                                                         developed by the Centers for Disease Control and Prevention (CDC),                    x.jsp#checklist; also offers this as
                                                         with input from other federal partners. It is intended to help hospitals              an Adobe® PDF (2 MB) or online
                                                         assess and improve their preparedness for responding to pandemic                      at:
                                 Comprehensive           influenza. Because of differences among hospitals (e.g., characteristics              http://www.pandemicflu.gov/plan/he
                                 hospital checklist –    of the patient population, size of the hospital/community and scope of                althcare/
               Influenza -       pandemic influenza      services), each hospital will need to adapt this checklist to meet its                hospitalchecklist.html.
July      2007 pandemic          preparation             unique needs and circumstances.




                                                         The new guidance focuses specifically on healthcare workers and their
                                                         employers. The diversity among the providers of healthcare, from
                                                         emergency departments to ambulances to temporary patient care
                                                         facilities, makes preparing for a pandemic influenza challenging. The 104-
                                                         page document is organized in four major sections: clinical background
                                                         information on influenza, infection control, pandemic influenza
                                                         preparedness planning, and OSHA standards of special importance. It
                                                         addresses flu diagnosis and treatment, healthcare worker vaccination,
                                                         and personal protective equipment. The appendices include additional
                                                         resources for healthcare institutions, such as communication tools for
                                                         promoting employee infection control practices, strategies for planning
                                 OSHA – Complete         respiratory protections programs, triage algorithms, supply and pandemic              http://www.premierinc.com/quality-
                                 HCW pandemic flu        planning checklists, and even a crisis communication guide for handling               safety/tools-
               Influenza -       preparedness            questions from the media.                                                             services/safety/topics/influenza/inde
June      2007 pandemic          guidance                                                                                                      x.jsp#pandemic
                                                        checklist that describes steps that long-term care and other residential
                                                       facilities can take to prepare for influenza pandemic is available from the
                                                       Department of Health and Human Services (HHS) and the Centers for
                                                       Disease Control and Prevention (CDC). The checklist was developed to
                                                       help long-term care and other residential facilities assess and improve
                                                       their preparedness for responding to pandemic influenza. Based on
                                                       differences among facilities (e.g., patient/resident characteristics, facility
                                                       size, scope of services, hospital affiliation), each facility will need to
                                                       adapt this checklist to meet its unique needs and circumstances. The
                                                       checklist states that facilities should have a structure for planning and
                                                       decision-making, overseen by a multidisciplinary group focused on
                                                       pandemic flu planning, and to develop a written influenza plan. The
                                                       written influenza plan should include flu surveillance and detection
                                                       measures; communications; education and training in basic prevention
                                                       and control measures for personnel, residents, and residents' family
                                                       members; and an infection control plan for managing residents and
                                 Pandemic flu          visitors with pandemic influenza; an occupational health plan to address                The checklist is available at:
               Influenza -       checklist – Long-term staff absences and related issues; and plans for vaccine and antiviral                  http://www.pandemicflu.gov/plan/
June      2006 pandemic          care                  use and surge capacity.                                                                 LongTermCareChecklist.html.




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                                                                                                             Premier Safety Share



                                                                                                                                        IHI
   Month   Year   Topic by Tab            Tool                                          Description                                    Tool                Location




                                                         Online resources and information from the California Distance Learning
                                                         Health Network (CDLHN), a non-profit organization of the Graduate
                                                         School of Public Health at San Diego State University. The section on
                                                         pandemic influenza resources includes the U.S. national strategy for
                                                         pandemic influenza and World Health Organization avian influenza
                                                         updates. A summit designed to inform California leaders in business,
                                                         education, local government, healthcare, social services and other
                                                         sectors to better prepare California for influenza pandemic is available as          Go to:
                                  California Distance    a Webcast. The summit presents the current threat of avian influenza                 http://cdlhn.com/create_frameset.cf
                Influenza -       Learning Health        and the risk of a human influenza pandemic and several training videos               m?id=32&CFID=523799&CFTOKE
May        2006 pandemic          Network (CDLHN)        related to mass vaccinations and disease investigation.                              N=19783253


                                                         The Department of Health and Human Services (HHS) has developed a
                                                         checklist to help home healthcare providers care for the sick during an              Go to: English -
                                                         influenza pandemic. The checklist will help organizations assess their               http://www.premierinc.com/all/safet
                                                         readiness to respond by identifying strengths and weaknesses. It also                y/publications/04-06-downloads/06-
                                  Home Healthcare        explains that building community contacts will provide a strategic                   healthcare-checklist.pdf; Spanish -
                                  Services Pandemic      advantage if a pandemic influenza strikes. The checklist was designed                http://www.premierinc.com/all/safet
                Influenza -       Influenza Planning     with a pandemic influenza in mind, although it may be used in other types            y/publications/04-06-downloads/06a-
April      2006 pandemic          Checklist              of emergencies.                                                                      spanish-healthcare-checklist.pdf



                                                                                                                                              http://www.premierinc.com/all/safet
                                                                                                                                              y/publications/12-05-downloads/10-
                                  Use of personal                                                                                             questions-answers-ppe-during-flu-
                                  protective equipment                                                                                        outbreaks.doc and
                Influenza -       during influenza                                                                                            http://www.premierinc.com/all/safet
December   2005 pandemic          outbreaks                                                                                                   y/resources/influenza/index.jsp




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                                                                                                                                      IHI
  Month    Year   Topic by Tab            Tool                                         Description                                   Tool                Location



                                                       A home care influenza toolkit, published by Montgomery County's
                                                       Advanced Practice Center, is designed to help people manage influenza
                                                       at home. This simple toolkit, "Stay At Home Toolkit for Influenza,"
                                                       includes checklists on what to keep in the home, tips on how to
                                                       recognize flu signs and symptoms, instructions on using thermometers,
                                                       isolating the sick, making disinfectant with bleach, and cleaning
                                                       potentially contaminated areas, a personal care log to help caregivers               http://www.premierinc.com/quality-
                                                       track observations and action, guidelines for those returning to work after          safety/tools-services/safety/safety-
                Influenza -       Stay At Home Toolkit recovering from flu, and items to keep on hand for pets for disaster                 share/02-08_downloads/13_Stay-at-
February   2008 seasonal          for Influenza        preparedness.                                                                        home-toolkit.pdf


                                                          For the beginning of the new influenza season, the Centers for Disease
                                                          Control and Prevention (CDC) is releasing updates of a few new flu
                                                          resources. The CDC's flu Web site at www.cdc.gov/flu has been revised
                                                          and is easy to navigate as a resource. This year, the CDC is                      Downloads are available for printing
                                  CDC updates             emphasizing high-risk children (such as those with asthma or diabetes)            at:
                Influenza -       influenza tools for the and their caregivers, as well as focusing on protecting infants and the           http://www.cdc.gov/flu/professionals
October    2007 seasonal          new season              elderly through family and community vaccination.                                 /flugallery/.

                                                         A Web site sponsored by the National Influenza Vaccine Summit called
                                  New Web site           "Prevent Influenza Now!" provides information updates on the current
                Influenza -       provides influenza     influenza vaccination season. The site contains vaccine information for
Dec        2006 seasonal          vaccination updates    the public about influenza, the benefits of v                                      http://www.preventinfluenza.org/



                                                                                                                                            http://www.premierinc.com/all/safet
                                                                                                                                            y/publications/12-05-downloads/10-
                                  Use of personal                                                                                           questions-answers-ppe-during-flu-
                                  protective equipment                                                                                      outbreaks.doc and
                Influenza -       during influenza                                                                                          http://www.premierinc.com/all/safet
December   2005 seasonal          outbreaks                                                                                                 y/resources/influenza/index.jsp

                                                         The National Foundation for Infectious Diseases' "Kids Need Flu
                                                         Vaccine" initiative now includes a new patient education resource for
                Influenza -       Children's vaccine     physicians and healthcare providers. The new patient education
October    2005 seasonal          education kit          resource kit includes a parental brochure, fact sheet and                          http://64.242.251.230/index1.html


                                                                                                                                            Last year's National Influenza
                                                                                                                                            Vaccine Summit guide is available
                                                                                                                                            online at
                                                        The purpose of the guide is to provide frontline healthcare personnel with          http://www.immunize.org/influenza/
                                  Influenza Vaccination information about indications and contraindications for the two types of            pocketguide.htm, and this site
                Influenza -       Pocket Information    influenza vaccines, as well as groups to be vaccinated and how to                   should be checked periodically for
August     2005 seasonal          Guide                 administer the vaccines. The draft of the                                           the 2005-2006 version.

                                                         As reports of influenza increase during the current season, the Centers
                                  New posters in five    for Disease Control and Prevention (CDC) continues to offer new
                Influenza -       languages for          resources in the fight to prevent the illness. The "Cover Your Cough"              http://www.cdc.gov/flu/protect/cover
January    2005 seasonal          healthcare, schools    campaign has new language-specific flyers and pos                                  cough.htm


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                                                                                                          Premier Safety Share



                                                                                                                                   IHI
  Month    Year    Topic by Tab           Tool                                        Description                                 Tool                Location


                                  Summary of
                                  resources to prevent                                                                                   http://www.premierinc.com/all/safet
                Influenza -       spread of flu in the This latest tool from the CDC provides various resources, including               y/publications/11-04-downloads/08-
November   2004 seasonal          workplace            important telephone numbers, Web pages, and poster/flyer links.                   flu-tools.pdf
                                                                                                                                         The tool is supported by the
                                                         A free online resource to help health care providers conduct influenza          National Influenza Vaccine Summit
                                                        immunization programs for children is available from The National                and can be accessed through the
                Influenza -       Kids Need Flu         Foundation for Infectious Diseases (NFID). The "Kids Need Flu Vaccine,           NFID Web site at
August     2004 seasonal          Vaccine, Too!         Too!" program aims to increase immunization ra                                   http://64.242.251.230/.




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                                                                                                 Premier Safety Share




                                                                                                                         IHI
Month   Year Alpha      Keyword         Topic by Tab            Tool                                  Description       Tool   Location   Type   Media




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                                                                                                              Premier Safety Share




                                                                                                                                         IHI
  Month     Year   Topic by Tab            Tool                                         Description                                     Tool               Location



                                                         The newsletter provides news and success stories about topics such as
                                                         reduction of medical waste, computer recycling, green cleaning
                                                         programs, conversion to reusable products, laboratory chemical
                                                         recycling, energy efficient lighting and light bulb recycling. Premier's EPP
                                                         program is a collaboration of the Premier Safety Institute and Premier's
                 Environmental                           group purchasing services. The program is part of Premier's commitment
                 and Safety                              to helping healthcare facilities with their environmental efforts, including          Go to:
March       2006 Products          Green Link            waste minimization and the elimination of the use of mercury.                         http://www.premierinc.com/safety

                                                         Pollution prevention reduces some of the regulatory compliance issues,
                                                         such as the hazardous waste rules, by encouraging the use of less toxic
                                                         materials. The fact sheets are:                  Mercury in Healthcare
                                                         Lab Reagents
                                                         Mercury in Labs and Pharmacies
                                                         Mercury in Patient Care Areas
                                                         Mercury in Non-Patient Care Areas                                                     The fact sheets may be obtained
                                                         Formalin Recovery in Health Care Labs                                                 from the MnTAP Web site at
                                                         Suction Canister Waste Reduction                                                      http://www.mntap.umn.edu (click on
                 Mercury Pollution                       Ten Tools To Get Below the Regulatory Radar                                           "Industries" and "Healthcare" for
August      2004 Prevention        Mercury fact sheets   MnTAP Profile, a general fact sheet on MnTAP's services                               more information).
                                                         This resource provides information on such topics as the health effects
                                   Healthcare Hazard     of mercury exposure; reducing occupational exposures, including
                 Mercury Pollution Control System        thorough training and personal protective equipment; and applicable                   http://www.osha.gov/SLTC/mercury
September   2003 Prevention        Volume 2              OSHA standards and guidelines.                                                        /index.html




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  Month    Year    Topic by Tab           Tool                                            Description                                      IHI                 Location
                                                                                                                                          Tool

September 2008 Patient Safety     Patient Safety and       This three-volume, 1,400-page handbook for nurses on patient safety                   http://www.ahrq.gov/qual/nurseshdb
                                  Quality: An Evidence-    and quality resources contains 89 contributions that represent the work               k/
                                  Based Handbook for       of a broad range of nurses and other patient safety researchers
                                  Nurses                   throughout the nation. The handbook is grouped into six sections:
                                                           Patient Safety and Quality; Evidence-based Practice; Patient-centered
February   2008 Patient Safety    AHRQ toolkits – 17       Care; Working Conditions and the Work Environment for Nurses; Critical
                                                           The Agency for Healthcare Research and Quality (AHRQ) has                             http://www.ahrq.gov/qual/pips
                                  patient safety           developed a series of toolkits designed to help reduce medical errors.
                                  resources                These 17 toolkits, "Patient Safety at the Point of Care," range from
                                                           checklists to help reconcile medications when patients are discharged
                                                           from the hospital to processes to enhance effective communication
                                                           among caregivers and with patients, to toolkits to help patients taking
                                                           medications, and can be adapted to most healthcare settings.


February   2008 Patient Safety    FDA – Downloadable The latest FDA medication safety-related videos, including some                             http://www.ismp.org/Tools/fdavideos
                                  medication safety  developed in cooperation with ISMP, are now available free for viewing                      .asp
                                  videos             or downloading on the ISMP Web site.The videos added from October
                                                     include warnings about Vincristine errors, luer misconnection, and how
                                                     the use of a disposable straw with Exactacain, a local anesthetic spray,
                                                     may pose a safety risk to patients. November videos highlight side
                                                     effects of codeine in nursing mothers, avoiding mix-ups with
                                                     Amphotericin B formulations, and warnings for Rocephin use with any IV
                                                     product that contains calcium.


