VA’s National Center for Patient Safety (NCPS) www.patientsafety.va.gov leads the VA’s patient safety efforts throughout the Veterans Health Administration (VHA) www.va.gov/health, by offering expertise on patient safety and related healthcare issues. Patient safety officers at the VA’s 21 regional healthcare systems and patient safety managers at 153 VA medical centers and other large facilities participate in the program.
The VHA’s Patient Safety Centers of Inquiry (PSCI) managed by NCPS, develop, disseminate, and implement clinically relevant innovations to improve patient safety in VHA facilities. Successful PSCIs provide specific tools to help to improve patient safety.
PSCI’s have helped to improve patient safety within VHA by contributing to teamwork and simulation training. They have accomplished work in the areas of safe patient handling and movement, patient fall prevention and management, plus studies on clinicians’ fatigue and how this effects their performance.
PSCIs have focused on improving the safety of drug prescribing practices and medication administration and have worked to reduce medication errors related to ordering of chemotherapy for treatment of malignancies.
An important goal is to develop and test tools and products specifically designed to promote patient safety, such as clinical tools, cognitive aids, educational materials, policy reports, and handbooks.
More recently PSCIs have focused on improving electronic communication and alerts, improving patient safety during times of moderate sedation, improving home safety for high-risk patients, reducing hospital acquired infections, and improving the sterilization of reusable medical equipment.
In June 2017, VHA announced an opportunity for various entities within VHA to compete to become new PSCIs. Ten PSCIs are currently funded through the end of FY 2018. Starting with FY 2019, VHA NCPS will start funding additional PSCIs each for a three year period. Total annual costs proposed for a single PSCI cannot exceed $290,000 per year. Each PSCI’ will be evaluated at the end of each fiscal year as a condition for continued funding.
NCPS has studied the patient safety literature to identify areas in healthcare where new PSCIs are most needed. These areas include infection control, improving the safe prescribing of Opioids, preventing falls and injuries, preventing hospital acquired infections, reducing diagnostic errors, improving outpatient care/ambulatory care safety, preventing adverse drug events, and reducing delays in treatments for patients.
Go to https://www.hsrd.research.va.gov/funding/PSCIsolicitationFY2019-21.pdf for more information on VHA’s proposed solicitation and for entities within VHA to apply to become a PSCI, go to https://www.patientsafety.va.gov/professionals/centers.asp.