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NQF Endorses 30 Universal Health Care Safe Practices

Donna Young

The critical role pharmacists play in improving patient safety and reducing adverse events was recognized by government and health care groups in April when the National Quality Forum (NQF), a public–private partnership created in 1999, approved a health care “safe practice” stating that pharmacists should actively participate in all phases of the medication-use process.

"Pharmacists should actively participate in the medication-use process, including, at a minimum, being available for consultation with prescribers on medication ordering, interpretation and review of medication orders, preparation of medications, dispensing of medications, and administration and monitoring of medications."

—National Quality Forum 

NQF’s set of 30 approved safe practices should be universally used by health care organizations to “reduce the risk of harm resulting from processes, systems, or environments of care,” according to the 190-member organization that includes consumer groups, employers, insurers, health care providers, and government agencies. 

“These practices provide a yardstick for consumers and those who are providing oversight to see what is available in hospitals,” said Kenneth W. Kizer, a physician and NQF’s president.

The Centers for Medicare & Medicaid Services and the Agency for Healthcare Research and Quality will consider whether to adopt the entire set of safe practices or only some of them as conditions of participation for health care organizations that receive government funding, Kizer said.

“The safe practices have been through an extensive review, they have been scrutinized in every way possible, and there is a very high degree of support for essentially all of them,” he declared.

The safe practices underwent more than two years of development, Kizer noted.

NQF surveyed health professional organizations and industry and established 220 initial candidate safe practice standards.

Using the five criteria of specificity, effectiveness, benefits, readiness, and ability to be universally applicable, he said, NQF “whittled down” to 30 the number of safe practices it endorsed. There are 27 additional safe practices that are undergoing further research for future consideration, he added.

Suzanne Delbanco, executive director of the Leapfrog Group, a coalition of more than 135 public and private purchasers of health care, said her organization is considering incorporating “all or a subset” of NQF’s endorsed safe practices into a set of purchasing standards for its members.

Three of NQF’s safe practices are already recommendations made by Leapfrog: implementation of computerized prescriber order-entry (CPOE) systems, evidence-based hospital referral for patients having high-risk conditions or surgical procedures, and that intensive care units should be staffed by physicians trained and certified in critical care medicine.

Hospital organizations, Kizer said, have raised concerns about the costs associated with implementation of CPOE and the current work-force shortage of intensive care specialists.

But, he said, he is confident that, if “the practice of using intensive care specialists is pushed, then our training programs will start turning out more intensivists.”

Hospitals’ objections to CPOE, he said, are not because “it’s not a good thing to do. It’s simply the question of how are they going to pay for it. Their objections are [with] implementation details, not with the practice. I think that is a very important distinction because sometimes it gets blurred.”

The safe practice pertaining to pharmacists underwent several revisions before its approval, said Kasey K. Thompson, director of the ASHP Center on Patient Safety.

NQF’s specific acknowledgment of pharmacists in an approved safe practice is a “broad endorsement that pharmacists have a defined, unique expertise in medication use,” Thompson said. Some physician and hospital groups had opposed earlier drafts, he said, arguing that it was unnecessary to explicitly call for the inclusion of pharmacists in all stages of the medication-use process.

Some of the groups had misinterpreted the safe practice as stating that pharmacists should be involving in prescribing and ordering medications for patients, he said. Other groups were concerned that hospitals, in the midst of a pharmacist work-force shortage, would be required to hire more clinical pharmacists to meet the safe practice if adopted as a standard by a regulatory or accrediting agency.

Darryl S. Rich, associate director of surveyor management and development for the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), said that NQF’s pharmacist-specific safe practice is consistent with his group’s medication management standards, which are scheduled for release in September as part of the 2004 Comprehensive Accreditation Manual for Hospitals.

JCAHO reviewed NQF’s draft safe practices when developing the medication management standards, Rich said. But JCAHO, he noted, is not using NQF’s safe practices as part of the accreditation survey process. “We are surveying against our own national patient safety goals,” he said.