Proposed additions to 2009 patient safety goals

Below are some of the proposed additions to The Joint Commission's National Patient Safety Goals (NPSGs) for 2009, with challenges outlined for each:

• The patient should be involved in the identification process when possible.

"I don't believe there is any surprise here," says Kathleen Catalano, RN, JD, director of health care transformation at Plano, TX-based Perot Systems. "This has been a running theme throughout all of the NPSGs."

This is probably already included in your organization's policy and procedure for improving the accuracy of patient identification. "Tracking that this has occurred will probably be accomplished through direct observation and documentation," says Catalano.

• Eliminate transfusion errors related to patient identification.

This would require matching the patient to the blood product and the blood product to the order, with a two-person verification process or an automated identification technology such as bar-coding. "Also, when the two-person verification process is used, both individuals must be qualified to perform the tasks at hand," says Catalano.

• Implement best practices to prevent multiple drug-resistant organism infections.

The 16 implementation expectations for this goal include education of health care workers, patients, and families; implementation of hand hygiene guidelines, contact precautions for patients with methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile–associated disease (CDAD), a MRSA surveillance program; implementation of a laboratory-based alert system that identifies new patients with MRSA; a CDAD surveillance program; and effective cleaning and disinfection of both patient care equipment and the patient care environment.

"These programs have already been instituted across the country. Increased monitoring may now be required but, in essence, this is in place," says Catalano.

• Prevent catheter-associated bloodstream infections.

"There are 13 implementation expectations for this goal, and all should be the practice in hospitals today," says Catalano. "These would be implemented collaboratively through infection control, patient care, and the quality department."

• Prevent surgical site infections.

Infection control, perioperative areas, and the quality department will need to work together to be certain that surgical site infection rates are measured, compliance with best practices is monitored, and the overall effectiveness of prevention efforts evaluated, says Catalano.

• Perform modified medication reconciliation processes in settings where medications are not used, are used minimally, or prescribed for a short duration.

This will impact ambulatory care, urgent and emergent care, office-based surgery, outpatient radiology, and behavioral health care. "Here, when no changes are made to the patient's current medication list or when only short-term medications, such as five days of an antibiotic, are prescribed, the patient is provided a list containing the short-term medication additions," says Catalano.

If any long-term chronic medications are prescribed, a complete list of reconciled medications is provided to the patient, family, and primary care provider or original referring provider.

"It is likely that most organizations have set up a medication reconciliation task force," says Catalano. "This task force could be resurrected to determine how the organization will address the additions to the NPSGs. The quality department, as a member of the task force, would help in determining measurement of the NPSGs components."

• Patients must be provided with information on infection control measures for hand hygiene practices, respiratory hygiene practices, and contact precautions.

"Tracking of how often the information is actually provided will be one piece of the puzzle," she says. "The other, that naturally follows, is assessing whether or not the patient and family understand the information provided. This will probably involve questioning of the patient and patient's family to seek their level of understanding."

Organizations also must provide surgical patients with information on the prevention of adverse events in surgery. "The organization will need to determine how this information will be dispersed to its surgical patients. The quality department will have to help develop a tracking mechanism that will work for the organization," says Catalano.

• There are new requirements for the Universal Protocol.

Quite a few revisions and additions have been made to the Universal Protocol in an effort to clarify the requirements, says Catalano. These revisions and additions must be taken seriously by the perioperative team, and by any other staff involved anywhere in the facility where procedures are performed. "They, along with the quality department, will need to develop measures for tracking of these important revisions and additions," says Catalano.

There are also new requirements for the final "time out" verification immediately before starting the procedure. "There needs to be an interactive verbal communication between team members and the ability for any team member to express concerns about the procedure verification," says Catalano.

[For more information, contact:

Kathleen Catalano, RN, JD, Director of Healthcare Transformation, Perot Systems, 2300 W. Plano Parkway, Plano, TX 75075. Phone: (972) 577-6213. E-mail:]