Evidence-Based Quality Improvement: A recipe for improving medication safety and handover of care

In healthcare we strive to provide the highest possible quality of care. Even though healthcare professionals work together with the intention to provide safe care, medical errors still threaten patient safety. Patient safety has received considerable attention since the beginning of this century, resulting in quality and safety improvement initiatives worldwide. Often these initiatives are implemented without evidence of their effectiveness. This may result in changes in the system of care, but it may not always be improvements. As a consequence, the changes are not naturally embraced by healthcare professionals and it may even result in resistance, frustration and waste of valuable resources. Through the studies in this thesis we researched the requirements for evidence-based quality improvement (EBQI) of two processes with high potential for errors: the medication process and handover of care. From our studies it becomes clear that important requirements for EBQI are: • Careful research into the complex problems that underpin QI with sufficient attention for local context. • Practice based iterative design and small scale evaluation of QI interventions that build up towards rigorous research designs and long term measurement of effectiveness as well as implementation. • Information from Electronic Patient Records (EPRs) that supports high quality care through the incorporation of clinical decision support as well as performance management through use of indicators. • Further professionalization in quality improvement, through continuous education and a safety culture with adequate leadership.