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Does appropriate prescribing result in safer care?
Does appropriate prescribing result in safer care?
  1. Vahé A Kazandjian
  1. Correspondence to:
 V A Kazandjian
 Center for Performance Sciences, 6820 Deerpath Road, Elkridge, MD 21075-6234, USA; vkazandjianmhaonline.org

https://doi.org/10.1136/qshc.2003.008698

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    The coming of age of “safety” indicators

    Can safer practices—especially pertaining to medication use—be measured and analyzed within the existing paradigm of performance assessment in health care? More than 20 years of experience in performance measurement and evaluation, primarily through indicators, have built a path upon which the more controversial, challenging, and yet similar concepts of safe practices can indeed proceed. Whether descriptive and qualitative (organizational culture towards punishment when errors are identified1–3) or quantitative (use of successive measurement methods to build a performance profile4–6), safer practice is affected by the same latent confounders of performance measurement.

    The latency of these confounders complicates identification of the explanatory factors regarding the safety of processes. Consequently, and with the recognition that many explanatory factors remain to be uncovered, the evaluation of safety faces at least the following challenges:

    • design of the measurement tools;

    • methods of analysis;

    • identification of linkages between what is done and what happens.

    These challenges are also considered by Paton and Lelliott in their paper on the quality of prescribing for psychiatric inpatients in this issue of QSHC.7 They present critical first steps in addressing medication use and safety issues. Based on the findings of this paper, a few additional comments on the …

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    Footnotes

    • Dr Vahé A Kazandjian is the President of the Center for Performance Sciences, a global outcomes research organization, and Adjunct Professor, the Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland. He is the original architect of and is responsible for the Maryland Quality Indicator Project® (QIP), the continuous performance improvement program used worldwide over the last 19 years by more than 1800 healthcare organizations. In the UK alone, over 125 hospitals from the NHS and the private sector have participated in the international component of the QIP since 1992. Dr Kazandjian is an advisor to the WHO, Europe Office, for the development of indicator projects in European countries.

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