February   2008 Patient Safety    NIH tool kit – Online                                                                                          http://nihseniorhealth.gov/toolkit/tool
                                  health information for                                                                                         kit.html
                                  seniors
February   2008 Patient Safety    Free tool for            A free DVD from the Agency for Healthcare Research and Quality,                       Order at:
                                  designing hospitals      "Transforming Hospitals: Designing for Safety and Quality," reviews                   http://www.ahrq.gov/qual/transform.
                                  for patient safety       evidence-based hospital design and how it increases patient and staff                 htm
                                                           satisfaction and safety, quality of care, employee retention, and results in
                                                           a positive return on investment. Key concepts of evidence-based design
                                                           in a hospital include single-patient rooms, the use of noise reducing
                                                           construction materials, easily accessible workstations, and improved
                                                           layout for patients and staff. Patient safety issues addressed are falls,
                                                           hospital-associated infections and medical errors. The DVD also
                                                           presents cases of three hospitals that have incorporated evidence-based
                                                           design elements in their construction and renovation.



December   2007 Patient Safety    AHRQ free DVD –          A new free DVD addressing patient safety consists of eight modules                    Order at:
                                  Patient safety           involving one to five separate lessons, and provides processes and tools              http://www.ahrq.gov/qual/psicdvd.ht
                                                           that can be used to develop a systems-based approach to patient safety.               m
                                                           The modules include the investigation of medical errors and their root
                                                           causes; identification, implementation and evaluation of system-level
                                                           interventions to address patient safety concerns; and steps necessary to
                                                           promote a culture of safety within a hospital or other healthcare facility.




             Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety
                                                                                                            Premier Safety Share




  Month    Year    Topic by Tab           Tool                                         Description                                     IHI                 Location
                                                                                                                                      Tool
December   2007 Patient Safety    Advancing the                                                                                        √     http://www.premierinc.com/quality-
                                  Practice of Patient-                                                                                       safety/tools-services/safety/safety-
                                  and Family-Centered The Institute for Healthcare Improvement (IHI) recently released a report              share/12-07-downloads/6_Patient-
                                  Care                 titled ―Advancing the Practice of Patient- and Family-Centered Care‖ that             Family-Centered-Care-2007.pdf
                                                       includes assessment tools to help hospitals determine the degree to
                                                       which patient- and family-centered approaches exist in their current
                                                       organizational culture; IHI also released a tool that helps gather
                                                       information about the perceptions and attitudes of staff and
                                                       administrative leaders. The report describes how hospitals can get
                                                       started with understanding how quality and safety are advanced by
                                                       bringing patients and families directly into the planning, delivery and
                                                       evaluation processes. This 25-page report provides rationale for a
                                                       patient- and family-centered approach to care and defines its core
                                                       concepts and outlines steps that a hospital can take to create
                                                       partnerships with patients and families.
October    2007 Patient Safety    Drug safety          The FDA has released the first issue of its new Drug Safety newsletter.               A fact sheet and the inaugural issue
                                  newsletter from FDA The online newsletter will be published quarterly and provide information              of the newsletter can be found at
                                                       for healthcare professionals, such as physicians, physician assistants,               http://www.fda.gov/cder/dsn/.
                                                       nurse practitioners, nurses, pharmacists, dentists, other allied healthcare
                                                       professionals, health professional associations and drug information
                                                       centers. The newsletter will feature findings of selected post-marketing
                                                       drug safety reviews from the agency's Center for Drug Evaluation and
                                                       Research (CDER), important emerging drug safety issues, and recently
                                                       approved new drugs. The newsletter provides post-marketing information
                                                       to healthcare professionals to enhance communication of new drug
                                                       safety information, raise awareness of reported adverse events, and
                                                       stimulate additional adverse event reporting.



September 2007 Patient Safety     NCI – End-of-life care The National Cancer Institute (NCI) has published a free palliative-care            The CD can be ordered or a
                                  tool                   training program for health professionals caring for cancer patients. The           brochure downloaded online. For
                                                         "Education in Palliative and End-of-Life Care for Oncology" CD-ROM and              more information, go to the NCI Web
                                                         DVD teaches palliative care competencies and interventions for cancer               site at
                                                         patients. The curriculum is designed to provide the practicing clinician            http://www.nci.nih.gov/aboutnci/epec
                                                         with information and strategies necessary to provide palliative                     o
                                                         interventions to his or her patients and to provide educational tools and
                                                         materials to use in teaching the core competencies of palliative care to
                                                         trainees. This curriculum is eligible for continuing education credit for
                                                         physicians and nurses.


September 2007 Patient Safety     Webcast – Best        Catheter-related blood stream infections (BSI) are a significant source of           http://www.cardinal.com/clinicalcente
                                  practices to reduce   morbidity and mortality associated with a variety of devices used to                 r/materials/webcasts/index.asp
                                  catheter-related      access the vascular system. Meticulous aseptic technique is both
                                  blood stream          required and effective to prevent BSI. Faculty share their observations,
                                  infections            best practices, and outcome data as they discuss this important topic.
                                                        This free webcast is a replay from the original August 17, 2007, webcast
                                                        provided by Cardinal Health's Center for Safety and Clinical Excellence
                                                        and will remain available for one full year. Continuing education credit is
                                                        also provided.




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  Month    Year    Topic by Tab           Tool                                          Description                                    IHI                 Location
                                                                                                                                      Tool
September 2007 Patient Safety     FDA – Free patient     The latest medication safety-related videos, developed by the FDA in                http://www.ismp.org/Tools/fdavideos
                                  safety videos          cooperation with ISMP, are now available free for viewing or                        .asp
                                                         downloading on the ISMP Web site
                                                         (http://www.ismp.org/Tools/fdavideos.asp).
August     2007 Patient Safety    OSHA – New             The new Healthcare Industry Quick Start module is directed primarily to             http://www.osha.gov/dcsp/complianc
                                  healthcare "Quick      small employers in the healthcare field. The module is designed to help             e_assistance/quickstarts/
                                  Start" compliance tool users find free resources on the OSHA Web site related to the
                                                         healthcare industry. The eight-step module includes information on
July       2007 Patient Safety    ACR – Updated          OSHA requirements that apply to many healthcare employers;
                                                         The white paper titled "ACR Guidance Document for Safe MR Practices"                http://www.premierinc.com/quality-
                                  guidance on            (.pdf) (335 KB) details MR safety, from the design of the MR suite and              safety/tools-services/safety/safety-
                                  magnetic resonance     the qualifications of personnel to screening patients and what to do in an          share/07-07-downloads/08-safe-
                                  safety                 emergency.                                                                          mr07.pdf
July       2007 Patient Safety    CDC – New              One young man's experience with meningococcal meningitis and his                    English:
                                  meningococcal          subsequent recovery is available in both English (.doc) ( KB) and                   http://www.premierinc.com/quality-
                                  vaccine information    Spanish (.doc) (59 KB) to be shared with patients and staff (.doc) (1.9             safety/tools-services/safety/safety-
                                  available in Spanish   MB). His story emphasizes the importance of receiving the available                 share/07-07-downloads/04-meninge-
                                  and English            vaccine.                                                                            survivor-story-english.doc; Spanish:
                                                                                                                                             http://www.premierinc.com/quality-
                                                                                                                                             safety/tools-services/safety/safety-
                                                                                                                                             share/07-07-downloads/05-meninge-
                                                                                                                                             survivor-story-spanish.rtf




June       2007 Patient Safety    AHRQ – Sample          The new Health Care Report Card Compendium is a searchable                          http://www.talkingquality.gov/compe
                                  healthcare quality     directory of more than 200 samples of report cards produced by a variety            ndium/
                                  report cards           of organizations. The samples show formats and approaches for
                                                         providing comparative information on the quality of health plans,
                                                         hospitals, medical groups, individual physicians, nursing homes, and
                                                         other providers of care. The purpose of the AHRQ Report Card
                                                         Compendium is to inform and support the various organizations that
                                                         develop healthcare quality reports, to provide easy access to examples
                                                         of different approaches to content and presentation, and to meet the
                                                         needs of health services researchers.


June       2007 Patient Safety    AHRQ toolkit –         A new guide available from the Agency for Healthcare Research and                   http://www.premierinc.com/quality-
                                  "Mistake-proofing"     Quality (AHRQ) titled "Mistake-Proofing the Design of Health Care                   safety/tools-services/safety/safety-
                                  healthcare process     Processes" describes simple, low-cost interventions that organizations              share/06-07-downloads/07-
                                  design                 can undertake to improve patient safety that includes more than 150 real            mistakeproofing.pdf
                                                         world examples of process or design features that have been
                                                         implemented as a result of root-cause analyses and other interventions
                                                         to help ensure that processes help prevent errors or the negative impact
                                                         of an error.


June       2007 Patient Safety    AORN Patient Hand-     The AORN "Patient Hand-Off Toolkit" helps caregivers effectively                    The toolkit can be downloaded free
                                  Off toolkit – Free     communicate key information such as the patient’s current and past                  of charge at:
                                  Web-based surgical     condition, ongoing treatments, and possible changes or complications                http://www.aorn.org/PracticeResourc
                                  patient transfer       that should be monitored closely. The kit includes sample checklists and            es/ToolKits/
                                                         forms, slide presentations on standardizing communication and
                                                         information exchanges, and a guide to additional resources.




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  Month   Year    Topic by Tab           Tool                                         Description                                     IHI                 Location
                                                                                                                                     Tool
May       2007 Patient Safety    CDC – HAI summary The CDC has published a national estimate of the number of healthcare-                   http://www.premierinc.com/quality-
                                 and slide set     associated infections (HAI) and HAI-related deaths in the United States                  safety/tools-
                                                   in a March-April issue of Public Health article, "Estimating Health Care-                services/safety/topics/guidelines/anti
                                                   Associated Infections and Deaths in U.S. Hospitals, 2002." The authors                   microbials.jsp#hc-assoc-infections;
                                                   concluded that the method they used for estimating the number of HAIs                    http://www.premierinc.com/quality-
                                                   made the best use of existing national data. Data were obtained from the                 safety/tools-
                                                   National Nosocomial Infections Surveillance (NNIS) System (1990-2002),                   services/safety/topics/guidelines/anti
                                                   the National Discharge Survey (2002), and the American Hospital                          microbials.jsp#hc-assoc-infections
                                                   Association Survey (2000). Study findings are summarized in a
                                                   PowerPoint presentation.


May       2007 Patient Safety    The Joint         The new information explains what the Joint Commission is looking for in                 http://www.premierinc.com/quality-
                                 Commission – FAQs adverse tissue reaction policies, such as the reporting of potential                     safety/tools-
                                 on tissue storage disease transmission to the recipient when notified by the donor source                  services/safety/topics/patient_safety/
                                                   facility and reporting adverse patient reactions to the donor source                     downloads/jc-standards-faqs.doc
                                                   facility. These actions must be carried out and the tissue's unique
                                                   identifier must also allow the organization to easily trace the records
                                                   when notified of a problem by either the donor facility or the patient's
                                                   physician. Tracing the tissue records includes the complete chain of
                                                   events, including who handled the tissue, how it was transported, stored
                                                   and processed, dates and times such activities occurred.


May       2007 Patient Safety    AHA – CEO             The second in a series of collaborative leadership tools for CEOs,                   Tool 2 is available at
                                 leadership tools      "Clarifying Expectations: A First Step in Developing Truly Effective                 http://www.americangovernance.co
                                                       Relationships Between CEOs and Trustees," focuses on clarifying                      m/americangovernance/resources/C
                                                       trustees' and CEOs' mutual expectations. It includes a simple exercise               LT/CLTtool2.html
                                                       for helping trustees and CEOs refine the way they work together. It also
                                                       includes information on the sources of misunderstandings and typical
                                                       expectations and describes the roles of and relationships between the
                                                       CEO and the board.


Mar       2007 Patient Safety    AHRQ – Audio          This site provides the agency's latest healthcare research findings, news,           This link is available from the Safety
                                 newscast series       and information. This site enables viewers to also hear the newscasts                Institute's Patient safety web site
                                                       through a computer or permit a download to a portable digital player such            under "Resources."
                                                       as an iPod.
Feb       2007 Patient Safety    New Hampshire –       An online tool created by the Foundation for Healthy Communities in                  http://www.healthynh.com/fhc/resour
                                 Health forms in       New Hampshire has a directory that enables healthcare workers working                ces/translateddocuments.php
                                 multiple languages    with culturally and linguistically diverse communities to easily find
                                                       translated health forms and documents. The directory provides access to
                                                       documents created and translated by New Hampshire health agencies
                                                       and organizations. The documents are intended for use by any
                                                       healthcare organization. Translated documents include consent forms,
                                                       patient bills of rights, financial assistance applications, and information
                                                       about cholesterol, asthma and child immunizations. Part of the
                                                       Foundation's Cultural Effectiveness and Quality Health Care Project, the
                                                       tool will be updated with documents and language translations. Access
                                                       the tool on the Foundation Web site.




            Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety
                                                                                                            Premier Safety Share




  Month   Year    Topic by Tab           Tool                                          Description                                     IHI                 Location
                                                                                                                                      Tool
Jan       2007 Patient Safety    Hospital Compare -     Beginning in June 2007, all hospitals, including Critical Access Hospitals           Hospital Compare Web site
                                 Mock data              (CAH), will have 30-day (risk adjusted) mortality rates for acute                    (http://www.hospitalcompare.hhs.go
                                                        myocardial infarction (AMI) and heart failure (HF) published on the                  v/). Information and updates about
                                                        Hospital Compare Web site through an initiative led by the Hospital                  this initiative will be posted
                                                        Quality Alliance (HQA) . The data reported in June will cover the period             periodically to
                                                        July 1, 2005, to June 30, 2006; reported data will also soon include                 http://www.qualitynet.org/ under the
                                                        pneumonia patients. So that hospitals may become familiar with the                   "Hospitals" section.
                                                        background of the measures and their own mortality rates, Centers for
                                                        Medicare and Medicaid Services (CMS) will provide a mock report based
                                                        on 2003 Medicare claims. The rates contained in these initial reports will
                                                        not be posted publicly on the Hospital Compare Web site. IThe CMS
                                                        timeline from November 2006 contains additional information, including
                                                        the important dates for public reporting. More information is available at
                                                        QNet exchange.


