Hospital Patient Safety Research Articles

Enhancing Hospital Service Quality and Patient Safety through the MIRACLE Model: A Partial Least Squares Equation Approach

Objective: Give a background why this model is worthwhile by briefly highlighting the current health system and how this study may help to improve this system. This study aims to assess the impact of the MIRACLE model onquality enhancement and patient safety within healthcare settings.
 Study Design: Employing a cross-sectional design, this research centers on four key variables and 19 corresponding indicators. Data were collected using a questionnaire distributed via Google Forms, targeting heads of work units at M. Djamil Central General Hospital in Padang, Indonesia.
 Method: The analysis utilizes the Partial Least Squares Structural Equation Modeling (PLS-SEM) technique to evaluate variable relationships. The variables studied are Communitarian, Apprenticing Affinity, Managing, and Quality and Patient Safety, with indicators integrated into the questionnaire.
 Results: Communitarian and Apprenticing Affinity emerged as influential factors directly impacting quality of health servicesand patient safety, moderated by Managing variable. Research findings reveal a significant positive impact of the Apprenticing Affinity variable on Managing (p-value = 0.013), underlining its significance in hospital management. Moreover, Apprenticing Affinity significantly affects quality and patient safety (p-value = 0.00), highlighting its pivotal role in healthcare enhancement. Similarly, the Communitarian variable significantly influences Managing (p-value = 0.11), notably impacting quality and patient safety (p-value = 0.00). However, Managing alone does not significantly impact quality and patient safety (p-value = 0.15). Indirectly, the research unveils that the Managing-moderated Apprenticing Affinity variable lacks significant influence on quality and patient safety (p-value = 0.268). Similarly, Managing-moderated Communitarian influence does not substantially impact quality and patient safety (p-value = 0.411).
 Conclusion: This study highlights the substantial impact of Communitarian and Apprenticing Affinity, moderated by Managing, on quality and patient safety. Notably, Managing alone lacks direct influence. These findings underscore the significance of cultivating collaborative, learning-oriented environments, alongside effective management practices, to bolster healthcare quality and patient safety.

Implementation of Effective Communication as an Effort to Improve The Quality of Service in North Sumatra University Dental and Oral Hospital

Communication is the most important aspect of collaboration between professionals consisting of doctors, nurses, pharmacists, medical records, and patients. In fact, 70–80% of errors in health services are caused by poor communication and a lack of understanding between team members or between professionals. Lack of communication can also cause delays in serving patients and errors in handling patients. One of the ways to provide Effective Communication training is through using the Situation Background Assessment Recommendation (SBAR) method. The purpose of this study was to create and correct effective communication to improve service quality and patient safety at the Dental and Oral Hospital of North Sumatra University. The research method used a qualitative approach, and the informants were all the staff or employees at the Dental and Oral Hospital of North Sumatra University. Methods of data collection were carried out by direct observation and giving questionnaires before and after the communication training. The changes observed or measured in the research were before and after the SBAR training, that is the increase and the change in the behaviour of the officers. The result of this study shows that respondents had fairly good percentage results, with knowledge of 73.65% and applying effective communication with the SBAR method of 57.49%. Concluded that Therefore, effective communication is one of the indicators for monitoring hospital quality and patient safety.

A-183 Improving Turnaround Time of Critical Value Reporting by Reducing Redundant Workflow

