How safe are your patients who use oxygen? NPSGs focus on risk of fire

Improving oxygen risk assessment included in 2007 goals

Changes and additions to the Joint Commission on Accreditation of Healthcare Organizations' National Patient Safety Goals are minor and should not pose problems for home health agencies, say experts interviewed by Hospital Home Health.

With an addition to Goal 8B, which required HHAs to communicate a complete list of a patient's medications to the next provider of service when the patient is referred or transferred to a different setting, it is now required that a complete list of medications be given to the patient upon discharge.

"This won't be a problem for agencies that are meeting professional standards," says Maryanne L. Popovich, RN, MPH, executive director of the Home Care Accreditation Program at the Joint Commission. "This is already part of good practice for all agencies."

One question that might arise when home health managers first read the amended goal is how to handle patients who "disappear" before the final home visit, Popovich says. "Surveyors will expect home care nurses to provide the list of medications upon discharge only when they have an opportunity to see the patient," she adds.

If a patient goes into the hospital, goes outside the home care service area to visit family members, or goes into a nursing home before the final home visit occurs, a note in his or her chart indicating that there was no opportunity to give the list to the patient will be sufficient. Surveyors understand that patients and their families don't always notify home care agencies about a change in their situation in a timely enough manner to allow for that final visit, Popovich adds.

"I suspect that many agencies do give the full list of medications to specific patients and their families based on their condition; but this goal does make it necessary for all patients to receive the medication list," she says. The purpose of providing an updated list is to ensure that patients have a complete list to help them communicate with their next health care provider.

The only other change to the 2007 National Patient Safety Goals for home care agencies is the addition of Goals 15 and 15A. Goal 15 requires the organization to "identify safety risks inherent in its population," and Goal 15A specifically requires the organization to "identify risks associated with long-term oxygen therapy such as home fires."

Identification and education about the risks associated with oxygen are "embedded in good home care practice," Popovich points out. The new goal does not indicate an increase in home fires or other sentinel events related to oxygen; it is meant to heighten awareness of the potential risk, she says.

Surveyors evaluating an agency for compliance with this goal will expect to see staff members not only assess risks upon the patient's admission to home care, but also reassess risks whenever there is a change in the environment or the patient's condition.

A sentinel event reported to the Joint Commission demonstrates the need for reassessment and re-educating. "The patient was admitted to home care in May, and the assessment and education related to oxygen risks occurred at admission," Popovich relates. A fire broke out in the patient's home in November due to the combination of oxygen and a kerosene space heater. While the safety education provided to the patient included warnings about open flames, it occurred at a time when no space heater was used; so the patient probably did not associate "open flame" with the space heater used in cold weather, she points out.

"This incident suggests that home care agencies might consider reassessment of risks in November or December in cold weather areas," Popovich suggests.

With cold weather and the use of fireplaces and space heaters in Pennsylvania, the staff at Titusville (PA) Hospital Home Health always reassesses the risk of fire for oxygen patients, says Debbie Miller, RN, policy regulation coordinator for the agency. "We always re-evaluate and reteach as cold weather approaches," she points out. The use of both written and verbal instructions, careful assessment of risks in the home, education of family members, and thorough documentation of assessments and teachings have worked well for the agency; so Miller does not anticipate major changes in their procedures.

The Joint Commission does not prescribe how agencies should comply with this goal, but Popovich recommends that each agency manager look carefully at the population, environmental factors, and family situations of each patient to thoroughly assess risk.

Overall, Popovich does not see these additions to the National Patient Safety Goals as a significant challenge for most agencies, though she admits, "Any time we introduce new patient safety goals or standards, there is a certain amount of anxiety about the interpretation of the requirements and the assessment of the agency's current practice.

"These goals, however, should only require a tweaking of current practice rather than development and implementation of new policies," she notes.


For more information about National Patient Safety Goals compliance, contact:

  • Maryanne L. Popovich, RN, MPH, Executive Director, Home Care Accreditation Program, Joint Commission on Accreditation of Healthcare Organizations, One Renaissance Blvd., Oakbrook Terrace, IL 60181. Phone: (630) 792-5742. Fax: (630) 792-5005. E-mail: