Joint Commission's new NPSGs for 2008 proposed
Joint Commission's new NPSGs for 2008 proposed
Worker fatigue, patient ID among issues addressed
The Joint Commission has announced its proposed 2008 National Patient Safety Goals. Here are the proposed goals with items to consider for each:
• Improve recognition and response to changes in a patient's condition, and enable health care staff to directly request additional assistance from specially trained individuals when the patient's condition appears to be worsening.
"Here, you're really looking at in-house rapid response teams. This practice has taken hold in many hospitals in the U.S., as a result of the Institute for Healthcare Improvement's call to action," says Kathleen Catalano, RN, JD, director of health care transformation support for Plano, TX-based Perotsystems. "This would be an excellent goal and one that most quality managers would embrace. The data would probably not be too hard to collect, and the practice has been proven to save lives."
• Reduce the risk of post-operative complications for patients with obstructive sleep apnea (OSA).
The organization would be required to screen for OSA prior to surgical procedures involving the use of centrally-acting anesthetic and/or analgesic agents. Patients would be screened for risk of OSA, identified risk factors included in the anesthesia plan of care, and a protocol developed for both known OSA patients and those at risk.
"This would be good practice, and there is backing from the American Society of Anesthesiologists task force. This is trackable. Setting up the criteria would be the hardest part," says Catalano.
• Prevent patient harm associated with health care worker fatigue.
The organization would be required to identify conditions and practices that may contribute to health care worker fatigue, acknowledge that fatigue poses a risk to patient safety, and take action to minimize risk. Suggested strategies include scheduling work hours and on-call period to minimize fatigue, limiting working hours, identifying tasks that may no longer be performed by individuals after extended duty hours, or that are assessed to be at a performance-degrading level of fatigue, and implementation of an annual "Fatigue Training."
"If this becomes a NPSG, rest assured that many companies will be helping organizations with the annual Fatigue Training and will tell hospitals how to restructure their staff hours," says Catalano. "Quality managers will need to be involved from the beginning when the facility has its designated task force meet to decide how to attack the different elements of this goal. Tracking will be difficult, and almost all hospital departments will be involved to some degree."
• Take steps to prevent catheter and tubing misconnections through risk assessment, line reconciliation procedures, and education.
"I believe every institution is already working on how to prevent errors that result from catheter and tubing misconnections," says Catalano. "The quality manager already receives word of these incidents. Education of staff should be fairly easy to track as well."
The Joint Commission's implementation expectations are well stated and lay out exactly what must be done to prevent errors of this type, adds Catalano. "Now the tracking of these incidents can include certain questions regarding rechecking tubing and catheter connections, the tracing of all patient tubes and catheters to their sources for correct route, and the labeling of all tubes and catheters at the point of connection," she says.
• Improving the accuracy of patient identification by planning for the use of technology to assist with patient identification.
"This requirement would be helpful for organizations that have not yet employed technology to assist in patient identification," says Catalano. "For those organizations that have already invested in this technology, it will be easy to document what they have done to achieve success."
To reduce the likelihood of patient harm associated with the use of anticoagulation therapy involving heparin, low molecular weight heparin, warfarin, fondaparinux and direct thrombin inhibitors, the organization develops and implements safety practices to minimize risk in the medication selection and procurement process.
"The organization is to look at safety practices while involved in the selection and procurement process — not later, after the drug has been selected and procured," says Catalano. "The onus here would fall on the pharmacy — and quality managers would need to be sure the steps needed were taken." [Editor's Note: The deadline for public comment on these goals was Jan. 26, 2007. The final goals will be released later this year.]
[For more information, contact Kathleen Catalano, RN, JD, Perotsystems, Director Healthcare Transformation Support, 2300 W. Plano Parkway, Plano, TX 75075. E-mail: [email protected].]
The Joint Commission has announced its proposed 2008 National Patient Safety Goals. Here are the proposed goals with items to consider for each:Subscribe Now for Access
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