Abstract Background Most laboratories and hospital patient safety committee define the critical value parameter together, and laboratory should notice the doctor when critical value reporting. “Critical value” as a result refers to the patient may be life-threatening or in imminent danger and require immediate treatment by a doctor. Especially, Troponin-I result is greatly affect door to balloon time. As soon as the critical value reporting, the patient will get therapy earlier. For patient safety, we implemented some methods to reduce the turnaround time of critical value reporting. Methods (1) Shorten the distance between specimen receiver and testing operator from 2 meter to 0 meter. Specimens are analyzed sooner due to reduced unnecessary walk. (2) Assess the difference of results between first and second exam, there are no significant difference. Reducing unnecessary repeat test to report critical value as soon as possible. (3) Reading barcode by both clockwise and counterclockwise way to improve barcode reading performance of analyzer, and reducing unnecessary re-label or manual operate. Results Emergency patient critical value report in 30 min completion rate increased from 80.5% to 93.3%. Inpatient critical value report in 60 min completion rate increased from 94.1% to 96.6%. Troponin-I report in 30 min completion rate increased from 89.3% to 97.0%. Conclusion Doctors treat according to result from laboratory, and delayed report is an impediment to patient care. Particularly critical value reports, that causes delays in urgent patient treatment. We reduced unnecessary work to short turnaround time for critical value reporting, patient will get better therapy faster, and further improve patient safety.

Middle manager responses to hospital co-workers’ unprofessional behaviours within the context of a professional accountability culture change program: a qualitative analysis

BackgroundThe critical role that middle managers play in enacting organisational culture change designed to address unprofessional co-worker behaviours has gone largely unexplored. We aimed to explore middle managers’ perspectives on i) whether they speak up when they or their team members experience unprofessional behaviours (UBs); ii) how concerns are handled; iii) the outcomes; and iv) the role of a professional accountability culture change program (known as Ethos) in driving change.MethodsQualitative, constructivist approach. Five metropolitan hospitals in Australia which had implemented Ethos. Purposive sampling was used to invite middle-level managers from medicine, nursing, and non-clinical support services. Semi-structured interviews conducted remotely. Inductive, reflexive thematic and descriptive thematic analyses undertaken using NVivo.ResultsThirty interviews (approximately 60 min; August 2020 to May 2021): Nursing (n = 12), Support Services (n = 10), and Medical (n = 8) staff, working in public (n = 18) and private (n = 12) hospitals. One-third (n = 10) had a formal role in Ethos.All middle managers (hearers) had experienced the raising of UBs by their team (speakers). Themes representing reasons for ongoing UBs were: staying silent but active; history and hierarchy; and double-edged swords. The Ethos program was valued as a confidential, informal, non-punitive system but required improvements in profile and effectiveness. Participants described four response stages: i) determining if reports were genuine; ii) taking action depending on the speaker’s preference, behaviour factors (type, frequency, impact), if the person was known/unknown; iii) exploring for additional information; and iv) addressing either indirectly (e.g., change rosters) or directly (e.g., become a speaker).ConclusionsAddressing UBs requires an organisational-level approach beyond supporting staff to speak up, to include those hearing and addressing UBs. We propose a new hearer’s model that details middle managers’ processes after a concern is raised, identifying where action can be taken to minimise avoidant behaviours to improve hospital culture, staff and patient safety.

A systematic narrative review of coroners’ Prevention of Future Deaths reports (PFDs): A tool for patient safety in hospitals

Patient harm due to unsafe healthcare is widespread, potentially devastating, and often preventable. Hoping to eliminate avoidable harms, the World Health Organization (WHO) published the Global Patient Safety Action Plan in July 2021. The UK's National Health Service relies on several measures, including ‘never events’, ‘serious incidents’, ‘patient safety events’ and coroners’ Prevention of Future Deaths reports (PFDs) to monitor healthcare quality and safety. We conducted a systematic narrative review of PubMed and medRxiv on 19 February 2023 to explore the strengths and limitations of coroners’ PFDs and whether they could be a safety tool to help meet the WHO's Global Patient Safety Action Plan. We identified 17 studies that investigated a range of PFDs, including preventable deaths involving medicines and an assessment during the COVID-19 pandemic. We found that PFDs offered important information that could support hospitals to improve patient safety and prevent deaths. However, inconsistent reporting, low response rates to PFDs, and difficulty in accessing, analysing and monitoring PFDs limited their use and adoption as a patient safety tool for hospitals. To fulfil the potential of PFDs, a national system is required that develops guidelines, sanctions failed responses and embeds technology to encourage the prevention of future deaths.

Patient Safety Culture, Infection Prevention, and Patient Safety in the Operating Room: Health Workers' Perspective.

A hospital's patient safety culture affects surgical outcomes. Operating room safety culture has been overlooked despite the importance of patient safety. The AHRQ's Hospital Survey on Patient Safety Culture (HSOPSC) has been used worldwide to assess and enhance patient safety culture. This study examined how patient safety culture and infection prevention effect patient safety in the Operating Room (OR). This observational study used an online survey and included 143 OR workers. Descriptive statistics and multilinear regression were used to examine how patient safety culture and infection prevention affects level of patient safety. Most responders worked in excellent-accredited general hospitals. Most responders were male, aged between 26 to 40 years old, and had bachelor's degrees. Most were hospital-experienced nurses. Less than half had worked in units for over ten years. Organizational Learning - Continuous Improvement; Teamwork and Handoffs; and Information Exchange had the most positive responses in the OR. However, Staffing, Work Pace, and Patient Safety ranked lowest. Organizational Learning - Continuous Improvement and Hospital Management Support for Infection Prevention Efforts were found to affect OR patient safety level perceptions. According to the findings of our study, the overall patient safety culture in the operating room remains weak which highlights the importance of continuing efforts to improve patient safety in the OR. Further study could be directed to identify organizational learning in infection prevention to enhance the patient safety in the OR.

Perception of patient safety and associated factors among health staff: A cross-sectional study in some hospitals in Vietnam

Objectives: Patient safety is a global challenge of preventing and mitigating medical errors which might harm patients during their course of treatment and care. This research aimed to assess the perception of patient safety culture and its associated factors among health staff in some hospitals in Vietnam. Methods: A cross-sectional study was conducted in three hospitals in Vietnam with a total of 763 heath staff. This study used the Hospital Patient Safety Scale developed by the American Health and Quality Research Organization. Bivariate and multivariate regression were used to analyze the association between the overall perception of patient safety culture among health staff. Results: The overall perception of patient safety among health staff in three hospitals was on the average positive response at 39.19% with a score of 3.93. Among the 12 dimensions of patient safety culture, “Feedback and communication about errors” had the highest average positive response (92.5%) with a score of 4.25, however, “Frequent of event reported” scored the lowest percentage of positive responses (20.71%) with a score of 2.49. There are two factors of department and position being found to have significant association with overall positive responses. Staffs who worked at the subclinical department are more likely to have overall positive responses than those who worked at the administration department, with an adjusted odds ratio of 2.76 (95% CI = 1.22 – 3.86). Nurses were less likely to have overall positive responses than doctors, with an adjusted odds ratio of 0.65 (95% CI = 0.45 – 0.95). Conclusion: This study reported that “Frequent of event reported” aspects that need to be improved because they are strongly related to patient safety culture and to knowledge exchange among health staff. It has been suggested that hospitals should deliver patient safety training courses and establish a supportive learning environment to improve these challenges. Keywords: Patient safety, patient safety culture, Hospital Survey on Patient Safety Culture (HSOPSC), hospital, health staff, Vietnam.

The Effect of Professional Autonomy and Nursing Work Environment on Nurses’ Patient Safety Activities: A Perspective on Magnet Hospitals