Dec       2006 Patient Safety    H2E – New              Hospitals for a Healthy Environment (H2E) has developed an                           http://www.h2e-
                                 environmental          "Environmental Compliance and Improvement Guide" that matches each                   online.org/regsandstandards/jcahoin
                                 compliance and         JCAHO Element of Performance to specific federal regulations. This                   tro.html
                                 improvement guide      guide helps facilities identify how to be in compliance with both. The
                                                        guide also suggests steps that facilities can take to encourage
                                                        environmental performance improvements. A comprehensive
                                                        environmental program, including waste minimization and pollution
                                                        prevention initiatives, not only ensures compliance, but can also help
                                                        reduce the costs of compliance. The guide provides links, tips and tools
                                                        that enumerate specific management practices, materials, regulatory
                                                        requirements, and facility infrastructure relevant to the specific JCAHO
                                                        Element of Performance (EP).



Dec       2006 Patient Safety    IHI – Patient safety The first tool is a "Global Trigger Tool" designed to help get started in the    √     Access IHI Trigger Tools
                                 trigger tools        approach; the other tools focus on specific areas such as measuring                    at:http://www.ihi.org/IHI/Topics/Patie
Dec       2006 Patient Safety    Medication safety    Creighton University perioperative care, neonatal provides care, to
                                                      adverse drug events,Medical Center, Omaha, NE, intensive a tool and                    ntSafety/SafetyGeneral/Tools/Introto
                                                                                                                                             http://www.premierinc.com/quality-
                                 guide – Ambulatory   guide considerations of resource requirements when evaluating the                      safety/tools-services/safety/safety-
                                 care                 ambulatory care environment for medication safety. The guide is titled                 share/12-06-downloads/07-chrp-best-
Dec       2006 Patient Safety                         "Medication tools Best Practices Guide for to the Surgical Care
                                 SCIP – New surgical, Several newSafetyhave recently been addedAmbulatory Care Use" (.pdf)                   practices.pdf
                                                                                                                                             VTE guidelines are available from
                                 VTE tools            Improvement Project (SCIP) Web site. The first, "Preventive Antibiotics                the Premier Safety Institute Infection
                                                      in Colon and Rectal Surgery: Discontinuation Within 24 Hours After                     Prevention and Safety Module under
                                                      Operation," is a presentation that discusses the importance of giving                  "Other guidelines, selected
                                                      recommended antibiotics in colorectal surgery with the equally important               resources."
                                                      factor of discontinuing the antibiotics within 24 hours. Other tools related
                                                      to venous thromboembolism include: Deep Vein Thrombosis Prophylaxis
                                                      Risk Factor Assessment, and Thrombosis Screen and Prophylaxis
                                                      Recommendations.




            Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety
                                                                                                            Premier Safety Share




  Month    Year    Topic by Tab           Tool                                         Description                                     IHI                 Location
                                                                                                                                      Tool
November   2006 Patient Safety    Workplace Violence Information in the report includes discussions of the scope of WPV,                     http://www.premierinc.com/quality-
                                  Prevention Strategies barriers to violence prevention, prevention programs and strategies, and             safety/tools-services/safety/safety-
                                  and Research Needs research needs. The report discusses information on barriers and gaps                   share/11-06-downloads/10-
                                                        that impede the development and implementation of WPV prevention                     workplace-violence-prevention.pdf
                                                        programs, and summarizes the best workplace violence
                                                        strategy/program practices presented by conference participants, general
                                                        research needs and the importance of linking research findings to
                                                        practical prevention efforts.


November   2006 Patient Safety    The Med Form tool     The Med Form tool helps patients maintain a single, updated record of                The Med Form is available in
                                                        their medications, vitamins, immunizations and allergies to share with               Spanish and English at
                                                        their healthcare providers. The Arizona Hospital and Healthcare                      http://www.themedform.com/.
                                                        Association's Safe & Sound Patient Safety Initiative, Arizona Medical
                                                        Association, and Arizona Partnership for Implementing Patient Safety
                                                        sponsored the form and it is available statewide in physician offices and
                                                        hospitals.
Oct        2006 Patient Safety    New JCAHO             Meeting the Joint Commission's 2007 National Patient Safety Goals, is                To order, call JCR Customer Service
                                  resource – 2007       available as a tool for all accredited organizations preparing to implement          toll-free at 877.223.6866, 8 a.m. to 8
                                  National Patient      the 2007 National Patient Safety Goals. The publication explains how to              p.m. CT, weekdays, or visit
                                  Safety Goals          comply with the 2007 goals and requirements of the goals, through a                  www.jcrinc.com
                                                        compilation of articles, book excerpts and tips. Detailed topics such as
                                                        identifying safety risks inherent in patient populations, and encouraging
                                                        the involvement of patients and families in patient care are among those
                                                        covered in the book.


Sept       2006 Patient Safety    Sentinel event and    The Joint Commission on Accreditation of Healthcare Organizations has                The automated complaint tool is also
                                  complaint reporting   a secure extranet Web site that offers new automated tools for reporting             available on the Joint Commission
                                                        sentinel events and complaints. Full transition to the online tools is               Web site at:
                                                        required by January 1, 2007. Locate the tool on the extranet home page               http://www.jointcommission.org/Gen
                                                        under "Self Report Sentinel Event" in the "Continuous Compliance Tools"              eralPublic/Complaint/
                                                        section. Root cause analyses (RCA), action plans, and sentinel event
                                                        measures of success may be submitted to the Joint Commission using
                                                        an online RCA collection tool, also accessible from the "Continuous
                                                        Compliance Tools" section under the "Sentinel Event Activities" link.



July       2006 Patient Safety    AMA – Guidelines for A new consensus report from the American Medical Association Ethical                  http://www.premierinc.com/quality-
                                  improving patient    Force Program offers guidelines to help healthcare organizations ensure               safety/tools-services/safety/safety-
                                  communications       effective, patient-centered communications with patients of diverse                   share/07-06-downloads/06-
                                                       backgrounds. This report lists a number of specific, measurable                       improving-communication.pdf
                                                       expectations for performance that organizations can use as a framework
                                                       for evaluating performance, as well as a guide for improving
                                                       communication quality. An organizational self-assessment toolkit based
                                                       on the report is being field-tested.


July       2006 Patient Safety    SCIP – Surgical care The Surgical Care Improvement Project (SCIP) Web site has added                       http://www.premierinc.com/quality-
                                  improvement tools    practical tools for the four SCIP areas: cardiac, infections, venous                  safety/tools-services/safety/safety-
                                                       thromboembolism, and respiratory. Tools include help with antibiotic                  share/07-06-downloads/13-scip-
                                                       timing, glucose management, and prevention of deep vein thrombosis.                   antibiotics-pocket-card.pdf,
                                                       Visitors can download a DVT order set, an antibiotic recommendations                  additional tools at
                                                       chart, and a glucose management protocol order set.                                   http://www.medqic.org/scip




             Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety
                                                                                                             Premier Safety Share




   Month   Year    Topic by Tab           Tool                                          Description                                     IHI                 Location
                                                                                                                                       Tool
May        2006 Patient Safety    Patient Safety         The Joint Commission International Center for Patient Safety has a new               Go to:
                                  Practices - JCAHO      online resource that links to resources related to sentinel events and               http://www.jcipatientsafety.org/psp
                                  web site               Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
                                                         National Patient Safety Goals. The site, "Patient Safety Practices,"
                                                         contains tools and resources addressing issues related to the causes
                                                         and types of adverse events, U.S. and International Patient Safety Goals
                                                         and free access to many of their articles from a variety of journals,
                                                         including the "Environment of Care." http://www.jcipatientsafety.org/psp



April      2006 Patient Safety    Evaluation of Safe   The National Institute for Occupational Safety and Health (NIOSH) draft,               Go to:
                                  Patient Handling and "Evaluation of Safe Patient Handling and Movement Principles",                         http://www.cdc.gov/niosh/review/pub
                                  Movement Principles available for comment until May 30, 2006. The presentation was                          lic/safe-patient/
                                                       developed for use in nursing schools to improve work practices for
                                                       patient care workers. It covers the definition of ergonomics, risk factors
                                                       for musculoskeletal injury during patient handling and movement,
                                                       recognizing high-risk patient care activities and conditions that result in
                                                       high-risk patient-care environments, and identifying the best solutions for
                                                       patient handling.


March      2006 Patient Safety    IHI white paper –      Reviews of perinatal care have consistently pointed to failures of             √     Go to:
                                  perinatal care         communication among the care team and documentation of care as                       http://www.premierinc.com/all/safety/
                                                         common factors in adverse events that occur in labor and delivery. Such              publications/03-06-downloads/10-
                                                         failures also have been shown to be prime factors leading to malpractice             idealized-design-perinatal-care-
                                                         claims. A new white paper from the Institute for Healthcare Improvement              2005.pdf
                                                         (IHI), "Idealized Design of Perinatal Care," is an innovative project based
                                                         on the principles of reliability science and the IHI's model for applying
                                                         these principles to improve care. The Idealized Design model focuses on
                                                         comprehensive redesign to enable a care system to perform substantially
                                                         better in the future than the best it can do at present.



March      2006 Patient Safety    AHRQ toolkit –         The toolkit presents strategies for comprehensively redesigning and                  Go to:
                                  Hospital process       transforming processes of care in a hospital. It details how healthcare              http://www.premierinc.com/all/safety/
                                  redesign strategies    systems can redesign (including the planning steps needed for such                   publications/03-06-downloads/09-
                                                         transformation) and presents strategies for translating information                  hospital-redesign-toolkit.pdf
                                                         gathered into proposed projects for implementation. Many of the
                                                         techniques included in the toolkit can be used to guide process
                                                         improvements without embarking on comprehensive system
                                                         transformation.
March      2006 Patient Safety    Medication safety tool guide is designed to help outpatient physician practices incorporate safer           Go to:
                                  – ambulatory care      systems for medication sample prescribing and dispensing. The checklist              http://www.premierinc.com/all/safety/
                                                         format helps users rate their current medication use processes                       publications/03-06-downloads/08-
                                                         (prescribing, dispensing, administering, counseling, and monitoring) so              best-practices-ambulatory-care.pdf
                                                         plans for improvements can be prioritized and implemented. The guide
                                                         also addresses processes in technology and safety, office environment,
                                                         error management, workplace conditions, safety education, and safety
                                                         perceptions.




             Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety
                                                                                                              Premier Safety Share




  Month    Year    Topic by Tab            Tool                                          Description                                    IHI                 Location
                                                                                                                                       Tool
January    2006 Patient Safety    Having Surgery?        Having Surgery? What You Need to Know is designed to help patients                   Go to
                                  What You Need to       make informed decisions when planning for surgery. The brochure                      :http://www.premierinc.com/all/safety
                                  Know"                  suggests questions to help patients obtain needed information including              /publications/01-06-downloads/13-
                                                         how and where their operation will be performed, what kind of anesthesia             surgery.pdf. A Spanish language
                                                         will be used, whether non-surgical medical treatment and watchful                    version,
                                                         waiting are options, possible risks of not having the surgery, potential             http://www.premierinc.com/all/safety/
                                                         risks and expected benefits if they have the surgery, and how long                   publications/01-06-downloads/14-sp-
                                                         recovery is expected to take. Additional questions include cost,                     surgery.pdf, is available.
                                                         insurance and whether a second opinion is required and/or covered. The
                                                         publication is part of a series of healthcare resources from AHRQ to help
                                                         people be more active in making informed decisions that can help them
                                                         obtain high-quality healthcare.



November   2005 Patient Safety    ASA Practice           The American Society of Anesthesiologists (ASA) has approved a                       http://www.premierinc.com/all/safety/
                                  Advisory – reduce      practice advisory on anesthesia awareness intended to help                           publications/11-05-downloads/09-
                                  awareness under        anesthesiologists reduce the risk of unintended patient awareness under              aware-advisory-10-05.pdf
                                  anesthesia             general anesthesia. The ASA reports that one to two out of every 1,000
November   2005 Patient Safety    Pediatric Indicator    patients receiving general anesthesiaimprove population health using the
                                                         This module applies the AHRQ QI to regains consciousness and may                     http://qualityindicators.ahrq.gov/user
                                  Module                 AHRQ QI as a catalyst for quality improvement, implications of ICD-9-CM              meeting_presentations_2005.htm
                                                         coding practices, the use of the AHRQ QI in the National Healthcare
                                                         Quality Reports, methods for creating aggregate performance indices,
                                                         and considerations in using the AHRQ QI for comparative reporting and
                                                         pay-for-performance.


November   2005 Patient Safety    Multimedia safety tool A free multimedia safety tool kit is available and contains a five-minute,           http://www.emmisafety.com/ashrm
                                  kit for patient        Web based version of the patient safety Emmi TM tool that explains the
                                  education              patient's role in preventing mistakes and infections in hospitals. The tool
                                                         kit is sponsored by the American Society of Hospital Risk Management
                                                         (ASHRM), Rightfield Solutions, the creators of Emmi patient education
                                                         system, and the Health Research and Educational Trust (HRET) of the
                                                         American Hospital Association. Hospitals can post this program on their
                                                         Web sites for patients to view prior to coming to the hospital, or
                                                         broadcast the two-minute version on an in-house television network.



