Medication lists for patients, development of a process for patients to express concern, and identification of patients at risk for suicide are the main changes and additions to requirements of the Joint Commission on Accreditation of Healthcare Organizations' 2007 National Patient Safety Goals for ambulatory and hospital-based outpatient surgery programs.
Goal 8B was included in the 2006 safety goals and required organizations "to communicate a complete list of medications to the next provider of service when a patient is referred or transferred to another setting, service, practitioner, or level of care." This goal has been amended to say "the complete list of medications is also provided to the patient on discharge from the facility."
"I don't see that this requirement will be a challenge for most outpatient surgery programs, but it may pose a problem for diagnostic programs such as endoscopy programs," says Michael Kulczycki, executive director of the Ambulatory Accreditation Program at the Joint Commission. The difficulty for smaller, more diagnostic-oriented programs is related to the nature of the program, he points out. Goal 8A requires organizations to have a process that enables them to compare a patient's current medications with new medications that are ordered, so an organization will have a list of medications for the patient. But organizations may not have a method to easily provide that list to the patient, he explains.
Lisa Hamilton, practice administrator of Asheboro (NC) Endoscopy Center, says her facility is a little different from many other endoscopy centers. "We are a freestanding center, but we are owned by one group of physicians, and our electronic medical records system interfaces with the physicians' office system," she says.
This connection means that Hamilton's center has access to information on medications that the patient has reported to the physician as well as medications the patient reports to the endoscopy center upon admission for service. "We do have patients that ask us to give them a copy of their medication list, and we can easily do it by pushing one key on the computer," she adds.
The only process change the Asheboro center will need to make to comply with the new goal is to automatically give every patient a copy of the medication list, says Hamilton. "On a personal level, I am glad to see this requirement added to the patient safety goals," she says.
With an elderly father who has multiple medical conditions, Hamilton points out that it is difficult for her father and mother to keep up with everything that he is taking. "Endoscopy centers see a lot of elderly patients who are going from provider to provider for care for multiple health conditions," she points out. With several different providers involved, it is likely that a medication will be forgotten when the patient is asked to list medications, she says. "Although we may only see them once every few years, at least we can provide a list that serves as a good starting point, and they can revise it as needed," she adds.
Even without electronic medical records, there are tools that outpatient surgery programs can use to encourage a patient to keep an updated list of medications, says Kulczycki.
"Joint Commission's Speak Up program offers different tools, including a wallet-sized medication card that organizations can print with their logo and distribute to patients," he says.
Identify patients at risk
One piece added to the hospital patient safety goals is under Goal 15, which requires organizations to "identify safety risks inherent in its population." Goal 15A requires organizations to identify patients at risk for suicide, says Kulczycki.
Implementing a risk assessment in the admission or pre-op process, and having a process to refer the patient to a crisis hotline or counseling, would meet this goal, he says.
The new goal added for ambulatory organizations is Goal 13, which requires them to encourage patients' involvement in their care. Goal 13A requires organizations to "define and communicate the means for patients and their families to report concerns about safety and encourage them to do so."
One of Joint Commission's accreditation participation requirements (APR 8) already defines an expectation for the organization to notify patients about the process to report concerns about patient care and safety, points out Kulczycki. "The patient safety goal is meant to reinforce the intent of that requirement for ambulatory organizations," he says. While the Joint Commission does not prescribe the exact manner of meeting this goal, an organization can use its web site, a brochure, posters, or a statement included on the informed consent form to notify a patient of the process for reporting concerns, he says.
"We give a patient survey to all patients upon discharge, with instructions that if they have any concerns, we want to hear about them," she says. "It's important to develop a good rapport with patients so that they will come back, and we want them to know that we are always trying to improve and fill in any gaps in good service that they may see."
For more information about 2007 National Patient Safety Goals, contact:
- Lisa Hamilton, Practice Administrator, Asheboro Endoscopy Center, 700 Sunset Ave., Asheboro, NC 27203. Telephone: (336) 625-0305. E-mail: email@example.com.
- Michael Kulczycki, Executive Director, Ambulatory Accreditation Program, Joint Commission on the Accreditation of Healthcare Organizations, One Renaissance Blvd., Oakbrook Terrace, IL 60181. Phone: (630) 792-5290. E-mail: firstname.lastname@example.org.
To access free artwork for wallet cards for patient medication lists, go to www.jointcommission.org, highlight "patient safety" on the top navigational bar, then click on "Speak Up." Scroll down to "Medication Mistakes." In addition to artwork for wallet cards, organizations can download artwork for patient brochures and posters.