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JCAHO’s new safety goals routine for most HHAs
Medications, falls, timely reports top list of goals
Medication safety, improved communications, and reduction of falls are among the new additions to the Joint Commission on the Accreditation of Healthcare Organizations 2005 National Patient Safety Goals.
The majority of the safety goals, including the new ones, should not be a problem for home health care because they represent standard operating procedure for most agencies, says Maryanne L. Popovich, RN, MPH, executive director of the Joint Commission home care accreditation program.
For example, a part of Goal 2C focuses on improved communications by assessing the timeliness of reporting critical results, she notes.
If a digoxin level on a patient is outside a normal range, the nurse automatically contacts the physician. "While new processes won’t have to be developed, current processes may be evaluated and tweaked." The most difficult part of this requirement is that the Joint Commission has not defined "critical," Popovich says.
Just as the Joint Commission added further clarification to the requirement to identify do-not-use abbreviations after the goal was announced, she explains there are advisory groups working on definitions of "critical" and "timely."
Because home health nurses deal with patients on an individual basis, the requirement that look-alike, sound-alike medications be identified also should pose no problem, she notes.
"The agency does have to develop a list of look-alike, sound-alike medications that patients may use, but it is unlikely that the nurse will find two of these medications in the individual patient’s home," Popovich explains. The benefit of developing this list will be increased awareness among home health staff, she adds.
"Remember, too, that phone and verbal orders must continue to be read back to the originator to verify orders and medications. This read-back, along with the awareness of look-alike, sound-alike medications, will increase patient safety," Popovich says.
While other health care organizations may struggle with the new requirement that a complete list of patient medications be documented, home health agencies always have collected this information and in a manner that other health care providers might envy, she adds.
"Other providers have to rely upon the patient providing the information. Our nurses can simply ask to see everything, then copy the information off the prescription bottles, herbal containers, or over-the-counter packages," Popovich notes. Because gathering an accurate list of medications is imbedded in the home health nurse’s practice, she sees no problem for home health agencies to meet this goal.
The challenge for home health with the medication list will be educating the patient to keep an up-to-date list with him or her in case of a visit to the physician or the hospital, Popovich says. "Other organizations will rely upon the patient to provide the information and home health can help by making sure our patients and their caregivers know to keep the list with them."
Another patient safety goal that will provide a challenge for hospitals is the goal to reduce the risk of patient falls. "Home health is already the only health care program that automatically assesses the patient’s environment for risk of falls as a normal part of the initial assessment," adds Popovich.
Although this area always has been addressed in home care, the Joint Commission’s goal with patient safety has been to highlight the areas of greatest risk to patient safety, she says.
"All of our advisory committee members agreed that although reduction of the risk of falls is addressed throughout home health, it is still a serious enough risk to patients to be highlighted in the national safety goals," Popovich explains.
As home health agencies raise questions about patient safety goals and how to meet the requirements, the Joint Commission will post updated information and responses to frequently asked questions on its web site, she says. "We are continuously evaluating feedback and providing information that will help home health agencies comply."
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