Patient Safety, 2009

West Virginia University Hospitals

March 2009

As a result of implementing AHRQ's Hospital Survey on Patient Safety Culture, West Virginia University Hospitals changed clinical practices and policies in an effort to improve the culture of safety in its facilities.

Tamma Melton, RN, BSN, Patient Safety Coordinator, reports that the AHRQ survey results were incorporated into the hospital's Performance Improvement Plan for 2008. The plan—which sets goals, establishes measures, conducts review sessions, and charts progress—now contains elements specifically related to areas identified for improvement.

A Comprehensive Unit-Based Safety Program was implemented to enable staff to focus safety efforts on unit-specific programs highlighted by the AHRQ survey. Projects and procedures that have been developed include the following:

• Method for easier incident reporting.
• Procedure for securing endotracheal tubes.
• Purchase of a patient lift device for Intensive Care Unit (ICU) patients.
• Procedure for disposal of used guide wires.
• Development of an ICU Rounding Tool—a "to-do list."
• Installation of communication boards in patient rooms.

Patient outcomes are also being positively affected because of increasing efforts to improve safety and communication. Educational opportunities are now being provided for both patients and their family members.

The hospital's administration first learned of the Hospital Survey on Patient Safety Culture by conducting a literature search to determine the availability of validated survey tools. There were also staff members with previous experience using the AHRQ survey tool.

The initial survey was completed by employees in the Adult ICU and Respiratory Department in August 2007. The Children's Hospital Group and Pharmacy completed the survey in August 2008. The goal is to implement the safety program hospital-wide, using the AHRQ survey tool specifically to guide each team. Questions to assess the progress of the initiative are included in plans for future repeated surveys.

West Virginia University Hospitals includes seven facilities and is based in Morgantown. In 2007, services were provided to 96,467 patients.

Impact Case Study Identifier: CQuIPS 09-02
AHRQ Product: Hospital Survey on Patient Safety Culture
Topic(s): Patient Safety, Policy
Scope: West Virginia

Hospital Survey on Patient Safety Culture. Update. October 2008. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/qual/hospculture

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