October    2005 Patient Safety    Toolkit – Medication   The South Carolina Hospital Association (SCHA) Patient Safety                        http://scha.org/document.asp?docu
                                  safety                 Committee has developed three tools to help consumers, healthcare                    ment_id=2,3,32,3491
                                                         facilities, and healthcare workers keep track of all personal medications.
                                                         These tools can help consumers, hospital inpatients and outpatients,
                                                         hospitals, nursing homes, physician offices, emergency medical workers,
                                                         and pharmacists "stay on the same page" so that everyone knows all of
                                                         the medications a person takes. The tools are: Universal Medication
                                                         Form (UMF), Patient Medication Brochure, and Medication Reconciliation
                                                         Form (MRF)




             Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety
                                                                                                           Premier Safety Share




  Month   Year    Topic by Tab           Tool                                         Description                                     IHI                Location
                                                                                                                                     Tool
October   2005 Patient Safety    Regional              The agenda at the regional forums and networking meetings includes                   For more information about these
                                 Performance           results from the CMS-Premier Hospital Quality Improvement                            programs and a schedule and
                                 Improvement forums,   Demonstration project (how-to's and success stories from top decile                  registration, visit:
                                 Rapid Improvement     performers), patient safety, managing length of stay, physician                      http://www.premierinc.com/all/confer
                                 Web tool              engagement, interactive working groups, and live demonstrations of the               ences/ceo/index.jsp?ref=october-
                                                       Rapid Improvement Program and Web portal).                                           safety-share


August    2005 Patient Safety    Suggestions on        The Joint Commission's August issue of Perspectives on Patient Safety                Access the suggestions at
                                 meeting the 2006      offers suggestions on meeting the 2006 National Patient Safety Goals                 http://www.premierinc.com/all/safety/
                                 National Patient      (.pdf) (345 KB). The special issue, provided free for a limited time,                publications/08-05-downloads/11-
                                 Safety Goals          describes each goal and accompanying requirements and offers                         perspectives-07-05.pdf
                                                       compliance tips. For example, JCAHO describes measures implemented
                                                       by some organizations to increase compliance with hand hygiene
                                                       guidelines from the Centers for Disease Control and Prevention (CDC),
                                                       which is required under the goal for reducing the risk of healthcare-
                                                       associated infections. Tips for non-hospital settings, such as home care
                                                       or long-term care, are also included where compliance needs could differ
                                                       from acute care settings.


August    2005 Patient Safety    Move Your Dot:        A new Institute for Healthcare Improvement (IHI) Innovation Series white       √     White papers are free and available
                                 Measuring,            paper expands on a previous paper, "Move Your Dot: Measuring,                        online at:
                                 Evaluating, and       Evaluating, and Reducing Hospital Mortality Rates," that introduced a                http://www.ihi.org/IHI/Products/Whit
                                 Reducing Hospital     novel perspective and methodology for understanding and reducing                     ePapers/
                                 Mortality Rates       inpatient deaths. "Reducing Hospital Mortality Rates (Part 2)"
                                                       summarizes preliminary results from a three-year pilot project in which
                                                       eight hospitals, working with IHI, are testing the theory that hospital
                                                       mortality can be consistently reduced through a combination of evidence-
                                                       based interventions.

July      2005 Patient Safety    Self-Study Modules    ―Self-Study Modules on Tuberculosis,‖ a new education tool specifically              The modules can be accessed at
                                 on Tuberculosis       designed for healthcare workers and other professionals involved in the              http://www.phppo.cdc.gov/phtn/tbmo
                                                       identification, treatment, and care of individuals with tuberculosis and             dules/Default.htm.
                                                       latent tuberculosis infection is now available. The tool is the result of a
                                                       partnership between the Centers for Disease Control and Prevention’s
                                                       (CDC) Division of Tuberculosis Elimination and the Division of Media and
                                                       Training Services. These courses are also appropriate for staff of
                                                       correctional facilities, drug treatment centers, migrant clinics, nursing
                                                       homes, homeless shelters, or other facilities serving persons with or at
                                                       risk for tuberculosis. Each course has a separate set of modules,
                                                       registration process, exam, and credits. The modules can also be
                                                       worked through without registering. Content from both the print-based
                                                       Self-Study Modules on Tuberculosis and the video-based "A Satellite
                                                       Primer on Tuberculosis" was used to create Self-Study Modules on
                                                       Tuberculosis that can be delivered via the World Wide Web.




            Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety
                                                                                                            Premier Safety Share




  Month   Year    Topic by Tab            Tool                                         Description                                     IHI                 Location
                                                                                                                                      Tool
July      2005 Patient Safety    Alternative medical    Alternatives to using medical waste incinerators for treating regulated              Additional information is available
                                 waste treatment        medical waste were the focus of a free teleconference July 8, 2005, and              from H2E at www.h2e-
                                                        hosted by Hospitals for a Healthy Environment (H2E). Teleconference                  online.org/events/teleconf/index.cfm.
                                                        speaker Sally M. Patterson, regulated medical waste program                          The slide presentation, (Append
                                                        coordinator, New York State Department of Health, discussed the                      8_RMW_NY.ppt) as well as a chart
                                                        advantages and disadvantages of using alternative treatment                          of alternative technologies can be
                                                        technologies approved in the state of New York, including low-heat                   downloaded. (Append
                                                        treating systems, high-heat treating systems, and chemical treatment                 9_alttechchart.pdf
                                                        systems.


July      2005 Patient Safety    Tools for managing     A checklist that can aid safety and environmental managers managing                  To review the checklist and
                                 obese patients         obese patients is now available on the Healthcare Hazard Control (HHC)               assessment tool, login at
                                                        Members' Web site. The list can help staff ensure that a healthcare                  http://www.ecri.org, click "HHC
                                                        facility's physical structures and equipment safely accommodates                     Homepage," and click the "Sample
                                                        extremely obese patients and visitors. An assessment tool to guide                   Policies" link on the left-hand side of
                                                        caregivers on the safe handling of extremely obese patients has also                 the screen. The tools can be found
                                                        been added. An analysis on the safe accommodation of extremely obese                 under the "Miscellaneous" heading.
                                                        patients and visitors will be published in the August 2005 HHC mailing.


July      2005 Patient Safety    Roadmaps for           The American Medical Association (AMA) has released a new primer                     The project is supported by an
                                 Clinical Practice,     designed to help physicians improve immunization rates, particularly in              unrestricted educational grant from
                                 Improving              minority populations. The primer, ―Roadmaps for Clinical Practice,                   Sanofi Pasteur and is available
                                 Immunization:          Improving Immunization: Addressing Racial and Ethnic Populations,‖                   online at www.ama-
                                 Addressing Racial      addresses the leading health indicator of immunization and infectious                assn.org/go/roadmaps.
                                 and Ethnic             diseases, with a special focus on reducing racial and ethnic disparities in
                                 Populations            immunizations. In addition to resources, the primer provides tools to help
                                                        physicians ensure that patients are up-to-date with their vaccinations and
                                                        includes immunization schedules for both children and adults. The primer
                                                        is the latest volume in the AMA’s ―Roadmaps for Clinical Practice: Case
                                                        Studies in Disease Prevention and Health Promotion‖ series, which
                                                        provides physicians and other health professionals with clinical strategies
                                                        and tools to address the leading causes of preventable morbidity and
                                                        premature mortality.


June      2005 Patient Safety    HHS pocket guide       A new pocket guide recently released by Health and Human Services                    Download the guide at
                                 offers resources to    (HHS), "Helping Smokers Quit: A Guide for Nurses," was developed by                  http://www.premierinc.com/all/safety/
                                 assist patients with   AHRQ in collaboration with "Tobacco Free Nurses," a national initiative              publications/06-05-downloads/13-
                                 smoking cessation      funded by The Robert Wood Johnson Foundation. This new tool is                       hlpsmksqt.pdf or go to
                                                        designed to give nurses evidence-based information that they can use to              http://www.ahrq.gov/about/nursing/hl
                                                        help their patients quit smoking. The free guide gives nurses' easy                  psmksqt.htm
                                                        access to information based on the "5 A's" approach to cessation
                                                        intervention: Ask, Advise, Assess, Assist, and Arrange. It also includes a
                                                        current listing of smoking cessation medications approved by Food and
                                                        Drug Administration (FDA) and a referral to HHS' National Quitline, 1-800-
                                                        QUIT NOW.




            Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety
                                                                                                              Premier Safety Share




  Month   Year    Topic by Tab            Tool                                          Description                                      IHI                 Location
                                                                                                                                        Tool
June      2005 Patient Safety    Quality of Care for     The Commonwealth Fund's chart book assesses the quality of care                       All chart books are available at:
                                 Medicare                provided to elderly and disabled Medicare beneficiaries. This is just one             http://www.cmwf.org/index.htm.
                                 Beneficiaries           of several chart books available from the Commonwealth Fund on health
                                                         policy matters. The chart books are available in either Adobe or
                                                         PowerPoint Other topics available include insurance, access, and quality
                                                         of care among Hispanic populations, the state of child health care in the
                                                         United States, adults' primary care experiences in five industrialized
                                                         countries, the health of women in New York City, and the value of state
                                                         pharmacy assistance programs.


June      2005 Patient Safety    TrendWatch              The 5th annual collection of charts and graphs depicts key trends                     Go to:
                                 Chartbook 2005          affecting hospitals and health systems. Sections include trends in the                http://www.ahapolicyforum.org/ahap
                                                         overall health care market, organizational trends, utilization and volume,            olicyforum/trendwatch/chartbook200
                                                         trends in hospital financing, workforce, and the economic contribution of             5.html
                                                         hospitals.
June      2005 Patient Safety    AHRQ-DOD                A compendium of 140 peer-reviewed articles on patient safety studies by               Go to:
                                 compendium - Four-      government-sponsored researchers. These studies include findings on                   http://www.ahrq.gov/qual/advances/.
                                 volume set of patient   medication safety, technology, and investigative approaches to better
                                 safety research         treatment, process analyses, human factors and practical tools for
                                 studies                 preventing medical errors. The 140 articles in the four-volume set cover
                                                         a wide range of research paradigms, clinical settings, and patient
                                                         populations. Where the research is complete, the findings are presented;
                                                         where the research is still in process, the articles report on its progress.
                                                         In addition to articles with a research and methodological focus, the
                                                         compendium includes articles that address implementation issues or
                                                         present useful tools and products that can be used to improve patient
                                                         safety.


May       2005 Patient Safety    New self-assessment     The Institute for Safe Medication Practices (ISMP) announced it has                   Find the tool at
                                 survey for              developed a new tool (.doc) (33 KB) designed to assist hospitals in                   http://www.premierinc.com/all/safety/
                                 antithrombotic          evaluating antithrombotic therapy. The survey has been mailed to                      publications/05-05-downloads/11-
                                 therapy                 hospitals with a submission deadline of September 1, 2005. The self-                  ismp-self-assessment-launch.doc.
                                                         assessment will help organizations examine medication safety practices                Further information is available at
                                                         associated with the use of antithrombotic drugs in their facilities.                  http://www.ismp.org.
                                                         Hospitals may submit data through a secure Web-based form, which will
                                                         allow them to compare their weighted scores with aggregate data from
                                                         similar hospitals.


May       2005 Patient Safety    Environmentally         The American Society for Healthcare Environmental Services has                        See Premier Safety Institute's
                                 friendly pest control   partnered with Orkin, Inc. to promote more effective and environmentally              Environmental and Safety Product
                                 practices               friendly pest-control practices in healthcare settings, including the                 list at:
                                                         release of a guide on integrated pest management. The partners also                   http://www.premierinc.com/all/safety/
                                                         plan to publish educational articles and host two educational sessions on             resources/lists/
                                                         the recommended practice at ASHES' annual conference in September.
                                                         The partnership was launched in response to a growing movement in
                                                         healthcare toward hazardous-chemical reduction.




            Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety
                                                                                                               Premier Safety Share




  Month   Year    Topic by Tab             Tool                                          Description                                      IHI                Location
                                                                                                                                         Tool
May       2005 Patient Safety    Simplifying advanced Advance directives, the legal documents that allow individuals to make              √     The forms are available in both
                                 directives           their personal healthcare wishes known before a serious illness or injury,                English
                                                      can be confusing and difficult to understand. The Institute for Healthcare                http://www.premierinc.com/all/safety/
                                                      Advancement has an advance directive form designed for American                           publications/05-05-downloads/09-
                                                      adults who read below a fifth-grade level. The forms are available in both                advance-directive-english.pdf (.pdf)
                                                      English (.pdf) (906 KB) and Spanish (.pdf) (911 KB). The form is                          (906 KB) and Spanish
                                                      designed in a simple fill-in-the-blank format with illustrations and easy-to-             http://www.premierinc.com/all/safety/
                                                      read bullet points. Low-literacy Americans will be able to choose an                      publications/05-05-downloads/10-
                                                      agent to make medical decisions for them, make their healthcare wishes                    advance-directive-spanish.pdf (.pdf)
                                                      known so that their loved ones don't have to guess for them, and provide                  (911 KB).
                                                      the necessary signatures to make the document legally binding.



May       2005 Patient Safety    Rapid HIV antibody      The Health Research & Educational Trust, an affiliate of the American                  To view the charts go to:
                                 screening tests         Hospital Association (HRET/AHA), has developed two charts to help                      http://www.hret.org/hret/programs/hi
                                                         hospitals select the best rapid HIV test for their needs. The charts,                  vtransmrpd.html
                                                         developed with input from the Centers for Disease Control and
                                                         Prevention (CDC), are designed to help hospitals as they implement the
                                                         CDC's recommendation that the test be offered to all women presenting
                                                         to labor and delivery with undocumented HIV status. One chart
                                                         compares information on test price, external controls, numbers of tests
                                                         per case, catalog number, storage temperature, operating temperature,
                                                         shelf lives of tests and controls, time required to conduct test, and
                                                         validity window periods; the other chart compares information on FDA-
                                                         approval date, specimen type, CLIA-status, specificity, sensitivity,
                                                         manufacturer, HIV-2 detection capabilities, list price, and external
                                                         controls.