Aim. This study aimed to identify the effects of nurses’ professional autonomy and work environment on patient safety in general hospitals. By understanding this relationship, we sought to identify practical measures to improve patient safety in the healthcare context. Background. Professional autonomy and nursing work environments have positive effects on job performance, job satisfaction, and patient outcomes. Methods. Data were collected from 200 nurses working in general hospitals, using a cross-sectional survey design. The survey was conducted in 2021 using self-report questionnaires that included the Nursing Work Environment Scale and items on professional autonomy and patient safety activities. Results. The total professional autonomy score was 162.06 (range: 60–240). The mean scores of nursing work environment and nurses’ patient safety activities were 2.55 out of 4 and 4.22 out of 5, respectively. Multiple regression analysis revealed that professional autonomy (β = 0.234 and p = 0.001 ) and nursing work environment (β = 0.138 and p < 0.05 ) were identified as variables that had significant effects on patient safety activities. Among the independent variables, professional autonomy had the greatest influence on patient safety. Conclusion. The findings confirm the need to improve and find ways to enhance nurses’ professional autonomy and nursing work environment. Implications for Nursing Management. The findings confirm the need to improve and find ways to enhance nurses’ professional autonomy and the nursing work environment. Based on these findings, medical institutions and nursing managers should continue to make efforts to improve the nursing work environment to enhance patient safety, especially system improvements, expand nurse autonomy within medical institutions, strengthen hospital management support to evaluate its effectiveness, and further improve government-level policies and systems.

A study of error reporting by nurses: the significant impact of nursing team dynamics.

Error reporting is crucial for organisational learning and improving patient safety in hospitals, yet errors are significantly underreported. The aim of this study was to understand how the nursing team dynamics of leader inclusiveness, safety climate and psychological safety affected the willingness of hospital nurses to report errors. The study was a cross-sectional design. Self-administered surveys were used to collect data from nurses and nurse managers. Data were analysed using linear mixed models. Bootstrap confidence intervals with bias correction were used for mediation analysis. Leader inclusiveness, safety climate and psychological safety significantly affected willingness to report errors. Psychological safety mediated the relationship between safety climate and error reporting as well as the relationship between leader inclusiveness and error reporting. The findings of the study emphasise the importance of nursing team dynamics to error reporting and suggest that psychological safety is especially important to error reporting.

Penerapan Keselamatan Pasien Preoperasi dan Post Operasi di Rumah Sakit

This research examines how the study of the implementation of pre-and post-operative patient safety in hospitals. The research used by researchers is a Systematic Literature Review with data obtained from journals and research articles from 2013-2023. The data source platforms used in this study are Google Scholar and PubMed. In this study, it is known that patient safety is an important health problem worldwide, and patient accidents in the operating room can cause serious problems. This miscommunication situation is a potential threat to patient safety because issues can easily go unnoticed by the rest of the team. Hospitals must provide a useful framework of requirements and safety protocols to address these challenges. One standard that can be used is the surgical safety checklist designed by WHO. The use of this list, in research, can increase safety procedurally, when surgery is performed, and after the action is given. Not only that, but hospitals must also provide formal instructions through various activities such as seminars, workshops, to conferences needed to increase awareness regarding patient safety before and after surgery.

Penerapan Sasaran Keselamatan Pasien di Rumah Sakit: Literatur Review

This study examines how the literature review regarding the implementation of patient health goals in hospitals. The research used in this research is a qualitative research which is described descriptively. Various sources were processed in this study such as books, research results, journals, and research articles. The results of this study are patient safety is a variable for measuring and evaluating the quality of hospital services that have an impact on health services. One of the safety services in this hospital is the application of patient safety goals which starts with the accuracy of patient identification. This is because patient identification errors at the beginning of the service will continue to the next service error. Patient Safety Goals encourage specific improvements in patient safety including the Hospital Patient Safety Goal Standards. All of this must be done considering the complexity of hospital operations, of course, has the potential for errors. Furthermore, patient safety will have an impact on the patient's medical condition and increase health costs.

