2010 National Patient Safety Goals consolidated, condensed, clarified?
2010 National Patient Safety Goals consolidated, condensed, clarified?
Seven requirements move to being accreditation standards; no goals added
The Joint Commission had said it would not be adding any new National Patient Safety Goals for 2010. And it didn't. And most of the changes it did make it characterizes as mostly editorial, clarifying language. But there are some significant changes. Chief among those: Of 20 NPSGs, there are now 11. And in addition to updated NPSGs, The Joint Commission finally issued changes to its Universal Protocol, something for which it has been seeking field review for some time after acknowledging rumblings from the field about clarification and after continuing to receive reports about wrong-site surgery.
Of the 2010 NPSGs, Maureen Carr, MBA, project director for The Joint Commission's division of standards and survey methods, says, "We removed a number of elements of performance and NPSGs. A number of NPSGs were moved into standards. One was deleted and the others were retained, but we did do an edit or looked at the clarity of the language for all of them."
NPSG changes
According to Sandy Burke, RN, MPH, LHRM, consultant with The Mihalik Group, the big changes are:
- Seven NPSGs were integrated into standards.
- One goal was deleted as redundant (sentinel events in infection control).
- In the requirement on critical tests and results "critical test was eliminated to concentrate on critical results and their turnaround times."
- Empty vials no longer have to be kept in procedural areas.
- Surveyors will no longer cite organizations for instances of noncompliance with hand hygiene, but hospitals must show they have a program to educate, analyze, and improve compliance with hand hygiene. (For a list of all the changes, see box.)
Kurt Patton is CEO of Patton Healthcare Consulting in Glendale, AZ, and former executive director of accreditation services at The Joint Commission. Commenting on the changes, he says the removal of critical tests from goal 2 is a positive. "That was a concept no one understood. So getting rid of it is very valuable." The goal, he adds, should now be easier to comply with.
Combining EPs, which he says was the logic behind much of what The Joint Commission did this year, should make things clearer. But he also gives a caveat: If a person glosses over things, he or she could miss an important concept. So, overall, he says, "I don't know that that's a real value-added change."
Under goal 3, EP 7 — "all original containers from medications or solutions remain available for reference in the perioperative or procedural area until the conclusion of the procedure" — was deleted. Patton says this is a "very positive change.... because a lot of people were not doing that." Anesthesiologists or others performing procedures didn't want a lot "of junk" in the sterile field, so they were throwing those containers away, he says. There is a requirement in the goal that he finds confusing though. Hospitals are required to list the quantity and the volume of medication on each syringe. The Joint Commission, he says, had already "required volume, such as 2 milliliters, and quantity, I'm assuming, is number of milligrams. And if you already know it had 2 milliliters, I don't necessarily see the additional value to say 2 milliliters or 4 milligrams. It just seems like one more thing that you can get stung by if you fail to do it properly."
Of the anticoagulation management goal, he says it is relatively unchanged except for deleting the references to notifying dietary services if a patient is on warfarin. "I think that reflects the fact that hospitals have different ways of doing it," Patton says. "As long as the patient is educated about anticoagulation, you could do it with whoever is available to do it. That's a positive change."
Another positive change he sees is the way The Joint Commission will be handling hand hygiene. He says it seems that rather than assessing compliance or noncompliance, The Joint Commission "is going to drill down to what is the organization's assessment techniques and techniques for improving compliance."
In moving seven goals into standards, Carr says, "What we tried to do in this is have people focus... The NPSGs are like a spotlight on things that we know are important safety issues. So through this process we're not saying that some of these that moved are not important. They're still requirements. But we felt they no longer needed the spotlight of a National Patient Safety Goal."
"Moving things to standards, in general, that conceptually is sort of a demotion for the requirement... But then again, the issues that are being moved into standards have demonstrated in recent years pretty high levels of compliance, so it should be a relatively immaterial change," Patton says.
"I think they're still identifying the ones where compliance is somewhere problematic and where the impact of the safety goal is very important." And he thinks The Joint Commission is going in the right direction this year by not adding goals. "They've been listening to the industry, and the industry has talked about fatigue with the pace of change. And The Joint Commission is changing so much as a result of its alignment with CMS and hospitals are struggling to keep up with that. You don't need to be struggling to keep up with new safety goals also."
Effective immediately, surveyors will not be looking at deleted EPs. All other changes are effective Jan. 1.
The Joint Commission had said it would not be adding any new National Patient Safety Goals for 2010. And it didn't. And most of the changes it did make it characterizes as mostly editorial, clarifying language. But there are some significant changes. Chief among those: Of 20 NPSGs, there are now 11.Subscribe Now for Access
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