Joint Commission sets 2003 patient safety goals

ICPs can use as target for programs

Confusion in identifying patients, miscommunication among caregivers, wrong-site surgery, infusion pumps, medication mix-ups, and clinical alarm systems will be the focus of the National Patient Safety Goals for 2003 set by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). For infection control professionals involved in patient safety, the goals can be used to direct quality improvement efforts. Accredited facilities will be evaluated for compliance with the recommendations, which were identified by JCAHO and its advisors as important targets for intervention.

"Patient safety is the top priority for the Joint Commission," says Rhonda Anderson, RN, member of the JCAHO Board of Commissioners, and chief operating office at Desert Samaritan Medical Center in Mesa, AZ. The Joint Commission expects to issue national patient safety goals each year.

The 2003 Joint Commission patient safety goals and attendant recommendations are:

Goal 1

Improve the accuracy of patient identification.  
Recommendations:

• Use at least two patient identifiers (not the patient’s room number) whenever taking blood samples or administering medications or blood products.

• Prior to the start of any surgical or invasive procedure, conduct a final verification process, such as a "timeout," to confirm the correct patient, procedure, and site, using active — not passive — communication techniques.

Goal 2

Improve the effectiveness of communication among caregivers.
Recommendations:

• Implement a process for taking verbal or phone orders that requires a verification "read-back" of the complete order by the person receiving the order.

• Standardize the abbreviations, acronyms, and symbols used throughout the organization, including a list of abbreviations, acronyms, and symbols not to use.

Goal 3

Improve the safety of using high-alert medications.  
Recommendations:

• Remove concentrated electrolytes (including, but not limited to, potassium chloride, potassium phosphate, sodium chloride > 0.9%) from patient care units.

• Standardize and limit the number of drug concentrations available in the organization.

Goal 4

Eliminate wrong-site, wrong-patient, and wrong-procedure surgery. 
Recommendations:

• Create and use a preoperative verification process, such as a checklist, to confirm that appropriate documents (e.g., medical records, imaging studies) are available.

• Implement a process to mark the surgical site and involve the patient in the marking process.

Goal 5

Improve the safety of using infusion pumps. 
Recommendation:

• Ensure free-flow protection on all general-use and patient-controlled analgesia intravenous infusion pumps used in the organization.

Goal 6

Improve the effectiveness of clinical alarm systems. 
Recommendations:

• Implement regular preventive maintenance and testing of alarm systems.

• Ensure that alarms are activated with appropriate settings and are sufficiently audible with respect to distances and competing noise within the unit.