March     2005 Patient Safety    Communicating           The February issue of the Joint Commission Journal on Quality and                      http://www.jcrinc.com/subscribers/jo
                                 critical test results   Patient Safety has been made available for a free download now online,                 urnal.asp?durki=8739&site=14&retur
                                                         the issue focuses on communicating critical test results and includes                  n=455#FEBRUARY%202005
                                                         numerous important topics.
March     2005 Patient Safety    Clinical Simulation     The American Hospital Association's (AHA) Health Research and                          http://www.hret.org/hret/programs/si
                                 Tools                   Educational Trust (HRET) Web site has a section with information on                    mulations.html
                                                         studies that describe the use of clinical simulations to train physicians
                                                         and other healthcare workers in the latest medical developments. An
                                                         advantage of clinical simulations training is that skills are learned without
                                                         risking harm to real patients. Simulation-based training also provides
                                                         trainees with a broad range of learning experiences, including the
                                                         treatment of uncommon conditions unlikely to be encountered in
                                                         traditional patient-based training. The Clinical Simulation Tools site links
                                                         to AHA simulation resources.




            Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety
                                                                                                                Premier Safety Share




  Month    Year    Topic by Tab           Tool                                            Description                                       IHI                 Location
                                                                                                                                           Tool
March      2005 Patient Safety    Medical liability White The Joint Commission on Accreditation of Healthcare Organizations has                   http://www.premierinc.com/all/safety/
                                  parper                  released a white paper (.pdf) (643 KB) recommending demonstration                       publications/03-05-downloads/08-
                                                          projects to test alternatives to the nation's medical liability system. A               medical-liability.pdf
                                                          commission of medical liability and patient safety experts states that the
                                                          current liability system does not do enough to reduce negligence and
                                                          compensate victims of medical errors. The paper recommends
                                                          encouraging the adoption of information and simulation technology by
                                                          considering plans to offset implementation costs and by expanding
                                                          evidence-based reporting. The white paper states that any medical
                                                          liability changes need to ensure that the greatest number of injured
                                                          patients is fairly compensated, while allowing practitioners and providers
                                                          the opportunity to report errors, learn from them, and ensure that those
                                                          errors are not repeated.


February   2005 Patient Safety    OSHA Memo                                                                                                       http://www.premierinc.com/all/safety/
                                                                                                                                                  publications/02-05-downloads/14-
                                                                                                                                                  standard-interpretations.doc

February   2005 Patient Safety    Tool kit for physician The American Society for Healthcare Risk Management (ASHRM) has a                        A sample tool kit has been made
                                  office risk managers CD-ROM tool kit created for the various healthcare professionals who                       available,
                                                         work in the physician practice area. Risk managers can use it to conduct                 http://www.premierinc.com/all/safety/
                                                         an on-site survey of a practice for auditing purposes and also as a                      publications/02-05-downloads/13-
                                                         baseline tool to develop additional checklist items. Key areas covered in                physician-office-toolkit-sample.pdf,
                                                         the tool kit include principles of documentation; what to report to the                  and the complete kit can be
                                                         insurance claims representative; medical practice office systems risk                    purchased at
                                                         prevention strategies; qualities of effective patient relations for office               http://www.ashrm.org/ashrm/resourc
                                                         staff; and risks and strategies related to effective telephone                           es/products.html#toolkits.
                                                         communication. The tool kit also can be used as a pre-assessment tool
                                                         to identify potential risk areas. The tool kit contains Adobe Acrobat® and
                                                         PowerPoint® files.


February   2005 Patient Safety    Health information     Health information managers are directly involved in clinical quality                    To read the complete article, go to:
                                  manager role in        issues and outcomes through quality management programs, according                       http://library.ahima.org/xpedio/group
                                  patient safety         to the January practice brief titled, "The HIM Role in Patient Safety and                s/public/
                                                         Quality of Care." Issued by the American Health Information
                                                         Management Association, the document discusses the legal and
                                                         regulatory environment, data standards, and return on investment in
                                                         technology. Health Information Managers also affect quality through
                                                         improved medical record documentation, accurate coding, and index
                                                         integrity. The author concludes that the health information managers'
                                                         ability to affect patient safety is great, particularly through data reporting.
                                                         As the coordinators of data quality, the health information managers are
                                                         the "overseers" of consistent and accurate quality data.




             Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety
                                                                                                               Premier Safety Share




  Month    Year    Topic by Tab           Tool                                            Description                                    IHI                 Location
                                                                                                                                        Tool
January    2005 Patient Safety    Safety Share toolkit     One of the special resources developed from past issues of Safety Share             documents/ahima/pub_bok1_02548
                                                           is an archive of all safety tools published in the monthly newsletter. The          7.html.
                                                           resources are organized in an Excel® spreadsheet, with descriptions of
                                                           each tool and where they can be accessed. The spreadsheet is
                                                           categorized by topic and includes many tools that are available from the
                                                           Institute for Healthcare Improvement. These are listed separately as well
                                                           as included under each pertinent topic.


December   2004 Patient Safety    Preventing               A free copy of the book, "Preventing Occupational Exposures to                      Order free copies of the book from
                                  Occupational             Bloodborne Pathogens," a collection of articles from Advances in                    the Premier Safety Store at:
                                  Exposures to             Exposure Prevention (1994 to 2003), is available from the Premier                   http://www.premierinc.com/all/safety/
                                  Bloodborne               Safety Store. This 235-page book is edited by Jeannie Jagger and Jane               store/
                                  Pathogens                Perry from the International Healthcare Worker Safety Center at the
                                                           University of Virginia.
December   2004 Patient Safety    First, Do No Harm™,                                                                                          For ordering and more information,
                                  Part 3: Healing Lives,                                                                                       go to: www.p4ps.org.
                                  Changing Cultures

November   2004 Patient Safety    Guiding Principles for   The National Diabetes Education Program (NDEP) has two new                          Obtain the booklets at the following
                                  Diabetes Care; 4         evidence-based publications for healthcare providers and patients. The              addresses:
                                  Steps to Control Your    first helps providers identify people with pre-diabetes and undiagnosed             http://www.premierinc.com/all/safety/
                                  Diabetes for Life        diabetes, and provide patient-centered care. The second booklet                     publications/11-04-downloads/06-
                                                           complements the first and is for people with diabetes. It helps healthcare          guide-prin-hc-eng.pdf;
                                                           providers educate patients about self-care principles and how to be                 http://www.premierinc.com/all/safety/
                                                           active partners in their own care.                                                  publications/11-04-downloads/07-4-
                                                                                                                                               steps.pdf


October    2004 Patient Safety    Guidance for Using       Using the AHRQ Inpatient Quality Indicators or Patient Safety Indicators
                                  the AHRQ Quality         to report on hospital quality or make payment decisions are discussed in
                                  Indicators for Hospital- a new guide. AHRQ's Quality Indicators are measurement tools that
                                  Level Public             were developed by AHRQ and researchers to help individual hospitals
                                  Reporting or Payment use their own discharge data to better understand and improve the care
                                                           they provide.
October     2004 Patient Safety   Look alike/Sound         The JCAHO has updated its frequently asked questions (FAQs) on the                  http://www.jcaho.org/accredited+org
                                  alike drug list          2005 NPSGs and included a new look-alike/sound alike drug list.                     anizations/patient+safety/05+npsg/0
                                                                                                                                               5_npsg_faqs.htm
October    2004 Patient Safety    Rationale and         This document provides insight into how surveyors will be interpreting                 http://www.premierinc.com/all/safety/
                                  Interpretive          the goals next year.                                                                   publications/10-04-downloads/11-
                                  Guidelines" for the                                                                                          npsg-guidelines-09-04.pdf
                                  2005 National Patient
                                  Safety Goals


August      2004 Patient Safety   Measuring Safety         This conference brought together a diverse group of medication safety               To learn more about this or past
                                  with Smart IV            leaders from nursing, pharmacy and technology to explore the newest                 conferences,
                                  systems                  generation of medication safety technology – designed to help prevent               http://my.premierinc.com/all/safety/p
                                                           infusion programming errors and to collect data on IV delivery practices.           ublications/08-04-downloads/09-
                                                           The specific focus of this conference was using the data the technology             alaris-conf-grid4.doc
                                                           yields as a road map for process improvement at hospitals




             Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety
                                                                                                             Premier Safety Share




  Month   Year    Topic by Tab           Tool                                           Description                                     IHI                 Location
                                                                                                                                       Tool
July       2004 Patient Safety   Pay-for-performance The database is intended to raise awareness among healthcare                             The Leapfrog Compendium can be
                                 programs            purchasers, providers and plans to improve care quality. The Leapfrog                    freely accessed at
                                                     Compendium documents and categorizes financial and non-financial                         http://www.leapfroggroup.org/ircomp
                                                     programs, such as those that reward providers with quality bonuses, and                  endium.htm.
                                                     those that reward providers with public recognition. Incorporated are the
                                                     Leapfrog standards of computerized physician order entry, evidence-
                                                     based hospital referrals and hospital intensivist programs. The site can
                                                     be searched by state for programs targeting hospitals, physicians,
                                                     consumers and health plans, or it can be searched from a nationwide list.



July       2004 Patient Safety   Measurement guide       Hospital flow can be measured at five levels: patient and community;           √     http://www.ihi.org/IHI/Topics/Flow/P
                                 for hospital flow       hospital throughput; hospital activity; hospital performance; and unit               atientFlow/EmergingContent/Hospita
                                 patterns                performance. Each level provides a portion of the total measurement                  lFlowMeasurementGuide.htm
                                                         picture. Use this guide to learn how to measure data in these key areas
                                                         to help you improve patient flow.


June       2004 Patient Safety   Patient Safety: Your    The National Patient Safety Foundation (NPSF) has a brochure and                     Purchase information at:
                                 Role in Making          companion video entitled "Patient Safety: Your Role in Making                        http://www.mederrors.org/Merchant2
                                 Healthcare Safer        Healthcare Safer." It was created to help patients become more involved              /merchant.mv?Screen=SFNT&Store
                                                         in their healthcare safety. The companion video will help supplement and             _Code=NO
                                                         reinforce the safety message with patients. The brochure and video are
                                                         part of the National Patient Safety Foundation's Stand up for Patient
                                                         Safety campaign, which is designed to help patients learn practical ways
                                                         to help ensure their safety in both inpatient and outpatient settings.


June       2004 Patient Safety   Five steps to patient   The poster, available in English and Spanish, succinctly describes the               http://my.premierinc.com/all/safety/p
                                 safety                  five steps patients can take to ensure safer care.                                   ublications/06-
                                                                                                                                              04_full_txt.htm#Safety_tools
June       2004 Patient Safety   Designing the 21st      The webcast features researchers, design professionals, and hospital                 http://www.rwjf.org/news/hospitaldes
                                 Century Hospital:       leaders presenting and discussing how hospitals of the future should be              ign
                                 Serving Patients and    built, organized, and managed to maximize patient safety and outcomes
                                 Staff                   and improve staff performance and satisfaction. Featured are up-to-the-
                                                         minute evidence-based design concepts for healthcare buildings. With
                                                         an anticipated $20 billion in new hospital construction and major
                                                         renovations projected annually for the next decade, the central question
                                                         of the conference was how hospitals' physical design, operating systems,
                                                         and "corporate culture" affect patients, staff, and hospitals' bottom line.



May       2004 Patient Safety    Preventing              A new NIOSH Alert is meant to increase healthcare worker awareness                   http://www.premierinc.com/all/safety/
                                 Occupational            about the health risks when working with hazardous drugs. The alert also             publications/05-04-downloads/11-
                                 Exposures to            is intended to educate workers on the steps they can take to protect their           2004-hazdrug-alert.pdf
                                 Antineoplastic and      health. ―Preventing Occupational Exposures to Antineoplastic and other
                                 other Hazardous         Hazardous Drugs in healthcare Settings‖ may be downloaded in
                                 Drugs in healthcare     prepublication form. Pharmaceutical agents are classified as hazardous
                                 Settings                drugs if research indicates that they may cause cancer, have
                                                         developmental or reproductive toxicity, or harm organs in exposure at
                                                         low doses.




            Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety
                                                                                                                 Premier Safety Share




   Month    Year    Topic by Tab            Tool                                           Description                                       IHI                Location
                                                                                                                                            Tool
May         2004 Patient Safety     JCAHO tips -           Suggestions on how to comply with the National Patient Safety Goal                      http://www.premierinc.com/all/safety/
                                    Compliance with        related to dangerous abbreviations are now available from the JCAHO.                    publications/05-04-downloads/10-
                                    prohibited                                                                                                     implementation-tips.doc
                                    abbreviations
May         2004 Patient Safety     Prevention of wrong-   The Ohio Hospital Association and Patient Safety Institute have                         http://www.premierinc.com/all/safety/
                                    site, wrong-patient,   developed a surgical protocol (232 KB) to help Ohio providers prevent                   publications/05-04-downloads/08-
                                    wrong-procedure        the incidence of wrong-site; wrong-patient and wrong-procedure surgery.                 ohio-surgical-protocol.pdf
                                    errors                 The protocol outlines three steps for caregivers to follow prior to surgery:
                                                           patient verification, marking of the surgical site and a "time-out" before
                                                           incision to conduct a final checklist.


April       2004 Patient Safety     The Tools and          A new Web site, "The Tools and Techniques of Improved Medication                        http://www.aahp.org/content/navigati
                                    Techniques of          Use," is intended for those in the healthcare community who design                      onmenu/medcollab/medcollab.htm
                                    Improved Medication    medication safety programs and/or seek information to enhance existing
                                    Use                    patient safety efforts.
April       2004 Patient Safety     Drugs @ FDA            A new easy-to-use Web site to help consumers and health professionals                   http://www.accessdata.fda.gov/script
                                                           find information about FDA-approved drug products more quickly and                      s/cder/drugsatfda/
                                                           efficiently. The new interface, Drugs @ FDA, is a searchable database
                                                           that includes information on approved prescription drugs, some over-the-
                                                           counter drugs, and discontinued drugs.