Effect of Early Warning Score on Length of Stay and Mortality of Non-Surgical Patients in the Intensive Care Room at Dr. Moewardi Hospital Surakarta

Background: One of the efforts to improve the quality of life and patient safety in hospitals is the use of the Early Warning Score (EWS). The purpose of this study was to analyze the effect of EWS on the length of stay and mortality of non-surgical patients in the intensive care unit of Dr. Moewardi Hospital Surakarta.Subjects and Method: This study is an observational study conducted using a prospective cohort study. A purposive sampling study conducted on June 10 - July 10 was carried out by taking a sample of 120 non-surgical patients in the ICU of Dr. Moewardi Hopital, Surakarta with inclusion and exclusion criteria. This study chose the early warning score as the independent variable and length of stay and mortality as the dependent variable. The method of collecting data on EWS, length of stay, and mortality was using an observation sheet filled out by the researcher. This study assessed differences in baseline characteristics and outcomes using the Chi-Square test and one-way analysis of variance (ANOVA).Results: There is a statistically significant effect of EWS on length of stay (p = 0.024). EWS also has a statistically significant effect on mortality p<0.001.Conclusion: There is an effect of EWS on the length of stay and mortality of non-surgical patients.Keywords: EWS, length of stay, mortality, non-surgical patients, intensive careCorrespondence: Luthfiana Nadhiifa Khoirunnisa. Faculty of Medicine, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java, Indonesia. Email: luthfiana@student.uns.ac.id. Mobile: +62 82111170000.Indonesian Journal of Medicine (2023), 08(03): 310-316https://doi.org/10.26911/theijmed.2023.08.03.08

Penerapan Sasaran Keselamatan Pasien melalui Penilaian Resiko Jatuh yang Terintegrasi dengan Rekam Medik Elektronik

This study aims to discuss the methods used to implement patient safety standards through a fall risk assessment in a hospital integrated with electronic medical records, which were obtained from several research journals. The method used is a Literature Review, which originates from journal searches on online databases, including Pubmed, ProQuest, Clinical Key Nursing, and Science. The study results show that using technology to prevent falls in patients generally indicates positive results, which are very beneficial for both patients and improve the quality of patient safety in hospitals. In conclusion, there is a need for further development of how to prevent falls in patients at the hospital so that they can show even better results.
 
 Keywords: Assessment, Patient Safety, Nursing, Electronic Medical Records, Fall Risk

Pelaporan Indikator Mutu Keperawatan dengan Penerapan Berbasis Teknologi dan Sistem Informasi

This study aims to improve the application of unit quality indicator reporting through a digital system that makes it easier for nurses to access so that reports can be submitted quickly and accurately. The method used is a literature review of 11 kinds of literature and various other literature on improving the quality of nursing through the reporting system. The research results show that the basis for nurses in supporting the work program of the Department of Nursing is to maintain the quality or quality of nursing services, which is guided by hospital patient safety. One is implementing a technology-based and information system-based nursing quality indicator reporting system. In conclusion, reporting unit quality indicators becomes more accessible, faster, and precise. It becomes an effort to determine the quality of performance and nursing services in each nursing unit which is very beneficial for health workers, hospitals, and the community.
 
 Keywords: Nursing Quality Indicators, Hospital Information Systems, Digital Technology

A Literature Review: Implementation of SBAR Communication in The Implementation of Patient Safety in Hospital in Indonesia (Study in Indonesia

Background: In carrying out patient safety, the hospital has varied ways to maximize the implementation of patient safety, one of which is the use of effective communication as an effort to maximize the implementation of patient safety at the hospital. One of the effective communication methods is SBAR communication (Introduction, Situation, Background, Assessment, Recommendation) to achieve critical thinking skills and save time. SBAR communication used in effective communication is a system that is easy to remember amd a real mechanism used to convey a patient's condition that is critical or needs immediate attention and action. Purpose: The purpose of this study is to determine the application of effective SBAR communication in the implementation of patient safety in hospitals. Methods: The method used is to conduct literature reviews from various journals and articles related to the application of SBAR communication in hospitals and its implementation in patient safety in hospitals in Indonesia. The articles used are taken based on filtering through a database which is then filtered for titles, abstract to completeness and conformity with the research theme. Result: The results are implementation of the effective SBAR communication technique recommended by WHO has been used by most hospitals in Indonesia, although in practice there are still some things need to be fixed and managed but the implementation itself has proven to be effective and very influential on patient safety in the hospital. Conclusion: SBAR communication is an effective communication framework used in patient safety in hospitals. There are factors that influence the implementation of SBAR communication including experience, years of service of practitioner, equalization of perceptions and understanding of implementation related to SBAR techniques, socialization or debriefing related to the use of these techniques and the existence of SOPs in hospitals. In its implementation, SBAR communication is mostly considered effective and has a positive relationship with patient safety efforts.

Investigating Racial and Ethnic Disparities in Maternal Care at the System Level Using Patient Safety Incident Reports

Maternal mortality in the United States is high, and women and birthing people of color experience higher rates of mortality and severe maternal morbidity (SMM). More than half of maternal deaths and cases of SMM are considered preventable. The research presented here investigated systems issues contributing to adverse outcomes and racial/ethnic disparities in maternal care using patient safety incident reports. The authors reviewed incidents reported in the labor and delivery unit (L&D) and the antepartum and postpartum unit (A&P) of a large academic hospital in 2019 and 2020. Deliveries associated with a reported incident were described by race/ethnicity, age group, method of delivery, and several other process variables. Differences across racial/ethnic group were statistically evaluated. Almost two thirds (64.8%) of the 528 reports analyzed were reported in L&D, and 35.2% were reported in A&P. Non-Hispanic white (NHW) patients accounted for 43.9% of reported incidents, non-Hispanic Black (NHB) patients accounted for 43.2%, Hispanic patients accounted for 8.9%, and patients categorized as "other" accounted for 4.0%. NHB patients were disproportionally represented in the incident reports, as they accounted for only 36.5% of the underlying birthing population. The odds ratio (OR) demonstrated a higher risk of a reported adverse incident for NHB patients; however, adjustment for cesarean section attenuated the association (OR 1.25, 95% confidence interval 1.01-1.54). Greater integration of patient safety and health equity efforts in hospitals are needed to promptly identify and alleviate racial and ethnic disparities in maternal health outcomes. Although additional systems analysis is necessary, the authors offer recommendations to support safer, more equitable maternal care.

Factors Affecting Patient Safety in Working at the Madiun Hospital (RSUD Madiun)

Patient safety in hospitals is a service system in a hospital that provides safer patient care. The purpose of the study was to analyze the factors that affect patient safety in working. The research design used was quantitative with cross-sectional approach. The population of all nurses in Madiun Hospital was 195 respondents. The sample of some nurses was 131 respondents with purposive sampling. The results showed that there was an influence on the role of communication (p=0.001), environmental conditions (p=0.003), distractions at work (p=0.014), workload (p=0.042) and staff education (p=0.000). Multivariate analysis showed that the most influential variable on patient safety was staff education with a significance level of p=0.000 and B=0.068. It is expected that nurses in providing health services must improve the quality which will be able to provide comfort and quality services to patients in terms of improving patient safety.

Patient Safety Climate, Quality of Care, and Intention of Nursing Professionals to Remain in Their Job During the COVID-19 Pandemic.

This study aimed to examine the relationship between patient safety climate, quality of care, and intention of nursing professionals to remain in their job. A cross-sectional study was carried out in a teaching hospital in Brazil wherein nursing professionals were surveyed. The Brazilian version of the Patient Safety Climate in Healthcare Organizations tool was applied to measure the patient safety climate. Spearman correlation coefficient and multiple linear regression models were applied for the analysis. A high percentage of problematic response was observed for most dimensions, except for fear of shame. Quality of care resulted in a strong correlation with organizational resources for safety and with overall emphasis on patient safety, and the nurse-perceived staffing adequacy was strongly correlated with organizational resources for safety. The multiple linear regression model showed higher scores in quality of care in dimensions related to organizational, work unit, and interpersonal aspects as well as in the adequacy of the number of professionals. A higher score in intention to stay in one's job was also found in the dimensions of fear of blame and punishment, provision of safe care, and adequacy of the number of professionals. The organizational and work unit aspects can lead to a better perception of the quality of care. Improving interpersonal relationships and increasing the number of professionals on staff were found to increase nurses' intention to remain in their jobs. Assessing a hospital's patient safety climate will enable improvement in the provision of safe and harm-free health care assistance.