April       2004 Patient Safety     Nurse Advise-ERR       A peer-reviewed newsletter published by the Institute for Safe Medication               Register at
                                                           Practices (ISMP), Nurse Advise-ERR (February, 2004), addresses                          www.ismp.org/NursingArticles/index.
                                                           issues such as mixing up IV lines while setting up or programming a                     htm
                                                           multiple-channel IV pump, the risks of leaving an unnecessary intra-
                                                           arterial line in place, a list of high-alert medications, and questions to use
                                                           when evaluating infusion pumps. Nurse Advise-ERR, a medication safety
                                                           newsletter written especially for nurses by nurses, is offered free for the
                                                           remainder of 2004.


April       2004 Patient Safety     Patient                The Institute for Family Centered Care has produced a number of useful                  http://www.familycenteredcare.org/
                                    representative on      resources to support the involvement of patients on hospital/healthcare
                                    safety committee       advisory committees and boards. These resources have been developed
                                                           from the experiences of many hospitals/healthcare facilities and the
                                                           patients, family members and community representatives who have
                                                           worked with them.
March       2004 Patient Safety     Hospital e-tool        OSHA’s Hospital e-tool is a Web-based training tool for safety and health               http://www.premierinc.com/all/safety/
                                                           hazard assessments in hospitals that provides a virtual hospital using                  resources/needlestick/resources.htm
                                                           graphics and visual assists for learning.                                               l#OSHA
March       2004 Patient Safety     Quick Takes            A free electronic bi-monthly newsletter produced by OSHA to inform the                  http://www.premierinc.com/all/safety/
                                                           public about recent OSHA activities.                                                    resources/needlestick/resources.htm
                                                                                                                                                   l#OSHA
 February   2004   Patient Safety   Internal Bleeding:     This book includes stories of all types of medical errors such as wrong                 The book can be purchased from
                                    The Truth Behind       patient cases, judgment calls gone awry, and retained sponges. The                      Rugged Land at
                                    America's Terrifying   analysis of the causes of errors leads to their suggestions of what                     http://www.ruggedland.com.
                                    Epidemic of Medical    providers, patients, policymakers, and healthcare leaders need to do to
                                    Mistakes               cure this epidemic. The 320-page hardcover book includes an extensive
                                                           bibliography and 40 pages of footnotes.




              Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety
                                                                                                                Premier Safety Share




  Month     Year    Topic by Tab             Tool                                          Description                                    IHI                 Location
                                                                                                                                         Tool
 February   2004   Patient Safety   Checklist -            Tips for conducting a self-evaluation of compressed gas and cylinder                 http://www.premierinc.com/all/safety/
                                    Compressed gas         safety. The article includes a checklist of 10 questions addressing proper           publications/02-04-downloads/09-
                                    safety                 storage, use, and handling of compressed gas cylinders to prevent                    oregon-OSHA-checklist.doc
                                                           associated hazards such as oxygen displacement, fires, explosions, and
                                                           toxic exposure.
January     2004   Patient Safety   Fire safety tips       The National Fire Protection Association (NFPA) provides information on              http://www.premierinc.com/all/safety/
                                                           how to interface elevators and fire alarm systems. The information                   publications/01-04-downloads/08-
                                                           ensures safe emergency operation of modern elevators that meet                       interfacing-elevators-fire-alarms.doc
                                                           requirements under NFPA and American Society of Mechanical
                                                           Engineers codes.
January     2004   Patient Safety   Fire safety tips       Safety tips for preventing hospital bed fires, the safety recommendations            http://www.premierinc.com/all/safety/
                                                           apply to both electrically powered and manual healthcare beds, as well               publications/01-04-downloads/07-
                                                           as adjustable medical beds. Some of the initial safety-check suggestions             FDA-bedfires-12-18-03.pdf
                                                           involve simple observations.
January     2004 Patient Safety     Governance, Quality    Through interviews, narration and a viewer's guide, the program                      The video can be purchased for
                                    and Safety: The        highlights actions that trustees can take to improve patient safety within           $275 using order code V02/03AAH.
                                    Impact of Joint        their organizations. This video can also aid orientation efforts for new             To order, call Joint Commission
                                    Commission             trustees while reinforcing current trustees' understanding of their role in          Resources (JCR) Customer Service
                                    Accreditation on       creating an organizational culture that focuses on patient safety.                   at 877.223.6866 weekdays from 8
                                    Health Care Delivery                                                                                        a.m. to 8 p.m. CT, or visit Infomart
                                                                                                                                                on the JCR Web site at:
                                                                                                                                                www.jcrinc.com.


December    2003 Patient Safety     Healthy Hospitals:     The report offers tips and resources for how hospitals can manage pests              http://my.premierinc.com/all/safety/p
                                    Controlling Pests      while also protecting the health of people and the environment.                      ublications/12-03-downloads/11-
                                    Without Harmful                                                                                             pesticides.pdf
                                    Pesticides
December    2003 Patient Safety     Magnetic resonance     The paper is an educational tool designed to provide consensus-based,                http://my.premierinc.com/all/safety/p
                                    safety                 valid and medically credible information and features detailed, useful               ublications/12-03-downloads/12_MR-
                                                           checklists.                                                                          safety.pdf
November    2003 Patient Safety     Conversations Before A resource guide designed to help the elderly and their children start                 http://www.premierinc.com/all/safety/
                                    the Crisis           discussions about end-of-life wishes before an unexpected illness arises.              publications/11-03-downloads/08-
                                                         The booklet is geared toward the elderly and children of the aging, and                crisis-convo.pdf
                                                         includes a resources list with helpful books and Web sites.



November    2003 Patient Safety     Strategies for        A resource folder designed to help hospitals communicate with patients                http://www.premierinc.com/all/safety/
                                    Leadership:           and families.                                                                         publications/11-03-downloads/10-
                                    Improving                                                                                                   pcp-english.pdf
                                    Communications with
                                    Patients and Families


October     2003 Patient Safety     Epidemiology and    The Pink Book – ―Epidemiology and Prevention of Vaccine Preventable                     The book is available for download
                                    Prevention of       Diseases,‖ the 7th edition from 2002, is now in its second printing.                    or purchase at
                                    Vaccine Preventable                                                                                         http://www.cdc.gov/nip/publications/
                                    Diseases                                                                                                    pink/default.htm

October     2003 Patient Safety     The Pocket Guide to This guide is intended to remind providers to deliver appropriate                       The guide is available in English at
                                    Good Health for     preventive services while involving patients directly in their preventive               http://www.ahrq.gov/ppip/adguide/
                                    Adults              care. It includes recommendations on screening tests and
                                                        immunizations, questions for patients to ask health care providers, and
                                                        resources for additional information.


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  Month     Year   Topic by Tab             Tool                                           Description                                     IHI                 Location
                                                                                                                                          Tool
September   2003 Patient Safety    The Failure Modes       The Failure Modes and Effects Analysis (FMEA) tool is a method for              √     http://www.qualityhealthcare.org/.
                                   and Effects Analysis    analyzing any process to see where it is likely to fail; to see how changes
                                   (FMEA)                  you are considering might affect the safety of the process; and to track
                                                           changes in the Risk Priority Number (or RPN) of the process over time.

September   2003 Patient Safety    The Trigger Tool for    The Trigger Tool for Measuring Adverse Drug Events (ADEs), developed            √     http://www.ihi.org/IHI/Topics/Patient
                                   Measuring Adverse       with Premier, is a simple yet powerful method of identifying and tracking             Safety/MedicationSystems/Tools/
                                   Drug Events (ADEs)      the number of medication errors in your hospital – using a retrospective
                                                           review of patient records to look for sentinel clues or "triggers" that
                                                           indicate a medication error has occurred.


September   2003 Patient Safety    Learning from Each The award recognizes excellence in graphic design, editorial content,                      http://www.premierinc.com/all/safety/
                                   Other: Success         and the ability to achieve overall communications excellence.                          publications/09-03_downloads/08-
                                   Stories and Ideas for                                                                                         learning-from-each-other.pdf
                                   Reducing
                                   Restraint/Seclusion in
                                   Behavioral Health


September   2003 Patient Safety    Quality Colloquium      Sessions on patient safety officer training, along with general conference            The CD-ROMs can be purchased at
                                   conference at           sessions on error reduction and quality enhancements; the role of                     http://www.qualitycolloquium.com/.
                                   Harvard University      technology; informatics; competition for quality and six sigma process
                                                           improvement.
September   2003 Patient Safety    Flu Gallery             This season's flu campaign emphasizes protecting yourself and the ones                http://www.cdc.gov/nip/flu/gallery.ht
                                                           you love by getting a flu vaccine. You'll find materials for parents,                 m
                                                           Spanish speakers, those at high risk for flu complications, and
                                                           immunization providers. Materials are free and can be downloaded
                                                           easily.
August      2003 Patient Safety    The Priority Focus      The fourth installment of the Joint Commission's free video information               To view this video, go to:
                                   Process and Tracer      series, "The Priority Focus Process and Tracer Methodology". The five to              http://www.jcaho.org/accredited+org
                                   Methodology             seven-minute videos highlight the key components of the new                           anizations/svnp/svnp_video.htm
                                                           accreditation process.

August      2003 Patient Safety    Resource for PCA        The ISMP Medication Safety Alert's a two-part series on PCA pumps.                    http://www.premierinc.com/all/safety/
                                   pumps                                                                                                         publications/08-
                                                                                                                                                 03_downloads/09_ISMP_PCA_pum
                                                                                                                                                 psafety_07-03.doc
August      2003 Patient Safety    5 Steps to Safer        Posters and fact sheets providing tips to help patients avoid errors                  http://www.premierinc.com/all/safety/
                                   Healthcare              related to prescription medicines, laboratory tests, procedures and                   publications/08-03_downloads/10_5-
                                                           surgery                                                                               steps.pdf
July        2003 Patient Safety    Surgical Site Infection QHC requires free registration to access all tools. The site will include       √     All materials are available at:
                                   Tools                   results from teams that participated in the collaborative, as well as tools,          http://www.qualityhealthcare.org/QH
                                                           such as forms, policies and order sets.                                               C/
                                                                                                                                                 Topics/PatientSafety/SurgicalSiteInf
                                                                                                                                                 ections/
July        2003 Patient Safety    The Effect of Health Evidence in the scientific literature to make specific recommendations                   http://my.premierinc.com/all/safety/p
                                   Care Working          about these strategies for improving patient safety.                                    ublications/07-
                                   Conditions on Patient                                                                                         03_downloads/11_AHRQ_worksum.
                                   Safety Report                                                                                                 pdf




              Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety
                                                                                                            Premier Safety Share




   Month   Year   Topic by Tab             Tool                                        Description                                    IHI                 Location
                                                                                                                                     Tool
June       2003 Patient Safety    Your Medicine: Play It To help consumers use prescription medicines safely.                               http://www.ahrq.gov/consumer/safe
                                  Safe                                                                                                      meds/safemeds.htm for the English
                                                                                                                                            version,
                                                                                                                                            http://www.ahrq.gov/consumer/safe
                                                                                                                                            medsp/safemedsp.htm for the
                                                                                                                                            Spanish version.
June       2003 Patient Safety    IHI’s global online   Improving access in the office practice                                       √     http://www.QualityHealthCare.org
                                  improvement
                                  resource

June       2003 Patient Safety    Standing Orders       A collaborative effort to improve influenza vaccination rates                       http://www.ama-
                                                                                                                                            assn.org/ama/pub/article/2403-
                                                                                                                                            7702.html

May        2003 Patient Safety    SARS Triage Tools     Tools for rapid assessment of a patient who may present with one or                 These algorithms and a ―stop‖ sign
                                                        more symptoms suggestive of SARS                                                    that can be printed and used in
                                                                                                                                            these settings – if this becomes
                                                                                                                                            necessary – are available on
                                                                                                                                            Premier’s Emergency and Public
                                                                                                                                            Health Preparedness site.


May        2003 Patient Safety    Trigger Tool for      The trigger tool measures adverse drug events and provides instructions       √     http://www.qualityhealthcare.org/QH
                                  Measuring Adverse     for conducting a retrospective review of patient records using triggers to          C/Topics/PatientSafety/MedicationS
                                  Drug Events (ADEs)    identify possible ADEs.                                                             ystems/Tools/Trigger+Tool+for+Mea
                                                                                                                                            suring+Adverse+Drug+Events+(IHI+
                                                                                                                                            Tool).htm
April      2003 Patient Safety    First, Do No Harm     Case studies and safety responses                                                   http://my.premierinc.com/all/safety/st
                                                                                                                                            ore/P4PS_video_form.doc
April      2003 Patient Safety    National Quality      The site enables searching for measures by specific disease, treatment,             http://www.qualitymeasures.ahrq.go
                                  Measures              age range, gender, and a variety of other topics. The clearinghouse also            v/
                                  Clearinghouse™        permits side-by-side comparative measurements that identify which will
                                                        best work for a given organization.

March      2003 Patient Safety    Pathways for          A set of tools designed to reduce medication errors and help hospitals              http://my.premierinc.com/all/safety/p
                                  Medication Safety     take a system-based approach to address such errors.                                ublications/03-
                                                                                                                                            03_downloads/11_extraordinary.pdf

March      2003 Patient Safety    Wrong-site surgery    Recommendations for eliminating as well as managing the discovery of a              http://my.premierinc.com/all/safety/p
                                  checklist             wrong-site surgery.                                                                 ublications/03-
                                                                                                                                            03_downloads/11_extraordinary.pdf

February   2003 Patient Safety    Perspectives on       The report is devoted entirely to JCAHO'S 2003 National Patient Safety              http://my.premierinc.com/all/safety/p
                                  Patient Safety        Goals and provides practical advice and tips for meeting those goals.               ublications/02-
                                                                                                                                            03_downloads/13_ps_01-03.pdf
February   2003 Patient Safety    Web M & M (Web        A new online peer-reviewed journal to showcase patient safety lessons               http://www.webmm.ahrq.gov/
                                  Morbidity and         drawn from actual cases of medical errors. The journal is designed to
                                  Mortality),           educate healthcare providers about medical errors in an engaging, blame-
                                                        free environment.




             Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety
                                                                                                             Premier Safety Share




  Month    Year   Topic by Tab            Tool                                          Description                                    IHI                 Location
                                                                                                                                      Tool
January    2003 Patient Safety    Pathways for           A set of tools designed to reduce medication errors and help hospitals              http://www.medpathways.info/
                                  Medication Safety      take a system-based approach to address such errors

January    2003 Patient Safety    www.orprecautions.c The site provides safety resources, injury and exposure data, industry                 http://www.orprecautions.com/
                                  om                  information, information about the Needlestick Safety Act, and
                                                      convenient links to much more OR safety information.
January    2003 Patient Safety    Veterans’              Tools to help reduce the potential for entrapment in hospital bed                   http://my.premierinc.com/all/safety/p
                                  Administration guide   systems.                                                                            ublications/01-
                                  on bed safety zones                                                                                        03_downloads/12_VHA_bed_entrap
                                                                                                                                             ment.pdf
January    2003 Patient Safety    Sample OR guides -     Increased attention to medical errors and patient safety as they relate to          http://my.premierinc.com/all/safety/p
                                  Veterans'              correct surgery sites is leading institutions to develop guides and other           ublications/01-
                                  Administration         instructional materials to help reduce such errors.                                 03_downloads/12_VHA_bed_entrap
                                                                                                                                             ment.pdf,
                                                                                                                                             http://my.premierinc.com/all/safety/p
                                                                                                                                             ublications/01-
                                                                                                                                             03_downloads/14_CorrSurgPt.pdf,
                                                                                                                                             http://my.premierinc.com/all/safety/p
                                                                                                                                             ublications/01-
                                                                                                                                             03_downloads/14_CorrSurgPt.


December   2002 Patient Safety    First, Do No Harm      Takes the dialog within the patient safety movement to new levels                   http://www.fdnh.com/
                                  Part 2: Taking the
                                  Lead
December   2002 Patient Safety    AHRQ WebM&M            Peer-reviewed, Web-based medical journal to showcase patient safety                 http://www.webmm.ahrq.gov/
                                  (Morbidity and         lessons drawn from actual cases of medical errors.
                                  Mortality Rounds on
                                  the Web)




December   2002 Patient Safety    Physician drug e-      It organizes the technology into four categories based on function: (1)             http://my.premierinc.com/all/safety/p
                                  prescribing            electronic drug references, (2) e-prescribing solutions, (3) integrated             ublications/12-
                                                         drug references and formulary tools, and (4) integrated electronic                  02_downloads/07_improv_drug_pre
                                                         medical records and e-prescribing systems.                                          scrib.pdf

November   2002 Patient Safety    Role of the Patient    Valuable tips on how patients can choose "advocates" to look out for                http://my.premierinc.com/all/safety/p
                                  Advocate               their best healthcare interests                                                     ublications/11-
                                                                                                                                             02_downloads/08_nspf.pdf
November   2002 Patient Safety    OR design tools       This site includes details of the design process, infection control and              http://www.ordesignandconstruction.
                                                        case studies.                                                                        com/
October    2002 Patient Safety    Preventing Infections Provides patients with helpful principles for managing their healthcare              http://www.npsf.org/download/Preve
                                  in the Hospital —     and becoming an active partner with their healthcare team through                    ntingInfections.pdf
                                  What You as a         infection prevention
                                  Patient Can Do

October    2002 Patient Safety    Let's Talk             Step-by-step instructions on how to disclose medical errors, why                    http://www.npsf.org/htm/prevent_infe
                                                         disclosure is important, and how open communication can strengthen the              ctions.html
                                                         patient-provider relationship are some of the subjects on the video.




             Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety
                                                                                                               Premier Safety Share




  Month     Year   Topic by Tab            Tool                                          Description                                      IHI                 Location
                                                                                                                                         Tool
October     2002 Patient Safety    Videotapes: Patient, Case studies of successful safety programs                                              Case studies of successful safety
                                   worker, environment                                                                                          programs –Order from Premier
                                   and medication safety                                                                                        Safety Institute online Safety Store.



September   2002 Patient Safety    Resources to reduce The materials outline methods for reducing errors in pediatric medicine.                 http://66.77.20.158/ahrq/childhealth
                                   pediatric medicine                                                                                           webconf/
                                   errors
September   2002 Patient Safety    Air mattress dangers A recent study cautions doctors that air mattresses used in hospitals,                  http://my.premierinc.com/all/safety/p
                                                        nursing homes, and home care can have deadly consequences for some                      ublications/09-
                                                        patients                                                                                02_downloads/08_Air_mattresses_a
                                                                                                                                                bstract.doc
September   2002 Patient Safety    Web-based safety       The Web notification will disseminate device-related safety information               http://www.fda.gov/cdrh/safety.html#
                                   notification program   useful to healthcare providers but inappropriate for the FDA’s existing               web
                                                          notifications.
September   2002 Patient Safety    American Society of    A new survey indicates that larger hospitals reporting a shortage of                  http://my.premierinc.com/all/safety/p
                                   Anesthesiologists      anesthesiologists are also delaying elective surgery and limiting access              ublications/09-
                                   survey                 to operating rooms                                                                    02_downloads/09_ASA_07-30-
                                                                                                                                                02.doc
August      2002 Patient Safety    Radiation safety       An excellent resource for radiation information and training                          http://www.orau.gov/reacts/define.ht
                                   basics                                                                                                       m
July        2002 Patient Safety    ED delays              Hospital emergency departments (EDs) are the source of more than 50                   http://www.jcaho.org/about+us/news
                                                          percent of all reported cases of patient death or permanent injury due to             +letters/sentinel+event+alert/index.h
                                                          delays in treatment                                                                   tm




June        2002 Patient Safety    Medication Safety      Institute for Safe Medication Practices (ISMP) offers six tips to reduce              http://my.premierinc.com/all/safety/p
                                   Alert - May 29, 2002   the risk of overdoses from patient- controlled analgesia (PCA) by proxy.              ublications/06-
                                                          Tips include selection criteria, protocols, monitoring, and education.                02_downloads/05_36_2002_niosh_v
                                                                                                                                                entilation_139.pdf

June        2002 Patient Safety    Reducing Medication More than 40 nationally recognized safety experts sharing their                          "Reducing Medication Errors," one
                                   Errors              strategies for successful programs on patient safety, prevention of                      of a four-part videotape series titled
                                                       medication errors, and occupational and environmental safety.                            "Safety Issues in Healthcare,"s is
                                                                                                                                                available from the Safety Institute's
                                                                                                                                                Safety Store.


June        2002 Patient Safety    Quality of Health      The book describes the state of healthcare in the United States by                    http://my.premierinc.com/all/safety/p
                                   Care in the United     examining medical mistakes, substandard care for chronic conditions,                  ublications/06-
                                   States: A Chartbook    disparities in care, and the lack of preventive care.                                 02_downloads/02_quality_care_US_
                                                                                                                                                status_rpt.pdf

June        2002 Patient Safety    Crossing the Quality   The manual summarizes the report’s themes for improvements in the                     http://my.premierinc.com/all/safety/p
                                   Chasm                  U.S. healthcare system using a four-level framework: patients’                        ublications/06-
                                                          experiences; functioning of small units of care delivery; functioning of the          02_downloads/03_IOM2_manual.pdf
                                                          organizations that support microsystems; and the

June        2002 Patient Safety    Nursing Home           A pilot Web site that lists health deficiencies for nursing homes that have           http://www.medicare.gov/
                                   Compare                been filed, examined, and confirmed following complaints.



              Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety
                                                                                                         Premier Safety Share




 Month   Year   Topic by Tab            Tool                                        Description                                  IHI                 Location
                                                                                                                                Tool
May      2002 Patient Safety    How to Protect        The brochure outlines specific steps for preventing medication errors,           http://my.premierinc.com/all/safety/p
                                Yourself and Your     wrong-site surgery, and infections                                               ublications/05-
                                Family from Medical                                                                                    02_downloads/12_AHRQ_Protect_Y
                                Errors                                                                                                 ourself_Family.doc




May      2002 Patient Safety    Ways to Help Your     A patient fact sheet with 20 tips on preventing medical errors and a             http://my.premierinc.com/all/safety/p
                                Family Prevent        family-oriented brochure                                                         ublications/05-
                                Medical Errors                                                                                         02_downloads/13_AHRQ_Patient_F
                                                                                                                                       act_Sheet_20-Tips.doc




           Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Patient Safety
                                                                                                           Premier Safety Share




                                                                                                                                     IHI
  Month    Year   Topic by Tab           Tool                                         Description                                   Tool                Location




                                                      Audio files and slides are available from a recent Premier webcast that
                                                      describes how hospitals can bring their organizations into compliance
                                                      with current EPA hazardous waste regulations and Joint Commission
                                                      requirements while preparing for future disposal restrictions. Increasing
                                                      national interest in a sustainable environment has accelerated the
                                                      healthcare industry's attention to waste management and recycling
                                                      practices. Among those challenges in waste management and recycling
                                                      is safe disposal of leftover medications, antibiotics, and other chemicals
                                                      that may find their way into our drinking water and food chain. Premier
                                                      hosted a public webcast titled ―Implementing a pharmacy waste
                                                      management system‖ to understand the problem of pharmaceutical
                                                      waste and suggest solutions and tips on how to separate, label and
                                                      dispose of common chemicals and drugs. Charlotte Smith, president of
                                                      PharmEcology Associates, LLC, presented the topic, noting that                       http://www.premierinc.com/quality-
                Pharmaceutical   Implementing a       managing pharmaceutical waste is becoming a nationwide issue, and                    safety/tools-
                Waste            pharmaceutical waste highlighted the impact on the ecosystem from disposal of leftover drugs              services/safety/news/2007/11/Phar
December   2007 Management       management system through flushing and landfilling.                                                       maSafetyStory_11162007.jsp


                                                       A standardized hazardous waste manifest form that must be used by all
                                                       hazardous waste generators and treatment, storage, and disposal                     More information on the Uniform
                                                       facilities to track waste's progress from generation to disposal is                 Hazardous Waste Manifest,
                                                       available from the U.S. Environmental Protection Agency (EPA).                      including a list of printers approved
                                                       Handlers of waste (generators, or treatment, storage or disposal                    by EPA to supply the new form and
                                                       facilities) must obtain the new forms from any source that has been                 state requirements for use of the
                Pharmaceutical                         approved for printing and distribution by the EPA Manifest Registry.                new form, can be found at:
                Waste            Uniform Hazardous     Some states have additional requirements regarding the use of the new               http://www.epa.gov/epaoswer/hazw
Oct        2006 Management       Waste Manifest        Uniform Hazardous Waste Manifest.                                                   aste/gener/manifest/
                                                       The document, "Managing Pharmaceutical Waste: A 10-Step Blueprint,"
                                                       is designed to help hospitals develop and implement a comprehensive
                                                       pharmaceutical hazardous waste management program. The plan
                                 Managing              combines regulatory compliance and best management practices with                   http://www.premierinc.com/quality-
                Pharmaceutical   Pharmaceutical        waste minimization while minimizing risk in a cost effective manner. It is          safety/tools-services/safety/safety-
                Waste            Waste: A 10-Step      organized to permit using the steps as needed, and not necessarily                  share/06-06-downloads/13-h2e-
June       2006 Management       Blueprint             consecutively.                                                                      pharma-blueprint-04-15-06.pdf




             Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Pharmaceutical Waste Management
                                                                                                         Premier Safety Share



                                                                                                                                   IHI
  Month     Year   Topic by Tab           Tool                                       Description                                  Tool                Location




                                                        Hospitals for a Healthy Environment (H2E) hosted a March 11
                                                        teleconference on disposal of chemotherapeutic wastes. Presenters from
                                                        a waste consultancy and H2E offered an overview of proper
                                                        chemotherapeutic waste segregation, treatment, and minimization
                                                        techniques to reduce the safety, health, and environmental impacts of
                                                        managing this hazardous waste stream. The conference included
                                                        education on safest practices, with the understanding that many
                                                        chemotherapeutic agents in use today are not regulated under
                                                        Environmental Protection Agency's (EPA) Resource Conservation and                Teleconference materials are at
                                                        Recovery Act, but should be included from a safety and health                    http://www.h2e-
                                                        perspective. H2E as provided six free Microsoft® Excel spreadsheets to           online.org/events/teleconf/molydesc
                                                        help hospitals collect and manage waste data (solid waste, solid waste           .cfm?Date=2005-03-11&t. at
                                                        recyclables, hazardous waste, hazardous waste recyclables, infectious            http://www.hercenter.org/wms.html
                                  H2E resources -       waste and general facility information). The bottom half of the                  to access the H2E Waste
                 Pharmaceutical   Chemo conference;     spreadsheet contains basic data and the top half of the spreadsheet              Management System and receive
                 Waste            waste disposal        does the calculations. Users register and then receive a notice if the           updates about the tool.
May         2005 Management       management tools      database is updated.