Edukasi Patient Safety pada Pasien dan Keluarga Pasien di Instalasi Poliklinik Rumah Sakit Umum Daerah Sayang Rakyat Kota Makassar

In 2019, data was obtained that there were 12 cases of Potential Injury Events (KPC) at RSUD Sayang Rakyat. Therefore, RSUD Sayang Rakyat is the target of Patient Safety Education activities for patients and their families at the Polyclinic. The aim of carrying out community service is to prevent and reduce risks, errors and losses that occur to patients during the provision of health services. This community service uses educational methods for polyclinic patients and families using video and flayers and is simulated directly to patients and families. Besides that, to measure patient and family understanding before education, they are given a pre-test and after education, it is given a post-test which consists of 6 multiple choice questions related to 6 patient safety goals in the hospital. The evaluation results obtained after 3 times of education showed significantly increased knowledge of patients and patient families compared to before education with values 0,529 (p= 0,041) in education 1, 0,8 (p=0,046) in education 2 and 0,692 (p=0,041) in education 3 it is hoped that hospitals will pay more attention to and improve patient safety in hospitals in order to prevent incidents to patients.

Reducing Unnecessary Acid Suppression Use in Hospitalized Patients: A Description of Targeted Strategies Implemented Across a Large Health System.

Ensuring the appropriate use of proton pump inhibitors (PPIs) and histamine type 2-receptor antagonists (H2RAs) is an important hospital patient safety and quality initiative because therapy may be inappropriately continued during transitions of care. In this article, we aim to describe the impact of targeted quality improvement strategies to reduce unnecessary acid suppression use in hospitalized patients across a large health system. Beginning January 1, 2018, focused quality improvement strategies to prevent unnecessary initiation and continuation of proton pump inhibitors (PPIs) and histamine type 2-receptor antagonists (H2RAs) were implemented throughout a large health system. Targeted strategies were initially tested as part of the PPI deprescribing Institute for Healthcare Improvement (IHI) International Innovators Network initiative and were expanded to include H2RAs for hospitalized patients. Strategies to decrease PPIs and H2RAs during hospitalization included standardization of stress ulcer prophylaxis care pathways, evidence-based order set modifications, technology-driven support, and clinical pharmacy metric performance to goal. PPI/H2RA days of therapy (DOT) per 1000 patient days were measured from the first quarter (1Q) of 2017 to the fourth quarter (4Q) of 2021 to determine if implemented strategies resulted in improvement. After quality improvement strategies were implemented, the number of PPI/H2RA DOT was reduced by 7.9 days per 1000 patient days each quarter over 4 years. The average PPI/H2RA DOT per 1000 patient days decreased from 592 (1Q 2017) to 439 (4Q 2021). In the fourth quarter of 2018, 45 hospitals (28%) achieved a 10% reduction in combined PPI/H2RA DOT per 1000 patient days, and 121 hospitals (97%) attained the goal of greater than 25% of eligible patients deprescribed PPI/H2RA for ICU patients in the fourth quarter of 2019. In the fourth quarter of 2020, 97 hospitals (87%) met the metric of 40% or more of eligible patients deprescribed from PPI/H2RA in or after an ICU stay, and 85 hospitals (87%) reached 50% or more of eligible patients deprescribed PPI/H2RA in or after an ICU stay in 4Q2021. Targeted quality improvement strategies decreased unnecessary PPI and H2RA use for a large health system over 4 years. Continually evaluating measured results along with establishing a new clinical pharmacy metric goal each year to encourage further improvement contributed to deprescribing success.