                                                       The Environmental Protection Agency (EPA) has new guidance about
                                                       how the general public should handle used syringes/needles and other
                                                       sharps generated at home or other non-healthcare locations. The
                                                       guidance suggests that syringe users dispose of used syringes in ways
                                                       that keep the sharps out of the general trash, with a goal of protecting
                                                       workers along the solid waste "stream" and at land fills. The new EPA
                                                       guidance is published in two brochures: Protecting Your Community from
                                                       Sharps: Options for Safe Disposal of Sharps and Protect Yourself,
                                  EPA guidance - Safer Protect Others: Safe Options for Needle Disposal.
                 Pharmaceutical   needle, sharps                                                                                         http://www.premierinc.com/all/safet
                 waste            disposal in public                                                                                     y/publications/02-05-downloads/10-
February    2005 management       areas                                                                                                  med-govt.pdf
                                  Preventing
                                  Occupational
                                  Exposures to
                                  Antineoplastic and                                                                                     http://www.premierinc.com/all/safet
                 Pharmaceutical   Other Hazardous                                                                                        y/resources/pharma-
                 waste            Drugs in Healthcare                                                                                    waste/downloads/2004-
September   2004 management       Settings              NIOSH Alert on antineoplastic drugs                                              HazDrugAlert.pdf




              Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Pharmaceutical Waste Management
                                                                                                            Premier Safety Share




                                                                                                                                     IHI
  Month    Year   Topic by Tab            Tool                                          Description                                 Tool                Location




                                  The Guidance for
                                  Industry and FDA
                                  Staff: Frequently       The Food and Drug Administration's (FDA) Center for Devices and
                                  Asked Questions         Radiological Health (CDRH) has released a new FAQ on single-use
                                  (FAQs) on the Status    devices. The document, titled, "The Guidance for Industry and FDA
                                  of Reprocessed          Staff: Frequently Asked Questions (FAQs) on the Status of Reprocessed
                                  Single Use Devices      Single Use Devices (SUDs) that receive a Not Substantially Equivalent
                                  (SUDs) that receive a   (NSE) Letter," (.pdf) (140 KB) explains instances in which a NSE letter
                                  Not Substantially       pertains to a reprocessed SUD and whether in-stock, reprocessed SUDs             http://www.premierinc.com/all/safet
                Reuse of Single   Equivalent (NSE)        can be used once the reprocessor can no longer distribute the SUDs as            y/publications/12-04-downloads/14-
December   2004 Use Devices       Letter                  a result of a NSE letter.                                                        sud-guidance-nse-ltr.pdf
                                                                                                                                           The CD-ROM is $475 for AAMI
                                                                                                                                           members and $655 for non-
                                                                                                                                           members. Contact AAMI at
                                                                                                                                           800.332.2264, Ext. 217, or visit
                Reuse of Single   AAMI sterilization                                                                                       http://aami.org and click on
July       2004 Use Devices       documents                                                                                                "marketplace."
                                                     Revised forms and instructions for voluntary and mandatory reporting to
                                                     MedWatch for healthcare facilities and others to use in reporting adverse
                Reuse of Single   MedWatch reporting events involving single-use medical devices that have been reprocessed                http://www.fda.gov/medwatch/getfor
March      2004 Use Devices       forms              for reuse.                                                                            ms.htm
                                  An Overview of the
                                  Regulatory
                                  Requirements for
                                  Reprocessing of
                Reuse of Single   Single-Use Devices      A two-CD set that covers the regulatory requirements that a hospital             http://www.fda.gov/cdrh/reuse/reus
August     2002 Use Devices       by Hospitals            must meet if it reprocesses single-use devices (SUDs).                           e-important.shtml




             Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Reuse of Single Use Devices
                                                                                             Premier Safety Share




                                                                                                                                    IHI
  Month   Year   Topic by Tab            Tool                                        Description                                   Tool                Location




                                                     A new pamphlet being released by the CDC – Sharps Safety for
                                                     Healthcare Personnel – describes healthcare worker risk, how and when
                                                     injuries occur, how sharps safety devices reduce injuries, and the
                                                     importance of developing a "culture of safety" for sharps injury
                                                     prevention. This and other sharps injury prevention brochures are
                                                     publicly accessible on the Safety Institute Web site to assist frontline             http://www.premierinc.com/quality-
                                                     workers in selecting safety devices to evaluate for their institutions. The          safety/tools-
                                                     Web site also contains links to national lists of sharps safety products. A          services/safety/topics/needlestick/d
               Sharps Injury    Sharps Safety for    new addition to the available tools is the needlestick prevention booklet            ownloads/cdc-sharps-brochure-10-
October   2007 Prevention       Healthcare Personnel for non-acute care.                                                                  01-07.pdf


                                                      The U.S. Public Health Service has updated the recommendations for
                                                      the management of healthcare personnel (HCP) with occupational
                                                      exposure to blood and other body fluids that might contain human
                                                      immunodeficiency virus (HIV). Published in the September 30, 2005
                                                      Morbidity and Mortality Weekly Report (MMWR) , the recommendations
                                                      (.pdf) (267 KB) emphasize adherence to postexposure prophylaxis
                                                      (PEP) regimens when indicated, expert consultation in managing                      http://www.premierinc.com/all/safet
               Sharps Injury    HIV post-exposure     exposures, follow-up to improve HCP adherence to PEP, and monitoring                y/publications/10-05-downloads/11-
October   2005 Prevention       prophylaxis           for adverse events, including seroconversion.                                       hiv-rr5409.pdf


                                                  A resource book for healthcare organizations, clinicians and others
                                                  designed to make it easier to find sharps injury prevention, blood                      The Compendium is now available
                                                  exposure prevention and infection control products that can protect                     for immediate purchase as in e-
                                                  patients, healthcare workers and others. A cooperative effort from                      book. The printed version will be
                                                  medical device and infection control product manufacturers, the                         available in a few months. The
                                                  Compendium is sponsored by the Premier Safety Institute, ISIPS,                         price will be $129.95, but for a
                                                  Managing Infection Control Magazine, AOHP and NAPPSI. It will be                        limited time, a pre-publication price
                                                  published both as a printed book and as an e-book. In the printed book,                 of $89.95 is available. For more
                                The Compendium of each device is paired with a custom evaluation form to facilitate record                information, call 801.280.8797 or
               Sharps Injury    Infection Control keeping. The digital edition of the Compendium will have each product                   send an e-mail to
July      2005 Prevention       Technologies      linked directly to the Sample Procurement Center.                                       info@medicalsafetybook.com.




          Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Sharps Injury Prevention
                                                                                                  Premier Safety Share



                                                                                                                                          IHI
   Month   Year    Topic by Tab            Tool                                          Description                                     Tool                 Location


                                                          The Environmental Protection Agency (EPA) has new guidance about
                                                          how the general public should handle used syringes/needles and other
                                                          sharps generated at home or other non-healthcare locations. The
                                                          guidance suggests that syringe users dispose of used syringes in ways
                                                          that keep the sharps out of the general trash, with a goal of protecting
                                                          workers along the solid waste "stream" and at land fills. The new EPA
                                                          guidance is published in two brochures: Protecting Your Community
                                                          from Sharps: Options for Safe Disposal of Sharps and Protect Yourself,
                                  EPA guidance -          Protect Others: Safe Options for Needle Disposal.
                                  Safer needle, sharps                                                                                          http://www.premierinc.com/all/safet
                Sharps Injury     disposal in public                                                                                            y/publications/02-05-downloads/10-
February   2005 Prevention        areas                                                                                                         med-govt.pdf
                                                          A free copy of the book, "Preventing Occupational Exposures to
                                  Preventing              Bloodborne Pathogens," a collection of articles from Advances in
                                  Occupational            Exposure Prevention (1994 to 2003), is available from the Premier                     Order free copies of the book from
                                  Exposures to            Safety Store. This 235-page book is edited by Jeannie Jagger and Jane                 the Premier Safety Store at:
                Sharps Injury     Bloodborne              Perry from the International Healthcare Worker Safety Center at the                   http://www.premierinc.com/all/safet
December   2004 Prevention        Pathogens               University of Virginia.                                                               y/store/



                                                          A list of journal articles published between 1988 and 2004 that pertains              Document:
                                                          to the review, selection, testing, or evaluation of safer needle devices.             http://www.premierinc.com/all/safet
                                                          The document, titled "Articles and abstracts," includes a list of selected            y/resources/needlestick/downloads/
                                  Literature review for   references, followed by the citation and full abstract. Detailed analysis of          sharps-journal-lit-listing-abstract-08-
                                  review, selection,      the same journal list is provided in a tabular summary format (link                   04.doc               Tabular format:
                                  testing or evaluation   below), permitting ease in sorting the journals by: study focus, author,              http://www.premierinc.com/all/safet
                 Sharps Injury    of safer needle         journal, title, population-setting, study design, key findings-summary,               y/resources/needlestick/downloads/
Sept        2004 Prevention       devices                 conclusions and key words for searching.                                              sharps-journal-lit-analysis-08-04.xls


                                  Sequence for            A poster from the Centers for Disease Control and Prevention (CDC)
                                  Donning and             that describes the order for donning and removing personal protective
                                  Removing Personal       equipment may be downloaded. Entitled ―Sequence for Donning and                       http://www.premierinc.com/all/safet
                Sharps Injury     Protective Equipment    Removing Personal Protective Equipment (PPE),‖ the poster (643 KB) is                 y/publications/05-04-downloads/09-
May        2004 Prevention        (PPE)                   available in both English and Spanish.                                                ppeposter-1322.pdf


                                                          The ―Frequently Asked Questions‖ (FAQs) regarding sharps safety were
                                                          updated following a recent Premier-sponsored audio conference that
                                                          featured speakers from OSHA and CDC. Issues addressed include
                                                          specific devices, device selection, evaluation and replacement, worker                http://www.premierinc.com/all/safet
                Sharps Injury     Frequently Asked        training and compliance, record keeping, schedules and implementation                 y/resources/needlestick/downloads/
April      2004 Prevention        Questions               and a list of OSHA resources.                                                         OSHA-FAQs.pdf




            Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Sharps Injury Prevention
                                                                                              Premier Safety Share



                                                                                                                                    IHI
  Month     Year   Topic by Tab            Tool                                       Description                                  Tool                Location


                                                                                                                                          http://www.epa.gov/epaoswer/other
                                                                                                                                          /medical/sharps.htm, Disposal Tips
                                                                                                                                          for Home Health Care (patient
                                                                                                                                          flyer) (.pdf), Disposal Tips for
                                                                                                                                          Home Health Care (professional
                                                        A new at-home sharps disposal options based on the recommendations                brochure) (.pdf), New Information
                                                        of the Coalition for Safe Community Needle Disposal. It has added to its          About Disposing of Medical Sharps
                 Sharps Injury    Sharps disposal       current recommendations additional new options for disposal of medical            (.pdf)
March       2004 Prevention       information flyers    sharps outside the healthcare setting.
                                                        States the agency's policy on disposal of contaminated needles and
                                                        blood tube holders following blood-drawing procedures. The bulletin also
                                                        provides the most recent sharps injury data from the Exposure
                                                        Prevention Information Network. OSHA developed this ―Information
                                                        Regarding the Disposal of Contaminated Needles and Blood Tube
                                  Policy on             Holders Used for Phlebotomy‖ to provide relevant information regarding            http://my.premierinc.com/all/safety/
                 Sharps Injury    contaminated blood    its policy on the prohibition of contaminated needle removal from                 publications/12-03-downloads/10-
December    2003 Prevention       tube holders          medical devices.                                                                  OSHA-tib-10-15-03.pdf

                                                                                                                                          A link to an order form, is available
                                                                                                                                          at:
                 Sharps Injury                          ECRI presents ratings of eight sharps disposal containers designed for            http://www.ecri.org/Newsroom/PR_
September   2003 Prevention       Health Devices        patient rooms or patient treatment areas.                                         Detail.asp?DN=20030828_73

                                                        The Premier Safety Institute's Bloodborne Pathogen (BBP) Assessment
                                  Bloodborne            Tool provides a comprehensive checklist for assessing compliance with
                 Sharps Injury    Pathogen (BBP)        OSHA's complete bloodborne pathogen rule, including considerations                Download the tool from the Sharps
August      2003 Prevention       Assessment Tool       for a complete sharps injury prevention program.                                  Injury Prevention module
                                                                                                                                          http://www.premierinc.com/all/safet
                                                     This site from the CDC’s Business/Labor division provides helpful                    y/publications/08-
                 Sharps Injury    HIV/AIDS workplace information and toolkits that help businesses tailor a program specific to           03_downloads/12_HIV_wkpl_mgr_
August      2003 Prevention       policy materials   their workplace.                                                                     kit.pdf
                                  ECRI - General        In addition to standard performance and human-factors design issues,
                 Sharps Injury    infusion pumps and    the report addresses patient safety, reflecting some exciting
December    2002 Prevention       patient safety        advancements in infusion pump technology                                          info@ecri.org
                 Sharps Injury    OSHA Compliance       OSHA compliance tools and resources for implementing a                            Premier Safety Web resource:
May         2002 Prevention       Tools                 comprehensive sharps injury prevention program.                                   OSHA compliance tools




            Excel: Premier / Modules / e4f4c77f-c4ea-451b-8702-22c3a83b18fa.xls / Sharps Injury Prevention
  Month     Year   Topic by Tab            Tool                                      Description




                                                        Available resources include: An audio-conference with downloadable
                                                        materials, including DVT research slides, physician and nurse
                                                        assessments, sample order sets, and a recording of the audio
                                                        conference. A webcast on anticoagulation therapy includes speakers
                                                        from hospitals with successful anticoagulation therapy programs who
                                                        share their journey to reduce adverse events and discuss The Joint
                                                        Commission's 2008 National Patient Safety Goals for anticoagulation
                                                        therapy. Slides and an audio file of the webcast and other resources
                                                        also are available. An Informatics comparative data tools help users
                                                        identify potential problems, track progress and monitor variations,
                                                        enabling users to actively reduce the rates of DVT and other serious
                                                        avoidable conditions, establish performance benchmarks and share
                                                        best practice interventions. Premier’s "Performance Improvement
                                   Premier Safety       Portal" is a resource for clinicians to get information on performance
                                   Institute – QI and   improvement advice and best practices on key clinical quality and safety
                                   patient education    issues, including prevention of VTE. AHRQ Consumer’s Guide –just
                 Venous            tools for VTE        released in August 2008 Your Guide to Preventing and Treating Blood
September   2008 Thromboembolism   prevention           Clots.
 IHI
Tool               Location




       http://www.premierinc.com/quality-
       safety/tools-
       services/safety/topics/Venous-
       Thromboembolism/venous-
       thromboembolism.jsp

				
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